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Below is the HillCo client report from the April 22 House Corrections and House Criminal Jurisprudence Committee's joint hearing.

The committees met to consider the following interim charge:
Examine the association between co-occurring serious mental illness and substance use disorders and parole revocation among inmates from the Texas Department of Criminal Justice. Review current policies and procedures for incarcerating individuals with a dual mental health diagnosis in both state and county correctional facilities and examine potential remedies within the State's criminal justice system to ensure that the public is protected and that individuals with a mental health diagnosis receive a continuum of mental health services.
 
Chairman Parker

  • 833,000 people in Texas suffer from a mental health (MH) related illness
    • 1/3 are served in a proper MH facility
    • The rest end up in jails
    • Need to find a way to successfully release them back into society after they serve their term

 
John Newton, LBB

  • Discussed funding in the criminal justice system for MH
  • 150,000 people incarcerated in Texas
    • 22,900 offenders are receiving outpatient services
    • 1,500 offenders are receiving inpatient services
    • Schizophrenia, Bipolar and Major Depressive disorders
  • 87,000 parolees
    • The Texas Correctional Office on Offenders with Medical or Mental Health Impairments (TCOOMMI) ensures continuity of care
  • Texas Department of Criminal Justice (TCDJ) provides funding to LMH centers and parole centers for mental health services in the community
  • $60M per fiscal year for MH services
  • $172 per fiscal year for substance abuse (SA) services

 
Brad Livingston, TCDJ

  • The Legislature has provided substantial resources for MH and SA in the correctional system
  • Increased funding in ’07 and ‘09
  • Sustained during fiscally difficult session in ‘11
  • Recidivism is declining
  • UTMB delivers health care services in TDCJ
  • 38 MHMRs are partnered to provide continuity of care in the community
  • Sheffield
    • What are the top three things you would wish to have?
      • More resources for TCOOMMI
      • Probation department resources
      • Parole resources to improve the delivery of services
  • Parker
    • Describe the process when a new inmate comes into the system
      • Screening for the need for immediate services
      • In the first 14 days there is a full medical screening
        • Staff on site for both inpatient and outpatient services
      • SA screening and testing
      • Bigger challenges exist pretrial

 
Chair of the Board of Pardons and Parole

  • Consideration of MH history in the parole process
  • If they decide to release an inmate, there can be specific conditions related to the release
    • ISF, monitoring, Safe P
  • The Board will be reviewing their special conditions in their July meeting to ensure that they are using effective processes
  • 7 member Board appointed by the governor
  • 14 Commissioners that are state employees make release decisions in groups of 3
  • 90% of those released on parole are revoked due to new offenses
  • Policies and rules have been tweaked over the years to better understand the MH population and help them

 
Nueces County Chief Probation Officer

  • Many prisoners have MH issues
  • There is greater demand for treatment than supply
  • CHRISTUS Spawn in Corpus is in need of at least 7 more psychiatrists than they currently have
  • MHMR turnover is high due to low salaries
  • Caseloads are high, TCOOMMI needs more resources
  • If these individuals cannot receive services in the community, they relapse and go back into the system
  • Herrero – where would these additional funds be used specifically?
    • Nueces has a large volume of homeless people and has the highest rate of commitments to the psychiatric facility in San Antonio
  • Herrero – So more hospital beds in the facility would be helpful?
    • Or giving more money to local MHMRs to be able to have more interventions and help at the local level to keep people from going to jail
    • There is a rumor that Dallas and Harris County ship their homeless to Corpus when it gets cold
  • Rose – inmates try to be stabilized in jail and either are sent to a psychiatric facility when a bed is available or back to court if they are deemed stabilized

 
Prosecutor, Tarrant County DA’s office

  • Described the intervention program their county utilizes
  • Identifies, stabilizes and attempts to get individuals through the program in 12-24 months
  • Judge gives sanctions appropriate to offenses
  • Program works with patients with severe MH illness with a high risk of reoffending
  • Parker – The higher the risk the more frequent the meetings with the program director?
    • How can we emulate statewide?
      • Currently grant funded, would need additional resources from the state
      • Has a great relationship with Harris County MHMR so any resources to expand would be great

 
Dr. Joseph Penn, UTMB Correctional managed care

  • Forensic psychiatrist
  • Have provided correctional health care since 1994
    • Partner with Tech who provides 20% of the services
  • Programs:
    • Intake screenings, identify level of care, case management, skills building, crisis management, sexual assault interventions
    • 80% of offenders are on psychotropic drugs
      • 16% in MH unit
    • Can provide civil commitment
    • Treatment and Relapse Prevention Program
      • Follows the continuum of the patient
  • Sheffield asked for the definitions of schizophrenic, major depressive and bipolar disorder for the benefit of the committee
  • Sheffield – how much of a role do genetics play?
    • Genetics plus the environment – historical stigma of being on these medications

 
Tracy Kohler, MHMR TCOOMMI services in Tarrant County

  • 10 years ago Tarrant County Assertive Treatment was developed
    • MH diagnosis for those with a pending felony court case
    • If eligible they are sent to a specialty court
      • Creates a support system
      • Helps to build the patient back up in the community and they offer advocacy and all the tools needed to live in the community
  • Parker asked for the metrics of the program
    • 96% success rate
    • Program is 6-8 months
    • Access to services based on individual needs
    • Assessed 246 in 2013, 120 were accepted for full services
    • Make use of peer to peer services

 
Linda Frost, Hogg Foundation for Mental Health

  • There are challenges to the workforce, geographical distribution
    • Working to improve
  • Diversion options:
    • Law enforcement crisis intervention training
    • Crisis services
    • Mental health first aid
    • Diversion courts
    • Restoration pilots
  • Burnam asked for statistics on cost savings from diversion programs in other states
  • Early intervention with youth provides great opportunity
  • There are disparities to access and treatment
  • Recommends intervention in public schools by supporting positive behaviors instead of punishing bad
  • 40% of people in county jails have a diagnosis of mental health illness before entering the facility
  • The funding for supportive housing is helping from last session

 
Jennifer Herring, Harris County Sheriff’s office

  • Mentoring Mom’s Program
    • Pregnant women receive holistic services during and post-partum for up to 3 years
    • Began last November with 60 patients
    • Classes are provided by volunteer community partners to support, educate and council the women
    • Many pregnant women suffer from mental health issues, especially depression
    • Discharged 40 moms back into the community, to residential facilities or their families
    • 0 have returned
  • Parker asked about the program’s barriers
    • Lack of staffing, want to expand- caseworkers are the bloodline
    • Partnering with U of H
      • 100 volunteer student and grad students as caseworkers
  • White any issues that the legislature can help with?
    • Valid assessments are key

 
Douglas Denton, Association of SA Programs

  • Executive Director of Homeward Bound
    • Program to keep men out of jail
    • 4,081 received services in 2013 for co-occurring  psychiatric and substance abuse disorders
    • Funded by DSHS
    • By addressing co-occurring illness, the revolving door is slowed
  • Parker asked about metrics
    • Established in 1980 based on the jail overcrowding
    • Established the first halfway house and the model has spread through the country
    • 150 bed facility and a small one in west Texas
    • Work with the Dallas Co jail diversion programs
    • Screenings need to be more timely and accurate
  • Hughes asked about decompensation
    • A person with MH problems in a stressful situation will decompensate and the symptoms will escalate
  • Rose asked about drug induced psychosis
  • Parker asked about staffing ratios
    • 2 pt. time psychiatrists
    • 3 APRNs
    • Medical Director
    • 20 LVNs and RNs
    • 5 MA counselors
    • 10 licensed chemical dependency counselors

 
Megan Randall, CPPP

  • Mental Health Peers Program
    • Evidence based program using a person who has personal experience with mental heal illness to provide guidance and mentorship to others with similar experiences
    • Discussed a Pennsylvania program, and recommended that Texas consider a similar pilot program

 
Sarah Paul, Texas Criminal Justice Coalition

  • Recommendations:
    • Improvement in identification and assessment of MH issues early
    • More accurate screenings by well trained professionals
    • Diversion programs, pretrial, pre-arrest, pre-booking

 
Joshua Houston, Texas Impact

  • Stressed the importance of coordination of care
  • Advocates for faith based resources in the community
  • Advocates for diversion before an individual enters the criminal justice system
  • Need to develop best practices in jails for those with mental illness so that they can be successful

 
Greg Hanch – Texas NAMI

  • Local jails have the highest prevalence of inmates with mental health issues
  • Need a more accurate detection of co-occurring disorders
    • Better screening and assessment tools, used on an ongoing process
  • Integrative therapy has better outcomes
  • Herrero asked if there was a uniform standardized assessment tool
    • No

 
Lance Lowery, American Federation of State and County Municipal Police, Texas Correctional Employees

  • There is a lack of training and it is of great concern
    • No training on MH          
  • Wants to develop a MH court, like a drug court
  • Jail is not a rehabilitative place – usually exacerbates illness

 
Marc Levin, TPPF

  • 61,000 inmates with co-occurring disorders
    • 3 times more likely to incarcerated
    • Mentally ill patients cost 3 times more in the correctional setting
  • Solutions:
    • Expand TCOOMMI
    • Current law requires a sheriff to notify a magistrate of a defendant’s mental illness within 72 hours of booking
      • There is no evidence this is happening
    • Advocates for the Bexar County model
    • Crisis intervention center
      • Need assessment for traumatic brain injury as well