7 22 2010 Efforts To Address Mh Sa And Homelessness A One Stop Approach

Efforts to Address Mental Illness, Substance Abuse and Homelessness: A One Stop Approach
Gilbert Gonzales Director, Communications and Diversion Initiatives The Center for Health Care Services Mental Health and Substance Abuse Authority Bexar County San Antonio, Texas [email_address] Aaron Diaz Director, Crisis and Diversion Services The Center for Health Care Services Mental Health and Substance Abuse Authority Bexar County San Antonio, Texas [email_address] July 19-23, 2010 / Austin Convention Center / Austin, Texas

The Problem

The Crisis Care Center The Restoration Center Haven for Hope Homeless Campus The Purpose The Service The Value 1 2 3

Show me the DATA !!!

An Ounce of Prevention Taxpayer Costs Avoided through Preventing Crime
Criminal Behavior and Its Cost to Society
1.7 Trillion including victimless
crime – Perazzo 2002
674 Billion Federal, State and Local – Shapiro 1999
1.0 Trillion (2 million people incarcerated) – Adrienne
2005
Cost Avoided if One Criminal Career is Prevented
$ 976,217.81
Average annual adult cost (2004) - $40,865
Average annual juvenile cost (2004) - $32,888
Source: Dr. Victoria Reinhardt, An Ounce of Prevention presentation To NACo, July 2008

San Diego 529 high utilizers ran up a cost of $18 million dollars (2000-2003) including: $4 million for Emergency, Police, and Court $14 million for medical, ICU and surgery Impact San Diego SIP, Annals of Emergency Medicine, Vol 47, No.4:April 2006 15 chronic homeless inebriates (in eighteen months) cost $1.5 million The New Yorker Magazine, Million Dollar Murray, Issue 2006-02-13 and 20, 2006

The Case of Million Dollar Murray MILLION-DOLLAR MURRAY by MALCOLM GLADWELL The New Yorker Magazine, Issue of 2006-02-13 and 20, Posted 2006-02-06 News Release Emergency Departments See Dramatic Increase in People with Mental Illness Seeking Care Emergency Physicians Cite State Health Care Budget Cuts at Root of Problem American Psychiatric Association Hillarie Turner, 703-907-8536 June 2, 2004 hturner@psych.org Release No. 04-30 Sharon Reis 202-745-5103 Cost “ in one study, it had been concluded that one homeless person can cost the City and County about $200,000 in one year”. Philip F. Mangano, Executive Director of the United States Interagency Council on Homelessness (USICH), May 1, 2007. “ It cost us one million dollars not to do something about Murray,”

The Problem gets worse: Poor and or reduced funding Scant, limited and rationed services Reduction of State Hospital treatment beds The Problem

Law Enforcement Detention/Jail CIT Judicial/Courts Magistrate, County, District Mental Health Public and Private Providers Crisis Care Center Jail Diversion Psychiatric and Medical Clearance Specialty Offender Services Community Dynamic Crisis Jail Diversion Information Exchange Police, Sheriff Probation, Parole Civil and Criminal Treatment Continuity of Care County City-wide Emergency Services
Data exchange through
Community Collaborative
Crisis Care Center
CIT/DMOT
Jail and Juvenile Detention
Statewide CARE Match
System County City-wide Entry Points System Level

Operations
24/7 services
Psychiatric screening and evaluation
Jail and detention medical consultation & clearance
Medical screening
Lab and Radiology
Appropriate Staffing and Co-located office space allocations
Coordinated Services with SA/Homeless

Total = 991 Total = 8,758 Crisis Care Center Data April 16, 2008 – March 31, 2009

Then (prior to Sept 2005)
Wait times for Medical
Clearance/ Screening at
UHS ER - 9 hours, 18 min.
Wait times for Medical
Clearance/ Screening and Psychiatric Evaluation was between 12 and 14 hours.
Now
The wait time for Medical Clearance/ Screening at the Crisis Care Center is 45 minutes.
Wait time for Medical Clearance/Screening and Psychiatric Evaluation is 60-65 minutes.
Impact on WAIT TIME for LAW ENFORCEMENT

Emergency Room utilization has dropped 40% since the inception of the Crisis Care Center. 40% of (7619 total seen at CCC) 3048 Persons diverted from the ER (in 2006 first year) X $1545 Cost Savings relative to ER Utilization $4,709,160 Source: Jean R. Setzer, Ph.D., University Health System Emergency Room Utilization (Medical Clearance) What Works

The Restoration Center Opened April 15, 2008
Public Safety- Sobering
Unit
Detoxification Facility
Community Court
Outpatient Substance
Abuse Services

To establish a system of care for homeless, serial inebriates that includes
24/7 Access to Substance Abuse Treatment
Safe affordable housing
Medical Care
Psychiatric Care
Vocational/Employment Assistance

The Restoration Center Programs include:
Public Safety Unit (PSU)
Injured Prisoner Medical Clearance & Treatment
40 person sobering unit (4-6 hr stay)
Detoxification Unit – 27 beds - 3 to 5 day stay
Substance Abuse Intensive Outpatient Services
16 weeks- 6 days per week, 4 hrs per day
counseling program

Substance Abuse System of Care Partial/Day Hospital, “ Intensive” Outpatient
Urgent Care Center
“ Front-Door”
Substance Abuse Triage
Mental Health Jail Diversion
Haven for Hope
Homeless Housing
Initiative
Community Patients Community Patients Outpatient Treatment Recovery ! X Relapse Medical Detoxification CHCS Detoxification

Public Safety Sobering Unit
Cost is High Cost Savings can be achieved Public Inebriates are sobered Up In Jail Can Now Be Sobered up In a location where treatment Is possible. Experienced Peer Recovery Specialists provide Motivation to enter treatment RNs monitor/evaluate 24/7

Therapeutic Justice Partnerships with Bexar County Community Supervision and Corrections Dept.
Two-100 Bed Substance Abuse Treatment Facilities (SATF-1 &
SATF-2,
60 Bed Young Adult “boot camp” residential facility- Zero
Tolerance)
One- 60 Bed Dual Diagnosis Unit (MH/SA) Mentally Ill Offender
Facility
Outpatient Substance Abuse Treatment Program (lH 10)
Dual Diagnosis Outpatient Substance Abuse Program (Palo Alto)
Drug Court Treatment Services, Dual Diagnosis Drug Court
Treatment Services, Mental Health Court Services, and the
upcoming commencement of Veteran Drug Court Services.

Therapeutic Jurisprudence Partnerships with the Public Inebriate Population
April 16, 2008 – March 31, 2009 $1,795,200. $1,267,200. $528,000. Injured Prisoner Diverted from UHS Emergency Room $2,419,009. $1,983,574. $435,435. Public Inebriates Diverted from Detention Facility Direct Cost Avoidance Bexar County City of San Antonio Cost Category

July 2010 Update

Combined CCC and Restoration Documented and Immediate Cost Avoidance $6,668,693 $5,174,599 $1,494,094 Total $385,522 $385,522 K. 0 Reduction in Jail Time for Competency Restoration on Bond and on Return $137,898 $137,898 J. 0 Reduction in Wait Time in Jail for Outpatient Competence/Wait Time for Restoration compared to Inpatient $255,055 $255,055 I. 0 Reduction in Competency Restoration Wait Time in Jail for Hosp Admission 5/08-3/09 $579,509 $371,350 H. $208,159 G. Mentally Ill Diverted from Magistration Facility $1,096,500 $774,000 F. $322,500 E. Mentally Ill Diverted from UHS ER Cost $1,795,200 $1,267,200 D. $528,000 C. Injured Prisoner Diverted from UHS ER $2,419,009 $1,983,574 B. $435,435 A. Public Inebriates Diverted from Detention Facility Direct Cost Avoidance Bexar County City of San Antonio Cost Category

Centralized Services Sites Crisis Center Restoration Center

Haven for Hope
To increase the community capacity for mental health, substance abuse and detoxification services
The Community Wide Initiative Haven for Hope and CHCS collaboration Goal:

Haven for Hope Homeless Facility CNN Video Clip
http://www.diversioninitiatives.net/2010/07/haven-for-hope-cnn-video-just-before.html

Haven for Hope Facts
Haven for Hope is the largest, most comprehensive Homeless Transformation Campus in the U.S.A.
Haven for Hope conducted a best practice study reviewing the homeless services in 12 states and over 200 shelter operations.
The Haven for Hope Campus is made up of 15 Buildings, on 37 Acres, with almost a half a million square feet of service space under roof.
Haven for Hope currently has a network of service provision with 78 non-profit and government Partner Agencies
On any given night there will be roughly 1600 individuals residing on the Haven for Hope Campus.
http://havenforhope.org

Haven for Hope Campus http://havenforhope.org

Report run date: 7/20/2010 Haven For Hope Daily Counts Report 7-20-2010 109 2 Women 350 1 Men Total Today Campus Intakes 166 0 Children 116 0 Adults Total Today Family 741 3 Total Campus Intakes 1098 5 Total PCY Intakes Total Today PCY Intakes 1839 8 PCY+Campus Intakes 106 2 Women 294 3 Men Total Today Current Residents 138 0 Children 113 0 Adults Total Today Family

For additional information online Copies of this presentation and additional data on diversion initiatives can be found at: http://diversioninitiatives.net

The Center for Health Care Services Leon Evans, President/CEO The Center for Health Care Services Mental Health Authority www.chcsbc.org [email_address]

7 22 2010 Efforts To Address Mh Sa And Homelessness A One Stop Approach

by Gilbert Gonzales

Accessibility

Upload Details

Usage Rights

1 Embed 12

Statistics

7 22 2010 Efforts To Address Mh Sa And Homelessness A One Stop Approach Presentation Transcript