1

Efforts to Address Mental Illness, Substance Abuse and Homelessness

Addressing the Challenge

Texas Homeless Network Annual Conference

October 7, 2010

Gilbert GonzalesDirector, Communications and Diversion Initiatives

The Center for Health Care ServicesMental Health and Substance Abuse Authority

Bexar CountySan Antonio, Texas

http://www.diversioninitiatives.net

What’s In It For Me ?

2

3

Connection

Progress

Relationship

CPR

4

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

5

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, 2004hturner@psych.org 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,”

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 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 CriminalTreatm

entC

ontinuity 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-wideEntry 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 ClearanceCrisis LineCrisis 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

14

15

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.

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 $1545Cost Savings relative to ER Utilization $4,709,160

Source: University Health System

Emergency Room Utilization (Medical Clearance)

What Works

19

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

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/CEOThe Center for Health Care Services

Mental Health Authority210 731-1300

www.chcsbc.org http://diversioninitiaives.net levans@chcsbc.org