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Document Sample
Jail Symposium: Crowding
in Texas – Origins and
Solutions
Leon Evans, President/Chief Executive Officer,
The Center for Health
Care Services,
Bexar County, MHMR
February 7, 2008
Community Wide Jail Diversion
The Problem
Criminalization of Mentally Ill
Inappropriate Cost to Society
20% + in jail
Increase use of emergency rooms
Homelessness
Public Safety Net
Consumers at risk
Law Enforcement at risk
Public at risk
Texas Department of Criminal Justice
MHMR Match Statistics
October, 2007
C.I.D. Parole Probation Total
Total TDCJ Population 152,661 77,755 432,359 662,775
# of Care Matches* 40,883 19,763 54,727 115,373
% of Total Population 26.78% 25.41% 12.65% 17.40%
*Represents all Clients served since 1985, including those whose diagnosis is no longer eligible for MHMR
Civil and Criminal
System County City-wide System Level
Entry Points
Judicial/Courts
Magistrate, County, District
Probation, Parole
County City-wide
Continuity of Care
Police, Sheriff
Treatment
Law Enforcement Crisis Care Center
Detention/Jail
Jail Diversion Mental Health
CIT Public and Private
Psychiatric and Medical Providers
Clearance
Specialty Offender Services
Emergency Services
Data exchange through
Dynamic Community • Community Collaborative
Crisis Jail Diversion • Crisis Care Center
Information Exchange • CIT/DMOT
• Jail and Juvenile Detention
• Statewide CARE Match
Crisis Care Center Summary
Actual Facility Total Seen = 7,619
(from Sep 05 to Aug 06)
Sep -
Dec Monthly Jan- Feb Mar Apr- May- Jun- Jul- Aug-
Summary Stats 2005 Average 06 -06 -06 06 06 06 06 06 Total
Facility Total 2777 694.25 666 523 770 463 670 600 581 569 7619
Psychiatric Crisis
Clinic 2076 519 497 405 609 313 487 425 418 443 5673
Express Med
Clinic (Med Clear) 701 175.25 169 118 161 150 183 175 163 126 1946
Express Med Sep - Jan- Feb Mar Apr- May- Jun- Jul- Aug-
Stats Dec Average 06 -06 -06 06 06 06 06 06 Total
Cases Requiring
Lab and/or X-Ray 236 59 56 40 41 44 67 47 60 38 629
Opened Aug 30, 2005 Hurricane Katrina Evacuees Arrive Aug 31, 2005 Full Year Completed Aug 31, 2006
Crisis Care Center
Preliminary DATA (continued)
WAIT TIME for LAW ENFORCEMENT
Then Now
• Wait times for Medical • The wait time for Medical
Clearance/ Screening at Clearance/ Screening at the
UHS ER - 9 hours, 18 minutes. Crisis Care Center is 45 minutes
• Wait times for Medical • Wait time for Medical Clearance/
Clearance/ Screening and Screening and Psychiatric
Psychiatric Evaluation is Evaluation is 60-65 minutes .
between 12 and 14 hours.
Crisis Care Center
Diversions from Jail and Emergency Rooms
Summary Stats
***2006 2007
Psychiatric Crisis Clinic 5,673 4,790
San Antonio PD 1,256 1,287
DMOT/Sheriff 347 282
Path Homeless Program 579 1,315
Magistration 30 129
Facility Total 7,619 6,581
Express Med Stats
Express Med Clinic (Med
Clear) 1,946 1,791
Jail Consults Not Available 1,690
Cases Requiring Lab
and/or X-Ray 630 486
*** Hurricane Katrina
Re-incarceration/Re-Hospitalization
Sample Outcome: Forensic Intensive Case
Management - 2006
Manos – a post diversion program for misdemeanor offenders
Objective: Reduce rates of re-incarceration for Manos program mentally
ill offenders released from jail or prison by 25%.
Of the 371 patients admitted to the Manos Program, 23 were
re-incarcerated for a 6.2% rate. This compares to a re-
incarceration rate of 67% for mentally ill offenders without the
intensive case management services offered by the jail
diversion program.
Objective: Reduce rates of hospitalization for Manos program mentally ill
offenders released from jail or prison by 25%.
Of the 371 patients participating in the jail diversion program 12
were hospitalized after diversion for a program rate of 3.2%.
Program Recidivism Rate
Genesis – Offender Outpatient program for
Felony Probation and Parolees
FY 2007
429 - Felony Probation and Parole Offenders Served
29 - Re-arrested
State Revocation/Decompensation rate (without
treatment)= 52%
Genesis Revocation Rate (with treatment)= 6%
Research
The Bexar County Jail Diversion Program:
Measuring the Potential Economic and Societal Benefits
Policy Report
Michael Johnsrud, PhD Sponsored by the
Associate Director Center for Health Care Services
The Center for Pharmacoeconomic Studies Robert L. Jimenez, M.D., F.A.P.A Chairman
The University of Texas at Austin Leon Evans, President and CEO
December 2004
Dr. Johnsrud - Findings
In the last decade, persons with mental illness accounted for 7%
of all police contacts, 16% of prison inmates, and 7% of the
entire jail population.
As a percentage of total county revenues, Bexar County spends
approximately 75% of all public funds on law enforcement,
detention, and the justice system. As much as 14% of the Bexar
County jail population is estimated to have a mental illness.
Interim results of the program show over 1,700 diversions from
jail incarcerations during state Fiscal Year 2004, potentially
resulting in an estimated range of $3.8 million to $5.0 million
dollars in avoided costs within the Bexar County Criminal
Justice System.
Research (con’t)
Jail Diversion in Bexar County,
Texas:
a Cost/Benefit Study
Dr. Alexander J. Cowell
2008
RTI International is a trade name of Research Triangle Institute
Research Objectives
4 Inter-connected Objectives
OBJECTIVE 2
OBJECTIVE 1
Assess Cost-shifting
Compare the costs of
Between Criminal Justice
pre-booking and post-
System and Treatment
booking diversion
“Are increased treatment
“What does each type of
costs offset by reductions
diversion cost?”
in criminal justice costs?”
OBJECTIVE 3
OBJECTIVE 4
Assess the Cost-
Effectiveness of Diversion
Refocus Objectives 1-3 on
Crisis Care Center (CCC)
“What is the program’s
bang-for-buck?”
Community Success
Working As a Collaborative
Received the American Psychiatric “Gold Award” for
Community Program Innovation
Received the National Council for Community
Behavioral Healthcare Directors “Service Excellence
Award”
Visited by 17 State Delegations and two Countries
(Canada and the Republic of China)
Six Year Cost Benefit Study nearing completion
Substance Abuse Detox Services Expansion for
Community and 600 Bed Homeless Facility
Medical Directors Roundtable Committee Established
Crisis Care Center -Psychiatric Screening/Medical
Clearance 24/7 Established
Congressional Testimony
Thank you !
www.chcsbc.org
Leon Evans, President and Chief Executive Officer, The Center for Health
Care Services San Antonio, Texas
For additional information contact: Leon Evans,
Ph. 210 731-1300 Email: levans@chcsbc.org
