Travis County Commissioners Court
Tuesday, November 16, 2010,
Item 21
>> 21, consider and take appropriate action on legislative matters including a, a determination of legislative priorities for the 82nd Texas legislature from the list of policy positions previously adopted by the Commissioners court.
and b, a letter from the court to members and members elect regarding the impact of proposed health and human services budget cuts.
>> and I guess basically in that letter portion, it does mention as far as dealing with the sheriff, I’ve invited
>> [inaudible] and scott from the sheriff's department because what actually is happening if there is significant cuts in the health and human services for the state, then what is happened is that the example that we're looking at is dealing directly with the sheriff's department.
and what I was trying to research was to look at the persons that are incarcerated within our jail that have mental challenges.
and, of course, the numbers are staggering, and because it's not only the change that we have to provide to the mental challenge that will incarcerated, the medical, the psychological type of situation that we have to deal with and according to summers and mr. Smith, that's only 50% of the jail population is actually being served that has mental challenges so they can't even get to everybody.
so right now that is about -- and I asked p.b.o.
to look into this also and I have some figures from them, and basically right now that's running from the general fund, that's about $21 million to cover this type of care for mental challenge incarcerated in jail.
and, of course, if the state of Texas looks at in cutting, again, mental health situations and, of course, it's going to get -- the numbers are going to be staggering because of the situation that exists now.
so I was basically asks mr. Summers and mr. Smith, who is with the sheriff's department, to come in and maybe give us a big picture of how significant this is in cuts are made where funding may be needed to help us out in this situation.
as far as the incarceration of the person there and then -- and the continued need to -- to facilitate the mentally challenged in our jail currently.
could you maybe -- somebody help me on that?
>> sure.
currently in the jail we have about 599, that's just a snapshot today, 599 persons --
>> could you identify yourself?
>> mike summers.
inmate treatment services.
>> thank you.
>> we have 599 inmates currently right now in custody who have a -- a mentally ill diagnosis.
we tend to get in about three to five individuals per day.
it comes out to around 90 to 150 individuals per month that are coming in new.
right now we have about -- require approximately 1,000 appointments with a psychiatrist or a psychiatric nurse practitioner each month, but about 250 per week, and we are currently able to service approximately 100 to 110 of those per week.
part of that has to do with recent changes.
effective September 1st of this year we had a part-time psychiatrist resign and we had been unable to fill that.
on September 30th, the contract physician who had been with us five or six years also left the -- left the service of the sheriff's office.
on October 31st, our psychiatric nurse practitioner resigned, retired, primarily to take another position with integral care which paid her approximately $40,000 more per year.
so right now we're trying to catch up, and one of the things that we're discovering is that there just isn't enough money to purchase psychiatry time in the budget.
>> so do you anticipate a growth in incarceration since -- let me understand this.
is the jail providing incarceration of mental challenge inmates -- could you tell me the overall, I guess, capacity as far as what we're doing there, as far as comparing it with somebody -- somebody else in the county that may be face -- or another county that may be facing the same situation in comparison.
where do we rank?
are we pretty large as far as volume, as far as taking care of the mentally ill?
>> we are.
we're right up there.
harris county, of course, has a higher average daily population than we do.
at the current time, they employ 12 psychiatrists.
to treat their population.
the majority of their -- their mental health authority is their local mhmr. Dallas, Travis County -- or tarrant county, those are all fairly large jails.
and el paso county are probably the largest jails including Travis County in the system.
>> right.
>> we have about 25 percent of our average daily population, our psychiatric inmates who have an identified psychiatric illness.
that is a little bit high as compared to other jails across the country, not just in Texas.
it's been on the increase from anywhere from 18 to 24% over the past number of years.
just an increasing number of -- that this particular population in the community who tend to get arrested more frequently.
particularly when, you know, if there is a protocol of local law enforcement that you identify and arrest offenders who have been previously convicted or arrested for various types of crimes, which is the case in Travis County and particularly Austin, that last year we had about 62,000 inmates admitted through central booking.
approximately 42,000 of those folks were repeat offenders.
>> would you speculate on the effects of being topped out on our bed allotment at the Austin state hospital as having an effect on that?
>> absolutely.
there currently is no place, police officer, law enforcement, when they arrest somebody or identify somebody who is in the community who obviously is mentally ill, they have a couple of choices that they can -- at that particular time.
they can take them to Austin state hospital where the beds are always -- almost always full, or they can take them to an emergency room.
and what happens when they take them to emergency room, a peace officer emergency commitment, the majority of the time they are released from that emergency room within a very short period of time because it's -- the e.r.
physician in the emergency room will determine this person, they will ask them, you know, is this person immediate danger to self other others.
well, the person says no, I’m not, so they will be released back to the communityment and frequently law enforcement to simply have this person off the streets and in a protected place will bring them to jail, and that's how they tend to get into our facilities.
a number of these folks, right now we have 66 inmates that are in other -- out to other hospitals, state hospitals for competency restoration.
we have 48 that are currently waiting that is in our custody to go to other state facilities.
and the average wait time for a bed at ash is about four and a half months.
so a person arrested on a relatively mild charge, class c misdemeanor, class b misdemeanor, something without any violence, many times what happens before they ever get to the state hospital, their maximum time for that particular event is up.
so they come back to us and are frequently released directly from the jail.
we're primaryly holding people for mental illness treatment.
>> and so it appears that the population continues to grow in this particular regard as far as the ones that we have in our custody for -- and also have mental challenges.
>> right.
>> and judge, the reason why I asked these gentlemen to come down was basically -- I’m sorry, did you want to say something?
go ahead.
>> well, I guess I wanted to make sure since deece was not here, the igr's office and health and human services has been working together to look at the impact of the health and human services proposed cuts, and just in line with the discussion you were having, amidst those cuts is a cut to state hospitals.
and so the direct impact, I think, you know, most of our partners are hesitant to throw out a number, but the impact could be somewhere around 260 beds across the state.
and, of course, Austin state hospital would then take its proportionate share of that cut.
so there's no question that the cuts being proposed at the state level will have a phenominal impact on us at the local level and we've attempted to analyze that to the best that we can with the information that we have today.
you all may have already seen on your email an article calling for the departments to look at two to three percent cuts before the end of this budget or this second year of the biennium, and that, of course, is not represented in our analysis of these cuts.
>> now, the 2% in aggregate would make the total amount of cuts that are being requested in the eligible divisions to be 12 to 15%.
>> yes.
>> and that 2 to 3% puts corrections back on the chopping black where they were exempt from the original call for across the board cuts and now corrections is being pulled back in as eligible for those across the board cuts.
>> yes.
so I will not speak for deece, but one of the reasons he's not here, he's meeting with one of the members of the delegation and providing the information provided by health and human services, but it's important to note that's a snapshot in time.
as we continue to receive information about requesting decisions at the state level, that information will continue to shift.
two things, first is that the administrative cuts, while they are much harder to quantify translate into longer lines and calls not being answered and services not being rendered, and your system, as I remind you quite frequently, is driven a lot by other systems failing.
so when people are in crisis when they can't get food stamps or can't receive state funded services, you are the payer of last resort.
so I remind you of that not because it's good news but because that is the macro level impact is in a your systems will be further taxed when those systems don't perform as they should.
>> I had p.b.o.
to, of course, run some numbers for me, planning and budget office, because I wanted the make sure what we're funding currently out of the general fund to take -- to off set the expense of the incarceration of mentally challenged that are in jails now.
of course, it's 25% of the population, general population, 2400 inmates.
so round about 600 is what we are dealing with their.
and I guess my concern right now, I really do not know exactly how much of the -- how many billions of dollars that the shortfall is at the state level.
some are saying 25, I’ve heard 15, I’ve heard 21 billion, so I really don't know what the exact number is.
but whatever that number is, it appears that there will be maybe some cuts that will come from the state level and it will also impact local governments, and, of course, that particular money that's being funded right now, the $21 million that I spoke of earlier to fund the mental challenge that we have incarcerated in our county facility, jail facility, that's just a piece of what I think is going to come down the pipeline, and, of course, that is paid out of our general fund revenue which basically, of course, we're operating on the basis of property taxes.
so it may be an indirect unfunded mandate that we have to look at and there's going to be serious challenges that we'll all have to address in the county across the board.
thank you.
>> I just wanted to bring this up.
of the eight priorities, the major change in what has been presented previously in this agenda is that the priority list has been expanded to eight to pull out some of those defensive items that we really need to be on the front burner in this legislative session.
but with regard to the issues that you raise, Commissioner, I believe that priorities, and these, of course, are not in any kind of order, priorities 1, 3 and 4 all address that.
1, unfunded mandates, 3, cutting of social services, whether mental health or not, but health and human services, and 4 is specifically what he were addressing, support legislation that would provide fund irrelevant and infrastructure to improve mental and physical care.
those are three items that speak directly to your concern, I believe.
>> yes, they do.
>> any comments?
>> I’m just here to answer any questions.
one thing I would mention about the $21 million number that mr. Davis --
>> billion, isn't it?
>> no.
no, 21 million.
>> as far as the state, 25 billion.
>> [multiple voices]
>> I’ve heard two different numbers.
>> $21 million in the sheriff's office that we believe is likely spent on providing services for those with mental health designation.
we were contacted yesterday and coincidentally we met with the sheriff's office and found out the number is about 25% of average daily population.
I did quick calculations and applied that 25% to corrections budget, to inmate medical services, to central booking and inmate services and then applied 100% to the crisis and intervention team.
that's how I came up with the $21 million.
>> so it's a conservative number?
>> I think it is.
>> very conservative.
>> has your personnel department been working with human resources to try to do a market analysis of what psychiatric professionals are paid?
>> that was one of the things that at our meeting yesterday and human resources is working with Travis County human resources to make that happen.
and I think the plan was to brief you all -- I know major was planning on briefing you to get you to goose that up a little bit.
>> mhmr is also struggling with maintaining psychiatric expertise and I mean it's anectdotal, but I also understand that the ability to access mental health professional services even in the private community for people who can pay are having a difficult time finding psychiatric services.
>> it's tough.
>> what we need is a market analysis.
I mean, we have been having to bump the pay of medical professionals periodically for the last 20 years.
that's from nurses to nurses aides as well as any corrections.
>> can you tell me, you lost me on the 21 million.
>> sure.
okay.
what I did was -- hi to make some broad assumptions yesterday.
>> I understood your assumptions, but is the impact --
>> no, if we look at the sheriff's budget, $129 million, what portion for dollar amount of that budget is likely spent on inmates with mental health designation or outreach in the community to serve those with mental health issues.
21 million is roughly 16% of the sheriff's overall budget.
>> okay.
got you.
>> another big item is pharmaceuticals.
and pharmaceuticals are just a huge expense.
>> did that number include the pharmaceuticals?
>> it did.
again, keep in mind it's a rough number.
I just blankly applied the 25%.
it's likely those with mental health issues probably spend a lot more than 25% of the pharmaceutical budget.
>> so it's base -- your calculation is based on a per capita --
>> it's just based on the population.
I didn't include law enforcement.
likely some of law enforcement's time is applied to, you know, serving that particular population.
it's likely our department's administration is also applied to that, but I tried to pick a fair number that was conservative that -- could at least be a starting point that we could put our arms around saying this is what it means to the sheriff's office in Travis County.
>> the medication portion of that, make sure we get -- capture the full flavor of this example.
>> and that doesn't include the juvenile or does it?
>> does not.
>> so it's a very conservative number.
>> this population I would -- higher need and more attention than likely the other 75%.
on average.
>> as a part of those -- those juveniles that are in the facilities now, there's an increasing number of those individuals and the cut backs are going to affect them greatly once they become adults.
even as juveniles it's going to impact on them and they are going to be in our system as adults.
>> no doubt.
and pharmaceutical, and we talked about pharmaceutical, that's been I guess an increased driver on the juvenile probation side for their budget.
it's something we've had to increase over the last couple of years just to deal with those issues on the juvenile side.
>> and that's also included in the agenda with regard to -- specifically with regard to juveniles as well because we're well aware our per capita costs on juvenile mental health care is higher than the general population, but also we're aware the per capita -- is actually lower and more effective.
>> do you track in all the veterans within the mental health category?
like the post-traumatic stress syndrome and is that increasing?
>> david smith with the sheriff's office, and one of the things we've been doing --
>> can you just pull that mic around?
>> one of the things we've been doing with the constables is doing a study on the number of veterans coming into central booking and tracking that.
we should have results of the second study coming out in the next few months.
one of the things we do is when an inmate comes into the jail, if they are receiving treatment, we set them up with the v.a.
and we have a v.a.
representative come in the jail and meet with them and we have a representative from the v.a.
who gets in contact with them and sets them up with services.
>> but that is a self-report.
we don't have any access to v.a.
records in order to determine if any of our population is currently accessing or is eligible to access.
>> that is correct.
>> anything further?
>> no.
>> move approval of a and b.
discussion?
all in favor?
that passes by unanimous vote with Commissioner Gomez off the diaz.
The Closed Caption log for this Commissioners Court agenda item is provided by Travis County Internet Services. Since this file is derived from the Closed Captions created during live cablecasts, there are occasional spelling and grammatical errors. This Closed Caption log is not an official record the Commissioners Court Meeting and cannot be relied on for official purposes. For official records please contact the County Clerk at (512) 854-4722.
Last Modified:
Tuesday, November 16, 2010 3:20 PM
