Albert G. and Sara I. Reuben Engagement Center
Board of Directors Meeting Minutes
Thursday, October 15, 2015
Members Present: Jan Davidson, Andrea De Mink, Nick Ball, Bill Moreau, Kenneth Catenacci,
Major James Martin, Dr. Aaron Kalinowski, Charnette Garner
Members Absent: Manny Mendez, Judge Jose Salinas, Lynnea Redmon-Williams, Margie
Payne, Johnie Underwood
Guests: Kirk Taylor, Dr. Walter Hughes, Paul Harris, Julie Fidler, Sgt. Bob Hipple, Jen Hunt,
Alex Slabosky, Bryan Roach, Louis Dezelan, Dawn Adams, Patrick Monahan, Pauline Beeson
San Antonio Conference Call Guests: Amanda Miller, Joseph Smarro, Ernie Stevens, Brian
Clark, Leon Evans
Introductions
Board and guests introduced themselves.
Leon mentioned a previous trip to Indianapolis. During this trip, he spoke about the
criminalization of the mentally ill and knows our community has a deep rooted interest in not
criminalizing the mentally ill.
Leon said around 25,000 people a year are brought in to the restoration center.
Board members proceeded to ask questions.
Restoration Center qualifications (Sobering Unit and Mental Health Facility)?
San Antonio said there is a “no wrong door” policy. If you are brought into the sobering center,
it’s because you had contact with police. Prior to this center, they would go before a magistrate
and receive a fine and then get thrown in the drunk tank. Once they sober up, they would be
released. The City of San Antonio found it was paying $16M per year in court costs.
At the Restoration Center, there is no charge to the person entering the sobering unit. They did
have beds, but people fell out of them. Now they use mats.
There is a 90-day treatment and this allows individuals time to think about their disease and the
impact it has made on their life. During this time, the restoration center starts to hook up people
with natural community supports and begin to work on housing and employment. Sixty to
seventy percent of people who have gone through full treatment are still sober one year later.
Ninety-five percent of San Antonio’s officers have gone through CIT-training and can recognize
the signs and symptoms of mental illness.
For people who are mentally ill, they can come in on their own or family members can bring
them. The Mobile Crisis Team goes out on calls in the community. This unit also visits
emergency rooms and engages people who are in the ER, but should be placed in a treatment
center.
Documenting transfers?
If the officer brings someone to crisis center, then the officer does a report. It’s a requirement for
the officers to file a report, if they are transporting an individual.
San Antonio’s police department policy?
The sobering unit is voluntary. The center staffs a deputy who is off-duty but is uniformed. This
officer is there to let someone know what happens if they leave.
For mental health referral, they can accept people for 72 hours for psychiatric episodes if they
are in danger of hurting themselves or others.
Outlined discretion for officers as to protect the officer?
A general outline exists and it will be sent out. The officer has the ability to bring a person to
crisis center in lieu of arrest if the crime is a misdemeanor or non-violent crime.
There are a series of intercepting points before the person is enrolled in jail.
1.
2.
3.
4.
The officer can immediately divert the person
There are a series of questions asked before the person is jailed or booked
Mental health screeners are present before the book-in.
Screening to see if the person is a danger to themselves.
The center also integrates itself in the children’s, drug, mental health, and veteran’s court
system.
How big are the dorms?
There was a discussion about a program in Portland, which acts as a college dorm and is
having great success with addiction recovery.
Indianapolis asked about people in jail who have a bond of $500 or less, but do not pay it
because they cannot or because they have no place to go.
There’s a program in Portland and they have reduced recidivism and their own jail is at 60-70
percent occupancy rate. They have a standardized county tool to assess the dangerousness of
someone. Most of these people who have these bonds are poor and get caught doing a petty
crime and they lose their jobs. San Antonio suggested calling Multnomah County (Portland, OR)
about their tool.
Liability if a client walks out of the center?
San Antonio contracts with the sheriff’s department for security. If you leave the facility and are
intoxicated, a cop is following you and you are arrested and taken to jail.
Indianapolis asked San Antonio is they had any numbers on getting arrests out of your system.
San Antonio said there are about 5 out of 600 clients who enter the services who get arrested
because of a violent charge. San Antonio then discussed the differences between the mental
health unit and other patrolman. Officers from the mental health unit said they always try to
bring someone to the center because they know this group will do more than triage and assess.
Other officers may not do the same because of time constraints.
San Antonio added that hospitals are important partners in this because hospitals with high
readmission rates could be docked on Medicaid and Medicare dollars. And some of the largest
illnesses that hospitals deal with are mental health and substance abuse. People who have
these illnesses are a part of the rising healthcare costs.
Various funding streams
San Antonio said they have about 100 different funding streams. San Antonio said they turn
over every rock and try to find any way to get money for their programs. The Restoration Center
is also willing to take their data in front of any groups and this issue has become a non-partisan
issue.
San Antonio said more information will be sent regarding funding.
Biggest PR nightmare?
San Antonio said there had a few deaths on their grounds. These stories were either not
reported or underreported.
Indianapolis clarified their question about an officer having a chance to arrest someone and
bringing them in to the engagement center. The person then leaves and then goes and commits
a violent crime and this crime could have been prevented if the person was arrested and placed
in jail.
San Antonio said their sobering unit is locked, but it’s not licensed by any medical authority,
which allows them to have more leeway. If someone is intoxicated and tries to leave, they will
talk to the person before he/she leaves. No one has gotten out of the doors without an officer
engaging them first.
Limiting liability for officers?
The person being transported by an officer is under detention, not under arrest. They are
detained during the transport but once they get to the sobering center they are released. One of
the benefits of dropping someone off at the center is the quick turnaround time. It takes three
minutes between the drop-off and the officer exiting the facility on the sobering unit. For the
mental health side, it is 10 minutes, but that’s still much faster than going to any ER at any
hospital in the city.
Ambulance crew drop-off individuals at the center?
San Antonio said paramedics go through CIT-training and this puts officers and paramedics on
the same page. But an officer is the only one who can transport them to the Restoration Center.
This helps paramedics be able to stay on the road. Paramedics are now carrying vouchers so
they can transport mental health patients.
What San Antonio would do differently if they could start over?
San Antonio said they would build a bigger facility and keep males and females separated.
There is a common lounge area and a facility for eating. And they would have added a bigger
facility for men and women. The sobering facility gets crowded during Friday and Saturday
nights. And because there are close quarters, women and men get in to skirmishes.
They also would have brought in the fire department much sooner on the CIT-training. San
Antonio encouraged Indianapolis to bring in ground-level guys. Having patrolmen on board will
make implementing changes easier. It will have a true rippling effect and has helped resolve
operational issues.
San Antonio added that the reason this works is because it’s truly a community-needs
approach. There are different laws and funding streams that exist in San Antonio and may not
exist in Indianapolis or other communities. San Antonio encouraged Indianapolis to review other
communities and take best practices from those places along with the information provided by
San Antonio.
Run warrant checks?
San Antonio said their mental health unit does not run warrant checks unless that person is
causing havoc and/or making threats. Ninety-nine percent of the people this unit deals with are
because of mental illness. Running a warrant may sway the way they do an assessment and a
warrant is not going anywhere. In some cases, San Antonio will try to remove the warrant.
Officers run a warrant check for everyone they encounter on the streets. If the warrant is a
misdemeanor, then the officer has the discretion to arrest them or divert them to the Restoration
Center. If it is a violent crime, then the officer has to process the warrant.
Follow-up questions:
Dawn asked what role faith-based partners play in San Antonio, if any?
Kirk reminded board members that San Antonio is a 37-acre campus. Their flow is vastly
different than what the engagement center’s flow will look like. They have chapels on
campus. San Antonio noted that faith-based partnership is a part of those services.
Collaboration is big part of their vocabulary.
Patrick asked about the difference between their patrol officers vs. their specialty team?
Sgt. Hipple said Indianapolis doesn’t have any officers dedicated to mental health. His
team has picked it up. His team has started to make in-home visits. This year, the
department has made 2,003 immediate diversions.
Kirk said San Antonio has a mental health unit and they a sheriff’s mental health unit too.
They may call in that unit if a situation escalates to a scale where they are needed. The
San Antonio patrol unit is more focused on sobering.
Issues to follow-up with San Antonio
1. Procedure 611 and booking slip
2. Funding streams (data is an important part of their ability to get funding).
Discussion about funding streams:
Major Martin discussed a diversion initiative that Indianapolis did with hospitals. He said
the resources are being wasted by dropping people off at the hospital because officers
are having to arrest people.
Patrick said showing cost avoidance is going to be a major factor. Patrick, Bart Brown,
Kirk, and Julie are drafting a Pay for Success Model. Eskenazi Health and IU Health are
interested in the savings provided by the engagement center.
3. Restoration Center’s mental health system and their intercept model (Louis D.)
4. Other types of court cases that might qualify for diversion (Judge Salinas and Polly
Beeson).
5. Intersection of problem-solving courts and screening systems (Julie)
6. Their model is for healthcarel for people who come and a little more detail on their
staffing model (Dr. Aaron Kalinowski)
7. Look at what San Antonio does and minimize it to a 30-bed facility (Bryan)
Follow-up on architect meeting
Julie said the meeting went well. They toured Pedigo Health Center. They looked at equipment
and exam rooms. It gave Cripe Architects a better idea on layout and design. There will now be
a MOU between CHIP and DPS and DPS and Building Authority. Julie said she is working on
getting an MOU with Eskenazi Health. This will allow the working group to bring the individual
who is the preferred director on board. This person has been asked to come to meetings.
Julie will let Major James Martin know when the architects need access to the APC. They will
just need an elevator key and to sign in at the front. Storage still needs to be removed. The tour
can be arranged at any time.
Budget update
Julie said there is no budget update. As she said last meeting, there will funding for the first six
months and the group will have go back for more funding. The City’s CFO does not believe this
will be a problem.