It is estimated that 30% of the county jail population in Texas has mental illness. Individuals in a mental health crisis are typically taken by law enforcement either to jail or to a hospital emergency room. The estimated 22,000 persons who suffer from mental illness are repeatedly cycling through jails, emergency rooms and hospital and are referred to as “super-utilizers”. They cause Texas taxpayers to incur at least $1.4 billion in emergency room costs and at least $450 million in local jail costs. Texas has the capacity to serve one in seven or 3,400 super-utilizers.
Persons with mental illness diverted from jail need treatment and medication as soon as possible. If not, it is very likely that they will go back into crisis and will end up back in jail. Often when an individual is released from a mental health facility or from jail, he/she will receive enough medication for “X” days and outpatient care information for follow-up care in the community. Much of the outpatient care is coordinated through the Local Mental Health Authorities. A reliable continuum of care, especially in an outpatient setting, was lacking.
The 84 th Legislature 1 began to address these issues by creating the House Select Committee on Mental Health which would submit recommendations for consideration by the 85 th Legislature 2 . The Committee held eight public hearings throughout the State with over 40 hours of testimony from more than 100 expert witnesses plus testimony from the public. Some of the recommendations of the Select Committee were: improve opportunities for integrated health care; utilize and expand use of technology through the use of telemedicine and mobile applications; and increase access to substance abuse treatment and housing supports and continued investment in mental health outpatient services.
The 85 th Legislature finally recognized that confining Texans with mental illness in jail is a bad policy. As a result of this recognition, jail diversion for nonviolent people with mental illness was recognized and codified in the Sandra Bland Act (SB 1849); with supporting laws for its implementation and funding, including SB 292 3 , HB 13 4 and HB 337. 5
Previously, SB 58 (83 rd Leg 6 ) expanded the delivery of mental health services, including targeted case management and rehabilitation services for the Medicaid population, from local mental health authorities to include private providers. The relevant portion of SB 58 reads: The Commission shall, to the greatest extent possible, integrate into the Medicaid managed care program implemented under this chapter the following services for Medicaid-eligible persons: (1) behavioral health services, including targeted case management and psychiatric rehabilitation services; and (2) physical health services. A managed care organization that contracts with the commission under this chapter shall develop a network of public and private providers of behavioral health services and ensure adults with serious mental illness and children with serious emotional disturbance have access to a comprehensive array of services. V.C.T.A., Government Code § 553.00255 (a)-(c). The above laws passed by the 83 rd and 85 th Legislature expanded mental health services to private providers and implemented policies to divert non-violent persons with mental illness from County Jails and emergency rooms.
Inspired believes having mental illness should not be a crime. As a result of the Legislature’s good work, it became the first (and only) facility of its kind in Texas and began accepting residents on August 2, 2018. It operates a voluntary jail diversion program for people with serious mental illness modeled on the Home and Community-Based Services—Adult Mental Health program. It provides supervised living services to adults who have serious mental illness and are in the criminal justice system and is licensed as an Assisted Living Facility. Currently, Inspired has two casita type homes housing thirty-one (16 men and 15 women) residents that have been diverted from Cameron County jail and a 15 bed residential facility for men in Fort Bend County.
Inspired has a contract with Cameron County and Fort Bend County to divert up to 47 persons with mental illness from the county jail, with an ultimate goal of 20 casitas and 320 residents. Under the Sandra Bland Act, inmates are identified by a Mental Health Professional from the Sheriff’s Office as candidates for treatment. And, if they choose to go to Inspired a personal recognizance bond is issued by the Judge. Compliance with the treatment and rules of Inspired are conditions of the bond. The residents are free to leave the facility at any time. And some have chosen to go back to jail.
Inspired has a great partnership with the County. The Commissioner’s Court, the District Attorney, the Sheriff’s Office, the County Court at Law Judges and Inspired work together to make this program successful. Inspired has had tremendous success in the short time it has been open and has demonstrated considerable evidence-based outcomes for improving the health of residents.