This is the first 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 2023.1 The goal of these recommendations is to provide solutions other than jail to address mental health and substance abuse disorders in the county.2
The project is a joint effort of the Travis County Commissioners Court and the Dell Medical School at The University of Texas at Austin. The project’s steering committee began meeting in May 2022.
In the 45-page recommendation document, the steering committee first defined the problem it was seeking to solve:
“People become trapped in or cycling through jail waiting for behavioral health services and solutions.” (The committee terms this the “intersection.”)
Next, the committee defined its planning principles:
“The needs of the people stuck in the behavioral health/criminal justice intersection, including crime victims, supplant the individual aims of the planners.
“We will correct sociodemographic inequities.
“We will make decisions by consensus, based on data, best evidence- and strength-based practices.
“We will hold conversations that are respectful, open-minded, and results oriented.
“We will build from and collaborate with existing groups focused on the intersection, including gaining as much community input as feasible while balancing a timely response.”
The vision of the project is that jail should not be used as a treatment, a holding space, or a solution for mental health or substance abuse conditions. Behavioral health conditions should be treated through clinical care and social supports.
Over the course of 100 days, eight workgroups met repeatedly to come up with recommendations for each of their respective topics: adjudication, alternatives to competency restoration, Central Booking, in-jail interventions, law enforcement interaction and arrest, legal representation, mental health evaluation, and successful re-entry and jail prevention.
“In an ideal system, when a peace officer is called to or encounters an individual potentially expressing behaviors from a mental health (including substance use) disorder, real-time clinical support is provided,” the recommendation document says.
Local mental health authority Integral Care’s Expanded Mobile Crisis Outreach Team (EMCOT) is an example of such a program that can provide real-time clinical support.
EMCOT is a partnership between Integral Care and law enforcement agencies to provide police/mental health co-responses to divert individuals into appropriate care settings rather than jail. The priority of EMCOT is to find the most appropriate location for a person to be evaluated and then appropriately treated—or “triaged.”
If appropriate, EMCOT can recommend the person be transferred to the emergency departments at Dell Seton Medical Center, St. David’s, Ascension Seton, or Baylor Scott & White. “Crisis respite units” operated by Integral Care are also available at Next Step, the Herman Center, the Inn, and 15th Street. The Sobering Center also offers substance intoxication recovery beds.
Despite EMCOT’s efforts, many people to whom EMCOT responds end up in one of two scenarios: back to where they started (frequently homeless and on the streets), or criminally charged.
“873 people with a mental health identifier are waiting in jail for an alternative solution,” the document says. “While in jail, people may be identified as incompetent to stand trial and be ordered to receive competency restoration.”
Austin State Hospital is a frequent destination for competency restoration, though it “lacks capacity for the volume of admissions requested and is frequently not the most clinically appropriate venue for this process,” the document says.
“In an ideal system, the clinician and peace officer can make a shared decision to either take the person to Central Booking for legal processing or invoke a ‘pre-arrest’ diversion to an alternative intervention, namely a diversion center,” the document says.
In this system, the diversion center is a secure facility that provides thorough clinical evaluation, offers legal support for those who have legal charges, and initiates and refers the individual for mental health disorder treatment. Admission to the diversion center may be voluntary or offered in lieu of legal processing and jail.
“The goal of the diversion center is to provide a location and services to help decriminalize mental health disorders while supporting the individual’s needs for long-term care and support in the community and processing any legal charges that are not or cannot be dismissed,” the document says.
Endnote
1 Travis County Forensic Mental Health Project
2 https://www.traviscountytx.gov/topics/forensic-mental-health-planning