Report looks at gaps in mental health services for criminal defendants

May 04--There are more mental health services for criminal defendants in Travis County than ever. But most programs lack sustainable funding and cannot meet rising demand, while limited access to substance abuse treatment and affordable housing remain among the major barriers to stability for many.

Such conclusions are drawn in the most recent report from the Behavioral Health Advisory Committee and are part of an effort among county and community groups to address a problem faced nationwide: lowering the number of mentally ill criminal suspects shuffled in and out of jail.

As of Friday, the total number of mental health calls to Austin police alone totaled more than 1,800 this year, while the number of people who were booked into jail and flagged as possibly having a mental illness has steadily increased, from 4,215 in 2011 to more than 6,000 last year.

The committee leaders said the aim of the study was to look at the resources available in hopes of identifying the gaps in care.

"It is a way for the community to examine its criminal justice system in a very thorough, pragmatic way and then go about tackling the problem by looking at it as 'you divert where you can,' " said County Court-at-Law Judge Nancy Hohengarten, who oversees the mental health docket.

The Spring 2015 report, released last month, is the latest of two evaluations from the advisory committee that Hohengarten helped form in the fall of 2011, with about 70 representatives from law enforcement agencies and mental health and social services providers across Austin and Travis County.

Committee members compiled information on more than 50 facilities, programs and services that could help divert a mentally ill person from incarceration at five different points of the criminal justice system, starting with the resources available when someone first calls 911.

Among the most successful programs polled were those that provided mental health training and backup to law enforcement officers. Particularly lauded was the Mobile Crisis Outreach Team under Austin Travis County Integral Care. The unit allows at least one licensed social worker or mental health practitioner to respond to mental health calls alongside Austin police, sheriff's deputies and Emergency Medical Services personnel.

That gives mental health professionals the chance "to provide the right care at the right time to avoid unnecessary incarceration," said Sherry Blyth, director of practice management of Adult Behavioral Health at the integral care agency. "Most people who are mentally ill are not calling our hotline or walking into our doors. The first person they see is the police."

Its leaders and members say the expansion of the mobile unit took extensive collaboration across various agencies, as it was a dramatic departure from standard emergency response protocol. And social workers and defense lawyers point to its big impact in the community: roughly 89 percent of the 529 emergency calls to Austin police and about 79 percent of the 641 Austin-Travis County EMS 911 dispatches to which the team has responded since May 2014 were resolved without any arrests.

But like for many of the mental health services surveyed, its biggest hurdles are funding and a strain on resources. Mobile unit members cannot make it to every call, even as the team has grown significantly since its inception in 2006, when it had only four members and a $400,000 budget that Travis County commissioners solely funded.

It now operates on county and state money totaling $3 million and has a staff of more than 40 people throughout the city. Yet after a federal waiver program phases out next year, the county and city will need to find an additional $1.8 million to sustain the unit at its current size.

At every point of intervention in the criminal justice system, the other major concerns are few options in substance abuse treatment and housing. Finding an affordable place to live has become a burden for all low-income residents in Austin, committee members said, but it is especially acute for mentally ill criminal suspects, many of whom cannot work and do not qualify for unearned income, such as Social Security benefits.

The challenges are compounded when defendants have been convicted of assault or other violent crimes, disqualifying them from certain housing programs.

Among communities most in need are homeless veterans' families, tallying more than 780 households in Travis County, according to the report. Caritas of Austin Supportive Services for Veteran Families said landlords must be willing to accept vouchers, as about 50 percent of homeless veterans are in need of permanent supportive housing.

Health advisory committee leaders say they are taking into account these issues moving forward, especially as stakeholders' top priorities in the coming year will be enhancing the county's mental health bond program and developing a plan to more quickly connect newly released inmates with health and social services.

Travis County officials just last month announced they would be refining the booking process in an attempt to reduce the amount of time offenders must wait to access community resources, which can take up to a month.

"Housing, transportation and connecting clients with basic resources are the biggest challenges I have faced," criminal defense lawyer Amber Vazquez-Bode said. "There is just more demand than supply."

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