Bexar County Mental Health Department Behavioral Healthcare from

Bexar County Mental Health Department Behavioral Healthcare from a Community Perspective

Mental Health Department Mission: Improve, coordinate, and increase mental health services. Vision: Transform Bexar County to a National model of a mentally healthy community. Initial Priorities: • Identify gaps • Increase capacity • Identify best use of County dollars Who we are: • Gilbert Gonzales ; Director Mental Health Dept. • Velma Muniz MA, LPC-S ; Department Program Coordinator • Melissa Lucio; Senior Program Analyst

Focus • Improve services for Bexar County citizens- build capacity • Improve mental health screening and access • Establish systematic approach to continuously assess mental health needs • Reduce stigma of mental illness • Strengthen the public safety net through an expanded mental health system of care • Receive community feedback from citizens and stakeholders • Address and support the mental health legislative agenda

What we are doing Dedicated Mental Health Department within Judicial Services • • Strengthen Mental Health • • System • Implement proven cost effective strategies • Identify gaps • Increase capacity • Integrate services Educate and inform Community Creation of a comprehensive Bexar County Resource Directory for Community Use Mental Health Consortium Build responsive system of care Identify community priorities Build model Mental Health System of care Address gaps in service Improve coordination of care Address stigma Smart Justice Central Magistration • 100% screening • Law Enforcement screening questions • Pretrial, clinical and Public Defenders integration • Clinical assessments/treatment plans • Direct access to treatment with approval • Independent Public Defender • Facilities Renovation Criminal Justice Coordinating Council • Joint City/County Coordinating council led by Mayor and County Judge • Review criminal justice issues • Receive progress reports • Identify priorities

Successes, Challenges & Opportunities Successes • Initial screening by Law Enforcement – implemented July 2015 • Improved Pre-trial screening process o Onsite Pre-trial and Mental Health coordination o Licensed Clinical Assessors seven days a week o Access to State MH Database and o Use of Best Practice Brief Jail MH Screen • Direct treatment access for justice involved – OUTCOMES: reduced Recidivism • Promoting Integrated Mental Health as integral part of Judicial Services • Supported Proven Programs o Crisis Intervention Training (CIT) o Children's CIT o Treatment alternatives o Residential treatment options • Providing Ongoing Mental Health Attorney Training

Successes, Challenges & Opportunities (cont. ) Opportunities • • Strengthen Mental Health System Implement proven cost effective strategies Identify gaps Increase capacity o Local Community Services o o State - Texas Council on Offenders with Mental and Medical Impairments Federal § § § Haven for Hope Homeless Campus Crosspoint Programs SA Behavioral Health, et al Strengthen continuity of care, Divert to treatment versus incarceration Identify best use of County resources; Inform and educate Stakeholders Integrate Behavioral Health, Criminal Justice, and Health

Successes, Challenges & Opportunities (cont. ) Challenges • • Chronicity of Illness Access to treatment resources Criminal Justice System forced to fill the gap Criminalization of non-violent persons with mental illness Poor screening for mental illness at pre-booking stage High recidivism rates for persons with mental illness Stretched Capacity Increasing Cost

Bexar County Smart Justice Initiative Sequential Intercept 2 • • Initial Detention Expanding Mental Health assessments, early identification 100 % Screening Four Mental Health Questions asked by all law enforcement Suicide Screening and Assessment Sequential Intercept 2 • • Counsel of State Governments: Dr. Tony Fabelo Magistration Introduction of Public Defender Integration of Pretrial Services, Public Defender, Mental Health and Hospital District Team Presentation to Judge Direct transfer to treatment Services

Diversion 1. 0 2003 to 2017 Community Medical Directors Roundtable - Monthly Reports 2004 Measuring Potential and Economic and Societal Benefits 2007 Cost Analysis of the Bexar County, Texas, Jail Diversion Program 2008 to 2016 Report of Success; Annual Diversion 2. 0 2014 Bexar County Pretrial and Mental Health Improvement Process 2015 Bexar County Smart Justice: Implementation Year One Progress 2016 Council of State Governments Intake Process and Recommendations for Change Diversion 3. 0 2015 Bexar County Consortium – Community Mental Health Model 2016 MHM/Meadows – Bexar County Mental Health Systems Assessment 2016 MHM/Capital Healthcare Planning – Bexar County High Utilizers/Homeless Healthcare Analysis (Cost) 2017 Law Enforcement Medcom Navigator funding secured 2017 CMAG Substance Use program launched 2017 Southwest Texas Crisis Collaborative created, strategic initiative launched

Diversion 1. 0 Sequential Intercept 1 Diversion - Pre Arrest Early Intervention • Crisis Intervention Training for Law Enforcement and First Responders • 40 hour Community based, no charge • Co-taught by San Antonio Police and the Bexar County Sheriff’s Office • Mandated training for Patrol by Sheriff and SAPD • Mobile Outreach Teams • Over 4, 000 Officers Trained Sequential Intercept 1 Diversion - 24/7 Drop Off (Restoration Center) • Psychiatric and Substance Use Crisis Services • Medical Clearance for Law Enforcement • Sobering Center • Detox Center • Over 18, 600 Accessed Services at the Restoration Center in FY 15

Diversion 2. 0 Magistraton Sequential Intercept 2 • • Initial Detention Expanding Mental Health assessments, early identification 100 % Screening Four Mental Health Questions asked by all law enforcement Suicide Screening and Assessment Sequential Intercept 2 • • Counsel of State Governments: Dr. Tony Fabelo Magistration Introduction of Public Defender Integration of Pretrial Services, Public Defender, Mental Health and Hospital District Team Presentation to Judge Direct transfer to treatment Services

Bexar County Smart Justice Initiative Summary: Challenge - The largest unmet need in Bexar County is mental health • 21% of persons in jail have significant mental health issues • Recidivism for persons with mental illness, especially those charged with misdemeanors is high • Early identification and process for diversion is complex • Treatment access limited Challenge – Central Magistration (CMAG; a pre booking facility) • 95% of all detainees booked at CMAG were not screened for MH needs • Screening for MH at CMAG was based on observation and staff report • Screening available for 8 hours, Monday through Friday only Timeline: 2014 2015 2016 2017 • • Commissioners create County Mental Health Department Bexar County Smart Justice recommendations endorsed by County Officials New CHCS Contract to include mental health clinicians NACo initiative to address the mentally ill in jail presented • Commissioners create Independent Public Defenders Office • City/County establish joint coordinating council and begins bi-monthly meetings to review criminal justice issues • CMAG improvements include expanded screening and full assessments, public defender presence and law enforcement administered mental health questionnaire for all brought to CMAG • CMAG-Pretrial 100% screening for MH needs, mental health clinician available 16 hrs per day, 7 days a week • Bexar County participates in Meadows Mental Health Policy Institute, State wide Smart Justice Task Force informing Texas Legislature on Mental Health and Criminal Justice issues • NACo, Council of State Governments Justice Center and the American Psychiatric Association launches “Stepping Up Initiative” to Reduce the Number of People with Mental Illnesses in Jails • Commissioners Court issues proclamation in support of Stepping Up Initiative • Bexar County invited to present at April 16, 2016 National Summit in DC. CMAG Facilities and staffing improvements continue; Re-entry Center and Video Visitation Center to open in April • • Jail remodel to include expanded work release capacity and re-entry programing Law Enforcement Medcom Navigator funding secured CMAG Substance Use program launced Southwest Texas Crisis Collaborative created, strategic initiative launched

Community Activities Create, leverage, encourage, and support ongoing mental health treatment services – Identifying community resources and capacity • Conducting gap analysis Community Education - Attorney Mental Health training - World Mental Health Celebration - Pathways to Hope: Faith based Initiatives - Health Behavioral Health Fairs Mental Health Consortium – Community stakeholders meet to address the needs of the community • Medical Directors Roundtable • Bi Monthly Consortium City-County Wide update

Community Mental Health Continuum Model • • Target Areas: Child-Family 1. Navigator: Coordination Portal (Law Enforcement/Community) Adoles-Family 2. Continuity of Care with focus on Residential Continuum/Supportive Housing 3. Outpatient Access- Gaps , Sharing information Adult-Family 4. Public Service Announcements Older Adult-Family 5. Evaluation • Community Support Transportation • Supportive Employmt • Housing Prevention - Wellness • Quality of Life • Medication - access • Guardianship • Trauma Informed Care • Residential Levels • Intensive Outpatient • Outpatient Services Coordination of Care • Jail • Secure Facilities • Stabilization Transitional • ER-Hospital S y s t e m s Judicial • Crisis ü ü Community • 911, CIT, Fire/EMS Intervention • Transitional Care C r o s s Wellness Sick Care • Crisis

Mental Health Navigator • Concept: To develop a central coordinating entity to ensure the most appropriate service is provided. Due to the varying needs of law enforcement and the general public, it was determined that two different navigators would be needed: Law Enforcement Navigator and Community Navigator. • Goal: Assess the caller’s need(s) and direct him/her to the most appropriate provider to ensure the best mental health continuum system of care. • • Law (LE) Enforcement Mental Health Navigator As LE call in, look up the individual’s Emergency Detention (ED) history to divert the individual to the most appropriate setting. Community Mental Health Navigator Assess the caller’s needs and direct him/her to the most appropriate service provider that best fits their needs, including crisis care, sick care and wellness.

MENTAL HEALTH DEPARTMENT Contact Information Paul Elizondo Tower, 101 W. Nueva, Suite 310 San Antonio, Texas 78205 www. bexar. org/mhd Gilbert Gonzales - Mental Health Department Director grgonzales@bexar. org (210) 335 -0071 Velma Muniz MA, LPC-S – Department Program Coordinator Velma_muniz@bexar. org (210) 335 -0763 Melissa Lucio- Senior Analyst Melissa. Lucio@bexar. org (210) 335 -0764