Travis County Commissioners Court
August 1, 2006
Item 25
Number 25 is to consider and take appropriate action on request from Travis County mental health stakeholders group for Travis County to fund a mobile crisis outreach team and related issues > good morning.
>> good morning.
>> good morning.
>> which one is it?
>> this one.
>> good morning, judge and commission, sharon flemming, executive Commissioner for Travis County veterans service. With me is trish young, ceo of the health care district. As she is setting up I will briefly go through what you have in your backup related to this item. There was an updated agenda memo circulated to you that included basically a description of the program we are about to discuss but also some sampling information that our research and planning staff jointly between health care district and health and human services was able to do to look at projects that are similar to what we are about to describe for you in the harris county and bexar county areas. That has been circulated to you. Also in your backup you have the presentation for today. Then a spreadsheet that describe describes your investments in mental health services through health and human services, and then there is a small excel spreadsheet that identifies contracts that we receive through purchasing that also show mental health investments that you make from the generally fund--from the general fund.
>> good morning.
>> good morning.
>> appreciate the opportunity to be here and thank sherry for setting this up for us. I have a short presentation I'd like to walk through with you. And try to set the stage for this discussion we're going to have today. You should have a copy of this presentation, I believe. It's just a few slides. I'm going to walk through it quickly. I know you have had a loft discussion about mental health matters in the past years. Dare I say decades? About the impact to the county countythe and various parts of our sim, the and the hospitals, about--the jails and the hospitals, about the lack of inadequate mental health services in our community. Particularly today we're going to be talking about crisis services. So I wanted to just try to set the stage for this discussion. The bottom line is that there is a lack of adequate services in Travis County to meet the needs of individuals experiencing mental health crisis, and this is nothing new to you. You have been dealing with it for years. But the he will care district now--health care district now since it's in existence and working with you and the rest of the community on this issue, we are now involved in trying to solve some of the problems that we are facing. So we are here right along with you. In terms of discussing the need for crisis services, we're going to focus specifically today on in patient beds that we often refer to as crisis beds. You might hear different terms used but that's essentially what we are talking about. Associated with those crisis beds we're talking about psychiatric emergency services that support individuals in crisis. We know that in this county, that we have historically relied on the Austin state hospital for use of in patient beds, and we typically use the Austin state hospital as a short-stay hospital even though it's designed as a long-term stay facility. That use of ash has basically been due to a lack of what is traditional in other community, locally funded in patient mental health beds. We also have experienced in this community a decline in private beds available in the community. And that decline of private bed availability has contributed to and exacerbated the situation with the use of our public in patient beds am we know that during the period from -- beds. We know that during the period from April of 2000 to March of 2006, ash was on diversion 4 times and effected 123 patients. The result--64 times. The result of that, when patient patients are not taken into ash they are diverted to other communities. Most recently in our community after last December, due to changes made by the local meant health authority, instead of transporting to other communities they are being brought to local emergency rooms and they are left to deal with these patients in crisis. We also know that our local mental health authority and as a representative of our community, has allocated a certain number of beds at ash for our use and we know that we continually ec seed that allotment. And that has the potential to result in what I refer to as ca chargeback position to the local mental health authority for the overuse of those beds. It remains unclear whether the state will in fact send, quote/unquote, send a bill to Austin, and hmr but--, and hmr, but it remains a risk. The district undertook an initiative last December which judge Biscoe and Commissioner Gomez have been participating in in. This group consisted of representatives--Travis County representatives, Austin county h hmr, city of Austin, the hospital system, the saint david hospital as well as the saint david foundation, and other members participating with us, judge herman from the court who has been most directly affected by this problem as well. The work of the stakeholder group that we started last December is really a continuation of all the work done in the community this far. You have been briefed and the district in its, during the last year was also given quite a bit of information about planning that had been accomplished in prior years, proposals on various components of the system that could be built out for mental services. I think we were all probably challenged by the price tag of trying to fill the gaps in mental health. So the work of the stakeholder group was really trying to create a plan that we could take the first steps in trying to address the gaps in services. And I would say that our plan does not represent the end. It's really merely a beginning. But trying to focus on putting our foot on the ground, taking a steprg and doing it in a clab ra ra--a step, and doing it in a collaborative way that allowed all of the stakeholders in the community to agree upon an approach and hopefully take these issues under advisement and be able to find funding to make advancements towards these problems. This proposed crisis services picture that you have in front of you is a way that we found to talk about this issue. I think some people call it the dinner plate. And we're sort of focusing on the very inner circle in terms of the work of this steak homed homeder group--stakeholder group group. What we tried to portray was what was the need for crisis services, the component of crisis services. That's what you find in the center circle or oval. Around that you have the additional services that take you sort of one ring out from crisis. The services that are needed to avoid crisis and keep people in stability. So you have things such as support in traditional housing, the assertive community treatment which is already in place for our community. We have jail di version efforts which are again ongoing in our community and I know that this court has made significant investments in those activities in the past years, and I believe it's considering additional activities for this coming year. And you have also in patient beds for longer term needs. Of course on the outer ring of that circle you have all the other mental health services that continue to support those in need that might have to do, that we might refer to as more community based services. But what we are focusing on in terms th?ve proposing that we have been working on in the stakeholder group for the last about eight months, is developing out the continuum of these crisis services. Some of these we have in place. We actually have a crisis hotline right now. We do not have a mobile crisis outreach team as listed in this diagram. We have 24 hour psychiatric emergency services but I don't know that any of us would say that they are adequate. They really do not function on a fully staffed, 24-hour basis. There is not an unvoluntary component which also limits its usefulness. We do have 23-hour observation capabilities at the current cycl cyclia tick emergency services that aup stin tract and hmr operates, along with the current 24-hour psychiatric emergency services. I think there's about a three- three-bed capability for that. We do not have what is common in other community, which is we call a crisis stabilization unit or also referred to here as the psychiatric emergency residential facility. I think that's a long word. I like cs u. That's easy to remember. We do have an intervention team. The mobile team works hand in hand with the crisis intervention team am we will talk about that a little later. Crisis respit beds, we have some in our community, again located at the psychiatric emergency services at the center with Austin tract and hmr. The question there is more one of adequate size of those respit beds versus the need. And then the brief targeted therapy which is a complementary service that needs to be provided to patients in crisis and in follow-up. All of these services that are listed in this center oval, except for the brief targeted therapy, represent recommendations that are coming from the state's crisis redesign work group. And I believe that you are aware that judge herman and other from are the community have been participating on that redesign work group. Our plan here has been developed in concert with that, trying to track the work and activity of that crisis redesign group because we do expect that the state will give us guidelines underwhich we will need to operate. When I say we, we as a community more specifically Austin, Travis County, and hmr in terms of if you fillment of their responsibility as the local mental health authority. So that work from that state crisis redesign team should be coming out in the next several months, and their goal is to bring forth not only those recommendations, but I believe some requests for funding to the various mental health, local mental health authorities across the state. Of course, it remains to be seen what the state legislature does with that request. If there were to be additional funds from that, our community would benefit from that as well.
>> who pointed, but what authority does--appointed, by what authority does the state crisis redesign team operate?
>> it comes under the state health Commissioner. The mental health authority for the state, which is an agency reporting under the state health services.
>> but did the governor or one of those legislative committees basically empower this group to take a look? Yes, sir.
>> I'm trying to determine--
>> I'm trying to determine the probability of additional funding by the legislature. A lot depends on who put this group in place.
>> that is true. I thinkthink--i'm not certain about the chances for success for funding.
>> okayi believe fairly certainly we will get guidelines about what crisis services are and what they need to contain. I hate to use the term unfunded mandate but it might sort of kind of fall through. It's not quite that. I think they are trying to see here are the guidelines of best practices. I think they are trying to put consistency into best practices. The practical matter is not all communities have these services so they can ends up as unfunded mandates. To the extent that communities have services in place, it may be a matter of providing them in a different way or linking them in different ways. But to the extent that they do not exist, this could represent additional requirements to local communities. And it remains to be seen whether there's going to be additional funding.
>> the state agency an anappointmented the members of this.
>> yes, sir. I forget, they have retitled all the state agencies, but it's--
>> the department of state health services?
>> it's within the department of state health service under the mental health area.
>> okay. Fine.
>> this next slide summarizes the, what I call the five components that we're focusing on in developing and trying to come up with a plan of implement implementation. Implementation could be during the next fiscal year and in later years. We have the crisis stabilization unit as an item that we are trying to create, again, which does in the exist right now, and mobile crisis outreach team which does mt. Exist right now-- now--not exist right now. We are trying to create housing both under the respit as well as rental or residential, which could also include a secondel residency occupancy type component of housing. And adding sufficient resources to the current psychiatric emergency services to get us to true 24-7 functioning, as well as adding funding into what we refer to as proven prevention services such as the emerge program, those that try to get people into care before they are in crisis and keep them in care and keep them stable, on their medications. So these are the five components that we are looking to obtain funding from the various partners through this process. I do want to point out that this particular focus on emergency services was one of the top priorities that came out of the mayor's mental health attaching force work and was issue--task force work and was issued in the jon 2005 financial report. There were two specific cites, I believe they referred to, and those, j 1 had to do with for our community--standard for our community as a mentally healthy community has a 24-hour cycle wra trick beds in local hospital hospitals. And t 1 which state that had a mentally health thing community has at least one psychiatric emergency center in an existing hospital with a detox center attached. I will tell that you our proposal here does not address the component of having a de deattacks center attached. I would say that's still a goal we holy out for our community. But what we are talking about in our proposed crisis service plan is a solution is that would involve taking space at seaten shoal creek hospital and creating the crisis stabilization unit, relocating the psychiatric emergency service that are now at the nadi nadine jay center and increasing the staffing component to get us a true 24-hour capable. The co location would provide the crisis stabilization componentrb the ability to do 23 hour observation as well as to function as a 24-7 crisis service center. There will also be, the planning for this proposal and the development of the implement implementation plan would include various law enforcement representatives from both the city and the county that are dealing with these patients that the criminal or that the law enforcement deals with in terms of their daily activities, trying to create the connectivity between getting people into services at the center and, of course, reducing the time that law force. Are spending in dealing with these marts.
>> let me interrupt you--these matters.
>> let me interrupt you just for a second. How is that invoked as far as law enforcement? How do they recognize that a person that's out there actually has a mental problem? Of course, they may be referred to what you suggest here, but I'm kind of concerned, how will they be educated or are they educated enough to identify the symptoms of a person that maybe has mental challenges in their life. You know, how are they determined.
>> I think we have in place now both in our sheriff's deputies and as well as the police, we have mental health trained law enforcement, and that is part of their duties, to handle those types of encounters. On the police side, I believe that on every shift within apd there are three trained mental health trained police office officecious and the county has the mental health sheriff that fuppings to deal with these issues. So they are typically sent out on these types of calls. And they are trained to identify what the issues are. What's typically the problem now is what to do with the patient once they identify that you do have mental health issuesissues.
>> I guess I'm trying to look at the logistics, not only the process. Let's say there is a person that is in the community for whatever reason, needs law enforcement needs to be there. The first responders that get there may not realize that this person has mental challenges. As an end result, you may get consequences that may not need to be invoked at the time by law enforcement. My question comes back, is how is that rectified in knowing that this person actually has mental challenges and needs to have that team of experts?
>> uh-huh.
>> is that across the board training that all law enforcement must have or is it just a unique team within law enforcement that deals with mental challenges? Because I feel that sometimes you may get situations out there where a person has mental s and it's not recognized probably-- probably--challenges and it's not recognized properly because the person is not trained to wreck myself that.
>> you may not--
>> hold it, Commissioner. Let them respond.
>> Commissioner, have I not seen the curriculum that the law enforcement officials have been using to train. I can tell that you there are brief assess that mental health workers and officers in the field can do pretty of immediately. An example would be talking to a person about and determining whether they are oriented to where they are, what day of the week it is, who is the president those kinds of quick questions, first of all, signal, you know, whether or not that person is oriented to where they are and what they are doing. Now, of course their behavior, the reports of witnesses, all of those things come into just a really quick assessment of what could potentially be going on with that person. But when mental health patients are decompensating, you know, they are without their medication or they are experiencing symptoms, it's going to vary from diagnosis to diagnosis as to what the present presenting symptoms are. But historically there are a few quick assessments with a few specific questions that folks who trained can ask that let them know that further assessment is needed or what professionals need to be engaged to help to work through that situation.
>> so that's a 24-hour availability of that type of assistance.
>> that exists now in our community in terms of within law enforcement, we do have individuals that are trained to be the resources for the remainder of the law enforcement individuals to be resources to them once they encounter individuals.
>> right.
>> so I think that what we are talking about is trying to augment that existing capability that we have right now through those that are already trained, the systems and the programs that are set up through law enforcement now, such as the crisis intervention team, which is a co-located, combined Austin police department and Travis County sheriff function, where you do have individuals that are more, I guess, more highly trained, may be the most appropriate way to say it, and are called in to deal in situations. I guess it's, is it fair to say, sherry, the first law enforcement officer encountering an individual may not be the only officer dealing with that individual. It depends upon what that assessment would show you. What we are talking about here is adding another component to that called the mobile crisis outreach team which adds more of a behavioral health component as opposed to law enforcement. You have the ability to bring in a licensed counselor to try to deal with that individual and then begin to link them into services, possibly into crisis services, possibly into out outpatient services, possibly to you know, just figuring out how to get them linked to getting back on their medsi understand that. I--
>> I understand that. I wasn't trying to sir couple vent the hospital. But I was question--circumvent the process. I was asking about the current process, what's currently out there and how it can be used accordingly. How this may be referral services for what those folks really need, but identify those particular persons that have mental challenges, the cruck of the matter, in my opinion. The--the crux of the matter. The services won't do any good if the law enforcement person that comes to help the person with mental challenges is not familiar even with this program, has not been trained enough to deal with the person and not knowing what thote mental challenges are. The person may be treated tot totally different because of that, the absence of that law enforcement being trained to recognize certain things.
>> uh-huh.
>> I'm trying to enter 2009 all of this together to--enter twine all of this together to look at the money we're investing in the program is all encompassing. That's what I'm trying to get t.
>> after our meeting a couple days ago I indicated I will contact the budget office about the crisis intervention team. In our '07 budget we have 11 fte fte's, one sergeant, eight certified peace officers, one senior d?p ty peace officer-- officer--deputy piece off officer, one office specialist, at a cost of roughly $795,500. I would be surprised if the city of Austin doesn't fund at least as much for police officers.
>> yes.
>> but in the urban centers that have the mobile outreach team, they also have a crisis intervention team.
>> that's correct, sir.
>> the challenges is both of them working together.
>> yes, and that is the model in the other communities, they are very closely linked. They are complementary services. What you have with your cit is law force. What the encot rents is the behavioral--rents is the behavioral health individuals, the counselors, psychiatrists, m mmedical personnel that help deal with the patient in getting them into service. So they do work in concert with your cit's. What we have heard is that there's many places of intersection. You may have law enforcement called out for a specific complaint. You might have an encot team member go with them. You might have a law enforcement called out for specific complaint and counter the situation and decide it's not a law enforcement issue but a member of the team could be brought in to handle and work with that patient. The encot team, if you think about it, it's really the behavioral health component, linking these individuals into services. And the individuals on that team typically carry a caseload. They don't just encounter an individual once. They may encounter them, may take them on for a series of en encounters over a period of weeks to be sure they are getting linked, staying out of crisis. Oftentimes it's medication driven, getting them linked back where they should be. It fuppings as a way to-- to--functions as a way to, also functions as way to get folks who don't traditionally come into service. They are not going to find their typical path. We know they are in the community and creating disturbances and other, they are not getting what they need in terms of staying out of crisis and being stable in the community.
>> crish, help me understand-- understand--trish, help me understand something. You have used the word behave yorl component. D?r behavioral component. Think what's lop sided is the proposed funding source. We, in creating the health care district, it was really to try and separate out and to kind of get away from the idea that the health care pieces and the behavioral health pieces ought to be handled by health care district, by us, Travis County, getting back into the biz of something that is not a law enforcement component, which clearly we're paying for. I know you heard the preliminary budget. We are talking about a mental health public defender that the going to cost $125,000, the mental health pilot and pretrial another almost 100,000, the mental health assessment team in the sheriff's office, another 3 300,000, plus whatever amount I think we'll do on a class b project. We're talking huge dollar amounts that we just need to do for the law enforcement and criminal justice component. So I'm confused as to why we are talking about something that is so clearly labeled the health component that is not, it may have an intersection with the criminal justice system but not part of the criminal justice system, why isn't the hospital district saying, this is our piece?
>> the hospital district is proposing to fund the crisis stabilization unit which are the actual medical beds.
>> they should be. But I'm not understanding why this in addition, especially since, unlike other counties, like bexar county, the cost of every one within our jail in terms of their meds and prescriptions and all their medical care, whether they are indigent or not, is coming out of the county's generally fun. In other applications they have clinic cards or being paid for by the hospital district. I'm trying to get to the policy question of why should something that is is clearly health related be put on what is primarily a criminal justice budget, and we get that confusion again as to why is it, why are we slipping back into that as opposed to, why isn't the hospital health care district, I'm going to have to learn how to say that, not stepping up to the plate as well on this particular piece of it, then you leave it to apd and tcs tcso to put more money into their crisis intervention teams for the pieces that are indeed law enforcement and there would be zero expectation to ask the health care district to assist on those pieces.
>> I think we have to go back to the start of the district. And the decisions that were made by both the city and the county at the time that the district was created. If you recall, at that time there was a decision made that the responsibilities that would be transferred to the district had to do with medical care. And both the city and the county retained the tax base as well as the responsibility for the mental health care that exists within their budgets at that time. And there was a decision made at that time that transferring responsibility for mental health services was not in the best interest of the district at that time. I think what I hear you saying, Commissioner, is how do we get from where we are today towards a more integrated system of both health care, of health care delivery in the community when we have started at a certain point. The district did not transfer responsibility for meant health care when it was created. The tax base that came over was for identified medical services which had to to for funding for hospitals and clinics. Ed funding for mental health services stayeded with the district and the county. I think what the district has been trying to do since its creation is figure out what role do we play in mental health. Because it's not clear in statute what our responsibility is. It's actually kind of vague, which I think is an opportunity, quite honestly, in terms of community.
>> I don't disagree with you on that in terms of what were the presumptions as we transferred over. But we're not talking about transferring for example the sheriff's crisis intervention team, which if we were to transfer that to you, which we are not, we would have to send tax base with it. I'm with you there. We're talking about new opportunities. My memory is you all ended has year because of the draw down of federal funds with about $19 million more than you had expected. You had a surplus and you have been trying to think very strategically about how to spend those dollars. And to me, the answer is also in christian's report, Travis County and the city of Austin grew you new tax base. There is now $2.583 billion in new value that the hospital district is going to be able to tax and capture new dollars from new tax base. So that's another opportunity to get new programs. We couldn't have this attitude that, well, we didn't transfer tax base so we can't do it. The answer is, that was just to get you all started. You were always going to grow new tax base and take on more responsibility.
>> I think more importantly, and I think it's important that we not lose site of this, there-- there--sight of this, there was a des tipping shun--distinction made when the district was created not to transfer responsibility to the district in order to give it the time to get established and to make its way, address the medical and other issues that were facing it it. You are correct in that that tax base that was transferred has generated additional revenue for the districtment and that additional revenue--for the district. That additional revenue is going to fund the programs that the district inherited and we're facing pretty significant cost drivers. We were here a few weeks ago when Commissioner Sonleitner and Commissioner Gomez were not here when we talked about our proposed budget, but we are looking at a proposed budget for '07 that an effective tax rate, we're having to draw out of our reservers to cover our base d?r reserves to over our base expenses, not even considering the additional investants that we are talking about. The tax base that we were transferred for the medical services responsibility that we assumed, the effective tax rate is not keeping up with the rate of inflation in terms of our on ongoing obligations for those programs and services, as well as the increase in enrollment that we continue to encounter with the medical assistance program where we actually pay for the medical services for those individuals. So you are right. We did have one-time, we had a surplus at the end of last year but that money did come from one one-time funds.
>> I understand.
>> we will not repeat that draw. I think it kind of ties back to discussions I heard the court having earlier in discussions with your budget, that we are very careful about not using what are one-time funds to fund ongoing service delivery to obligate ourselves to ongoing service delivery not knowing that there is a source of funds in the future to sustain that program. So what we have been doing in in stakeholder process is trying to carve out a plan on a community collaborative basis. I think the inherent assumption at the beginning was that the district was not in any way, shape or form from a financial perspective able to come in and to pay for all of mental health services in the community. We did feel, however, that our focus should be on the psychiatric emergency services, and particularly in patient beds beds. That's clearly considered a medical cost, the in patient beds. And we saw this as an opportunity to create a take, maybe what could be a first-step in taking the plans, the discussions that have been going on in the community for quite some time, to get something started. And in that process was an assumption that we weren't developing a plan that was simply going to be what the district would fund, but we have other partners coming to the table. We have the city of Austin coming through with housing, we have--
>> this may be a good time to talk about the contributions between partners as well as an estimate of the cost or contribution by that governmental entity.
>> yes. For the crisis stable ation unit we are looking at two component, capital costs required to establish the facility in the way that it should be created, and the district is prepared to make contributions for capital. Again, Commissioner, drawing out of that one-time fund. And also, city of Austin Travis County and hmr have indicated there could be availability of some funds from the sale of real estate that they contribute to that renovation of the facility. [one moment please for change in captioners]
>> st.david's fowption has made an -- foundation has made a commitment to fund over $800,000 in services that are community based, emermg like programs in the other community health services such as people community clinic, el buen clinic to add component services into their clinic services that can keep people in care and out of cries. The mobile crisis -- eng owe ithink this may get into one of our questions. We tried to look at this plan as interactive and figure out what parts of the system would be impacted by the investment. And we do believe that the mebl crisis outreach -- mobile crisis outreach team has multiple fek that can reduce hopefully the amount of time that law enforcement is spending on dealing with patients with mental health issues. It would help -- excuse me?
>> I didn't mean to cut you off, but there is a jail diversion piece in all of this seeing that we still have to house those perpz that are arrested. I guess a.p.d. Makes up the lateral perk of arrestees that end up in our jail. My question is how much does it cost for those mentally challenged perpz that are in our -- perpz that are in our -- persons that are in our jail, how much does it cost the tack pairs currently in I think it would be good to know. I don't know what the figure is from the sheriff or anyone else as far as how much it's confidenting us to hus housethose inmates until we can deal with them. So do we know what the jail diversion, what amount of money that we're talking about? If the mobile iew reach out each team is in place, how much will be diverted from jail?
>> this is a proposal. We have not calculated what we think the impact is on the jail. I don't have them with me, but I have seen figure from the sheriff's department about the cost of incarceration. I think that ha we could what we could do is look to the other community in terms of areas that have --
>> but there is a number for Travis County, an amount of money. I'm not asking -- I guess my question is I need to know -- it would be good to know what that figure is for information's sake because if we're goik to look at a proposal in the amount of money we're talking about here, it also impacts jail diversion, then of course that would be something that would offset some of the expense. So I just thought -- I didn't see it anywhere in the backup. Maybe I overlooked it.
>> in.
>> but I saw the yale diversion figure and I thought, goodness gracious, I know it confidents Travis County something it take care of the inmates that have these challenges. So if we can use another methodology where we have those -- as far as other folks willing to -- other entities willing to participate in this financially, then it means to me that we will have some relief on the jail situation that exists now in traik.
>> I'm sure you will.
>> so all of that should have been, in my opinion, all put before us, and it would be good to know what that number is.
>> I think we can essential get costs. I think it would be prediction as to how many incarcerations that you may avoid,. What other community have done is because this is based on best practice they've put them in place and then they have in fact measured what the impact of the program was. I believe we saw in san antonio, bexar county that --
>> look at your July 28th dated backup and the page 1 of fur of the overview. It's the July 28th dated backup. It did include the 84 view of the bexar county mobile -- overview of the bexar county mobile outreach and there is indication from staff that bexar county was indicating overtime pay to the tune of $700,000, and that was attributed to police have to wait in emergency rooms with clients for mental health services. They new estimate that police are back on the treat in less than an hour after being able to bring staff in to the combined -- the combined impact of the psychiatric emergency and the mobile crisis team. There is a notation that there has been a reduction in police waiting time, but in term of what that quantifiable dollar amount is, we don't have that. But if that is the kind of nms you would like -- information you would like to are, so we can give you apple and apples, police waiting time, reduction in jail population, those types of things, that would be easier to prepare. Talk. [overlapping speakers].
>> Commissioner Sonleitner and I both visited phoenix and they had their operation and the police officers were stepping up and saying that they supported this approach pause they because they dropped the people off. I think we can come up with good data locally that's -- so we can compare better. But there's no doubt that it works.
>> I think at your point, Commissioner, we really are -- we're talking about this complement of services to make sure they all work most effective active 1 together. And -- effectively teg. So having a place where the officers can drop a patient and literally do back to their job is one component. Getting people out into the community to keep, one, the officers are having to go out there, and also keeping them out of the crisis situation where they actually have to be transported, and then also, I think to your point, Commissioner Davis, is making sure we're not incarcerating people who have mental health issues. So it will seb as an expansion of the crisis services and help keep people out of your jail. This all works in concert and I think we can get the back grouped figures that -- background figures that have been developed to date. I think it difficult to say what the impact is, but I think you can put systems in place to measure and evaluate. I think that's part of why the proposal for this mcot team, if you had a chance to read the backup, you will see that it fairly moderate in size. And part of that is to be able to test it. You don't want to go out and tart a big thing and then find out it doesn't work. We want to make an impact and measure the impact, and then that gives you better nms in the future to, one, continue your investment, or two, decide whether that's an investment you want to continue.
>> how long would you need?
>> probably a good year in term of actually having it in place and tracking your information. There's all the implementation in term of hiring. The piggest impact -- biggest impact is going to make sure that the team is appropriately incident dpraited with your cit and all the functions -- these people have to be appropriately connected into services, all various providers. It all about linkage. It about getting patient where they need to go to get the services so they're staying out of the places in the system that thawr not posed to be.
>> let me ask four or five specific questions and try to get to the bottom line here. How real is the state's threat that they will do something to us if we don't reduce our use -- if we don't keep exceeding the number of state mental health beds that we've been allotted?
>> I think it's a significant bill. The question is whether it comes this year or later years. This year there's -- Commissioner sanchez did ask for a lot more funding for those services and I believe that he got them this year. That may help stave it off for this year.
>> of the meeting that I attended when Commissioner sanchez was still there probably six-month ago, basically we were told that other urban counties do a whole lot better in term of dealing with their mental health clients and they expected us to did better too. I cd this question for the last take holder meeting. Since Travis County has increased the investment and the jail area where we expedite release, try it improve case management, etcetera, if we have a couple or three thousand dollars, whether it would be better to hire an additional two psychiatrists to deal with this postponelation or whether the mobile crisis -- mental health crisis team was a better investment, and the anne I was give enwas -- the answer I was given was...
>> I believe the group believes that the mobile cries outreach -- crisis outreach team is a better investment.
>> so the investment is about $800,000.
>> what's the contribution of the health care authority in.
>> the district? We are looking at one and a half to two million on an ongoing operating cost, and probably a minimum of a half a million for capital. Plus we are -- in addition to the investments that we're making in the emerge program, we are going to be increasing those next year byner couple 100 -- another couple thousand dollars. So we will be expanding the psychiatric and the behavioral health component services available in community to keep people in care and out of crisis.
>> okay. What's seton's contribution?
>> we are working on trying to put a dollar value to the facility. They will be taking on the operations of this service. They will be taking over the operational responsibility for the service. It they will work in concert with mhmr to device and implement and run that program. They are -- they are working on a plan to develop what -- I don't want to use the wrong term because I don't want to confuse it with this mobile cries outreach team, but a clinical mobile team that will help the local hospitals, the er's, a team that should an individual prept in an emergency room that does need to be at shoal creek, they will facilitate the clinical team that can go in and help did that assessment and get that patient transferred over to the emergency services and to that unit.
>> so it true that we're waiting on a sort of statement of monetary value from seton?
>> yes, sir.
>> so I have a question mark by seton. What about the Austin-Travis County mhmr?
>> we did have a comument to their -- commitment to their current funding, plus an amount of capital that's been discussed. We don't know the actual cost of the program. That represents what now in.
>> the amount that they currently expend for psychiatric emergency services at the center. It's redirecting.
>> but it's current investment basically?
>> and we're talking with them about increasing that investment.
>> and the central texan?
>> we are -- the city of Austin?
>> we are till waiting on the evaluation, but they are waiting on the number of unit. This could be residential rental or single room occupancy. I don't have thur estimate back yet, judge.
>> theirs is predicated also on a bond, isn't it? Isn't that it?
>> they're talking about directing may of the bond money twar a specific type of housing. Transitional and single room occupancy.
>> now, this is -- I have three question marks, seton, mhmr and city of Austin. Clearly they plan to make significant contributions to this project. And I don't think when the question mark will have specific amounts there. Travis County clearly invests a tacial amount in mental health more than we did 12 months ago. This is a budget issue and it's brought today because we committed to stakeholders at the last meeting that we would bring it. But I did put them on notice because we were unable to determine the exact contribution of meab of the partners, then members of the court would have some issues with that. So I think we ought to put this on our list of bubbling issues, get back to the stakeholders group and tell them that we need specific numbers of contributions from the others. In the meantime, I think that we ought to try to put together a more specific statement of Travis County contributions in this area, and that we ought to indicate which ones are 12 to 18 months old, and consider those to be fairly new and longer than that to be fairly old because that's what many of the other stakeholders are said. This is a critical issue for us, and I think clearly the other urban counties are doing much better than we, and I think that Travis County has a responsibility to try to help out. At the same time, I'm not sure that it's completely far to hold us to a 400,000-dollar standard when we don't know what standard the others are being held it. On I think we ought to put this on hold, let them necessity that we've heard the -- know that we've heard the the precinct. This shouldn't strike anybody as being new. And I did tell them how we function here at the Commissioners court and the fact that when you say partners, we would expect the other pashz to make a definable contribution for investment if we're asked to did the same. So I wouldn't say may -- I would put it on this list because it real important. As it becomes mr specific and concrete over the neck two or three week, then -- next tw or three weeks, then we should revisit it. Our problem, and I menged this before, is the budget process here starts at a certain time and ends at a certain time. There are some things we can do to give us wiggle room next year if we choose to do so, pu we have to hand on that amount even if we want to preserve that wiggle room. And trish is sort of the messenger today. We did bring consultants in, we did have all the party at the table. We had the right people there. Toward the end, though -- it just so happens that the 400 thu 400,000-dollar project was left standing and Margaret and I were quiet.
>> I'm not sure there's goik to be a 50,000-dollar one.
>> we didn't beat you up too bad.
>> oh, no.
>> I would like to thank you and Commissioner dpe Gomez. It is a real tough issue and we've got to do something. When the information comes back in the future as we go through the budget process, it would still also be good to see the impact on other areas such as the I object cars ration of -- incarceration of folks. The impact on that, the augment on that, all of the information I basically requested farce offsetting some of these costs along with these other contributors that suggest they would put money into this thick. But what we can also if find out from what we deal with as Travis County, the ruk in reduction in cost, I would like to have that information when you bring it pack for the budget cycle.
>> I think we can do a similar schedule that shows you what you're I object investing in now and the various places that this additional investment would impact. We may not know what the thrar amount is, but we can demonstrate that.
>> those departments that are listed, they necessity what the dollars are. If they're listening, they have some shape, form or involvement dollar wise within those investments on what we're discussing today. We're just asking you to come forward with the nrms. Who they all are, you know, I don't really know the array of those departments.
>> we know who they are.
>> I'm just asking for them to step up to the table to see what impact it would be and how it's augmented as far as the cost is concerned to Travis County.
>> I wanted to add to the yuj's point that -- judge's point that the district, I will be bringing forward to the budget in the board of managers the district fund sufficient to cover the district's proposal here. So I think you -- unless I get shot down, I think you can assume that this is -- the district's committed to doing this.
>> although we're not able to quantify some of the contributions, they really are dpant. Dpant -- significant. It like the shoal creek facility that seton owns. When you start facilitating it, they're dedicating it to the project, and then when you start reb know rating it so we can use it, that's important. And then number of beds we asked about, anywhere from 10 to 30, right?
>> we're trying to figure out what the space will accommodate.
>> 10 is a big help. 20 or 30 is a whole lot more. So I'm not suggesting that their contribution is zero. I'm just suggesting that I think we would feel better if the commitment was a lot more specific than generally offering up, which is had you it sort of came across.
>> I think this is probably part of that timing issue when you're developing plans because they're in the process right now, seton has engaged a mental health hospital operational consultant to help them look at the space, figure out what they can did, how they could accommodate what we're trying to accomplish here and make that work. And of course our goals would be to minimize the cost and everything that we have to invest in that. So I believe that within the neck month or so there should be more pefk ideas about how that space could be utilized. I think going back to the concept that the stakeholder group and what the district is willing to do, our approach to this has been we know that we can't do it all ourselves. That's why we created the stakeholder dwrowp. We all have to make the investments, but we believed firmly that if we tonight put these core components in place, we're sort of -- we're essentially creating new services that are the highest cost in services and we have more people using them. For example, if all of a sudden we have bed we can place people in because they're in crisis but we do not focus on them staying out of cries, we will have a very high bill regarding those crisis services. Our goal is to keep them out of crisis, keep them table in the community, make the investments that keep them out of crisis. And I think that's why this plan has been presented as a whole pause we need each of these exoapt to make each one work more appropriately. We need the inpatient beds to make sure that -- and the psychiatric emergency services to make sure we're dealing with people in an appropriate setting and they're not going to the jail and receiving thur mental health services in the jail. We need services in the community it make sure that people stay in carry and get the care they need there and they don't become a problem that your law enforcement has to encounter or psychiatric emergency has to encounter. Our approach to this has been the district wants to inrest in this but it has to are its partners there and all these pieces need to be there in order for us to make a sound investment.
>> the other thing we don't want to recreate is it's not just for Austin Travis County. It's for a large region and it's not just our county that is having difficulties in terms of feeding space owe there, as judge herman would say, Williamson county has just as much of a stake in this. As we talk about appreciation of beds, if these are being paid for by the Travis County health care district with Travis County tax dollars, these need to be reserved for Travis County citizens on this.
>> absolutely.
>> and there needs to be some discussion with some other partners out there too that if the capital costs are being covered, for example, by seton which has a regional mission, then we need to make sure that our regional partners are there to bring forward dollars so that they can have access to those beds too. We should not be creating space at ash so that other counties can use those. It is a regional problem in terms of the overuse of ash, not simply Travis County overusing ash. Efb has to be on the able on this one.
>> I'm glad you brought this up because you're exactly right because of the Travis County funding. Our funding can only go to take care of traibt patients are -- paikt owe Travis County patients and it is and it will be. And we do -- all of ash is 84 utilizing, we unfortunately have one of those designations of being the highest. I think we want our piece of that you should control and I think all of these efforts have opportunities for regional collaboration. We shouldn't lose sight of that.
>> we saw ash was on diversion, it really means something quite serious because there are real life exasmz of where a law enforcement officer had it take a client 24r50e or four -- three or four hub miles away. Then the officer came back with an empty car and when it was time to transfer the inmate back to Travis County, someone from here had to get the person, client, patient, and bring the person back to Travis County. So a lot of costs involved in that. And at may president clinton I think judge herman -- I think judge herman ordered that they were taken to seton and they dbt have the professionals on hand to deal with the client. So that was not a safe situation. So when we had the first stakeholders meeting we really had a real life bad example, bad fact to deal with and our goal was to try to come up with a remedy. And I don't know that we were trying to spebd as much money as we could. It became clear that various pieces were needed and those pieces were also costly. That's how we got to where we are today.
>> we might just remember there was a plan presented last year when we were talking about jail diversion and various opportunities. And it had various components we were talking about and do you remember the price tag on that was fairly payable? Ic it was around $12 million. It was very lark.
>> it was substantial.
>> it was substantial and I think we all took a big gulp. But our objective on this is to take a bite and make progress and be Austin-bergstrom international to measure and see how we're impacting to then figure out what our next steps are. So to your point, juk, we are not trying to figure out how we can spebd the most must be that we can. We're trying it figure out how we can spebd a roabl amount of money to make a dent in the problem and then be able to figure out and assess what we're doik and how it is making an impact to figure out what the next step is. I believe everyone is taking that approach.
>> to we think we've expressed our concerns today in clear enough language for you to be able to communicate with the rest of the stakeholders what we hope to see?
>> sure. We'll work on tying those numbers down. You know that's all in progress. We'll tib to work with -- continue to work with them and we'll work with ms. Policemenning ms. Fleming and get that other nrms pulled together.
>> any other comments or questions from the court? Thank you.
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Last Modified:
Tuesday, August 1, 2006 7:14 PM