COLLABORATIONS THAT WORK:
EXPLORING A RELATIONSHIP BETWEEN
LAW ENFORCEMENT & MENTAL HEALTH
Exploring the collaboration between the
Houston Police Department and the
Mental Health Mental Retardation Authority of
Harris County.
Houston / Harris County
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Houston / Harris County Facts:
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Population of Houston: 2.1 million
Size of Houston: 656 square miles
Population of Harris County: 4.1 million
Size of Harris County: 1,703 square miles
Area Law Enforcement Agencies: 62
Harris County Jail population: 8,800
25% of people in jail receive psychiatric
medications
7,500 Homeless at any given time
55% self-report mental illness
Historical Collaborations
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1978: Mental Health Needs Council established by
the County Judge as an advisory group to the Judge
and Commissioners and still in operation today
Membership includes over twenty organizations
including professional associations, public providers,
medical schools, and advocacy organizations
Recommendations to county leadership have resulted
in the establishment of Harris County Psychiatric
Center (1986), the HPD Crisis Intervention Team
(1999), and the Psychiatric Emergency Service
(1999) at the Neuropsychiatric Center
1999 – 2004: Harris County approved funding for all
major components of a comprehensive psychiatric
emergency program
CPEP
Comprehensive Psychiatric Emergency Program
• 1999:
Psychiatric Emergency Services PES at the
(Neuropsychiatric Center-NPC)
• 2002:
Crisis Stabilization Unit (CSU)
• 2003:
Mobile Crisis Outreach Team (MCOT)
MHMRA Helpline
• 2004:
Crisis Residential Unit (CRU)
• 2008:
Crisis Intervention Response Team (CIRT)
• 2009:
Chronic Consumer Stabilization
Initiative (CCSI)
• 2011:
CIRT Expansion to include Harris County
Sheriff’s Office
Effective Collaborations
Between
CPEP PROGRAMS
and
LAW ENFORCEMENT
MCOT Mission / Goals
The goal of the Mobile Crisis Outreach Team is
to provide crisis intervention and relapse
prevention services to individuals who are
experiencing a mental health crisis and are
unable to access treatment on their own or may
be ambivalent about receiving mental health
treatment.
CPEP COMPONENTS:
Mobile Crisis Outreach Team (MCOT)
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Staffed with Psychiatrists, RN’s, Licensed Therapists, Case Workers,
and Psychiatric Technicians
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Hours: 7A - 10P Weekdays (after hours covered by CIRT)
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Served ~2,800 in last twelve months; only 7% required hospitalization
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60% had no prior jail, hospital or MHMRA crisis history
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Community based services include:
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Crisis Assessment, Crisis Intervention and Relapse Prevention
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Medication Services
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Individual Counseling and Brief Psychotherapy
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Case Management and Rehab Services
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Family Education and Support
CIT/MCOT Collaboration
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Shared crisis calls
Reciprocal referrals
Collaborative trainings
Ride alongs/MCOT Practicum
Case staffings
CIT administrative participation in MCOT rounds
Incident debriefing
Safety training
Long history of collaboration
Strengthened Third Party Credibility of clinicians with law
enforcement
MCOT by the Numbers
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270-300 referrals each month
7% are self-referred
~ 9-12% come from law enforcement
110-120 cases open to MCOT at any given time
7 Master’s Level Licensed Clinicians, 9 Bachelor
Level QMHPs, 3 RNs, 2 Psychiatrists, 6
Psychiatric Technicians
CPEP Components
Psychiatric Emergency Service (PES)
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24/7 psychiatric emergency room
Staffed with psychiatrists, licensed social services, RNs and
psychiatric technicians
Served ~16,270 in past 12 months
912 were children/adolescents
421 were diagnosed with intellectual or developmental disabilities
Over 5,580 were brought by law enforcement
50% were treated and did not require inpatient hospitalization
PES & LAW
ENFORCEMENT
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Prior to PES, it took about 8 hours to hospitalize
someone on an Emergency Detention Order (EDO)
Often Officers spent their entire shift waiting to
involuntary hospitalize someone
Booking someone into jail took significantly less time so
clients were often incarcerated in lieu of hospitalization
to save time
Currently, it takes an average of 45 minutes for law
enforcement to involuntarily hospitalize someone at the
PES on an EDO
The Houston Police Department Mental Health Unit is
also co-located at the PES
Law Enforcement to PES
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In the past 12 months the PES treated over 5,500
involuntary consumers brought in by law enforcement.
This is an upward trend, compared to, 3,872 in 2008,
4,379 in 2009 and 5,365 in 2010. Eight percent were
adolescents or children.
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Currently ~35-40% of total admissions to the unit are
brought by law enforcement.
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Law enforcement take another ~3% from the PES on to jail
after a brief psychiatric evaluation. These are generally
consumers with a more serious charge who appear to
have psychiatric symptoms. A brief assessment form
completed in the PES is taken by the officer to the jail.
Law Enforcement at the PES
Total Law Enforcement
6,000
5,032
4,908
5,000
4,000
4,054
3,616
3,030
3,000
2,000
1,000
342
476
457
325
256
0
2007
2008
Adults
2009
Kids
2010
2011
CIRT
Factors Contributing to the
Development of the Crisis Intervention
Response Team (CIRT)
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Increased number of CIT calls:
2007: 15,122
2008: 21,109
2009: 23,913
Nationally, it is estimated that 10% of all police calls
involve an individual in a mental health crisis
Two tragic outcomes in Houston involving individuals with
mental illness
Constantly improving relationship between MHMRA
clinicians and Houston Police Department officers
Crisis Intervention
Response Team (CIRT)
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Implemented in 2008 with 3 Teams, each consisting of one
Licensed Master’s Level Clinician partnered with one CIT
trained officer from HPD
• Respond in Ghost Marked patrol vehicles
• Respond to calls involving individuals exhibiting
symptoms of mental illness and SWAT calls.
• In 2011 teams responded to over 6,330 calls and selfinitiated over 1,000 calls. Less than 1% resulted in
arrests; 28% taken to NPC.
Expanded to 10 teams in 2010
Expanded to 13 teams in 2011 with the addition of (3)
deputies from the Harris County Sheriff’s Office
All 13 teams work together as one task force and respond
to calls county wide
CIRT by the Numbers
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Total CIRT calls for 2012 (YTD): 3,188
Admits to NPC: 4,198
Admits to Ben Taub: 1,406
Admits to V.A.: 165
Other Area Hospitals: 154
Jail Diversions (by CIRT): 614
DEADLY ENCOUNTER
May 6, 2007
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42 year-old female with history of
schizophrenia
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History of trespassing at police
headquarters
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Made claims of laser beams being shot
through her head, food being poisoned
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Numerous hospitalizations for mental illness
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Entered police headquarters with knife,
stabbing herself in head while screaming for
officers to kill her
DEADLY ENCOUNTER
July 21, 2007
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39 year-old male with lengthy history of
schizophrenia
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Detained and committed by HPD 3 times in prior
year
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Just released from HCPC 1 week prior to fatal
encounter with police
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Stopped taking medication, deteriorated
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Mother called 911 after being turned away by
HCPC
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Charged officers with pipe and told them “Shoot
me”
Chronic Consumer Stabilization Initiative
(CCSI)
WHAT IS CCSI ?
• The Chronic Consumer Stabilization Initiative (CCSI)
is a collaborative effort between the Houston Police
Department and The Mental Health Mental
Retardation Authority of Harris County (MHMRA)
• CCSI was designed to 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
CCSI Overview
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CIRT Officers reported seeing the same individuals in crisis
month after month even though they hospitalize them
Clients consistently failed to engage in mainstream outpatient
mental health treatment
HPD identifies individuals with:
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Three (3) or more admissions to the Neuropsychiatric Center
Excessive phone calls made to HPD by clients or others, on their
behalf
High utilizers of other public services (Fire Department/Ambulance,
Hospital ER, etc.)
Staffing:
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Four (4) case managers (15 clients each)
One (1) psych tech
One (1) HPD officer assigned as program liaison
CCSI PROGRAM GOALS
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Reduce the number of interactions with the Houston
Police Department
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Identify unmet needs and barriers in the community
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Link and coordinate clients with needed mental health
treatment and psychosocial services
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Provide support and education to the individual and
their family members
PROFILE OF A CURRENT
CCSI CLIENT
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Homeless 53 year-old male with history of schizophrenia and numerous
hospitalizations for mental illness
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History of trespassing at police headquarters and downtown federal building
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Known for waving knives while screaming to be doing “GOD’S work”
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Shot a citizen, and subsequently shot by police. Charged with Attempted
Murder, found to be insane and not convicted
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Charged with Robbery, sentenced to 37 months
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23 Police contacts and 5 arrests prior to CCSI
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Added to CCSI Program in January 2011
• 1 contact with police and no arrests since being on the program
• Living in a Personal Care Home
• Taking medication regularly
Chronic Consumer
before CCSI
Chronic Consumer
after CCSI
Benefit
A potentially
productive and
stable member of
society
Psychiatric
Hospitalizations: 17
$ 31,840
Psychiatric
Hospitalizations: 1
$ 680
Police Contacts: 23
$ 1,933
Police Contacts: 1
$ 202
Incarcerations: 5
$ 112,165
Incarcerations: 0
$0
Cost:
$ 145,938
Cost:
$ 882
CCSI Cost /Client: $ 4,633
+ Cost (after):
$ 882
- Cost (before):
$ 5,515
$ 145,938
Cost Avoidance: $140,423
See Slide Notes for details of figures.
PROFILE OF A CURRENT
CCSI CLIENT
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51 year-old male with Major Depressive Disorder and numerous hospitalizations
for mental illness
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Attempted suicide several years ago with a firearm, leaving him severely
disfigured requiring extensive daily medical care
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Known to be reclusive in his apartment where he abused drugs and alcohol
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Has attempted to disarm at least 3 police officers verbally requesting suicide by
cop
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16 Police contacts and 2 arrests prior to CCSI
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Added to CCSI Program in December 2010
• 3 contacts with police since being on the program
• Attending doctor visits monthly
• Taking medication regularly
Chronic Consumer
before CCSI
Chronic Consumer
after CCSI
Benefit
A potentially
productive and
stable member of
society
Psychiatric
Hospitalizations: 9
$ 15,780
Psychiatric
Hospitalizations: 2
$ 1,360
Police Contacts: 7
$ 588
Police Contacts: 3
$ 606
Incarcerations: 2
$ 5,600
Incarcerations: 0
$0
Cost:
$ 21,968
Cost:
$ 1,966
CCSI Cost /Client: $ 4,633
+ Cost (after):
$ 1,966
- Cost (before):
$6,599
$ 21,968
Cost Avoidance: $15,369
See Slide Notes for details of figures.
Chronic Consumer Stabilization
Initiative (CCSI) Successes
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Decreased the overall number of interactions
between CCSI clients and the HPD by ~ 50%
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Decreased admissions of CCSI clients to
Neuropsychiatric Center by ~ 30%
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Decreased admissions of CCSI clients to Harris
County Psychiatric Center by ~ 37%
Chronic Consumer Stabilization
Initiative (CCSI) Next Steps
Achieved:
• Provide Medic-Alert bracelets to clients participating
in the CCSI program
• Recent funding increase from City Council to fund 2
additional case managers
Proposed:
• Collaborate with MHMRA Helpline to make
scheduled phone calls to monitor former CCSI
clients
• Dedicate a full time police officer position to the
CCSI program
• Extend the Simmons Foundation Grant for 20132014
AWARDS AND RECOGNITION
Recipient of the 2010 IACP
Community Policing Award
Finalist 2010 Herman Goldstein Award for
Excellence in Problem-Oriented Policing
Recipient of the 2011 Simmons Foundation Grant
Homeless Outreach Team (HOT)
HOT Mission Statement
To improve the quality of life for all
Houstonians by combining police
and community resources in an
effort to reduce the number of
people who are living on the
streets.
HOT Goals
To help bridge the gaps that exist
between the providers and the
homeless in an effort to more
efficiently utilize available
resources.
HOT Statement regarding
Collaboration with MHMRA
Since the Homeless Outreach Team falls under
the supervision of the Mental Health Unit, the
team has benefited from the joint collaboration
with the Mental Health Mental Retardation
Authority. A full time case manager employed in
the PATH program of MHMRA is assigned to
our team. The case manager helps facilitate
basic services by providing linkage to various
resources in their agency.
HOT Team
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Houston Police Department established the
Homeless Outreach Team in 2011
Team is made up of a Sergeant and 2 Officers
from the Houston Police Department & a Case
Manager from MHMRA with over 10 years of
experience working with homeless individuals
experiencing mental illness
Team members travel the streets of Houston
establishing relationships with homeless
individuals with the common goal of getting
them off the streets and into housing
HOT Team Next Steps
Achieved:
• Acquired foundation grant to purchase
a new transport van
Proposed:
• Team expansion
• Increase community collaborations
• Expand City and County wide coverage
Ongoing Challenges for our
Community and Harris County
Comprehensive Crisis Services delivered in the absence of a
comprehensive menu of ongoing Mental Health services
accentuates the inadequacies of an over all MH delivery
system. These inadequacies include:
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shortage of inpatient psychiatric beds
limited outpatient services
limited housing options
difficulty engaging some chronic clients with history
of non-compliance with treatment
Rewards/Benefits of Collaborations
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Able to make the most of our limited
resources
Able to provide the most immediate/accurate
level of care to those referred to us
maintaining the safety of both clients and staff
Shared wisdom
Ongoing Reciprocal Training
Contact Information
Kim Kornmayer, LCSW
Assistant Deputy; Crisis Services
MHMRA of Harris County
kim.kornmayer@mhmraharris.org
Evelyn U. Locklin, MA, LPC
Program Director
Mobile Crisis Outreach Team (MCOT)
MHMRA of Harris County
evelyn.locklin@mhmraharris.org
Ann MacLeod, LPC-S, NCC
Program Director
Crisis Intervention Response Team (CIRT)
Chronic Consumer Stabilization Initiative (CCSI)
MHMRA of Harris County
ann.macleod@mhmraharris.org
Lawrence M. Pate
Police Officer
Houston Police Department Mental Health Unit
lawrence.pate@cityofhouston.net