Mental Health Jail Diversion3 4 th A n n u a l Te x a s C o u n c i l C o n f e r e n c eWayne Young, MBA, LPC, FACHEChief Executive OfficerThe Honorable Kim Ogg, JDHarris County District Attorney

The People We Serve80% of the people we serve have household incomes at or below the Federal Poverty Level.

Map of The Harris Center’s SitesWe have 2,400 team memberswho provide care in 74locations throughout HarrisCounty.30% of our services aredelivered where people live,work or go to school.

Harris Center Continuum of Carefor Justice-Involved PersonsCrisis CallDiversionProgramCrisisInterventionResponse Team(CIRT)Mental HealthJail DiversionProgram PostBooking Servicesand ncy andSanityEvaluationsDual DiagnosisResidentialProgram partnership withProbationTele-CIRTPilot Programwith Sheriff'sOfficeRehab Clinician care coordinationfor The HarrisCenter’s currentpatientsReintegrationCourt re-entryservicesMobile CrisisOutreach TeamHomelessOutreachTeam collaborationwith HPDJudge Ed EmmettMental HealthDiversion CenterForensic SinglePortal - transitionservices for thosereturning fromstate hospitalTexas OpioidResponse PeerServicesMental HealthJail DiversionProgramCommunitybased Services &SupportsNew STARTre-entry servicesChronicConsumerStabilizationInitiative collaborationwith HPDPeer Re-entryServicesJail-based ClinicalMental Healthand IDD Services– Funded underthe Jail ContractIntegratedcare –partnershipwith FederallyQualifiedHealthCentersArray ofoutpatientandresidentialmental healthservicesPre-BookingJail DiversionJoint ProcessingCenter DiversionDeskJail sedServicesLast year weserved just over25,000 people inour forensicdivision

District Attorney’s Diversion Programs Misdemeanor Marijuana Jail Diversion Program (MMDP)Responsive Interventions for Change: Controlled Substance InterventionSTAR Drug CourtMental Health CourtDriving While License Invalid or Suspended InterventionDWI Pretrial InterventionRetail Theft Pretrial InterventionProject 180 – Prostitution DiversionClean and Green Diversion ProgramVeteran’s CourtFIRSTMental Health Diversion Center

Why a Diversion Center? The Neuropsychiatric Center was the current diversion locationfor anyone with acute mental health issues, but the sub-acute,non-emergency mental health population had few diversionoptions. Of 4,585 defendants booked into Harris County Jail in 2016 fortrespassing charges, 3,886 (85%) of cases were identified ashaving a mental health or homelessness issue. 596 were repeat defendants On average, nearly 3,000 inmates are in the Harris County Jailare on psychotropic medications every day7

Why a Diversion Center? The Neuropsychiatric Center was the current diversion location for anyone with acutemental health issues, but the sub-acute, non-emergency mental health populationhad few diversion options. Of 4,585 defendants booked into Harris County Jail in 2016 for trespassing charges,3,886 (85%) of cases were identified as having a mental health or homelessness issue. 596 were repeat defendants On average, nearly 3,000 inmates are in the Harris County Jail are on psychotropicmedications every day In 12 months, 170 cases involved a Class B trespassing charge were defendant wasdeemed incompetent and legally unable to proceed to trial – resulting in a total of11,785 days in jail8

Collaborative Partners The Harris Center for Mental Health & IDDHarris County Judge’s OfficeHarris County Sheriff’s OfficeHarris County District Attorney’s OfficeHouston Police DepartmentHarris HealthHarris County Housing AuthorityHarris County Commissioners CourtHarris County Criminal Justice Coordinating Council9

ResourcesSB 292 Harris County Judge’s Office - 5,000,000HB 13 Harris County Sheriff’s Office - 2,500,000In-Kind Match Harris County Sheriff’s Office Harris County District Attorney’s Office Houston Police Department Harris County Housing Authority The Harris Center for Mental Health and IDD10

Judge Ed Emmett Mental HealthDiversion Center Pre-charge alternative for law enforcement to drop off people withmental illness picked up for low-level misdemeanors Opened September 4, 201811

Judge Ed Emmett Mental HealthDiversion CenterEligibility Offenders who commit low level, non-violent crimesThose who appear to have or have a history of mental illnessNot in an acute crisis – does not meet criteria for Emergency DetentionVoluntaryAdult12

Diversion CenterStandardized intake flow for diversion arrivals includes: Peer Support (our goal is for this to be the first connection) Medical Assessment/Triage by RN Evaluation by Psychiatrist Evaluation by Internal Medicine physician Evaluation by Master’s Level Clinician13

Judge Ed Emmett Mental HealthDiversion CenterOn Site Services Assessments Integrated treatment and care plans to assist in an individual’s stabilization Medication management On site primary care On site psychiatric care Psychosocial programming Substance use disorder interventions Rehabilitation services Respite beds Peer support Extensive discharge planning to coordinate access to housing, social services andtreatment post discharge, utilizing case managers and peer support14

Judge Ed Emmett Mental HealthDiversion CenterAftercare Services (Post-Release Services) Intensive Community Based Case Management Medication management Psychiatry Psychosocial programming Respite beds Crisis Housing Supports Detox/Residential Substance Use Disorder Services Peer support Permanent Supportive Housing15

Judge Ed Emmett Mental HealthDiversion CenterHouston Police DepartmentTraining Video0:00-2:307:00-8:5016

DemographicsJail Diversion YTD Through May 2019Female, 21%2 ADMITS, 12%1 ADMIT, 80%4 ADMITS, 1.4%Male, 79%3 ADMITS, 4%5 ADMITS, 0.4%6 ADMITS, 0.6%8 ADMITS, 0.2%9 ADMITS, 0.1%11 ADMITS, 0.1%13 ADMITS, 0.2%14 ADMITS, 0.1%Unknown,28%Housed,14%Homeless ,58%17

Chronic Consumer Stabilization InitiativeWe expanded our existing CCSI program to engage the “familiar faces”who have frequent visits to the Diversion Center with limited impact.Chronic Consumer Stabilization Initiative(CCSI) is a collaborative effort betweenthe Houston Police Department and THEHARRIS CENTER FOR MENTAL HEALTHAND IDD. CCSI is a program designed toidentify, engage, and provide services toindividuals who have been diagnosedwith a serious and persistent mentalillness, and have frequent encounterswith the Houston Police Departmenteither through their own initiative or byfamily and/collateral contacts.Available Services Outreach and Engagement Intensive Case Management Mental Health First Aid for client, family, & othersupport systems Linkage to secure, stable housing Linkage to primary healthcare Linkage to outpatient psychiatric care andsupportive service Linkage with substance abuse treatment Empowering client to assume responsibility formental health compliance18 Crisis Intervention

Evolution of Diversion CriteriaInitial Focus (SEP 2018) Offenders who arrested for trespassingExpanded Focus: Misdemeanor Marijuana Diversion Program (FEB2019) Referring those who have a mental health issue and are failing to meet requirementsover to Diversion Program (but not actual center) for community based engagementExpanded Charges (May 2019) Offenders who commit low-level (Misdemeanor), non-violent crimes No threat to public safety Law enforcement and prosecutors shall review offenders for diversion on a case-bycase basis19

Offenses not eligible for Diversion DWIWeapons offenses (i.e., UCW, Discharging a Firearm, Deadly Conduct)AssaultDomestic Violence offenses (i.e. Assault-Family Member, Terroristic Threat on FamilyMember, Violation of Protective Order) Terroristic Threat Burglary of a Motor Vehicle Any offense where public safety could be compromisedSpecial Note: No open warrants or detainers20

Examples of Expanded Charges - May 2019Diversion eligibility criteria may include other non-violent, misdemeanor charges that do notcreate a public safety threat: Criminal Mischief - Defendant kicked metro bus door and broke glass - 500 damage Theft 750 - Defendant stole coffee pot while trespassing at urgent care clinic Obstruct Highway/Passageway - Defendant standing in roadway begging for money Failure to Identify - Defendant identifies himself to officer as Jesus Christ Indecent Exposure - Defendant urinating in public Interfere with Public Duties - Defendant approach officer on unrelated traffic stop andrefused to leave False Report - Defendant calls 911 repeatedly to report someone is zapping her brain Drug Possession -Variety of offenses - Defendant has Xanax in his pocket when detainedfor trespassing at gas station21

Communication – Expansion of ChargesVery public discussion and announcements regarding the expansion of charges to addressquestions and build support.22

Immediate Impact (Sep 18 – May 19)1308Diversions11 MinutesAverage drop off time55 HoursAverage length of stay22 DaysLongest stay is 22 DaysSep 2018 – May 201923

Early Outcomes0 New Jail Bookings67% had no new jail bookings after 1st diversion25% Participantshave received outpatient and/or residential services after release (70% if agreed towrap-around services15% Booking ReductionCompared to own baselineProjected Year 1 Savings 9.5MProjected Year 2 Savings 11.7MSep 2018 – Apr 201924

Law Enforcement Agency Drop OffsSep 2018 – May 2019Baytown PD4Constable Precinct 7Bellaire PD4HCC PDConstable Precinct 1 18Constable Precinct 23203Metro Transit Authority16Pasadena PD86HCSO89South Houston PDHISD PD71Texas Medical Center PD11TSU PD12Constable Precinct 3 10HPD850Constable Precinct 4 14Humble PD5UH Central Campus PD24Constable Precinct 5 15Jersey Village PD3UT PD at Houston10Constable Precinct 6 32Katy PD3All Others58

Impact of Criteria ChangeCharges Diverted in MayClass AClass B1. Criminal Trespass2. Other3. Criminal Mischief4. Indecent Exposure5. Resisting6. Shoplifting7. Possession Substance8. Theft9. Theft of Service10. Failure to ID11. Urinating in PublicClass C612712116653221138Average Diversions inSep-Apr136Diversions in May22026

Joint Processing CenterDiversion DeskPrimary Objective:Identify and coordinatetransition of those with lowlevel misdemeanors toDiversion Center whenappropriate27

Joint Processing CenterDiversion Desk Screening and assessments tofacilitate identification ofpotential diversion candidates Review history to facilitateidentification of potentialdiversion candidates Answer and respond toquestions/requests viaDiversion Hotline28

Diversion Desk ActivityScreenings: 29Sent to Diversion Center:Diversion Declined by DA:Other:9191Total Diversion Hotline Calls: 401Information Inquiries:Client Inquiries:Other:6032813

Oversight CommitteeBegan as weekly, transitioned to every other week, and now moved to monthlyOrganizations represented on the committee: The Harris Center for Mental Health and IDD Harris County District Attorney’s Office Harris County Sheriff’s Office Harris County Budget Office Harris County Public Defender’s Office Harris County Community Supervision and Corrections Department Houston Police Department

Data Committee The Diversion Center has both the larger data committee and the data researchsubcommittee The Data Committee worked to ensure the data collection efforts from LawEnforcement and the Diversion Center capture the front end data necessary tounderstand the flow of justice-involved individuals into and through the DiversionCenter The Data Research Subcommittee has been working to develop the overarchinggoals and specific measures to determine the effectiveness of the DiversionCenter31

Data CommitteeThe Data Committee proposed the following two overarching research questions: How does the implementation of the Diversion Center impact Harris County’sfootprint for individuals with mental health issues who have engaged in lowlevel misdemeanor behavior? Does the Diversion Center improve the lives of those individuals who arediverted to the center?32

Program Goals/Outcomes Reduce the number of individuals with mentalhealth issues engaged with law enforcement onlow-level misdemeanant charges Improve the mental health stability of theindividual and reduce the number of psychiatricemergency visits. Reduce the number of individuals with mentalhealth issues in jail on low-level misdemeanantcharges Improve the overall well-being of individuals inthe long-term program. Reduce the number of individuals with mentalhealth issues in NPC/Psych emergency on lowlevel misdemeanant charges Improve the lives of clients through engagement,assessment, and treatment services. Assess and link individuals to necessaryprograms based on a comprehensiveassessment. Improve the daily living skills of clients served Improve (or maintain, if stable) the individual’shousing situation Maintain positive satisfaction scores Ensure positive stakeholder satisfaction withconsistent positive ratings.33

State Reported Measures Total number unduplicated individualsassessed per month. Percentage of clients linked to outpatientservices. Total number unduplicated individuals servedper month. Percentage of clients receiving services whohave reduced recidivism of target events. Number of clients who voluntarily admit toDiversion Center for treatment or socialservices. Percentage of clients scoring 3 or less in atleast one specified domain with score of 4 orhigher on all specified domains at follow-up. Number of clients linked to outpatientservices. Percentage of clients who voluntarily admit toDiversion Center who leave AMA within 6hours.34

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Constable Precinct 1 18 HCSO 89 South Houston PD 6 Constable Precinct 2 3 HISD PD 71 Texas Medical Center PD 11 Constable Precinct 3 10 HPD 850 TSU PD 12 Constable Precinct 4 14 Humble PD 5 UH Central Campus PD 24 Constable Precinct 5 15 Jersey Village PD 3 UT PD at Houston 10 Constable Precinct 6 32 Katy PD 3 All Others 58 Sep 2018 -May 2019