This document discusses efforts to address mental illness, substance abuse, and homelessness in Bexar County, Texas. It outlines collaborative initiatives between various community agencies and stakeholders to divert individuals from the criminal justice system into treatment services through programs like the Crisis Care Center. Data is presented showing improvements in wait times and reductions in emergency room utilization and associated cost savings since implementing these diversion and jail diversion programs.

1. Efforts to Address Mental Illness, Substance Abuse and Homelessness Addressing the Challenge Texas Homeless Network Annual Conference October 7, 2010 Gilbert Gonzales Director, Communications and Diversion Initiatives The Center for Health Care Services Mental Health and Substance Abuse Authority Bexar County San Antonio, Texas http://www.diversioninitiatives.net What’s In It For Me ?

3. Connection Progress Relationship CPR

4. 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

5. 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 “ 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,”

6. Cheer up, things gets worse: Poor and or reduced funding Scant, limited and rationed services Reduction of State Hospital treatment beds

7. Poor communication Poor system design Silos No strategic improvement plan Little use of prevailing best practices Lack of leadership and overview Why ?

8. Collaboration: It’s an unnatural act between… … two or more unconsenting adults .

9. Why can’t we all just get along ? Can we ? It’s impossible…

10. A mouse, a cat and a dog. http://www.youtube.com/watch?v=D85yrIgA4Nk

11. Jail Diversion Oversight Committee (34+ Community Agencies/Stakeholders) Community Medical Directors Roundtable Children’s Medical Directors Roundtable Bexar County Children’s Diversion School District Sub Committee Bexar County Children’s Diversion Child Protective Services Sub Committee Bexar County Children’s Diversion Juvenile Justice Probation Sub Committee Community Co-Location Coalition (29 Community Agencies including law enforcement entities meeting to address the homeless & public inebriate) Stakeholder Collaboration via:

12. 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 Community Collaborative Crisis Care Center Crisis Transitional Unit Crisis Hotline (Nurselink) CIT/DMOT SP5 Jail and Juvenile Detention Statewide CARE Match System County City-wide Entry Points System Level

13. Children Adult Children’s Community Medical Directors Roundtable Children's Crisis Intervention Team Extended Children's Crisis Services Mobile Outreach Team Judges Diversion Initiatives Bexar Cares System of Care Therapeutic Foster Care Youth Empowerment Services Waiver Texas Youth Suicide Prevention Head Start Mental Health Services Future – looking for placement opportunities Criminal Justice Co-Location Community Medical Directors Roundtable Crisis Care Center Crisis Services Minor Medical Clearance Crisis Line Crisis Transitional Unit MCOT-DMOT PATH Hope Transitional Unit Restoration Center Sobering Detoxification Intensive Outpatient Substance Abuse Services Supportive Outpatient Services Crisis Intervention Team (CIT) Training – Law Enforcement MIOF, Probation & CHCS Step Down Facility SA Treatment Facilities1&2 Felony Drug Court Misdemeanor Drug Court DWI Court Community Reintegration Program Involuntary Outpt Commitment Mental Health Court Substance Abuse Court Outpatient Competency Restoration NGRI Court Forensic Assertive Community Txt Outpatient Sub Abuse Treatment for Probationers Sub Abuse Services for Zero Tolerance Group Veterans Court Veterans Diversion Pilot Safety Net

15. 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.

16. Show me the DATA !!!

17. 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

18. 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: University Health System Emergency Room Utilization (Medical Clearance) What Works

19. 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

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

21. What can you do ? Connect, Progress, Relate http://www.youtube.com/watch?v=lFZ0z5Fm-Ng

22. The Center for Health Care Services Leon Evans, President/CEO The Center for Health Care Services Mental Health Authority 210 731-1300 www.chcsbc.org http://diversioninitiaives.net [email_address]