TARRANT COUNTY DIVERSION INITIATIVES Texas Council June 2015 Ramey C. Heddins, CCHP Director Mental Health Support Services Kathleen Carr Rae, Public Policy Specialist
WHAT IS THE PROBLEM? Prison 3-year re-arrest rates were 47.2%. State Jail 3-year re-arrest rates equated to 62.7%. These rates have remained relatively the same since 2004.
COMMUNITY JUSTICE MODEL JAIL, PROBATION, PRISON Reentry and Resource Coordination Community Reentry Council Community Community Policing REINTEGRATION GOAL Reentry Courts Community Prosecution Community Justice Courts
TAKING ACTION RETURN TO THE 19 TH CENTURY STANDARD? The negligence of people with mental illnesses in prisons in the 19 th century inspired the creation of institutions to treat them. In 1955 state mental institutions were established in the U.S. However, states began shutting down mental institutions/asylums in favor of community mental health centers but many centers were not built. This deinstitutionalization allowed patients to relocate into the community however, not all communities had the facilities or expertise to deal with them. In many cases patients were displaced to homeless shelters and incarcerated in local jails.
TARRANT COUNTY DIVERSION INITIATIVES Why divert mentally ill from jails? What is working in Tarrant County? What is needed to reduce the number of mentally ill coming to jail?
WHAT IS THE LARGEST MENTAL INSTITUTION IN AMERICA? 1. Cook County Jail Chicago 2. Los Angeles County Jail 3. Rikers Island Jail New York In 1955, there were 500,000 state hospital beds and 200,000 jail cells in the United States. In 2002 there were 50,000 state hospital beds and 2,000,000 jail cells in the United States. http://www.npr.org/templates/story/story.php?storyid=93581736
CORRECTIONAL STATISTICS In a recent five-site study of jail populations, researchers found rates of serious mental illnesses that are three to six times more than those found in the general population: 15% of the men, 31% of the women. Henry J. Steadman, Fred C. Osher, Pamela Clark Robbins, Brian Case, and Steven Samuels, Prevalence of Serious Mental Illness among Jail Inmates, Psychiatric Services 60 (2009); 761-765.
LET S DO THE MATH: 2012: Texas Population: 26.06 Million State Hospital Beds: +2,501 Severe Shortage
STATE MENTAL HEALTH HOSPITAL CAPACITY IS 18% LESS IN 2013 THAN IT WAS IN 1994: CAPACITY REACHED A LOW OF 2235 IN 2002 AND HAS SINCE CLIMBED TO 2501 NTSH reduced 16 beds to open Hill Country MHMR Inpatient Unit and 7 CPS contracted beds not renewed. 7 3rd party beds added to WCY 3,063 3,011 2,879 2,889 Special Legislative Authorization 2,774 2,729 2,671 2,607 Number of Beds 2,235 2,355 2,285 2,268 2,477 2,477 2,484 2,484 2,461 2,461 2,501 2,501 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 El Paso Psychiatric Center added to the system MSU expansion DSHS Hospital Capacity Presentation to HB 3793 Advisory Panel Logan Hopkins, DSHS September 24, 2013
WELCOME HOME American prisons and jails contain three times more mental ill people than do our psychiatric hospitals. Jailing an individual with a serious mental illness costs taxpayers almost three times as much as jailing other inmates ($137 vs. $45 per day). http://www.txcouncil.com/userfiles/file/impact%20of%20budget%20cuts%20to%20c ommunitybased%20mental%20health%20services%20final%203%209%2011.pdf
Cost of a Jail Stay for Inmate with Mental Illness Average Daily Cost Average Length Of Stay Total Cost Per Admission $137.00 80 $10,960.00 http://www.txcouncil.com/userfiles/file/impact%20of%20budget%20cuts%20to%20c ommunity-based%20mental%20health%20services%20final%203%209%2011.pdf
MHMR MENTAL HEALTH LAW LIAISON PROJECT
OUR PURPOSE The project assists law enforcement officers in appropriately diverting persons with mental impairments from the criminal justice system into treatment services
Tarrant County FUNDING SOURCES Justice Assistance Grant Funds
WHY A MENTAL HEALTH LAW LIAISON PROJECT? Arrest and incarceration of individuals experiencing mental health symptoms: Uses officers time, Uses department funds, Can worsen the individual s condition, Increase the chances of problematic behavior within the jail and the community.
WHEN MIGHT AN OFFICER CONTACT THE LIAISON TEAM? Minor offense or no offense Behavior which evidences unmet mental health needs Behavior which puts the individual or others at risk The individual is willing to seek help
WHAT DOES THE MENTAL HEALTH LIAISON PROJECT PROVIDE? Assessment by phone or in person of the condition and needs of the individual Consultation with the officer on the most appropriate action to take Facilitation of referrals Active and assertive follow ups Advocacy and community education
OTHER SERVICES PROVIDED Hostage negotiation Fort Worth Missing Persons Unit Fort Worth PD/Homeland Security Hoarding intervention
BENEFITS TO POLICE DEPARTMENTS Increased service delivery to the mentally ill Trained officers who can respond appropriately to a mental health crisis Diverts people from the criminal justice system back to treatment services More accurate records and information on those affected by mental illness Safety for officers, individuals, and the community
BENEFITS OF THE HURST CRISIS INTERVENTION TEAM (CIT) MODEL As the number of health and wellness checks increase and preventive follow ups are completed, warrantless detentions decrease, thus: Saves lives, Saves officer time, Saves department funds, and Helps increase hospital capacity due to hospitalizing only the most critical cases.
INCREASING HEALTH AND WELLNESS CHECKS 60% 55% 50% 45% 40% 35% 30% 25% 20% 15% DECREASES EMERGENCY DETENTIONS 10% 2007 2008 2009 Increasing the number of clients diverted from the criminal justice system.
INCREASING HEALTH WELLNESS CHECKS DECREASES EMERGENCY DETENTIONS 80% 70% 60% 50% 40% 30% 20% 10% 0% Emergency Detentions City A City B Hurst Health Wellness Checks
FORENSIC MENTAL HEALTH PROGRAM Tarrant County Sherriff s Department MHMR of Tarrant County Ramey Heddins CCHP, Director of Mental Health Support Services MHMRT
HOW PERSONS ARE REFERRED: Booking JPS medical Sheriff s department staff Family Self MH Services Providers in the Community Local Law Enforcement
FORENSIC MENTAL HEALTH SERVICES: Mental health assessment Suicide risk assessment Psychiatric evaluations Medication management Ongoing case-management during incarceration Mental health groups Up to 30-day supply of medication upon discharge Access to MHMR clinic within 30 days Coordination with the Tarrant County Courts, Probation, and Parole
AVERAGE LENGTH OF STAY 95 DAYS 110 100 90 80 70 60 50 40 30 20 10 0 Sep Oct Nov Dec Jan Feb Mar Apr May Jun July Aug
TOTAL PERSONS UNDER DOCTORS CARE 800 700 600 500 400 300 200 100 0 Sep Oct Nov Dec Jan Feb Mar Apr May Jun July Aug Average 686 persons per day
ANALYSIS OF 85 PEOPLE WITH 14 OR MORE ARREST OVER A 3 YEAR PERIOD Total of 1489 Arrest Person with Most Arrest Average Number of Arrest 51 19
14 OR MORE ARREST 3 YEAR PERIOD Gender Average Age 35 24% 76% Male Female
DIAGNOSTIC INFORMATION 80% 70% 60% 50% 40% 30% 20% 10% 0% Some type of Substance abuse Diagnosis Dual Diagnosis Substance Abuse Only No Diagnosis or malingering MH Diagnosis Only MHMR Priority Population
14 OR MORE ARREST DATA 80 80 Females 70 67 60 50 40 43 38 30 20 10 0 26 20 19 12 11 6 5 2 2 Female Arrests
300 250 251 14 OR MORE ARREST DATA Males 200 150 170 151 100 102 96 74 50 46 43 39 28 25 23 22 15 14 13 12 12 10 8 5 4 3 3 0
ENHANCED MENTAL HEALTH SERVICES DOCKET 4,316 individuals arrested last year for misdemeanor offenses. 1,399 were identified as having a mental health disorder. Over three years, these individuals averaged 4.45 arrests. Average length of stay of 105 days for each incarceration period It costs the county approximately $6,929.53 for each incarceration
ENHANCED MENTAL HEALTH SERVICES DOCKET $2,162,013 Potential Cost Avoidance
ENHANCED MENTAL HEALTH SERVICES DOCKET How the Docket Works: Review of misdemeanor intake lists Transfer to the MHMR docket list Meet with doctor Make tier determination Send client information to the judge Coordination of community treatment Docket PR bond/disposition of the case Planned release
ENHANCED MENTAL HEALTH SERVICES DOCKET Tier One Reserved for those in need of intensive case management services and added support in the community. These individuals have been arrested and incarcerated at least three times in the past 12 months and suffer from a chronic mental health issue. Tier Two Individuals who have been arrested two or more times in the past 12 months and would benefit from community support. Outpatient Competency Restoration (OCR) These individuals are referred to outpatient competency restoration services. Upon completion of OCR, they will be referred to the appropriate tier and case management services will be continued throughout the disposition of their case.
OTHER SERVICES Healthy Community Collaborative Grant with DSHS (target 45 homeless, mentally ill offenders for Housing First Services)
TARRANT COUNTY TCOOMMI SERVICES (Texas Correctional Office on Offenders with Medical and Mental Impairments)
PROJECT RAPP Rehabilitative Alternatives for Parolees and Probationers Provides intensive wrap-around services for severely and persistently mentally ill ex-offenders Services include psychiatric services, medication monitoring, rehabilitative training, benefits Extensive coordination and collaboration with Probation and Parole
PROJECT RAPP Specialized officers for both probation and parole are assigned to each offender enrolled in RAPP. Specialized officers are also a part of the treatment team with the case manager, psychiatrist, and other clinic staff. Specialized officers have a greater understanding of what is needed to supervise an offender on medications, who have support needs, and varying other issues related to mental health.
TARRANT COUNTY ASSERTIVE TREATMENT (T-CAT) PROGRAM MISSION To provide a formal structure for criminal justice, health and human service, and other affected organizations to communicate and coordinate on policy, legislative, and programmatic issues affecting offenders with special needs. Special needs include offenders with serious mental illnesses, intellectual difficulties, terminal or serious medical conditions, physical disabilities and those who are elderly.
Funded by TCOOMMI T-CAT OVERVIEW Program developed in 2007 Close coordination and collaboration with Tarrant County Jail Staff Judges and Court Officials Criminal District Attorney s Office Defense Bar Community Supervision and Corrections Department (CSCD) Probation CSCD Bond Pre-Trial Release Officials Mental health services and treatment
T-CAT PROGRAM PARTICIPANTS Defendants awaiting case dispositions Defendants with felony offenses that are in the mental health diversion program CSCD mental health felony cases CSCD Bond Pre-trial release program
T-CAT PROGRAM SERVICES Psychiatric evaluation, treatment, and pharmacological management Individualized case management Skills training Individual and group, guided by treatment team Assistance accessing resources housing, employment, disability benefits, Texas Benefits, social and community supports Chemical abuse/dependency treatment and continuity of care
T-CAT PROGRAM OUTCOMES Independent living skills Appropriate and effective communication Useful decision making and problem solving Mental health maintenance and stability Ongoing personal growth and maturity Respectful of authority Legal responsibility Positive contributor to society Complete detachment from criminal justice system.
T-CAT PROGRAM IMPACT Effective alternative to incarceration for offenders with special needs Consistently at program capacity, 60-69 individuals are actively receiving services through T-CAT 98% completion rate 2% recidivism rate
WHAT IS NEEDED: Increase in the number of state hospital beds (HB 3793 Report due Dec. 1, 2014) Places for officers to divert mentally ill besides jail or inpatient Mental health professionals to do assessments and recommendations at local lock ups Increase in crisis residential programs Housing; residential, affordable and supported housing, transitional housing Expand the presentence investigation report to include a community reentry plan containing reintegration services and resources. Code of Criminal Procedure, Article 42.12
WHAT IS NEEDED: Mental Health Court Docket to coordinate discharge from jail to community. Increase in funding to expand existing programs targeted for the Mentally Ill Offender (TCOOMMI programs, Mental Health Law Liaison Program, Forensic ACT Teams) Training for corrections staff ( Tarrant County Provides 40 MH Peace Officer Class Corrections Staff) Strengthen the outpatient commitment law to allow Rehospitalization due to Noncompliance with Medication
CONTACT INFORMATION Ramey C. Heddins, CCHP Director Mental Health Support Services (817) 569-5084 Kathleen Carr Rae, Public Policy Specialist (682) 215-1059