Mental Health and Criminal Justice Coalition Visits Bexar County

On Wednesday May 11th, members of the Mental Health and Criminal Justice Coalition visited  San Antonio, TX to learn more about Bexar County’s jail diversion programs. Hosted by the Center for Health Care Services (CHCS), the group met with program administrators, law enforcement, healthcare professionals, and representatives from mental health and judicial services of Bexar County.

CHCS states that they serve as a model for jail diversion programs, and they presented a lot of data to back up that claim.

Coalition members were greeted with care by Marisol Lucio, the Center’s Tour and Volunteer Coordinator. Leon Evans, President and CEO of CHCS, welcomed the group and discussed the history of the organization and other services in Bexar County. Following his welcome, the members took a tour of the facility, then settled back in for numerous presentations.

Law Enforcement and Mental Health

The theme of collaboration between law enforcement and mental health services was highlighted throughout the day. The group heard from representatives of the San Antonio Police Department Mental Health Unit, Officers Ernest Stevens and Joe Smarro, and Sgt. Mark Galan from Bexar County Sheriff’s Office Mental Health Unit. Coalition members learned that 95% to 100% of their officers go through Crisis Intervention Team (CIT)  training, well above other communities’ percentage of CIT trained peace officers. CIT is a 40 hour training for law enforcement officers to learn about de-escalation strategies, and promotes collaboration between mental health professionals and law enforcement. There also was discussion about the lack of mental health training in police academies and the need for a cultural shift to prevent mental health from being such a large predictor of long-term criminal justice involvement. This leaves us wondering what other alternatives there are to prevent interaction with law enforcement in the first place.

Jail Diversion Programs

The Restoration Center provides an alternate place for law enforcement to bring individuals instead of jail. As previously mentioned, CHCS and Bexar County staff presented much data about the effectiveness and efficiency of the jail diversion programs. The presentations highlighted the high cost savings of their programs, and the short-term data regarding minimizing criminal justice involvement. Although the facilities at the Restoration Center mimic a jail setting - an abundance of locked doors, small rooms, and bare cement walls - the center is an alternative option to jail and prevents someone from being charged with a crime and booked, keeping their record clean for that interaction with the police. The center offers sobering facilities, counseling, detox and substance use treatment. Law enforcement in Bexar County can use their discretion to bring people to the center rather than jail or a hospital, unless needed. Although the center can provide minor medical care, it is not equipped for more serious medical treatment. Because of a full agenda and the lack of time for questions, it is unclear what formal policies, if any, the law enforcement agencies have in regards to how they decide to utilize these programs. This seems to be determined by the Restoration Center’s eligibility criteria, and the discretion and training of the officer.

Overall, the center seems to be an opportunity for people to choose treatment over incarceration, with law enforcement still ultimately determining that fate. The programs provide access to interventions that may not otherwise be available.

Participants and Impact of Programs

In the last six months, the sobering center has served 2,003 individuals. The average stay is around 5 hours. Eighty-five percent were admitted because of alcohol use. Sixty-seven percent were experiencing homelessness. The majority, sixty-four percent of admitted individuals are referred by the San Antonio Police Department. From October 2015 to April 2016, the center served 2,003 individuals, compared to 1,452 persons that were booked for public intoxication.

The Restoration Center’s detox program served 1,031 individuals from October 2015 to April 2016. They report that fifty-seven percent have successfully completed detox, with the rest discharged prior to the full stay. This program is not involuntary, thus, participants have the option to leave prior to the completion of the program. Similar to the sobering center, most participants (78%) are experiencing homelessness. Unlike the sobering center, sixty-two percent of participants are detoxing from heroin/opiates, with thirty-two percent detoxing from alcohol. Eighty-one percent of participants are walk-ins, with only twelve percent referred by the sobering unit. *data from CMDRT reports

Haven for Hope

Coalition members ended the day with a tour of Haven for Hope in San Antonio, led by Scott Ackerson. Haven for Hope is a 22-acre campus with a variety of services and organizations that serve individuals experiencing homelessness. The campus now houses organizations all in one place, rather than spread throughout the city. The group was struck by the community space, landscaping, and the amount of services provided. Mainly, it didn’t feel like a shelter or a place of public assistance. It looked and felt like a community.

There seems to have been a shift in Haven for Hope’s service-delivery and approach from when the doors first opened. Under the influence of Mr. Scott Ackerson, the services have become more client-centered, including more peer support. He discussed the idea of treating clients as customers, an approach that listens to the needs of the individual in determining services.

The concept of treating clients as customers is interesting because it differs from traditional service-delivery. Typically, professionals create programs based on other organizational models and evidence-based practices, with limited input from the actual consumer. Furthermore, programs and services are often rigid, and are often not flexible in catering services to the individual. We see this in many mental health and criminal justice institutions. The idea of listening to the individuals receiving services to inform practice is not new, but rather often underutilized.

Conclusion

Looking at alternatives to jail is imperative to be able to minimize long-term criminal justice involvement. Furthermore, alternatives can promote healing and access to treatment, that otherwise would not be available.   

Thank you to the Center for Health Care Services for inviting us to learn more about Bexar County’s efforts. A special thanks to Dr. Lynda Frost at the Hogg Foundation for Mental Health for organizing the visit.

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