Travis County Commissioners Court
October 9, 2007
Item 6
6. Receive annual report from mayor's mental health task force monitoring committee.
>> good morning judge and economics, sherri flemming. As you know in 2004 mayor will wynn pulled together a task force to look at the mental health services in our community and engaged a group of partners to make recommendations on how we could make significant changes and how we address behavioral health needs in our community. And while it was a -- while it was an initiative of the city of Austin, certainly Travis County is a significant partner in -- in the provision of behavior health services in our community. There was significant involvement with county personnel during the initial task force and then following their report the mayor appointed a monitoring committee to -- to work towards the implementation of the recommendations of the task force. So today I have with me the executive coordinator of the mayor's mental health task force, dr. Susan stone, she is here today to share with you a summary of the second year report of the mayor's mental health monitoring task -- monitoring committee.
>> good morning. Delighted to be here, thank you for setting this up, sherri. I'm excited to share some of the work that we have been doing with the monitoring committee. As ms. Flemming stated. This -- the task force was originally formed partly out of the concern that arose in our community from the fatal shooting of a woman with serious mental illness in our community by the police department. This raised the awareness of the challenges that people would mental health needs face in our community. So 80 people met over four months representing over 40 agencies to come up with the task force report. And monitoring committee was charged in April of 2005 with making sure that the recommendations in that report are actually full if I amed. So we are charged for five years to continue working on this. We are a very broad based collaborative. We have representatives, ms. Flemming is on our committee. Austin independent school district, judges, lawyers, probation, police department, so we have a broad participation. Sort of moving forward and our charge is really to make Austin and Travis County into a national model of a mentally healthy community. Really goes well beyond just mental health services to really looking at what are the things that our community needs to really be a mentally healthy community. So we have spent a good deal of time thinking about what the role of our monitoring committee would be and we have kind of come up with two -- two separate rules. One is the good news is in Travis County there's a whole lot of planning going on, the bad news is there's a whole lot of planning going on. You see the same people at the same meetings discussing the same issues. What we really try to do is work as a collaborating entity to coordinate those planning efforts. We also take a more active role in areas where there aren't any planning efforts going on. Where there are gaps in planning. I would discuss some specific efforts really briefly that are included in this report to fill those gaps. We've identified six focus areas as a way to move forward with the recommendations. One -- proposal the most important is schools and youth. The schools and youth issues were underrepresented and the actual task force report and of course we have to recognize that the mentally healthy community starts with its children. Ms. Flemming is on our subcommittee for schools in youth, a very active subcommittee. We also obviously have a subcommittee working on access to mental health resources and important component indeed. We have a subcommittee on housing. We look at community awareness. We look at faith based activities, even though it goes across all of the other focus areas. We really believe that the faith based community is a real strength for us in moving forward. And also very importantly, we have been very active in criminal justice area. We partner closely with the Travis County mental health jail diversion committee, I will explain some of the things that we have done in that regard. As you look through the report, you will see that we have documented strengths and challenges for our communities, each one of these areas of how we move forward with the annual year of 2006. We also produced a report in 2005. Some of our specific planning activities that we have taken on are also included. One is what we call the behavioral health service system mapping. We kind of recognized as we looked through the task force report that we -- that we really don't have a good appreciation for what our current mental health system is in Austin and Travis County. We kind of get parts of it, but really needed to know what we currently have and how it's growing or shrinking in response to our population's needs. So we sent out a behavioral services system mapping survey, over 80 responses for over public, private, non-profit providers, really look an the overall system of what kinds of mental health services are out there, what's the capacity of those service, what are some waiting lists, why are the -- where are the services locating and very specific what are the funding streams. We did the original mapping report in for 2005, currently updating it. We will be updating that yearly to really look at how our service system is changing, making some recommendations about where we have needs. The other thing that we are doing is developing a mentally healthy community score card. Looking at -- the question is how do we know if we are making progress or not towards becoming a mentally healthy community. We identified indicators that let us look across our community to see how much progress we're making. We're doing quite a bit of work in the area, as you all know, the affordable housing is a major challenge for everyone in our community. But a very specific challenge for people with mental illness who really have to compete with people with other disabilities even for affordable housing that's been designated for folks with disabilities. So we've -- we conducted a consumer housing survey, really looking at what do mental health consumers really want and need in housing. Which documents a wide array of mental health housing needs. We are working with a non-profit corporation called the corporation for supported housing from new york and they are providing some technical assistance to us about how to do some financial modeling, make some projections about what kind of housing needs we have for individuals with mental illness in our community.
>> supported housing?
>> supported housing, right.
>> we also formed a joint subcommittee with the Austin Travis County suicide prevention council, looking at how do we -- as you may know Austin Travis County has the highest suicide rate of any major metropolitan area in the state of Texas. We really are looking at how it is that we can address that issue. One of the problems is that there really currently exists no system to get real time data about suicide. The most recent update about suicide rights from the department of state health services was in 2005. So we are looking at a system to work with the medical examiner's office to -- to try to get some real time data about suicides so that we can really address issues as they arise. We are creating an online resource tool kit. Which will include a speaker's bureau at our website so people, anybody who needs mental health information will be able to go to our website and get that. We also have an online calendar of mental health events and trains, things that deal with not just mental health but training activities. That's just a few examples. I would be happy to take any comments or questions?
>> just a couple of them, I will try to be as brief as possible. Once again I would like to thank you
>> [indiscernible] come up with to the public. Some time ago, a little bit ago, maybe two or three, maybe four years back, I can't exactly recall, there was money that was set aside because I know funding is of course very critical in any kind of program that you are trying to put your arms around, you need proper funding. There was federal dollars at that time available for -- for faith based initiatives and I know that you mentioned that when you were given your report, but the problem that -- that was revealed as far as acquiring some of these dollars was that it was very encompassing and very onerous to try to acquire these federal dollars because of the process itself. I would like to find out as far as those program dollars, those particular barriers have been -- have been moved whereby faith based initiatives can receive dallas are anyone that's trying to assist in this particular program, can you give me a status.
>> my perspective is those barriers have not been removed.
>> still there.
>> still there. I think applying for federal funds about in any avenue is difficult and cumbersome, but I don't believe that there's been much progress in that area.
>> religious institutions that I guess probably would like to participate in a lot of things. You have faith based initiatives, but then again getting the money to enact some of these things is a challenge. And I guess -- have there been any attempt to assist -- assist these particular faith based institutions that -- that -- that would lessen the impact of trying to acquire these federal dollars. Has there been an attempt to do that.
>> I think there's a lot of collaborative efforts in that regard. An issue, building brick by brick, which the monetary committee is a remember of. I think that's essential one of the goals -- certainly one of the goals, but moving the federal government is a difficult thing to do.
>> well, I just know there was significant money made available as far as funding to try to assist in such an endeavor as the -- before us but I guess the challenge still remains that there is additional dollars, I'm just wondering what we can do to maybe try to help remove some of those barriers.
>> thank you.
>> have we scored our performance to date.
>> we didn't do the mental health community score card as a real a, b, c, d, e, f. For the reason that we really wanted to look across the various parameters, to look at progress or look at lack of progress in particular areas. We didn't really give the community a gray, really looking at specific indicators.
>> > what's that score card supposed to do for us.
>> to look from year to year to see whether we are making progress in particular areas. For example, one of the indicators is employment, is our employment rate any better, getting worse, people with mental illness more or less employed as the years go by, to allow us as a monitoring committee to hypothesize about why they might be happening, either progress or lack thereof.
>> have we done that to date. One community score card so far. First community score card is included in this report it's for 2005ier updating is now for 2006 to look.
>> monitoring committee is supposed to do I guess what monitoring means. Is somebody taking the responsibility for taking the recommendations and trying to implement. I'm on a committee that I guess has taken several pieces of it, we have done a pretty good job on our pieces I think. But that would cover probably three or four of the 39 recommendations.
>> you will see in the appendix with this report. Developed action plans in each of the six focus areas. We have cross researched every one of the 39 criteria, in each one of those action plans. Some of the 39 identified by the task force were not really implementation items. We really tried to move this into more action items. You will see the action plans that each subcommittee is working on.
>> okay.
>> my final question is -- when the -- when the recommendations came forth, in my view they represented the best recommendations we had at that time. My -- my guess further is that -- that probably not all of them would be our recommendations today and that there would be some others added.
>> yes.
>> are we going through that process, also?
>> we are. That was one of the things that we made clear in the very beginning is that this is -- our action plans are really living items, that things change. As you have sign many things have -- as you have seen many things have changed since August of 2004. We really tried to move with the community in that regard.
>> okay.
>> questions, comments?
>> dr. Stone, could you just for our understanding take -- take one of the score card items and sort of walk us through it, how it works for you all, how you go back and compare 2006 to 2005.
>> look at the 50, 60 items in preparation for today, maybe we could have spent more time on this --
>> well, I appreciate your interest.
>> thought we would put you to work since we have you here in our meeting.
>> that's right.
>> if you look at the -- in page 57 of the report is the mentally healthy community score card. If you look at the overall employment rate, look at the national employment rate. How are we doing compared with the national employment rate. Better employed than the national in 2005. We look at the fitness index ranking, 23rd in the united states.
>> what does that mean the fitness index.
>> there is a national movement to look at overall health and fitness. This is not mental health, but this is physical health. But physical health and physical fitness is a key component to mental health. We are on really looking, making progress, falling behind in terms of -- of physical fitness. This --
>> we are 23rd as a county in the united states?
>> right. School attendance, when you go into the schools and youth area we looked at, you know, what is our truancy, what is it next year, changing, getting better, worse, what initiatives may be contributing to that. We looked at alternate education placements for serious and emotional disturbance, how many children are being placed in alternative placements and is that changing over time. So those are just a few examples of how it is that we will look and see if -- you know, if for example we're not making progress, if more children are put into alternative placements, what's going on with that? Why is that? We as a committee I think we have broad based expertise to really look at those issues, make, you know, policy recommendations about what might be happening to either make things better or worse.
>> is it possible, I guess I'm going to for up on that last -- to follow up on that last comment that I made to you earlier, that is the faith based initiative, unlocking of federal dollars to -- is there any way possible to -- to venture into that I guess if you have the local governmental entities to maybe look at ways to -- to alleviate or lessen those barriers yellow ribbon I think the more fund -- whereby I think the more funding you can get to serve the community, if that money is hard to get, maybe we could assist in that as far as unlocking those federal dollars, not you trying to do it yourself but have the local government to try to help unlock the vault of money that the federal government is sitting on is hard to get to as far as the process itself and the difficulty within the process of acquiring that grant money.
>> I think that would be an appropriate role for our committee because we do have the broad base.
>> exactly.
>> we have many faith based entities.
>> what I'm looking at, I'm looking at underserved. Possibilities of serving more persons that need the service. You brought up the suicide rate in higher -- in the urban, Travis County as being an urban county. The highest suicide rate in the county. That's alarming to me, I think it's alarming to persons that lose loved ones because of suicide. -- if there's a way to unlock that vault of money, if it's still available, how much can we get, how can we unlock that vault to get the necessary funds to assist in all of the services that -- that need funding, to bring these numbers to some -- some level. So I really don't -- I don't know if any of it is satisfactory, but to bring it to a level of better service.
>> one of the reasons we created a focus area for faith based activities, is the recommendation that many times people have mental health problems the first person they go to is their pastor, chapter, their priest. We are actually developing one of the planning activities. We are developing a curriculum for the faith based community for the pastors and chaplains and priests about how to recognize mental health issues, when to refer, when you have to be concerned about a particular individual. That's one of the activities that we are working on.
>> judge, I -- like I said, if there's anything that we can do to assist, I really hope we could as far as acquiring funding if it's still veil. Veil -- still available.
>> do you know
>> [indiscernible] status.
>> I can't speak specifically towards the faith based initiatives, but we do have resources dedicated in health and human services to look at funding opportunities across the spectrum. And one of the things that we have focused on in health and human services is looking at grants that are -- that are targeting units of government. So -- so those grants that it makes sense for the county to apply for, but not necessarily to grow programs for Travis County, per se, but the grantor is looking for a unit of government to be the fiscal agent, for example. Or the other thing is to look at grants and -- and proposals that -- that we might help with the grant writing expertise for a -- for a collaboration of agencies who -- who could benefit from bringing those funding dollars into the community. The other thing that I think that's important to note, though, and part of what we're trying to do in health and human services, is weigh the -- the amount of the grant funding versus the administrative costs of implementing it. We have talked about that issue for other projects that we have in health and human services and certainly we share those concerns that the court has when it comes to those kinds of challenges. So as these grant -- grant opportunities come forward, we do have staff in health and human services whose job it is to look at those proposals, identify whether that -- that grant proposal is a viable viable proposal, the cost benefit of bringing those dollars into the community and implementation and then the other barrier sometimes is the implementation strategy that's required. We may start on the front end with multiple, you know, hundreds of thousands of dollars to millions of dollars. But then the county's responsibilities once those dollars go away is something that we also feel that we have to measure and analyze. As we look at these grant proposals, we look at the potential partners. Those partners could be across the spectrum from the city of Austin to non-profit agencies and faith based organizations. So you do have resources in the social services arena to look at that. Of course planning and budget assists us with that, looking at match requirements and weighing those opportunities as they come forward.
>> is part of the monitoring responsibility the responsibility to evaluate.
>> we don't do specific evaluation. We really see ourselves as more of a collaborating entity. A coordinating entity, not really specific. We don't have evaluation expertise. We really have public policy expertise.
>> okay. Because -- because one or two of our recently adopted initiatives have been questioned. Publicly. And it sort of makes you wonder well has there been an independent he felt evaluation.is a program working. If you are in there every day it may be difficult to make that call. If you are standing on the outside looking at it and have expected results may be a bit easier, but when I look at -- we have adopted a lot of initiatives during the last two years and we have said we will challenge ourselves to make the call on success or failure. Better than we have historically. But it's much easier to say that than to do it.
>> one of the planning initiatives that we did undertake, we did this in conjunction with the Travis County mental health jail diversion committee is we submitted a joint application to be the beta testing site for a mental health jail diversion cost simulation tool. That's a mouthful. But it's a tool that's developed by human services research institute in boston. What it does is it looks at mental health jail diversion efforts, which I know are things that you guys have been very involved in, looks at the costs across the entire system of diverting people from the criminal justice system. Not just looking at costs to the jail and mental health system, but what about emergency rooms, ambulances, police department time. So what we were awarded that beta testing and they just presented the results to us on September 14th of this year. Basically what that shows, not really surprising, exactly what you are getting to, judge, you have to look over time that they don't show cost effectiveness in the beginning. That it's really two to three years out is when you start getting the cost effectiveness across systems. We are hoping that that tool will continue to help us as a community make decisions based on budgetary realities across the various systems. So we are pretty excited about that.
>> I'm sorry just -- that was the human resources research institute grant?
>> yes.
>> so it was they who reported the results on September 14th or was it this -- this -- this resource tool that was developed that was reporting the results is this.
>> the human resources -- hsri in conjunction with the tapa jail diversion center based in new york, they have collaboratively presented the results. What we did is we gave them data, took a three month sample of individuals with mental illness coming through the Travis County jail and gave them information about what services those people have use understand the past, what service needs they have, what are their functional levels, they use a model to then run the cost simulation of three different jail diversion programs.
>> reporter: we would have to see an executive summary -- we would like to see an executive summary of that.
>> I would be glad to get that to you.
>> my final question is as we get this data regarding suicide in our community, part of that I guess is trying to figure out the causes so we can prevent them. That's one of those stats that every time I hear it, I cringe. I really can't understand it. But we're not only leading the nation for adults but also for teens.
>> right.
>> the teen part is a frightening part because I understand that we are way ahead of second place community.
>> right.
>> that's really, you know, our committee is concerned because we don't really have good data. We don't really know what to look for because, you know, we know that suicides do happen in clusters at times. There will be strings of suicides in a particular school. But if you are looking at data that's three years old you are not going to be able to identify that process that may be happening to intervene quickly to avoid increases in numbers.
>> so I have always heard that seattle is the suicide capital of the milky way is not right.
>> [laughter]
>> I honestly don't know the suicide rate in seattle. The department of state health services looks at state of Texas in the -- then there's a national rate of suicide, but I don't know specific other cities.
>> because, I mean, weather, everything that I have heard, a think a lot of people would say what's the deal about seattle, I mean, and -- what you always hear is that the weather is gloomy or whatever and maybe that's an old wives tale. I bet you if you walked up to people in the street what do you think the suicide capital of the state --
>> people in seattle would point to Austin
>> [laughter] it really is amazing if we really are the capital.
>> dr. Stone thank you for sharing with us. Give our regards to the monitoring committee.
>> thank you very much.
>> excuse me, judge, may I close by asking dr. Stone to quote the website for the monitoring committee so that persons who might be interested in the full report could log on. And get that information
>> [multiple voices]
>> mmhtfmc.org. Which is why sherri wanted notice do it.
>> thank you.
>> all of our reports are on the website so that you have them.
>> all right. Good report. We will spend more time with it after today.
>> thank y'all.
>> thank you, sherri.
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Last Modified:
Wednesday, October 3, 2007, 18:30 AM