9 30 2010 diversion update v4
DESCRIPTION
Diversion Initiatives. Efforts to address mental illness, substance abuse and homelessness- Addressing the Challenge September 30, 2010TRANSCRIPT
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Efforts to Address Mental Illness, Substance Abuse and
Homelessness
Addressing the Challenge
Leon EvansPresident and Chief Executive OfficerThe Center for Health Care Services
Mental Health and Substance Abuse AuthorityBexar County
San Antonio, Texas [email protected]
Diversion Initiatives
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An Ounce of PreventionTaxpayer 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 presentationTo NACo, July 2008
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The Case of Million Dollar Murray
MILLION-DOLLAR MURRAYby MALCOLM GLADWELLThe New Yorker Magazine, Issue of 2006-02-13 and 20, Posted 2006-02-06
News ReleaseEmergency Departments See Dramatic Increase inPeople with Mental Illness Seeking Care Emergency Physicians Cite State Health Care Budget Cuts at Root of Problem
American Psychiatric AssociationHillarie Turner, 703-907-8536 June 2, [email protected] Release No. 04-30Sharon 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,”
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The Problem gets worse:
Poor and or reduced funding
Scant, limited and rationed services
Reduction of State Hospital treatment beds
The Problem
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Poor communication Poor system design Silos No strategic improvement plan Little use of prevailing best practices Lack of leadership and overview
Why ?
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Collaboration: It’s an unnatural act between…
…two or more unconsenting adults.
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• 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:
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Law EnforcementDetention/Jail
CIT
Judicial/CourtsMagistrate, County, District
Mental HealthPublic and Private
Providers
Crisis Care CenterJail DiversionPsychiatric and Medical
ClearanceSpecialty Offender Services
CommunityDynamicCrisis Jail Diversion
Information Exchange
Pol
ice,
She
riff
Pro
batio
n, P
arol
e
Civil and CriminalT
reatment
Continuity of C
are
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-wideEntry Points
System Level
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Funding• Jail Diversion Planning and Oversight Committee - Judge Poly Jackson Spencer
• Changing the Law - Senate/House Bills Madla/Uresti,HB 2292 Mandated Jail Diversion
• SAMHSA Jail Diversion Grant
• Police Chief Ortiz Funding - Drug Bust Money
• University Health System Partnership- Care Link & New Generation Medications Program
• Texas Correctional Office on Offenders with Mental and Medical Impairments (TCOOMMI)
• Genesis Outpatient Services - Probation and Parole• Mentally Impaired Offenders Program-Probation • Substance Abuse Treatment Facilities (SATF I and II)
• Texas Crisis Redesign - $82 million State-wide
• Bill Greehey/Bexar County - Transformation Center
• Medicaid Administrative Claiming
• Medicaid Eligibility and Carelink Workers• Third Party Billing
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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 ClearanceCrisis LineCrisis Transitional Unit MCOT-DMOT
• 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
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Therapeutic Justice Partnershipswith 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.
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Show me the DATA !!!
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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
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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 $1545Cost Savings relative to ER Utilization $4,709,160
Source: University Health System
Emergency Room Utilization (Medical Clearance)
What Works
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Cost Category City of San Antonio Bexar County Direct Cost Avoidance
Public Inebriates Diverted from Detention Facility
$435,435 A.
$1,983,574 B.
$2,419,009
Injured Prisoner Diverted from UHS ER
$528,000 C.
$1,267,200 D.
$1,795,200
Mentally Ill Diverted from UHS ER Cost
$322,500 E.
$774,000 F.
$1,096,500
Mentally Ill Diverted from Magistration Facility
$208,159 G.
$371,350 H.
$579,509
Reduction in Competency Restoration Wait Time in Jail for Hosp Admission 5/08-3/09
0 $255,055 I.
$255,055
Reduction in Wait Time in Jail for Outpatient Competence/Wait Time for Restoration compared to Inpatient
0 $137,898 J.
$137,898
Reduction in Jail Time for Competency Restoration on Bond and on Return
0 $385,522 K.
$385,522
Total $1,494,094 $5,174,599 $6,668,693
Combined CCC and Restoration Documented and Immediate Cost Avoidance
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Haven for Hope Homeless Facility
http://www.diversioninitiatives.net/2010/07/haven-for-hope-cnn-video-just-before.html
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The Center for Health Care Services
Leon Evans, President/CEOThe Center for Health Care Services
Mental Health Authority210 731-1300