Houston Police Department Mental Health Unit: Crisis Intervention Team

Houston Police Department Mental  H P li D M l Health Unit Health Unit

Houston’s Mental Health Crisis Response
 The HPD Mental Health Unit is located in the  Harris County NeuroPsychiatric Center  Crisis Intervention Team (CIT) started in 1999 as  result of collaboration with mental health  result of collaboration with mental health community  Houston has 1,670 Crisis Intervention Trained  (CIT) officers who respond to incidents involving  the mentally ill the mentally ill

Houston’s Mental Health Crisis Response
 Every year, Houston Police respond to over 25,000  incidents involving persons in a mental health crisis incidents involving persons in a mental health crisis  In 2008, HPD committed over 3,200 persons in a  , , p mental health crisis  On average, every 2.5 hours, HPD officers detain a  person in a mental health crisis and file an  Emergency Detention Order Emergency Detention Order

INCREASED CALLS

Law enforcement has become  the front  line mental health response li t l h lth
 Si l largest mental health facility in the U.S. is the Los Single l l h l h f ili i h U S i h L Angeles County Jail with over 3,000 prisoners a day on p y psychiatric medication  Harris County Jail averages 2,400 prisoners a day on psychiatric medication  As of 9/1/2009 all 10 state mental health hospitals had 9/1/2009, a combine patient count of 2,328

Approximately half of our SWAT calls involve a person  in a mental health crisis.  This trend is occurring  nationwide

Nationally, it is estimated that 10% of all police  calls involve a person in a mental health crisis calls involve a person in a mental health crisis

Collaboration is Key
 Response strategies are examples of Smart,  proactive, collaborative community policing proactive collaborative community policing  Identify a difficult issue and engage  stakeholders as partners  NAMI, MHMRA, MHA have been partners with  HPD for over 10 years

An effective mental health response is  more than just training th j t t i i
The following are three examples of need for specialized police response strategies:

January 8, 2007
Omar Esparza Omar Esparza 21 year‐old  with recent  symptoms of mental illness 3 weeks prior to shooting, began  acting irrational, not bathing or  changing clothes Had delusions of demons flying  through the windows Was on waiting list to be seen by  MHMRA After 2 hour standoff, charged  officers with hammer and fatally  wounded. 

May 6, 2007
Marnell Villareal 42 year‐old with history of  shizophrenia History of  trespassing at 1200  Travis Made claims of laser beams being  shot through her head, food  being poisoned Numerous hospitalizations for  mental illness Entered 1200 Travis with knife,  stabbing herself in head while  screaming for officers to kill her 

July 21, 2007
Stephen Guillory Stephen Guillory 39 year‐old male with lengthy  history of schizophrenia Detained and committed by HPD 3  times in prior year Just released from HCPC 1 week  Just released from HCPC 1 week prior to  fatal encounter with police Quit taking medication, deteriorated  Mother called 911 after being  turned away by HCPC   Charged officers with pipe and told  g pp them “Shoot me”

Crisis Intervention Response Team

Crisis Intervention Response Team (CIRT)
 Pairs a CIT officer with a licensed mental health clinician  a sa o ce a ce sed e a ea c c a from MHMRA  Respond to the most serious CIT calls  Seven full‐time units provide 24/7 coverage  Respond to all SWAT calls

Crisis Intervention Response Team (CIRT)
 Conduct pro‐active and follow‐up investigations o duc p o ac e a d o o up es ga o s  Pro‐actively engage the homeless population y g g p p  The only program of its type in Texas and one of a few  nationally (LAPD, San Diego, Vancouver)

CHRONIC CONSUMER  CHRONIC CONSUMER STABILIZATION INITIATIVE
A MULTI‐AGENCY COLLABORATION

WHAT IS CCSI ?
 The Chronic Consumer Stabilization Initiative (CCSI) is a  collaborative effort between the Houston Police Department,  The Mental Health Mental Retardation Authority of Harris  County (MHMRA) and The City of Houston Health and Human  Services CCS as des g ed to p oact e y de t y, e gage, a d p o de  CCSI was designed to proactively identify, engage, and provide  services to individuals who have been diagnosed with serious  and persistent mental illness and who have had frequent  encounters with the Houston Police Department encounters with the Houston Police Department

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 Mental Health Task Force formed in September  2007  Task force comprised of law enforcement,  community leaders, and mental health advocates community leaders and mental health advocates  Goal was to closely examine recent deadly Goal was to closely examine recent deadly   encounters and identify possible solutions  Met three times over a six week period

TASK FORCE RECOMMENDATIONS TASK FORCE RECOMMENDATIONS:
 1 Id tif 30 1. Identify 30 most chronically mentally ill with  t h i ll t ll ill ith highest number of police contacts  2.  Assign these 30 individuals to two mental  health caseworkers for intensive  supervision  3.  Add mental health screening to 911 dispatch  protocol

 The Chronic Consumer Stabilization Initiative began as a six The Chronic Consumer Stabilization Initiative began as a six  month Pilot Program: February 15, 2009 through August 15,  2009  Two Case Managers were hired & trained by MHMRA and  funded by the City of Houston Health & Human Services   Staff were responsible for engaging and interacting with thirty  (30) of the most chronic and problematic consumers  identified by the Houston Police Department s Mental Health  identified by the Houston Police Department’s Mental Health Unit; priority was based on the number of interactions with  police officers within the last calendar year

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PROGRAM GOALS
 Reduce the number of interactions with the Houston  Police Department  Identify unmet needs and barriers in the community  Link and coordinate clients with needed mental  health treatment and psychosocial services health treatment and psychosocial services  Provide support and education to the individual and  their family members

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ELIGIBILITY CRITERIA
 Three (3) or more admissions to the Neuropsychiatric Center  (NPC) by Houston Police Department (HPD). NPC is a  psychiatric emergency room  E Excessive and high frequency of phone calls made to HPD by  i d hi h f f h ll d t HPD b clients or others, on their behalf  High frequency of contact with HPD  High utilizers of City of Houston services h l f f

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STAFFING
 Direct Care Staff:

 One Master level case manager with  approximately 30 years of Case Management  approximately 30 years of Case Management experience  One bilingual (Spanish speaking) case manager  with approximately 8 years of Case  Management experience
  HPD Mental Health Unit Liaison Officer Administrative oversight provided by Assistant Deputy for  Administrative oversight provided by Assistant Deputy for CPEP services & the Lieutenant for the HPD Mental  Health Unit

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SERVICES PROVIDED
 Crisis Intervention and Relapse Prevention  Screening and assessment  Case management & psychosocial supports Case management & psychosocial supports  Referrals for primary health care substance abuse Referrals for primary health care, substance abuse  treatment, job training, educational services, and  relevant housing services  Family education and support 

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PILOT SUCCESSES
 Decreased the overall number of interactions  between CCSI clients and the Houston Police  Department by 70%  Decreased admissions to NeuroPsychiatric Center by 21%  Admissions to Harris County Psychiatric Center  y y (HCPC) decreased by 51%

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CCSI RESULTS

After the six-month pilot of intense engagement and interaction between the two case managers and the listed consumers, there was a 70% DECREASE in overall events reported by the police department This represents a significant reduction department. of police contacts. Calls-for-service decreased by 67.3%, emergency detention orders (EDO) decreased by 76.4%, and offense reports also decreased by 67.3%.

FINANCIAL IMPACT RESULTING FROM REDUCED  HOSPITALIZATIONS
Clients enrolled in the CCSI program achieved an overall decrease in admissions to the   NeuroPsychiatric Center and at the Harris County Psychiatric Center (HCPC).  This decrease in  admissions resulted in a cost savings of $176,550 during the six‐month pilot.

WHAT WORKED???
 Diverted calls from 9‐1‐1 by providing case  manager cell phone numbers to clients  Strong advocacy role of case managers  No State funding restrictions  Houston Police Department involvement and  support S Support from the District Attorney’s Office  tf th Di t i t Att ’ Offi  Consistency and dependability of case  managers  Networking(communication among providers)
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CURRENT STATUS AND NEXT STEPS
 City Council extended funding through 2011  Formation of an Advisory Council comprised of  representatives (who have decision making authority)  from community agencies from community agencies  Expand the program by adding additional clinical staff  pa d t e p og a by add g add t o a c ca sta and pair into teams to work with clients  Dedicate a full‐time police officer position to the CCSI  program

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QUESTIONS ?? QUESTIONS ??

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CONTACTS

WWW.HOUSTONCIT.ORG