Print 🖨

The House Committee on County Affairs met on September 26 to hear invited and public testimony regarding interim charges related to inmates’ behavioral health needs and deferral opportunities, monitoring the Sandra Bland Act and, behavioral health intervention in the school setting.

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 #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.

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 behavioral health intervention on the school setting and Sandra Bland Act implementation.

Gerald Yezak, Robertson County Sheriff, Texas Sheriffs Association

  • Partnerships are key to address the situation that emerge when people with mental health disorders interact with the justice system
  • Can be very difficult to separate and identify mental health from substance abuse
  • SB 1326 requires judges to consider alternatives like outpatient restoration programs – only 12 available in Texas
  • Options for diversion is very limited
  • More options for telemedicine is great and will give better options for many communities
  • Coleman – noted the funding as a whole given to this topic through multiple pieces of legislation but more is needed
  • Highlighted Maryland program for funding beds for mental illness patients

 

Tifani Witherspoon, Robertson County Jail Administrator

  • Issues seen at the rural county level include long wait times for mental illness patients while in jail before moving to a state facility
  • Coleman – are there gaps you have seen in waiting for beds at state hospitals? Is using private beds help at all?
    • It can at times, but there are some that require specific types of facilities based on need
  • Described specific instance of inmate being traumatized while waiting for a bed at a state facility
  • Would be good to have a waiting place that can offer appropriate care
  • Coleman – we want a place for people to be stabilized without being in jail, the counties that are further along in diversion are like Bexar County – the Sandra Bland Act attempted to provide that additional facility on a regional basis
  • Related to medication – some people are in crisis and some are not – described specific example of attempting to get appropriate medication for a person in crisis
  • We fail at getting people to get medication “as soon as possible” in terms of the Sandra Bland Act
  • Coleman – we were trying to give flexibility to the jailers and sheriffs in ways of getting to that point
  • Springer – are you speaking to psychotic drugs or standard health related? We passed tele psychotics, are you using that? Maybe we need to be talking about incorporating both into telemedicine
    • Use telemedicine – it hasn’t help get drugs any sooner
    • It has only help with screening but not get prescriptions
  • Uresti – what is the issue with not getting prescriptions?
    • We still wait for the LMHR to get in touch with us to make an appointment
  • Springer – the importance of the system is that it will help with small rural issues like pharmacy availability

 

Dawn Elder, Starlite Recovery Center

  • The piece that needs to be recognized is that mental health disorders and substance abuse go hand in hand
  • Described experience working with a specific individual
  • Biedermann – what about the piece of this that is the time it takes to get the medication the need in rural areas?
    • Many times, people will self-medicate with illicit drugs
  • Hunter – requested information on starlight recovery
  • Coleman – are you speaking about people with severe diagnosed illnesses?
    • Sometimes that is the case, but need to understand the dangerous types of drugs being used to self-medicate
  • Consistently hear that local law enforcement is the end user for mental health – believe that we need to be solution oriented and proactive and as a matter of best practice to begin at the point of the call
  • Proposed using funds for systems of care coordinator that works with public and private
  • Biedermann – discussed mental health round table held in Kendall county
  • Yezak – any PD that doesn’t have a county jail needs diversion alternatives – discussed intent of Sandra Bland Act as it related to grand funding
  • Coleman – realize there are missed gaps and unintended consequences, but there are also some tweaks that need to be made to ensure that the intent id followed

 

Al Auxier, Kendall County Sheriff

  • Encouraged by talking about behavioral health and not just mental health
  • New jail has capacity of 102 beds
    • Have 78 incarcerated today
  • Fast psych – an offshoot of tele psych program – was contracted through MHDD – spoke to psychiatrists in Arizona not in Texas – original idea was to use it for assessment
    • Has worked out really well and is a great tool
    • Use them 24/7
    • They do prescribe medication
    • Have employed full time LVN
  • Psych portion will stop being funded at the end of the year through the 1115 waiver
  • Springer – what is the cost of the portion that is going away?
    • Will provide that information to the committee
  • Relationship with MODD is exceptional but there are limited resources and capabilities
  • The spectrum of those who need help is very wide, but the solution needs to be comprehensive
  • Coleman – we haven’t been able to do what we want to do through multiple bills – discussed modeling healthy community collaboratives after Haven for Hope – it took TMA being comfortable with telemedicine and technology services before they could be implemented
  • Believes identification needs to begin in school
  • Coleman – discussed Medicaid coverage of mental health conditions through 1115 waiver

 

Jim Allison, County Judges & Commissioners Association of Texas

  • Jails are a huge portion of county budgets
  • Adequate surveillance and checking in jail is very important along with timely evaluations and identifications in order to get them needed help
    • There is some unevenness in implementation on this part of the Sandra Bland Act across the state
  • Problems with medication are arising related to refills – physicians are wary of authorizing refills without examination which is difficult when the person in incarcerated
  • Telepsychiatry will soon be available across the state at a reasonable cost
    • Tele physical medicine has been lagging behind – only just received rules from Board of Medical Examiners
  • Coleman – are there enough personnel to hire emergency medical services in the jails in rural communities?
    • It is a serious problem in the counties
  • Springer – discussed state based EMT options in “frontier” counties that cannot support those services
  • Has great hope for community collaborations – every LMHA will have a plan for one
  • indigent defense funding is limited – until that is corrected the justice system will remain unbalanced
    • need to get a handle on why the costs are increasing
    • what is needed to meet constitutional requirements
  • counties provide 100% of cost related to CPS cases
    • demand for services is often inverse to the tax base
  • need to start collecting more data on services provided in jails above initial evaluations
    • will help better show costs of mental health in a similar way to indigent defense costs
  • Coleman – the work the mental health select committee has done to create a framework to increase the number of beds for competency restoration outside the jail setting will take time, have we looked at what it will cost to do that?
    • Does not think the agency should be given any more money until the backlog has been reduced – contracted beds need to be better utilized
  • Need to maximize Medicaid access – jurisdictional boundaries need to be reduced
    • Need to move to a regional approach at the LMHA and the County level for diversion programs and outpatient programs
  • Coleman – am optimistic that we will be able to fill the hole created in 2003 – have been working toward that
  • Springer – noted that opioids are the thing that are getting all of the news, but there are many other types of substances that are being abused
  • Coleman – need to change the language being used to behavioral health to ensure that that the local and regional authorities can work on what is affecting them
  • Discussion of statewide bond issue for voters to consider for the capital needed for these types of programs with stipulations included

 

Brandon Wood, Texas Commission on Jail Standards

  • Standards of Sandra Bland Act have been implemented
  • Have been distributing funds to qualified facilities – related to equipment
  • Coleman – at $8,000 that just means that we didn’t put enough in
    • To be fair, costs for telemedicine infrastructure was not nearly as expensive as was expected
  • Counties still express concern with ongoing cost of providing the service
    • Working with stake holders to determine what the trigger for using the telemedicine options
  • Coleman – the intent revolves around overall services not just the screening aspect
  • There was some apprehensiveness on how to meet the requirement, but are working through that
  • Coleman – need to look at the governor’s law enforcement and mental illness grant funding
  • Regarding continuity of medications – language to allow flexibility was included specifically – continuing to work with counties to come up with solutions and plans to help ensure stable treatment of those in custody
  • Coleman – this was not in the SBA, but increasing personnel to accommodate some of the training requirements
    • That is a success, the funding provided was enough to provide for 3 full time personnel to provide training across the state, especially in rural areas
    • In less than a yea 6,000 jailers have received the training
    • Within 4-year period will have everybody trained
    • Will need more funding for additional training opportunities
  • One piece that needs to be cleaned up is related to 24-hour telemedicine for those who already provide 24-hour mental health surveillance
  • Memorandum will be sent out related to bed requirements by 2020
  • Coleman – if something requires a statutory change we need to get that done during this upcoming session

 

Michael Antu, Texas Commission on Law Enforcement

  • Described training released to officers: over 10,000 officers received training related to de-escalation and crisis intervention training
    • Crisis intervention was expanded from 16 hours to 40 hours
  • Coleman – discussed of licensing jailers in Texas
  • Biederman – How has the response been from the municipalities?
    • We have not received any negative feedback
    • Training always brings better practice

 

Holly Robles, Boerne ISD

  • Coordinator of affective learning within the district
  • We have been working on a comprehensive suicide prevention plan and drug abuse prevention plan after considering the components of HB 1386 and HB 2186
  • Because of our work, we have not lost a single student to suicide in over 3 years
  • Training our teachers, parents, and students to recognize mental health needs is necessary and an understanding of how to use the Columbia Suicide Rating Scale
  • Even with population growth of 11% over the last 3 years we have seen a 22% drop in substance abuse issues and violent offenses since the prevention services began
    • Also had a 90% drop in serious misbehavior in the DAEP
    • Offer alcohol and substance abuse prevention counseling in DAEP
  • There is no mandate to use Texas Suicide Safer Schools Plan in any district
  • Coleman – believes that it is mandatory, but if clarification is needed or if there is a reluctance for people implementing the plan, we need to set standards
    • I think there is a need for guidance
  • Coleman – I thought regional service centers would provide that guidance?
    • I have been asked by 6 service centers for help
  • Biedermann – Chairman, we know there will be a lot of emphasis on school safety and mental health this session. Shouldn’t we be able to tie this in?
  • Coleman – I believe this will get support. The difficulty is in identification and there are several ways of look at this and approaching it
    • What some of the research shows regarding school shooters is that 80 to 90% have reported suicidal ideation
    • There is potential in identifying suicidal ideation and stop a majority of shootings
  • Described personal opinion of need for LPC positions in schools
  • Have recruited clinical counseling interns and LPC interns on campus – all utilized for free
    • Specifically, clinical not school counseling
  • Uresti – How are you spreading this to other districts?
    • I have done info sessions. If there is no LPC supervisor in a district, then they cannot replicate the student intern program
  • Uresti – The fix would be to get the legislature to mandate and fund it next session?
    • That would be amazing
  • Biedermann – It’s not necessarily that we need to mandate it but make it more visible.
  • Coleman – One of my first calls after Santa Fe was to the governor’s office. I wanted to tell them that I was going to be very active in this.
  • Discussion of guidelines and permissive language for clinical counseling in schools
  • Uresti – discussed need to change school policies to allow for these types of programs to be implemented
  • Coleman – Could you send your major concerns and recommendations to the Committee?
    • Will provide that to the committee