This is the final installment in a series of seven articles about the Travis County Forensic Mental Health Project. This series of articles was named the Best Series of Articles – General Interest by the State Bar of Texas‘ Division III Stars of Texas Bars Awards.
The Travis County Forensic Mental Health Project delivered its recommendations to the Travis County Commissioners in March 2023. The goal of these recommendations is to provide solutions other than jail to address mental health and substance abuse disorders in the county.
In its Recommendation #3, The Travis County Forensic Mental Health Project compiled a list of what it termed “quick wins”—recommendations that can be implemented relatively quickly with low costs, one-time costs, or low ongoing costs.
Quick Wins – Low/No Cost
The first of these quick wins is to create training on Article 16.22 of the Texas Code of Criminal Procedure.
“The 16.22 Mental Health Evaluation can be requested by the magistrate judge prior to magistration and provides the judge with an overview of an individual’s mental health status, needs, and potential community programs and services they could enroll in if allowed to bond out of jail,” the document says.
Though the Texas Judicial Commission on Mental Health recently released the Texas CCP Art. 16.22 Guide – January 2023,1 “there is no official integrated training on how or when to request a 16.22, how to complete it, how recommendations in it could impact the outcome of release for an individual, and how a judge or attorney can read and/or interpret a 16.22 aimed at both legal and clinical professionals.”
The Project recommends developing 16.22 training in partnership with the Behavioral Health Care Judicial Advisory Committee, which “already has the appropriate legal and clinical stakeholders available to create a training program that could be implemented for all magistrate judges, and legal and clinical professionals who interact with the 16.22 evaluation.”
The only cost associated with this recommendation is the committee’s time, the document says.
“Ideally, this training program would be in place when the counsel at first appearance (“CAFA,” see article 62) pilot is reinstated and offered to both prosecuting and defense legal representatives, leading to synergistic improvement in the process,” the document says.
Another low-cost quick win is establishing data use agreements (“DUAs”) for sharing data between courts, jails, law enforcement, Integral Care, and other mental health stakeholders in the county. DUAs are “highly important to reduce time between sharing among county and other entities’ data for analysis, system improvements, and continuity of care,” the document says.
The major cost associated with this recommendation is an investment of time, while there are minimal ongoing costs once the DUAs are in place, the document says.
Another quick win is consolidation of probable cause affidavits (“PCAs”).
“Currently there are several different PCAs that circulate throughout the different jurisdictions located within Travis County,” the document says.
The Project recommends standardizing one PCA to be used throughout the county, developed cooperatively by representatives from local jurisdictions and Central Booking.
“This could be completed in a short time frame,” the document says.
The Project also recommends creating protocols for how individuals flow through mental health evaluation in jail.
“When an individual enters Central Booking, several assessments and evaluations take place almost immediately,” the document says. “Often, individuals are agitated, angry, anxious, or exhibiting other behaviors they normally would not exhibit due to the stressful and sometimes traumatic experience of being arrested and taken to jail; consequently, incomplete, or inaccurate information are collected, especially regarding mental health needs.”
The Travis County Sheriff’s Office (“TCSO”) attempts to re-evaluate individuals, but there is no standardized process for doing so, “which means their initial screening may be used while making decisions such as bond or accepting charges,” the document says. “To obtain the most accurate information and provide the best care for individuals,” TCSO mental health professionals should convene with legal professionals to standardize re-evaluation methods. The cost is an investment of time, the document says.
The Project also recommends all county employees and contractors who interact with the criminal legal system take Integral Care’s free Mental Health First Aid training.
“Time costs to consider are the coordination for training sessions and employee time from regular duties to attend trainings,” the document says.
The Project also recommends creating an evaluation referral system for individuals with brain-health conditions. It defines brain-health conditions, such as traumatic brain injuries, dementia, and Alzheimer’s, as more complex than mental health conditions, such as substance abuse disorders. While jails and courts currently can order in-depth evaluations of those suspected to have severe brain-health conditions, “a more robust referral process for an in-depth evaluation would be beneficial,” the document says. Such in-depth evaluations would include MRIs, CAT scans, and neuropsychological testing. Such an evaluation referral system could be handled by email.
The Project also recommends implementing in-jail guardianship screenings.
“Currently the jail does not screen for guardianship needs,” the document says.
Adding guardianship screeners to the intake process would add minimal time and will allow the county to collect more data on the needs of the individual.
Quick Wins – One-Time Costs/Minor Ongoing Costs
The Project recommends that pretrial services utilize the Coordinated Assessment tool managed by Austin’s Ending Community Homelessness Coalition (“ECHO”). According to ECHO, this tool uses a “vulnerability index to prioritize individuals and families most in need of housing services … . Once assessed, households are referred to the programs they qualify for.”3
“Pretrial services can explore utilizing the Coordinated Assessment to ensure someone is either on the housing need list or … have them added,” the document says. “Doing so will add a short amount of time to the pretrial services process, and cost is tied to the time of the staff completing this effort.”
The Project also recommends convening stakeholders to develop boarding home regulations and licensing. (See article 4.4)
Based on a 2008 report,5 Texas boarding homes were found to be “unacceptably dangerous …unsanitary … and negligent … . In addition, financial abuse was observed as several owners require residents to appoint the boarding home as their representative payee for any federal or state financial support,” the document says.
In order to provide a safe environment for individuals in boarding homes, the Project recommends a group of Travis County stakeholders convene to research existing counties that have implemented boarding home licensure and regulation improvements and provide recommendations to the Commissioners Court.
“Better regulation could have substantial impact on residents of the boarding homes and ensure their safety and wellbeing—physically and financially,” the document says, adding the costs associated with this recommendation would “potentially include a one-time consultant or contractor fee, as well as employee time.”
Major Investment
The Project’s Recommendation #4, increasing certified peer support specialists in the county,6 would be a major investment, though it could be implemented faster than the other priority recommendations, the document says.
“The highest priority recommendations will have the largest positive impact for individuals within the intersection of the criminal legal and mental health systems and the community,” the document says. “Regardless which recommendations are chosen to implement, we recommend that the Court assign an independent team for project management, guidance, and implementation to ensure efforts continue for the safety of the community and the care for the individuals in this complex revolving door.”
Shortly after these recommendations were delivered to the Travis County commissioners, a mental health diversion program was approved. In April 2023, the county set aside $6 million for the center.7
A pilot program, a collaboration of Travis County, the City of Austin, Integral Care, and Central Health, is expected to be up and running by May 2024, Travis County Judge Andy Brown told KXAN. Plans for a permanent diversion center are also being developed, but could take up to five years to come to fruition.
In total, the pilot mental health diversion program is expected to cost $23.7 million over three years, with city, county, and possibly state funding, as well as funding from Central Health and Integral Care.
ENDNOTES
1 https://texasjcmh.gov/media/fpeltz22/16-22-guide-final-for-web.pdf
2 Austin Lawyer, Feb. 2024, p. 22, “Decriminalizing Mental Health in Travis County: Part 6”
3 https://www.austinecho.org/leading-system-change/coordinated-entry/
4 Austin Lawyer, Nov. 2023, p. 20, “Decriminalizing Mental Health in Travis County: Part 4”
5 http://boardinghome.org/wp-content/uploads/2013/12/BH-Boarding-Houses-Report-01-09.pdf
6 Austin Lawyer, Dec. 2023/Jan. 2024, p. 20, “Decriminalizing Mental Health in Travis County: Part 5”