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Below is the HillCo client report form the May 5 House County Affairs Committee hearing.
 
The committee met to consider the following two interim charges:
 
Continue oversight of the Texas Commission on Jail Standards and issues jails currently face, including the mental health of those in jail, and make recommendations for refinement or improvement of processes and programs.
 
Monitor the health advisory panel stemming from HB 3793 (83R).
 
Jail Systems
Brandon Wood, Texas Commission on Jail Standards

  • Inmates are often not satisfied with health care in county jails
    • Jails have their own formularies, do not include painkillers
    • Half of the complaints the receive are regarding health care
    • Mental health is the highest cost and challenge
    • County jail is not equipped to serve mental health patients
    • Places a large burden on jailers
    • 25-30% of inmates have a mental health issue
  • Coleman – how many jurisdictions use mental health diversion courts?
    • Some urban and midsized counties have tried
    • Some have sobriety centers
    • Some have diversion programs that prevent incarceration entirely
  • 1.5B in DSRIP funds for mental health programs
  • Gonzalez asked about the training jailers receive for handling a mental health patient
    • Basic training
    • They have developed an extensive online training course to assist county employees in identifying red flags
    • The number of patients with mental illness is overwhelming to jailers
    • Rural counties face much more difficult obstacles due to lack of local services

 
Elizabeth Henneke, Texas Criminal Justice Coalition

  • Prison Rape Elimination Act of 2003 (PREA)
    • Data collection, training and technical assistance, grants to the state, development of national standards
    • Texas has received 3.5M
    • 15.7% of inmates indicate that they have been sexually assaulted
    • Local jails are under PREA, but there is not enforcement mechanism
    • Texas has the lowest rate of prosecution
    • Mass underreporting – statistics based on surveys
  • Krause – if we remove non-violent offenders from the prison, would that naturally lower the occurrence of rape?
    • No data, but think it might
  • There is a big problem with 17 years getting sent to an adult facility
  • PREA compliance is costly
    • Need more financial help
    • Suggests using the ombudsman for audits
    • Travis County is facing a 2M lawsuit for non-compliance

 
Linda Frost, Hogg Foundation

  • There are a lot of low level non-violent offenders incarcerated with serious mental health needs
  • “jails are the new state hospitals”
  • Need more focus on traumatic brain injury
  • Jails aren’t a comprehensive treatment facility
    • Patients need more supports than a jail can provide
  • Funded cost effective community based mental health services from appropriations in the 83rd
    • Waiting lists have been reduced
    • More supportive housing available
  • Should have more officers trained and more departments utilizing crisis intervention training

 
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
    • Peer support is a Medicaid billable service in Texas

 
Greg Hanch, NAMI Texas

  • Recommendations:
    • Each county jail should have a contract with a local nurse for inmate mental health assessments
    • Family members are restricted from medical information of inmates frequently
      • Need access
    • Potentially preventable suicides risk reduction
      • 31%of deaths in jail are suicides
    • Need to utilize local mobile crisis teams, and allow access to patients
    • Access to medication
      • Allow for prescriptions already prescribed to the inmate before incarceration be allowed to enter the jail if repackaged and certified by a pharmacist
      • Quicker access to medications, continuity of care
    • Kolkhorst: who would pay for the repackaging?
      • Family members

 
Chris Kirk, Brazos County Sheriff

  • Use best practices on mental health intervention
    • In 2005 they had an overcrowded jail
    • Mimicked the diversion policy from Williamson County
    • In 2006 they diverted 1000 individuals from jail due to crisis intervention
    • Assigned 4 full time deputies to the crisis intervention team
    • Transfers to the LMHA rather than jail
      • 2013 – 184 diverted
      • Savings of 390,000
  • 35% of their medical budget is spent on psychotropic drugs
  • They are responsible to transports, both locally and across the state
  • Crisis team does regular checkups on the diverted individuals
  • Improves continuity of care
  • There are great opportunities with public private partnerships

 
Dennis Wilson, Sheriff of Limestone County

  • More difficulty in rural Texas due to access to resources
  • Their pharmacy budget is 185k a year, of which they spend 90k on psychotropic drugs
  • PREA is a huge problem
    • Implementation is difficult, don’t have the staff
    • Classification problems, would need additional staff and housing to separate people to another area
    • A regional effort could work to farm these people out to a new locations to separate them from the rest of the population
  • Diversion is very difficult, they depend on ERs
  • 1115 money is critical for local LMHAs
    • Coleman – critical that we get the waiver renewed
    • Other local entities need to be aware of the 1115 waiver money to fill the holes
  • LMHAs are implementing programs that work and provide continuity of care

 
Catherine Giles, self

  • Personal story about her son’s medications being withheld at Denton County jail

 
Matt Simpson, ACLU

  • Mental health diversion at the point of crisis rather than being jailed, or before re-entry is key
  • Need to increase partnerships with LMHAs

 
HB 3793
Lauren Lacefield Louis, Assistant Commissioner of Mental Health and Substance Abuse, HHSC

  • Workgroup has looked a various factors:
    • Rapidly growing population
    • Workforce shortages
    • Priorities of the legal system
    • Demand exceeding resources
    • Increasing judicial commitments
  • Forensic commitments are increasing, civil commitments are decreasing
  • The bill requires that they develop a plan to implement timely mental health services
  • Stakeholder participation is active on the panel
  • Currently they are identifying the method for the implementation of the plan
  • Service and capacity
    • Texas has 11 beds per every 100,000 people, compared to the national average of 14
  • Analyzing where the holes are in the areas that didn’t benefit from DSRIP money or projects
  • Deciding the appropriate role of state hospitals vs community based services
  • Focusing on community engagement
  • Stickland is concerned that individuals are falsely self-reporting mental health issues to avoid jail
    • How do you weed out the bad actors
    • Coleman – these are mainly “frequent flyers” that have already been in the system

 
Jim Allison, County Judges Commissioners Association of Texas

  • This issue is their #1 priority, utilizing the mental health diversion funding from the 83rd legislature
  • There is a lack of facilities to treat persons who have been incarcerated and have to wait for a transfer in jail until they can access treatment
  • Mental health issue are not handled before incarceration
  • Funding isn’t the full answer
    • Working for a state plan to eliminate the transfer backlog
  • The plan and implementation won’t be the end of the problem – need to go much deeper
  • Need to get metrics on how to measure outcomes
  • Stickland – there will not be a single successful outcome, this is an ongoing issue
  • Kolkhorst – is this the first time in a long time that we have done an inventory?
    • This is the most comprehensive that has been done
  • We have an archaic system with warehousing mental health patients in the state hospitals
  • Kolkhorst – Not interested in single shots, wants the comprehensive and holistic plan
  • The continuation of the 1115 waiver is critical
  • The plan the panel comes up with needs to be reviewed every two years to ensure efficacy

 
Don Lee, Texas Conference of Urban Counties

  • This is an important effort in coordination
  • There has been a change in the nature of the state hospital system so it is the last stop for mental health services
    • This eliminates the openings for people looking for continuity of care services
  • The lack of resources in the community is what creates the need in the justice system
  • Wants a system that provides incentives to keep inmates out of the state hospital
  • Kolkhorst – there has been a huge increase of forensic beds?
    • This is the national trend
  • Coleman – we need to make sure the resources are dispensed appropriately and maximized

 
Lee Johnson, Texas Council of Community Centers

  • Encouraged by the emphasis being placed on mental health issues, and by the 17 members on the advisory panel
  • Collecting data and doing a needs assessment
    • How many people are waiting for a bed in the state hospital?
    • What services can be provided locally?
  • Stickland – are weekends worse, or are certain seasons worse for mental health episodes?
    • Yes, we do see some of that
  • The legislature’s investment is working, but there is a lot left to do
    • The waitlists have been dramatically reduced for access to mental health services
  • Mental Health First Aid
    • 476 new instructors
    • Trained to teach mental health first aid in the community this year
    • 5M appropriated for the biennium
    • 12,295 will be trained this year
      • Prevention and early intervention
      • Breaking down the stigma of mental health illness

 
Charlie McMurray Horton, Harris Health System

  • Psychiatric nurse
  • The funding was a start, but there is still a journey ahead
  • HPD sent 4,000 on emergency detention orders for mental health services last year
    • 95% of the time end up civilly committed
    • No one is sent from her emergency center to the state hospital
    • Do not have enough beds to meet needs – overflow goes to the ER and tend to have lengthier stays
  • 4,000 people a year voluntarily present
    • Need both medical and psychiatric services
  • Seeing a great benefit from the 1115 waiver, they have been able to expand outpatient capacity
    • Increased case management and wrap around services
    • The waitlist reduction is directly related to the 1115 waiver

 
Lisa Jenson, Methodist Health Care System San Antonio

  • Within 12 hours a physician must evaluate a patient after presenting at the ER
  • If admitted, the goal of the hospital is to move the patient to the appropriate location of care
  • 48% of the last year, their state hospital was on diversion
  • The MHMR does a 7 day follow up when a patient is released from the state hospital
  • Does not believe the ER is an appropriate place for mental health services to be rendered
    • Need the resources to move the patient to the right setting
  • There is an importance in having access to the state hospital AND wrap around services
  • Kolkhorst – do you collaborate with the hospital district, UHS, as well?
    • Absolutely
  • Recommends giving hospitals the ability to utilize crisis stabilization units
  • Stickland and Kolkhorst discussed the general state of health care
    • Stickland – it is a better system if I paid my doctor to keep me OUT of his office
      • Kolkhorst – we are changing the system, it is going to be a hard process but we will get there