Description of original award (Fiscal Year 2021, $550,000)
In San Antonio/Bexar County, Texas, mental health treatment needs have outstripped resources, and thousands of youth and adults with serious mental illness (MI) or co-occurring mental illness and substance abuse (CMISA) do not have access to timely, appropriate care. Their unabated mental illness triggers a host of adverse consequences, including job loss, alienation from friends and families, homelessness, and a reliance on petty crimes for survival. Bexar County’s experience is not unique, and is replicated in communities across the nation; however, the depth of the problem is particularly profound: at any given time, the Bexar County Detention Center houses 150-175 inmates who are on a wait list for a treatment bed and inpatient competency restoration services from one of Texas’ state hospitals. Wait times average 18-24 months, costing $651,240 per month or $16 million over two years. This expense is borne by Bexar County in general, and most particularly by the Sheriff’s Department, operator of the Detention Center.
To alleviate the issue, the local mental health authority (the Center for Health Care Services or CHCS) has worked with Bexar County, Bexar County Sheriff’s Department, and the South Texas Regional Advisory Council (STRAC) to develop a strategic plan that would enhance and coordinate local diversion resources, better identify and engage low-risk, non-violent offenders with MI or CMISA, and avoid their decompensation and harm to self or others. Key strategies include expanding pre-booking assessments and diversion, increasing Outpatient Competency Restoration (OCR) services, and adding Jail Based Competency Restoration (JBCR) services.
Based upon current data, the project will assess an average of 876 offenders per month (26,280 during the Implementation Phase), and of those assessed, 60 per year will be referred for the new JBCR services; the service period will fluctuate for each but an estimated 210 will benefit across the Implementation Phase. An additional 300 per year will be referred for OCR or diversion from the criminal justice system; in the latter case, charges will be dismissed and CHCS clinicians will make connections to outpatient treatment and wraparound services dually focused on recovery and the prevention of recidivism. CHCS will be the primary source of these resources, with support from University Health System.
The requested BJA funding will enable the partners to implement the strategic plan, reduce recidivism and enhance public safety. This evidence-based, humane response also will advance due process and preserve the civil rights of the offender.
Program Specific Priorities: CHCS and its partners will meet BJA’s Program-Specific Priority Areas by: 1) introducing/expanding evidence-based services (pre-booking clinical assessment, OCR, and JBCR) known to identify and reduce the risk of harm to persons with MI or CMISA; 2) using trauma informed care and approaches, evidence-based methods of identifying and treating female offenders with MI or CMISA; 3) using highly valued tools (OCR, JBCR, and the consistent monitoring of persons with MI or CMISA found to be IST) to support mental health courts; 4) using evidence-based models for reducing recidivism delivered with trauma-informed approaches (OCR and JBCR); 5) using an assessment tool that is evidence-based; and 6) applying BJA funds to public safety-enhancing measures.