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The House Committee on County Affairs met on September 25 to hear invited and public testimony regarding interim charges related to inmate behavioral health services and deferral programs, population limitations in Local Government Code Section 154.041 and 113.047, and monitoring the agencies and programs under the committee’s jurisdiction.

This report is intended to give you an overview and highlight of the discussions on the various topics the committee took up. It is not a verbatim transcript of the hearing, but is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.

 

Interim Charge #5: Monitor the agencies and programs under the Committee’s jurisdiction and oversee the implementation of relevant legislation passed by the 85th Legislature. Under the Committee’s oversight, the Committee will be discussing indigent defense, and family drug treatment courts

Fancy Jezek, Bell County Judge 426th District Court

  • Have attempted to make changes to find efficiencies in the system that would lead to better results
  • Costs for defense have risen significantly for indigent defense
    • Budgeting for that is very difficult
  • 2011 grant allowed for creation of online appointment system
    • Revamped pre-trial intake
  • Coleman – how do you assess if they are eligible for personal recognizance?
    • There is an assessment conducted
    • have a low failure to appear rate after 30 days for those on PR bond
  • unaware of any other county that is PR bonding at the rate that Bell County is
    • have been using that system since 2013 to reduce jail costs
  • Springer – what other costs are increasing that this is offsetting?
    • Attorney fees, and other things in the criminal justice system – non-related to the PR
  • Discussed conditions on commercial bonds compared
  • online system included attorney rating system
    • has not been used yet due to funding
  • has created a mental health docket
    • utilizes social worker interns from university of Mary Hardin Baylor
    • it slows the process down and is costlier but has much better outcomes
  • 40% of population incarcerated in Texas has behavioral health conditions
    • Identifying more people with more needs – need to be addressed to ensure that they do not continually cycle through the system
  • Noted work is needed to help ensure that medication is continued to be taken after release – likewise continuation of Medicaid benefits after release
  • Coleman – that has been a focus within the committee and legislature
  • Springer – does bell county have indigent defense department?
    • It is within pretrial services
  • Springer – do you have staff of attorneys that just do indigent defense?
    • Do not
  • Springer – who makes that decision?
    • The commissioners court would make the decision with the courts making a recommendation
  • Springer – are all cases getting more expensive or just one type?
    • It is across the board

 

Vincent Perez, El Paso County Commissioner Precinct 3

  • Identified many problems with indigent defense in the county: long stays in jail without access to counsel, slow appointment of attorneys, case loads were extensive
    • Sought assistance from indigent defense council
  • Texas ranked 48st in the nation related to indigent defense funding
    • El Paso funds 91 cents on the dollar – 1 cent from the state
  • Springer – is that total spending?
    • That is correct, total spending on indigent defense
  • Described graphs related to Texas spending on indigent defense compared to other states
  • Coleman – public defenders compared to public attorneys – what are the differences in quality representation?
    • Experts seem to be an area that are especially different by funding
  • Jezek – noted judges are responsible for maintaining effective defense for court appointed attorneys which can be an issue many times in remaining impartial
  • Caseworkers may be involved in ways that they are not in other cases – it is a more intensive process that may not be fully seen
    • It is costlier upfront but yields better outcomes
  • There is a lack of oversight on what is spend on appointed council – and very time consuming to verify vouchers
  • Jezek – the created web system allows for better oversight of that spending
  • Springer – is that system available for other counties?
    • Jezek – it is, the only problem is integrating it and training
  • Discussed tax rates as it related to indigent defense funding – directly connected to quality of defense
  • There are a lot of cost measures outside of the commissioner’s courts
  • Neave – how is the cost spending per district calculated as shown in written testimony?
    • It is a unique number and just an estimate

 

Mark Hocker, Lubbock County Judge County Court at Law #1

  • Lubbock has been on the forefront of indigent defense
    • 2012 created indigent defense office
    • Regional public defender that serves 16 counties in the area
  • Have seen decrease in cost per case in recent years
  • Approaching 50% of those that come into the system have had prior contact with mental health services
  • Noted that mental health is the most collaborative area in the justice system because of the desire to get good results
  • Have worked to get more senior attorneys in the court room to help bring up the young public defenders
  • Coleman – have spoken a lot about diversion and how to deal with competency restoration, what works well with the in-jail competency restoration?
    • 90% of restoration in medication related – if we can have them seen in the jail with therapeutic medication it is a better use of time and money
  • One thing the legislature could do to help is allow trying outpatient with as many people as possible, also need more outpatient options through healthcare providers
    • Discussed telemedicine as an option
  • Need a guardian of last resort
  • Coleman – noted that there was a sharp focus on certain provisions in the Sandra Bland Act and now we need to continue to move forward
  • Springer – one issue is how to get best practices compiled and spread around, and is there a scale of size issue?
    • When it comes to mental health and saving money it is a very good opportunity for collaboration – everybody wants to find better solutions
    • Court of criminal appeals created a commission on mental health and we are expecting very good results from that collaborative process
  • Jezek – regional solutions will be hugely important in creating solutions
  • Coleman – would encourage getting involved in the regions, Sandra Bland Act encourages regional collaboration, should consider recommendations for regional and local grants from the state

 

Kenneth Wilson, Haven for Hope

  • Thanked committee for work on Healthy Community Collaborative – one of the best tools available
  • Described Haven for Hope
    • Preform trauma informed care
  • Work to recruit people from the jail system to get them to Haven for Hope to get the help they need
  • Described outreach team process to recruit people as part of release conditions for PR bond
  • Have 50 people in the program currently
  • Gave a specific example of current patient experience
  • Uresti – has been very impressed with the work done at Haven for Hope
  • Have continued to have delegations coming to Haven for Hope

 

Mike Lozito, Bexar County

  • Working to better identify which people need to stay in jail and which ones should be able to be released to quality programs
  • Noted HB 13 has had a tremendous impact in creating partnership between counties and cities as well as SB 292 – allowing to create secure crisis unit that includes wrap around services
  • In efforts to remodel the state hospital – in preplanning and architecture stage
  • Coleman – we have made progress and need to continue to be sure that there are resources to continue filling the gaps in the system
    • Has been a good experience with preplanning to work with other counties to determine needs and best practices
  • County judge has been on the forefront to be sure that another jail is not built – leads to creation of more collaborative mental health facilities

 

Gilbert Gonzales, Bexar County

  • Focused on mental health and substance abuse disorders
    • Working to identify it as early as possible and routing to applicable care
  • Focus on continuity of care
  • Have implemented crisis intervention training – goal was to train 20% of police force, now at 100% of officers trained
  • Diversion requires a place to divert to

 

David Pan, Center for Healthcare Services

  • The collaboration brought together to address the issue as opposed to building new jails – was very impressed with the commitment of those involved to come up with new solutions
  • Have used grant funding to help fill gaps like crisis stabilization unit, qualified mental health professional staffing needs,
  • Getting law enforcement crisis intervention trained is a huge step forward – but need to have a place for those identified people to go after identification
  • Goal is to assist law enforcement and the justice system to get them help and to stay out of the justice system

 

Gilbert Gonzales, Bexar County

  • In addressing the public safety net, Bexar county sped $1.2 billion and noticed that many of the same people were going in and out of the hospitals
    • Real cost is hugely significant and there was a substantial systematic inefficiency
  • Written testimony includes breakdown of populations going to through the mental health department
  • Data collection allowed for collaboration between hospital administrators – led to tracking method for emergency detentions – funded through state, county, local, private and nonprofit entities
    • In 4th month of law enforcement navigation program
    • Efficiencies have grown exponentially
    • Over 6,000 emergency detentions coordinated in roughly 1 month
  • There are those that cannot be diverted from the Magistration Center
    • save roughly $1,500 per diversion

Mike Lozito, Bexar County

  • described magistration center operations and mental health releases
  • last year had 100% screening of individuals for mental health issues
    • conducted at the very first interactions
  • does utilize multiple screening throughout pre-trial services to divert as many individuals as possible
  • initial screening can put an individual on a fast track to services
  • success rate is very high – recidivism had decreased
  • robust department for pretrial services allows for more specialized identifications
    • allows for 31% of releases on PR bonds
  • working toward having public defenders at bail hearings
  • still need to increase bed capacity for those in jail for substance abuse and mental health
  • programs have been beneficial for police officers as well
  • Uresti – noted the questions that are being asked by the officer are also being asked by others in the process
  • Reviewed written testimony showing ultimate goal of effecting outcomes before people get into the system
  • Coleman – it is very beneficial to see the outlines of identified gaps – would be beneficial for other counties to use this as a guide to help identify local gaps

 

 

Interim Charge #3: Study how counties identify defendants’ and inmates’ behavioral health needs and deferral opportunities to appropriate rehabilitative and transition services. Consider models for ensuring defendants and inmates with mental illness receive appropriate services upon release from the criminal justice system.

Aurora Martinez Jones, Travis County Judge

  • Around 98% of those seen have mental illness issues
  • Family code allows for options to seek treatment without separating the family
  • Written testimony shows fiscal year 2017 data – shows collaboration with local mental health authority
  • Discussed preventative measures – 70% of children remain in care of parents – shows that we are not using the foster care system
  • Coleman – that is how we got here – the pipeline into the foster care system, how many people are using the model that you use for prevention and intervention?
    • There are a variety of models – but mostly people are not collecting data in the same ways
    • It would be helpful if more departments understood that chapter of the family code to provide more trauma informed practices without removing the child from the home
  • Coleman – how many families end up moving through this?
    • Had over 250 participants in the program
    • Most of the questions hat come up regard process – have been working with others
  • Coleman – do you think there is something that can be done in that area from the state?
    • Yes, but need to be careful because that is a section of code that needs to be used delicately
  • Noted that the program almost lost funding last session

 

Kristene Blackstone, Department of Family Protective Services  

  • Each case gets examined individually to determine needed services
    • May drug test children and parents to help identify needed services
  • Does not have ability to track specific types of substance abuse
  • Substance abuse accounts for 50-70% of factors that lead to removals
  • Coleman – can we get a snapshot of the children in these services and their needs?
    • Kids that are actively experiencing substance abuse issues are typically older children
    • These are typically problems that take a long time to work through
  • Described substance abuse by caregivers
    • Focus on resolving substance abuse first
  • Children who died from abuse and neglect typically are in circumstances related to substance abuse
    • Described the types of substances by category involved in the specific abuse and neglect fatalities
  • Discussion of race as it relates to children in CPS and the types of substances used/reported
  • Coleman – taskforce of health disparities expanded across all agencies – the potential to lose funding for programs like Travis County is a big deal
  • Noted Bexar county focuses on children after they have been removed and then make a meaningful intervention at that point to make successful reunification – average reunification after 6 months with very low rates of recidivism
  • Data shows that drug courts are effective without specific model
  • Coleman – do we need funding on the front end or in the middle?
    • Funding the front end is very important to avoid the foster care system, have seen that once they get involved it does not lead to good outcomes
  • Coleman – shouldn’t all of the models include a front end and reunification if they are removed?
    • That would be very beneficial
  • Barriers to parents getting treatment include: long wait times to receive treatment in their local community,
  • Uresti – you said you allow children to go back to their parents while they are receiving treatment, does that depend on the substance abuse?
    • There are many factors including treatment progress and support factors
  • Uresti – is it possible that a child would be returned to a parent that is actively using substances?
    • Cannot imagine a circumstance in which that would happen
  • Uresti – has concerns of possibilities of returning children back to those who are actively using methamphetamine
  • Bulk of purchase dollars go to drug testing
  • Working to strengthen relationships with county and local agencies and departments
  • Recommend exploring ways to provide supportive services after reunification in order to maintain sobriety

 

 

Interim Charge #4: Review the population limitations found in Local Government Code Section 154.041 and Local Government Code Section 113.047. Determine if counties with a population below 190,000 could benefit from the population limitations being removed.

Bruce Wood, Kaufman County Judge

  • Asked for flexibility to meet local needs
  • Commissioners court meets every week to pay bills and to approve payroll by statute because they are below the 190,000-population threshold
  • Can always have special meetings but would like flexibility to not meet weekly just to approve bills

 

Dolores Ortega Carter, Travis County Treasurer

  • Treasurer and auditor do not have authority to pay claims without approval of commissioner’s court
    • Commissioner’s court cannot delegate duty to treasurer
    • Applies to payroll and disbursements
  • Removing the cap will also have the effect of allowing for the advanced approval of those expenditures
  • Coleman – suggests bringing forward a solution on removing the cap
    • Will provide solutions for removing the cap to the committee
  • Springer – what is the solution you see today?
    • To remove the population cap
  • Springer – who would disagree with that and why?
    • Cannot think of a reason

 

Interim Charge #3: Study how counties identify defendants’ and inmates’ behavioral health needs and deferral opportunities to appropriate rehabilitative and transition services. Consider models for ensuring defendants and inmates with mental illness receive appropriate services upon release from the criminal justice system.

Greg Hansch, National Alliance on Mental Illness

  • Described NAMI
  • Noted SBA has made a big difference in diverting people and treating them as well as housing
  • There needs to be more housing options including step down options as people are leaving psychiatric hospitals or criminal justice facilities
    • need to focus on the continuum of care as people are released
  • HHSC exceptional item 7 and 8 can be tools to use on impatient mental hospitals
  • Springer – noted cost per bed were so large in urban areas and closed facilities in rural areas that would be a fraction of the price of building new facilities – this is an issue that we are not doing nearly enough on
  • Recommends considering options for competency restoration outside of the status que (state supported facilities) – could be a lot of potential in outpatient competency restoration programs
    • would be a form of diversion
  • recommends leveraging the mental health matching programs
  • Coleman – discussion of cots associated with the programs and why they are considered exceptional request items
  • Psychosis is an example of diversion situation that should be going to coordinated specialty care
  • Mental health block grant funs have been used to create CSC teams in over 10 of the LMHAs
  • Coleman – that was stair stepped?
    • That is correct
  • Coleman – for new money do we have to put up money?
    • No, but it will not be enough
    • HHSC has submitted an exceptional funding request to bring this program statewide
    • State approval is critical
  • HHSC has put in another one-time funding request for real time data sharing – would expand sharing between jails and LMHAs to respond faster to mental health needs
  • Uresti – when the jail gets a CCQ hit, the mental health department does not get one as well?
    • The local mental health authority doesn’t receive automatic notification from the CCQ system, only the county is getting it
    • This would enhance that real time data sharing
  • Texas Judicial council – guardianship mental health and intellectual and developmental disability committee issued report calling for reforms including amending state law to create new civil commitment option for class b misdemeanor defendants so use of in-patient bed is not the only option
  • Described new mental health officer training in Texas – 40-hour training
  • Recommending continuing to focus on prescriptions medication continuity
    • SBA required commission on jail standards to adopt prescriptions continuity standards
    • A clarification in statute that family can bring medication to the jail given certain circumstances
  • Believes strongly in peer services – recidivism is substantially lower through those services
  • Mental health club houses are an incredible resource for those coming out of facilities
    • State support would be hugely beneficial for those clubhouse services

 

Reginald Smith, Texas Criminal Justice Coalition

  • Recommend building out recovery and support services
  • The State spends over $600 million per year in local justice system costs on mental health and substance use disorders not provided in the community
  • Texas should continue to provide grant funding for pilot programs that address behavioral health needs before and after release from the justice system
  • Asset mapping can help determine which services in the community need to be expanded
    • In Reach – connecting services to those in jail
    • Need a statewide approach
  • Peer support and peer mentoring programs should be expanded across the state
    • Shown to be extremely successful and the most successful approach to reduce recidivism
  • Suggest funding a pilot program that addresses helping people exiting jails with an emphasis on addressing rural counties and counties that house one of the 8 residential centers
  • Currently only 4 reentry community organizations in the state – all in urban areas, most rural counties lack infrastructure
    • Recovery community centers offer low cost ways to begin offering services to rural communities
  • Have seen more types of opioids available although not seeing that as a cause of death in more cases yet
    • Possession related offenses are up
    • Creating a continuum of care for those released from jail is hugely critical
  • Recommend building partnerships in the community through justice reinvestment
    • Creating partnerships is an important first step to deploying services and preventative measures
  • Noted needs are different from community to community
  • Biedermann – how do we get programs like this started in rural communities?
    • There is already a network of people in the state that are working on RCOs
    • Recover People can give assistance to communities that want to start RCOs

 

Wesley Shackelford, Texas Indigent Defense Commission

  • Related to statewide tracking of prerelease through pretrial PR bonds – not tracked statewide, perhaps local staff tracks it
    • It is not reported on a statewide basis
  • Related to reporting of costs for indigent defense services related to mentally ill persons – not tracked by the state – is collected by state auditors and broken down by case type (felony, etc.)
    • It should cost more and does cost more, but it saves on jail expenses and recidivism
  • Springer – is the data there and we are just not reported or is it not collected?
    • Believe it is collected on the criminal justice side, but it would be new information on the indigent defense side
  • Springer – would like to look at recidivism rates with people with mental illness versus not
  • Coleman – noted anecdotal information would be better than nothing
  • Regarding different types in indigent defense models – do collect that information
    • About 20 public defender offices
    • 3 managed assigned council programs serving about 40 counties
    • Are seeing that on a regional basis
  • Springer – would imagine that hose 40 counties represents 80% of the population

 

Public Testimony

Tanya Lavelle, Hogg Foundation for Mental Health

  • Housing is a tremendous barrier for those experiencing mental health illness that are trying to transition out of the jail system
  • Need to take a community-based approach that uses housing as part of the continuum of care
  • Highlighted the Supportive Housing Rental Program (SHR) provides short term rentals and utilities operated through LMHAs to people experiencing mental illness who are homeless or eminently homeless
    • Program has showed positive outcomes
    • 70% reduction in hospitalizations and crisis interventions
  • Coleman – what is required for housing to be supportive housing for people with mental illness?
    • Main components of successful programs are associated with a service package through a LMHA
    • Programs do not prescribe which services a person needs to be seeking, and there are many different models
  • Springer – what would the average hospitalization on those have been?
    • Do not have those numbers
  • Coleman – requested more information on this kind of program
    • Will provide that to the committee