Continuity of Care Task Force Minutes
Friday, May 7, 2010
Harlingen, TX
The Continuity of Care Task Force held a public meeting in the Rio Grande State Center
Auditorium 1401 Rangerville Rd, Harlingen, TX 78551-2668 on Friday, May 7, 2010 from
12:30pm—2pm.
Meeting Attendees
Task Force Facilitator:
Susan Stone
Task Force Members:
Emilie Becker, DSHS
Sheriff Stan Parker, Howard County
Shelley Smith, West Texas Centers for MHMR
Other attendees:
Representative Eddie Lucio III
Public and other agency attendees:
Terry Crocker, Tropical Texas Behavioral Health
Lt. Jim Scheopner, Harlingen Police Department
Alissa Bozeman, La Paz Community Mental Health Clinic
Teresa Hall, La Paz Community Mental Health Clinic
Rosie E. Cavzos, Valley Baptist Behavioral
Jim VanNorman, Austin Travis County MHMR
Audrey Munoz, South Texas Behavioral Health
Joe J. Salazar, South Texas Behavioral Health
Eva Bower-Lopez, Tropical Texas Behavioral Health
Rick Gonzales, Tropical Texas Behavioral Health
Holly Borel, Tropical Texas Behavioral Health
Condi Aguirre, Tropical Texas Behavioral Health
Clarence A. Ebanb, San Benito P.D.
Ingrid Steinbach, Valley Baptist-Brownsville
Joel Robles, Pharr Police Department
Robert Lopez, Constable Pt. 4
Cesar Garcia, The Recovery Center of Cameron County, Inc.
Lucy Garcia, South Texas Behavioral
Jonathan S. Gill, Doctors Hospital-Edinburg
Miguel Torres, Tropical Texas Behavioral Health
Sonia Hernandez-Keeble, Rio Grande State Center
Blas Ortiz, Rio Grande State Center
Connie Martinez, Tropical Texas Behavioral Health
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Melissa La Cruz, Tropical Texas Behavioral Health
Sherry Russo, Valley Baptist Medical Center-Harlingen
Linda Conti, South Texas Behavioral Health
Homero Alaff, San Juan Police Department
Administrative Staff:
Nnenna Ezekoye, DSHS
I. Welcome and Introduction—Susan Stone—12:30pm
a. Introduction of task force members in attendance
II. Task Force Recommendations Presentation—Susan Stone
a. Background
i. Changes in the forensic and civil commitment rates
1. increase in forensic and decrease in civil
b. Task Force Goals
c. Task Force Timeline
d. Global Issues discussion
i. Increase of forensic commitments
ii. Cognizance that rural areas are different from urban areas
iii. Issues surrounding children and adolescents
e. Environmental Perspective
i. Report will address some of the environmental and global aspects of
mental health and treatment
f. Data Development
i. Task Force examined data about forensic and civil commitments,
repeat commitments, outpatient competency restoration, criminal
charges, multiple commitments, long term commitments, co-occurring
disorders, guardianship, and housing.
g. Policy and Practice
i. Housing
ii. Community supervision and medical necessity
iii. Step-down levels of care
iv. Funding for non-crisis services
v. Need for cognitive rehabilitative services
vi. Improved communication between courts and hospitals
h. Medical Clearance—Shelley Smith and Stan Parker—12:53pm
i. Discussion of medical clearance and the flowchart
1. Medical clearance requires large amounts of law enforcement
time waiting for the patient to be medically cleared
2. Texas Council of Community MHMR Centers formed a
workgroup of community centers and law enforcement to
study the issue of medical clearance.
3. Workgroup decided that they would work on a chart to assist
law enforcement in making the decisions about who should
have medical clearance
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a. Guide should be whether a sheriff would accept the
person in a jail with that medical issue—see chart
b. Recommended that each sheriff or jail come up with
their own guide as to how their system for medical
clearance will work
4. Discussion of how some community centers have found it cost
effective to put a staff person in the hospital to do medical
clearance
i. Statutory Changes
i. Clarify that maximum time commitment includes “time served” in jail
from the date of booking
ii. Include commitment expiration dates in court orders to facilitate
communication between hospitals and courts
iii. Limit of 90 days for misdemeanor commitments
iv. Allow forensic expert reports about individuals not likely to be
restored to competency in the foreseeable future for repeat forensic
commitments
v. Allow voluntary jail treatment for 14-21 days prior to evaluation for
competency to stand trial
vi. Clarify judicial authority under 46B.079(b)(2) (forced medications)
vii. Link 17.032 provisions to Permanent Supportive Housing (PSH)
legislative appropriations request—create incentives throughout
17.032 to utilize PSH for misdemeanor defendants
viii. Extended outpatient commitments
j. Training
i. Provide training and educational opportunities about the mental
health system, commitments, and community options for judges,
prosecutors, defense attorneys, mental health professionals, law
enforcement, and law schools
k. Clinical changes
i. Clinical competencies
ii. Professional development
iii. Salary analysis
iv. Peer support approach
v. Trauma informed care
vi. Cognitive Rehab and appreciation of co-morbidities in RDM
vii. Expanded time for testing, assessment, record analysis
l. Interim recommendations
i. Mental health code study
ii. Consideration of Medicaid Waiver for mental health similar MR
population
iii. Study of long term hospitalization population
iv. Improvement of data systems
III. Representative Lucio
a. Thanked the multiple groups for coming today to discuss these issues
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b. Discussed the issues of beds, transportation, training, and community
options
c. Discussed the importance of citizen advocacy both in terms of agencies and
also with elected representatives
i. Encouraged the audience to go to their elected officials with ideas to
save money, create better programs, and improve their communities
IV. Public Comments
a. Discussion about whether the data the Task Force examined included jail
data because jails are often the first screening for mental health
i. The Task Force did not examine jail data because it would require
requesting jail data from all 254 Texas counties
b. Discussion about whether law enforcement should have to obtain LMHA
permission to have someone admitted to the state hospital if the person is
exhibiting a mental health issue.
c. Medical clearance
i. some private hospitals require medical clearance to send people to
private psychiatric facilities
ii. Tropical Texas doesn’t require medical clearance
1. They do a screening phone call that has been very effective
d. State Hospital bed reduction
i. Discussion about reduction of 200 state hospital beds
ii. Reduction would force communities to use more private psychiatric
facilities, which cost more
iii. Concern that bed reduction will just increase the strain on jails and
counties
e. Transportation
i. Discussion about how the requirement to transport people to state
hospitals takes up substantial law enforcement time and money.
1. under current law enforcement is allowed to physically
restrain people for transport to a state hospitals; state
hospitals cannot restrain unless medically necessary
ii. Transportation also becomes an issue if the closest state hospital is on
diversion and must divert new patients to other much more distant
state hospitals
iii. Recommendation that DSHS take up the responsibility for
transportation
1. Rep. Lucio discussed how any recommendation concerning
mental health transportation includes training and safety
precautions.
f. Emergency Detention
i. Recommendation to have a judge issue a warrant for an emergency
detention either over the phone or email (Health and Safety Code §
573.011)
ii. Recommendation to have additional training or statutory amendment
of the emergency detention statute because law enforcement fearful
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of using it because of concerns about unlawful restraint and fears or
being sued.- (Health and Safety Code § 573.001)
g. Recommendation to create or fund nursing home care that specializes in
mental health treatment
h. Discussion about what does law enforcement means under the mental health
code—does the statutory term refer to just sheriffs or does it also encompass
police officers, constables, etc.
V. Adjourn
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