Travis County Commissioners Court
Tuesday, May 24, 2011 (Agenda)
Item 11
>> number 11.
11.
consider and take appropriate action on cost benefit analysis prepared for the mental health public defender office and recommendation to continue funding the program through the general fund.
>> good afternoon.
>> good afternoon.
we're going to load up a little powerpoint, while we're doing that, I'm roger jeffreys county executive for justice and public safety.
>> jeanette
>> [indiscernible] director of Travis County mental health public defender.
>>
>> [indiscernible] case management coordinator with the Travis County mental health public defenders office.
>> we're here today to present to you the results of the cost benefit analysis for the mental health public defender office.
we also, the fella that took the lead, our new planning manager in justice and public safety unfortunately just got ill.
so he had to run off.
but he took the lead on this and we're excited to present the results to you.
also if you don't mind I want to introduce jim from the Texas task force on indigent defense and carol connor also that came to support us today.
so thank y'all.
>> welcome to both of you.
>> in fact if you have anything to say, jim, you're welcome to come on up.
>>
>> [indiscernible]
>> okay.
>> do you want to come up and join us.
>> thank you.
>> so the mental health public defender office was established in 2007.
so it's been gosh over four years now.
the first stand alone mental health public defender office we think in the nation.
the Travis County has always been proactive in initiatives like this.
particularly when it's dealing with this particular population.
I don't know but I think at about the same time they created the mental health docket, is that true?
and mental health wheel for the private attorneys to address a very difficult situation that we have here.
through the generous funding we received $1.25 million in grant funds over the life of the office.
in fy '11, though, it was a graduated grant so the county has funded 80% so far.
the grant actually ends at the end of this month.
what we're coming here to do for you today is to remember the results of our analysis and to recommend that you continue funding this fiscal year and beyond.
the annual budget is $625,000.
which pays for two specialized attorneys, four social workers and case managers and two administrative support staff.
since inception of the program, heave taken on 1,236 legal cases, and taken on 1,762 case management referrals, which they get from both the legal cases that jeanette and her staff handles as well as the mental health wheel attorneys and I think that you even get some felony level referrals as well.
the program was established with four goals in mind.
one is to again to address a very difficult population.
to minimize the number of days a person with mental illness spends in the county jail.
the criminal justice system is often a system of last resort for these folks, another objective was to increase the number of dismissals among this population.
also by providing the case management, our aim was to reduce recidivism.
what else we have done is terrific, enhanced legal representation for these folks by providing attorneys throughout our community with specialized knowledge needed to defend persons with mental illness.
>> good afternoon, judge, Commissioners,
>> [indiscernible], criminal justice planning.
we also looked at each of the goals of the program that roger just mentioned.
are broken down in the next few slides.
as far as their program accomplishments.
the first that we looked at was time in jail.
what we did was took all of their legal clients, looked at them against or went in and grabbed their booking numbers and ran them for actually started out with the history of their frequency of visits to the jail since the jail started keeping the records.
we culled it down so that we were looking at a period preimage pdo and a period following.
in looking at those 735 clients for legal, what we found is that once for the legal appointments after mhpdo starting working with them, booking decreased 35% or 2,118 fewer bookings and bed days decreased by 13,112 jail bed days fewer.
for the social referrals, this is going to be specifically just the case management piece where the case managers are working with wheel attorneys, whether they're felony or misdemeanor.
booking decreased by 57% or 2,020 fewer and jail bed days by 20%.
or 14,184.
on average, since fiscal year '10, we looked at just
>> [indiscernible] so mhpdo handles comp department and incompetent clients.
for comparison purposes, it's difficult to get into the incompetent piece to compare the mhpdo clients to a cohort in the jail because we can't come by that data electronically through the jail.
so we looked at a --
>> repeat that, couldn't come by what?
the jail?
repeat that.
>> incompetent clients, sir.
clients who are not competent to stand trial at that time.
there was no way for us to really get to that information and pull it out, outside of the mhpdo clients.
we had access to that, but with the medical stuff the way it's set up, it wouldn't be easy to get to.
for the average length of stay information that we're going to go through, we just evaluated competent clients.
>> as far as getting to the -- the competency hearing clients, because that would be a good cohort to compare against, is it a hipaa issue or is it a -- or is it a deficiency in our data system?
or both?
>> a little of both.
>> yeah.
>> a little of both, I think.
>> but these are competent mental health clients?
>> the clients that we're going to evaluate or that we're looking at here in this slide are competent.
so --
>> they are not mental health clients at all.
>> no, no, they are mental health.
they do have a mental health diagnose, but don't meet the
>> [indiscernible] standard that's correct got it.
>> okay.
of that segment of the population, we looked at that segment of the population against a segment of the population in the jail that's coded as just a psychiatric clients.
the jail has three tiers of psychiatric clients, psychiatric special needs which is an indicator to go to the wheel.
priority population and then just psychiatric population.
so just that psych population was what we compared to.
we found that the mhpdo competent clients on class a misdemeanors their average lent of stay was 15% on class a misdemeanors than the psychiatric population in the jail.
and 14% less with class b's.
>> what does priority mean now?
>> priority population and valerie or jeanette might could explain that a little better, it's really for primary diagnoses, though.
>> access one priority population.
someone with bipolar, schizophrenia, schizophrenic effective or major depression, that's what we were originally funded for.
>> it occurs to me that we should probably back up, just because someone has an access 1 diagnosis from mhmr does not mean that they are incover --incompetent to stand trial.
a lot of people misunderstand if somebody has a severe, psychological illness, that doesn't necessarily mean that they incompetent to stand trial, particularly with people who are bipolar but they can't meet the mcnaughton standard.
you have to be both bipolar and mentally retarded in my opinion to meet the mcnaughton standard.
>> we were able to look at mental health public defender and comp department clients for legal clients.
again records that they keep.
a few years ago they were able to start tracking the new sheriff system online where they can, while the clients is in jail, they can get a booking number and date.
if they -- if the client happens to not be in jail, they have a hard time in coming to that information and that's a system issue.
here in the last couple of years, they have been able to start tracking this information and between fiscal year '10 and fiscal year '11 the average length of time for in jail for incompetent clients was reduced by 28.6 days.
so for the incompetent clients, that's usually a segment of the population that we see stay for a very, very long time.
at one point, a wait for competency, a bed in the state hospital for competency evaluation was up to about 3 to 4 months.
>> 28.6 jail bed day reduction, that's in county jail?
>> correct, yes, sir.
that's in their average length of stay.
>> okay.
>> any other questions on those slides?
>> I guess that's a good stat.
>> yes, sir, that's great.
one of the things, and either jeanette or valerie might could speak to this to as to why they think that number has gone down as significantly as it has.
one of the things that we came to was that the case managers evaluate the incompetent clients pretty regularly in jail.
so they are able to through their specialized training and knowledge and constant assessment determine if they think maybe that this client has now become competent through medications in the jail through forced medications which is a new process that's been started in the last year or two years.
at which point they cans for the forensic psychiatrist to come out pretty quickly.
then if they ever gain competency they go ahead and get their case handled instead of having a lengthy stay in jail waiting for competency evaluation.
>> can you tell me the -- I guess the wrap around expense of cost on an individual, on a daily basis, they have 28.6 days.
as far as -- as far as retention.
currently as far as the reduction in days.
what I'm trying to get at is the overall cost whether it be medication or, you know, for the pharmaceutical or for the person being incarcerated and of course some of these, the shortage of -- of -- that we have as far as beds of the facilities that would look into this.
could you give me actually the wrap around costing that it would cost us to have these persons retain themselves, incarceration within Travis County jail.
I'm just saying all of the -- all of the services that have been rendered, including pharmaceutical, medical and all of those things.
could you probably have a -- have a per cost per day.
>> Commissioner, this is actually probably a good time to talk about the second part of this evaluation.
the first part we evaluated the goals that were set out under the grant.
we're going to have a follow-up that comes to you and talks about the financial impact.
but a preliminary look --
>> I don't mean to get ahead of you.
but I'm wrestling with that because I do see the amount of money that we're looking at money that was maybe available before may not be available now, it is a good program.
but at the end of the day I want to make sure there's substantial enough money.
I may be ahead down the road, but that's just the way I think.
in wrestling with that, I still would like to isolate on that.
I would like you to be thinking about that as we go through this process.
it's very significant in a lot of things that we're discussing here today.
>> some of our research on that very subject, I think it's the Texas public policy institute, has put the range of cost of incarceration from 30 to $50 million in Texas for a year.
when we go revisit that, we're going to try to determine what that is here in Travis County.
but that's the range which I think is considerably more than a non-mental health in
>> okay.
go ahead, I'm just -- just thinking ahead.
>> moving on, another mental health defender accomplishment accomplishment that we look add, also a program goal was dismissal rates.
cumulative dismissal rates between the fiscal year '09 and 2011, 42% of legal cases were closed as dismissals.
that's pretty significant from a legal perspective that's certainly a desirable outcome from legal representation perspective.
also it may impact their access to benefits, that's really important to this segment of the population.
so the dismissal rate being as high as it is is certainly preferable.
in comparing to -- to fiscal years '09 and 2010 from the state website, criminal court administration, annually submits what the dismissal rate is for other misdemeanor cases, for all other misdemeanor cases or all misdemeanor cases in Travis County, that percentage was 35%.
dismissal rate was 35% as compared to the 42% dismissal rate with the mental health public defender office.
one of the last piece I will bore you all with today as far as data is concerned is recidivism and jail bed day savings.
this is where we look at that preand post mhpd involvement.
39% of the mental health public defender legal referral clients have not been rearrested in one to five years.
there was a reduction of over 13,000 jail bed days consumed by mental health public defender clients.
that equates to roughly 7 inmates per day in your average population.
on the social several side, 21% have not been rearrested in one to five years.
a reduction of over 14,000 jail bed days consumed and that equates to about eight inmates fewer per day in our average daily jail population.
one of the things that we also looked at was of those clients evaluated, we looked at, I wanted to look at the average number of days since the client was last released.
how long since they've last been released from the jail into our communities and for this piece we took from that 735 clients who were moved, those that might have felony as their lost offense to ensure that they hadn't been in the penitentiary, the average number of days since last release on legal clients was -- is 568 days.
and the average number of days since the last release on social referral clients was -- was 362.
I didn't write it down.
I think it was 362.
which were also pretty strong points.
>> so in addition to the savings in jail bed days, again as we mentioned at the beginning, this is we think it's one of the first stand alone mental health public defender offices in the country.
so it's very unique.
it's served as a terrific change agent in our community in that the education that you all do for your colleagues has resulted in a greater understanding of what these issues are and how to address some of them.
also the -- it's been innovative in the way that they've done hands on forensic case management in the community.
it's unique.
so our conclusions and I'll go through these pretty quick.
but as a result of the analysis the conclusions are that the mental health public defender did achieve most of the goals that were set out in the grant.
marked improvements in recidivism rates with this population.
you talk about the net savings, the -- the savings of jail bed days that large automatically your headings to well what does that mean, how does that translate into dollars.
we will do a follow-up to try to determine what that cost is.
that's part of the work that we're doing by the way with the urban institute.
remember when we came to you with the sobriety center and put the brakes on that because we weren't able to tell you definitively what we thought it would save.
they are helping us determine a correct methodology for valuing jail bed days and what kind of savings, really it's cost avoidance that you are seeing that's real, we'll be coming to you with that.
there is a small group and that's not unusual for this population.
there have been many successes but there's a small group of about 10% that we are not seeing improvements in.
but I don't know that that's all that surprising given the population that you are dealing with.
over time, the mental health public defender office has been as we mentioned earlier, been able to take on more of those incompetent cases that are so difficult.
>> do we know, have you ever been able to capture any information as far as your data retrieval is concerned on -- on veterans that -- that come into our custody and of course they may have mental challenges, have there been any break down of our veterans that -- that have served us?
have we looked at that, also?
>> yes, sir, we capture veterans within our data.
apartment jail also captures how many veterans we're treating.
despite my remarks earlier that I'm funded only for priority 1, access 1 priority population, I have several -- I have one veteran right now, he's -- he's 100% disabled marine, he did two tours in afghanistan, two in iraq, he has ptsd and substance abuse issues.
and the judge asked us to take his indication even though he didn't -- his case even though he didn't fit in this little grid we were originally funded for.
>> we can get you that number if you are interested in knowing how many veterans --
>> that would be good to know.
thank you.
>> is there a strategy for the 10%?
so far it has been difficult to change?
>> perhaps on a case-by-case basis.
when we talk about the 10%, one individual comes to mind that is a chronic 911 caller and I think in any community a small percentage of your population is going to make a high percentage of those calls.
I've met twice with mental health officers from the Austin police department to try to figure out what to do in this situation.
this person is on benefits.
is always incompetent and he lives in a board and care here in Austin.
and he calls 911 way too much.
he's one that comes to mind, we have tried several different approaches with him.
visiting him more.
trying to track where does he call?
does he call near the end of the month when his benefits are running out?
somewhat truth to that.
so in that case, we're exploring it and I don't know an answer to it.
>> okay.
>> the Austin police department wishes that I would find an answer.
>> but he's calling 911 when in fact he doesn't have an emergency.
>> correct.
>> so when they get there, there's nothing they can do for him except ask him not to call again?
>> some evenings he'll call 30, 40 times, they'll go pick him up because they're tired of him coming through the 911 system.
but they have to respond.
>> which in itself is a criminal offense.
>> right.
right.
>> one challenge was that we didn't have sufficient single occupancy residences for single individuals with mental health issues where we could provide case management to make sure they took their medication and I guess receive some assistance with handling their funds.
meager funds.
and as a community, though, we really have committed to do better and I guess those beds slowly but surely are being added to the inventory.
>> well, housing is a little a challenge in Austin -- is always a challenge in Austin, I think the housing we did out near del valle was very helpful.
>> I can tell you there's a coordinated effort between the city, county, medical community and health care district to try to bring online additional what they're calling permanent supportive houses for folks in the criminal justice system, it's a difficult population to house and treat.
I think it's in the talking stage, there's been a resolution by the city council.
I know a number of us have been asked to be a committee to look at ways to funds that.
that could be an answer.
also we will be getting to this in just a minute.
you all have given us in the past emergency transitional housing money for folks coming out of ctc in the last year we've expands that to the homeless clients that janet and her folks serve and that is at least a place for them to go while their case is being adjudicated and for what case managers can help them find some sort of housing.
so we will talk about that briefly.
but that's the other option from the housing perspective that we have.
>> well, we at Travis County feel pretty good apparently and our conclusions say so.
what is our state grantor say?
>> thank you for having me here today.
the expectations for this program when it was originally funded back in 2006 actually 2006, the expectations were high.
this program has well exceeded our expectations.
it's not only having a positive impact here in Travis County, but it's having a positive impact around the state of Texas because as roger noted and jeanette noted, it is the first of its kind, not only in Texas, but in the nation and when this office was formed, there wasn't this type of resource previously.
other jurisdictions from around the state have looked at Travis County and I know janet has shared the resources that she has to work with, fort bend has modeled a program after Travis County.
I think bexar county has looked at the program.
lubbock county.
so counties from around the state have -- have learned from what you all have done and it was a risk when you undertook this and I remember Travis County and I'm a resident of Travis County, Commissioner Huber you are my Commissioner, this was not a decision you made easily.
and there was probably a year or two years worth of planning and there was a number of defense community were actually outright opposed to this and they are thinking we've got a great system.
why is the state here medaling with a good -- meddling with a good system.
by golly when the senator passed this legislation in 2001 Travis County was the model.
well, you have a good system but what you did is you took the system better.
with what roger and his team are doing, when they shared a copy of the report, they told me that I could not distribute until they presented to you all.
this is excellent.
because ultimate my my board what they did is saved us a lot of effort because they wanted data to drive their decision making just like you want data to drive your decision making.
I'm really looking forward to the cost report because the services that jeanette and her team provide are not discretionary, they are mandatory, the services need to be provided in one way or another.
the vehicle that you all chose was a public defender office, then whoever hired jeanette made a very good decision, she's made good decisions with her people.
if you get a chief defender who is not good, just like with any type of department, it's for the going to be successful -- it's not going to be successful.
so they met and exceeded our expectations.
my full board meets on June 8th, which the chief justice serves on, we are two providing senators, county representativesment I'm going to be released to report on the closeout of this grant and this type of collaboration is what makes my job very enjoyable.
>> this is not the time for roger, jeanette and Commissioner Huber to ask for another $1.2 million.
>> [laughter]
>> you can always ask.
unfortunately, we're right now waiting, as a matter of fact our major bill is possible being heard in the senate right now and we're still a little bit in flux on budget.
but it's not going to be as dire as we were anticipating early on.
>> good news.
>> well, I understood emergency mental health particularly in the criminal justice realm is not seeing the cuts that -- that -- ongoing mental health services in the health and human services realm is -- we're not seeing the cut, I'm afraid the demand is going to go up because of the lack of services before someone gets to the criminal stage.
>> that's right.
>> I agree 100%, Commissioner.
>> speaking of ask, mr. Jeffreys?
>> well, sir, we're asking again the grant runs out on Monday and we're asking that you continue funding after the rest of this fiscal year into fq 2012.
we are -- fy '12.
we are recommend thank we continue the cost -- recommend continuing the cost benefit analysis, including the -- we are asking for about $40,000 in additional emergency transitional housing for this population and finally we recommend that we continue working closely with the larger community to address this issue.
but the big ask is to continue funding for this fiscal year.
>> ms. Peterson, I see you here.
there is a budget for that?
the rest of this -- of this fiscal year means between I guess today or Monday and through the end of September?
>> yes, sir.
>> right.
>> [indiscernible] planning and budget.
for the rest of fiscal '11, it's the recommendation to use salary savings to grant line item.
for any reason that is not adequate for the rest of the year, there is an allocated reserve earmark to continue this program until the end of the fiscal year for fy 2012, the entire amount is in their target.
there's some corrections we need to make, but otherwise the office should be fully funded through '12.
in addition there is also a budget request for an additional $40,000 for transitional housing, but we should have a recommendation for that in the preliminary budget.
>> so that will be for next year?
>> right.
>> next fiscal year.
>> right.
>> Commissioner Eckhardt?
>> the 40,000 is above the 625,000.
>> that is correct.
>> we will have the refined cost benefit analysis for the budget?
>> yeah.
after the budget, sure.
>> the -- probably the first part either late August or first part of September.
>> okay.
we can do that.
>> Commissioner Davis?
>> yes, thank you, judge.
I'm really pleased to be a part of this dynamic team that made some very serious strides and steps into a very serious problems that we've had in this community and of course this investment that hopefully the court will approve is just something that I think we need to continue to do because without this program what would the costs be?
if we don't do anything, what would the costs be as far as adding the mentally challenged persons in this community and also having the public defender program set up.
to address these concerns, again, I think overall we come out as a winner in this particular effort and I like to applaud your team in what you do, maybe hopefully next time around we can get some future state grant money that may come up in the late -- in the future.
but we're keeping our fingers crossed on that, but in the meantime what do we do?
I think it's appropriate to move forward with this particular recommendation that we have come up with because I think the wheel is in motion.
we are not going to miss a beat as far as taking care of the citizens of Travis County.
I hope the other persons in the state of Texas are witnessing this and seeing what else they can do to assist across the entire state of Texas with such a critical issue as this one.
thank you.
>> we have before us four recommendations, really one of them is a 2012 budget issue.
so work with p.b.o.
have that brought to us at the appropriate time.
the other one really is funding for the rest of this fiscal year, I understand Commissioner Davis' point right there was for us to fund that through the general fund beginning with salary savings and we take from the allocated reserve any amount necessary to supplement it to get us through the end of the fiscal year.
so I second that part of his motion.
>> thank you.
>> any discussion of that?
all in favor?
that passes by unanimous vote.
the other two bullets I think are key, one is to complete the cost benefit analysis, the other one really is to keep working with community partners to -- to beef up what we're doing in this area.
that's your last bullet there basically, right?
>> yes, sir.
>> the other thing is to the extent that we can keep improving services provided to -- to our mental health residents in an efficient, cost effective way by working with the Travis County health care district and mhmr, city of Austin and other partners, then we should do so.
as well as the state of Texas.
>> yeah.
>> and that is picked up in your fourth bullet.
>> yes, sir.
>> do we have those four bullets, ms. Porter, you and your colleague?
may I give you the county judge's backup.
precious backup.
that second one is a little bit more general, I move approval of that, too.
>> second.
>> seconded by Commissioner Davis.
discussion?
all in favor?
that passes by unanimous vote.
see how easy these motions are here.
they are not that easy at the state, are they?
>> same as the capitol.
>> [laughter]
>> thanks for visiting with us, y'all.
we appreciate it.
>> thank you very much.
>> county folk, keep on keeping on.
>> doing a great job.
>> good job.
>> great.
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