Backup Documents 06/05/2018 PresentationHOW WE GOT HERE, AND WHY
Commissioner Andy Solis, Chair
Collier County Board of County Commissioners
BRIEF UPDATE AND REVIEW OF
THE LAST YEAR
Collier County Sheriff’s Office
David Lawrence Center
National Association on Mental Illness
Treatment Courts
Collier County Sheriff’s Office
Mental Health Unit
•Mental Health Unit (MHU)
•Mental Health Intervention Team (MHIT)
•Crisis Intervention Team Training (CIT)
•National Alliance on Mental Illness (NAMI)
•Collier County Adult Treatment Courts
•Law Enforcement Assisted Diversion (LEAD)
Mental Health Intervention Team
Interactions
0
5
10
15
20
25
30
35
40
January February March April May
As of
5/23/18
❖85 Juveniles monitored daily during May
❖95 Adults monitored through Treatment Courts
Mental Health Intervention Team
Referral Sources
41%
16%
16%
12%
5%
5%
4%1%
DLC - 41%
MHIT - 16%
CCSO - 16%
Treatment Court - 12%
Community - 5%
Judicial - 5%
CCPS - 4%
NAMI - 1%
57%
30%
10%
3%
Linked to Services - 57%
Wellness Check - 30%
Baker Act - 10%
Arrest - 3%
Mental Health Intervention Team
Interventions
0
50
100
150
200
Mentally Ill Inmate Typical Inmate
Average Jail Stays for Similar Misdemeanors 1
Number of Days
Mentally Ill inmates stay in Jail an average
of 5 times longer than other inmates 2
1 Pueblo, CO study 2014 2 Study of 7 metro Denver Counties, 2008 Rocky Mountain PBS report
0
50
100
150
200
250
300
350
400
Hospitalized Arrested Living at Home
What approximately $30,000
will pay for if someone is:
Hospital: $31,623 ($1,888 Emergency Room admission + $29,735 19-day hospital stay)
Arrested: $30,258 (includes cost of arrest, 94-day incarceration, parole)
At Home: $31,280 (subsidized housing, disability income, outpatient mental health treatment)Days of CareSources: Jeffrey Swanson & Marvin Swartz, Duke University; Fletcher-Allen Health Care/University of Vermont
David Lawrence Center Update
Growing Community Needs
CCSO BAKER ACTS
01/01/2001 –12/31/2018 (projected)
YEAR Total
2001 300
2002 355
2003 357
2004 370
2005 409
2006 377
2007 477
2008 502
2009 707
2010 796
2011 892
2012 1052
2013 1182
2014 1226
2015 1303
2016 1336
2017 1434
2018 (projected)1570
Grand Total 14,645
0
250
500
750
1000
1250
1500
1750
25.23 26.65
19.13 18.68
24.77 24.68 24.61
28.04
22.52
25.97
26.20
34
29
28
26
31
29
32
34
33
35 35
12.29 12.81 13.06
11.54
13.47
11.42
14.07
16.46
12.87 11.97 11.65 12.1
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
40.00
FY 17-18 CSU & CCSU Combined Census Data
Current Av. Daily
Census
Highest Census
FY10-11 Av. Daily
Census
Hurricane Irma Occurred
in September 2017
2.9 3 2.93
3.93
4.4
5.77
5.19
7.18
4.9 5
5.87
6
7 7 7
8
9
8
10 10
9
11
0.55
1
1.63
0.77 0.57
1.16
2.23
3.17
1.32 1.1
0.52
1.53
0
2
4
6
8
10
12
CCSU FY17-18 Census Data w/Comparisons
Current Av. Daily
Census
Highest Census
FY10-11 Av.
Daily Census
Hurricane Irma
September 2017
Unit construction July-Dec 2016
Areas of Growth
•Inpatient Treatment Growth-Adults & Children
•Increase in Outpatient Services
•Enhanced Specialized Substance Treatment Services to
Attend to the Opioid Crisis
•Increased Specialty Treatment Court Services
•Increased Care Coordination Services
•Increased Support Through First Children’s Partial
Hospitalization Program in SWFL
146,986
165,062
180,285
209,224
222,015
228,500
264,924
140,000
160,000
180,000
200,000
220,000
240,000
260,000
280,000
FY12 FY13 FY14 FY15 FY16 FY17 FY18
2012-2017 Fiscal Year Growth
Total Services Provided to Children and Adults
(Fiscal Year July 1 -June 30)
* Percent Increase FY12 to FY18 (projected)
*80%
•SARAH ANN CENTER: Open 6 days / week
•Historically over 5,500 visits per year; 500/week; 30/day
•Wellness activities
•Socialization
•Support Groups (Hearing Voices, Seeing Things, Mindfulness, Peer
Support, Lotus Women’s Group)
•Art projects, Yoga, Meditation
•Hot lunch provided in partnership with St. Matthews House
SARAH ANN CENTER
•County support over the past year has:
•Allowed us to hire additional driver; 15 passenger van
•Four additional trips/week up to 60 people/week
•30% increase in visits
•Added staffing and activities (yoga, meditation)
•Sarah Ann participants include disabled, homeless,
Mental Health Court participants
Collier County Treatment Court
Review of Program
Completion Rates and Recidivism
2014 -2016
Drug Treatment Court
Graduation Rate
46
Terminated
73
Graduates
2014 –2016
Total Participants : 122
Graduation Rate : 60%
Drug Court
Recidivism Rate
Successful Graduates : 39% Recidivism Rate
2014 -2016
Drug Court
Recidivism Rate
Terminated Participants : 38% Recidivism
2014 -2016
71
Graduates
32
Terminated
Mental Health Treatment Court
Graduation Rate
2014 –2016
Total Participants : 105
Graduation Rate : 69%
Mental Health Court
Recidivism Rate
2014 -2016
Successful Graduates : 21% Recidivism
Mental Health Court
Recidivism Rate
2014 -2016
Terminated Participants : 40% Recidivism
Veterans Treatment Court
Graduation Rate
2014 -2016
Total Participants : 24
Graduation Rate : 76%
5
Terminated
16
Graduates
Veterans Treatment Court
Recidivism Rate
2014 -2016
Successful Graduates : 12% Recidivism
Veterans Treatment Court
Recidivism Rate
2014 -2016
Terminated Participants : 40% Recidivism
TECHNICAL PLANNING SESSIONS:
IDENTIFIED PRIORITIES
P A R T I C I P A N T I N G A G E N C I E S :
20th Judicial Circuit –State Attorney Office * Armor Correctional * Central Florida Behavioral Health
Network * Collier County Board of County Commissioners * Collier County Community and Human
Services * Collier County Public Schools * Collier County Sheriff's Office * David Lawrence Center
* Hazelden * Healthcare Networks of SW Florida * Hunger and Homeless Coalition * Isle of Palms
Recovery Center * NAMI of Collier County * Naples Community Hospital * Park Royal Hospital *
Physicians Regional Medical Center * Public Defenders Office * Southwest Florida Veterans Alliance
* St. Matthews House * The Willough at Naples * USF FMHI CJMHSA Technical Assistance Center
CJMHSA Planning Council
Technical Assistance Sessions
11.30.17 & 4.16.18
#Priority Lead(s)
1 Centralized Receiving System/Addiction
Receiving & Baker Act Receiving Facility Scott Burgess, DLC CEO
2 Permanent Supported Housing (Scattered
Sites and Supportive Services)
Pamela Baker, NAMI CEO;
Beverly Belli, DLC
3 Behavioral Health Data Collaborative
Commissioner Andy Solis;
Sean Callahan, County
Administration
4 Increase use of evidence-based practices,
e.g. Early intervention for 1st time psychosis.Nancy Dauphinais, DLC COO
5 Increase effectiveness and capacity of
Problem-Solving Courts
Judge Janeice Martin;
Beverly Belli, DLC
6 Baker Act / Marchman Act transportation Sgt. Leslie Weidenhammer,
CCSO
7 Build sustainability for Criminal Justice,
Mental Health & Substance Abuse
Reinvestment grant.
CJMHSA Planning Council
Priorities Identified in Technical Assistance Sessions
CENTRALIZED RECEIVING SYSTEM /
ADDICTION RECEIVING AND BAKER
ACT RECEIVING FACILITY
Scott Burgess, CEO David Lawrence Center
Dr. Allen Weiss, President & CEO Naples Community Hospital
PRIORITY:
Meeting this vital community need requires a
local community response.
Kaiser Family Foundation
State to State Per Capita Comparison
FY 2013
$338
$305
$295
$270
$253
$209
$185
$168
$144
$131
$111
$92
$71
$55
$37 $33
$25
$50
$75
$100
$125
$150
$175
$200
$225
$250
$275
$300
$325
$350
$375
The Challenge:
With continued population growth, Collier County’s mental health crisis
services will not be able to meet the community’s demands.
The David Lawrence Center (DLC) currently has 30 crisis treatment beds, and
the facility is consistently at peak capacity.
DCF ‘rule of thumb’ ratio is 30 Adult Baker Act beds for every 100,000
population.
That would mean over 100 Baker Act beds are needed in Collier County.
The Challenge:
There are approximately 100+ inmates in the Collier County Jail each day
who have mental health issues and/or co-occurring substance abuse issues
and are receiving psychiatric medication.
Each year, on average, approximately 700 individuals are in the Collier
County Jail under the Marchman Act.
If there were more treatment capacity, many of these individuals could be
treated in a different, less intensive and more effective setting.
The Challenge:
State data demonstrates a significant number of Collier Baker Acts are
currently being transferred out of the county.
* DCF/USF Baker Act Report, released March 2017, demonstrated almost
40% of Collier Residents needing to be Baker Acted were transferred out of
Collier (almost 700 residents).
* The same report noted Collier had the highest growth in the state, by
percentage, of Children’s Baker Acts, at 170% increase from FY 11-FY 16.
Population growth alone for the same time period was only 7.13%
All ER Visits for Mental Illness or
Substance Abuse
No Sugar Coating US Opioid Epidemic Examined
•The cost of the opioid epidemic in the
US is 2.8% of GDP and has coincided
with a decline in labor force
participation
•Opioid over-prescription (66.5 scrips
per 100 Americans) at crisis level, but
millions with chronic pain seek
alternatives.
•Pharmaceutical companies face
multiple lawsuits from cities and
states which could potentially result in
billions in penalties
•HSBC Global Research, May, 2018
The Central Receiving System Model…
•ensures a coordinated approach is utilized in a community,
across stakeholder groups (law enforcement, hospitals,
treatment providers), to most effectively and efficiently
manage the challenges associated with mental health and
addictions issues when they arise.
•In addition to the items that will be discussed under the
Central Receiving Facilities area, CR Systems may employ
other supports, such as Mobile Crisis teams, to ensure
immediate and appropriate response is swiftly available.
There are now several regions in Florida with both a
Central Receiving Facility and Mobile Crisis Teams.
A Central Receiving Facility...
•is a 24/7/365, single point of access, offering education,
assessment and effective linkage to services for individuals
who are exhibiting challenges associated with mental
health and/or addictions-related issues.
•assesses and evaluates those who are under either
voluntary or involuntary status
•provides support for all situations, any day, any time,
including: crisis, urgent and non-emergent. This means
individuals are always provided the right care at the right
time with the right service.
Why it is important:
•Provides rapid assessment and linkage to the most
appropriate level of care.
•Divert individuals into treatment vs. jail
•Decrease hospital emergency room overcrowding
•Availability of real-time resources can help address issues
in an outpatient setting vs. escalation and then need for
inpatient treatment
Why it is important:
•For those who are under a Marchman Act as well as those
under the Baker Act
•Assures a quick drop-off for Law Enforcement Officers so they
can swiftly return to their primary functions
•Envisioned greatly expanded observation rooms to meet
current and growing community needs
•Envision increased Peer supports which can assist in client and
family engagement into treatment
A Critical Part of the Solution:
Construct a new, larger facility that will increase the capacity of adult inpatient
mental health crisis and addiction treatment services and function as the
Central Receiving Center (CRC) for those receiving services under both the
Baker Act and the Marchman Act. In addition to better serving Collier County’s
expanding population, this would reduce some of the existing demands on the
Collier County Jail.
The new facility would be 55,000 square feet and would be located on existing
land adjacent to the main campus of DLC. Estimated cost of construction and
build out is $26.5 million. Additional ongoing operational cost are estimated to
increase between $1 million to $2.0 million, depending upon increased census.
Potential Features of the New Facility:
• Central Receiving Center (24/7/365)
• Dramatically Expanded Emergency Services Assessment Center (ESAC)
(currently 3 beds)
• Greatly expanded crisis stabilization unit (CSU) (22 beds currently)
• Licensing as an Addiction Receiving Facility (ARF) 20 bed adult detoxification
unit-(12 beds currently)
• 20 bed residential substance abuse treatment unit (18 existing beds would
remain operational in current location)
PERMANENT SUPPORTIVE
HOUSING
Pam Baker, CEO NAMI
Beverly Belli, DLC
PRIORITY:
HOUSING affordability
•About 40% of Collier citizens are considered
‘cost burdened’, spending more than 30% of
income on housing
•20% pay more than 50% on housing
•Income level is considered “very low,” if if less
than 30 percent of the $75,000 median income
or $22,500 per year
HOUSING and persons with
disabilities
Individuals with serious mental illnesses are even further priced
out of the housing market, many of whom rely on Supplemental
Security Income (SSI) due to disability.
SSI is currently $750 per month or just $9,000 per year,
That is 14.5% of the median income.
FAIR MARKET RENT
HUD FY 2018 Fair Market Rents by Unit Bedrooms
Year Efficiency One-
Bedroom
Two-
Bedroom
Three-
Bedroom
Four-
Bedroom
FY 2018
FMR $778 $996 $1,220 $1,630 $1,978
No place to go
•Renting even an efficiency at the fair market rent ($778) would
require more than 100% of their $750 income).
•Rental units at or below fair market rent in Collier County are
extremely scarce. Wait lists of over 5 years.
•Hurricane Irma further devastated the stock of affordable housing
throughout the county, often mobile homes, which will take time to
replace.
HOUSING IS CRITICAL FOR RECOVERY
•The lack of safe and affordable housing is one of the most powerful
barriers to recovery.
•When this basic need isn’t met, people cycle in and out of homelessness,
jails, shelters, and hospitals.
•Supportive housing provides an essential platform for the delivery of
services that lead to improved health and stability.
•Improves access to quality health care by providing a physical space for
service delivery staff
PUBLIC AND private solutions
•Many Supportive Housing models
•Considered Evidence Based Practice: It works!
•Need both structures and supportive services
•Scattered throughout the community; integrated; not
enclaves or mini institutions
BEHAVIORAL HEALTH
DATA COLLABORATIVE
Commissioner Andy Solis, Chair
Collier County Board of County Commissioners
PRIORITY:
EXPAND AND ENHANCE USE OF
EVIDENCE -BASED PRACTICES
Nancy Dauphinais, LMHC, MCAP
Chief Operating Officer, David Lawrence Center
PRIORITY:
WHY IS EVIDENCE-BASED PRACTICE
IMPORTANT?
Evidence-based practice (EBP) is a process in which a program
combines:
Well-researched interventions
Clinical experience
Ethics
Client preferences and culture
In order to guide and inform the delivery of treatments and services.
EBP aims to provide the most effective care available to improve
patient outcomes.
Patients can expect to receive the most effective care based on the best
available evidence
FOCUS AREAS WILL INCLUDE:
Early Intervention for First Episode Psychosis (FEP)
Develop wraparound program for families dealing with
FEP
Medication-Assisted Treatment (MAT) for Opioid Use
Disorder
Expand access to Vivitrol and Suboxone/Buprenorphine
Increase coordination with Methadone services
Expand access to Naloxone (opioid overdose reversal)
Peer Support Services in a Recovery-Oriented System of Care
(ROSC)
Refer to DCF document on “Creating a Recovery-Oriented System of
Care in Florida” (December 2017)
Trauma-Informed Care
Expand access to trauma-specific services
INCREASE EFFECTIVENESS AND
CAPACITY OF TREATMENT COURTS
Judge Janeice Martin
Beverly Belli, DLC
PRIORITY:
BAKER ACT / MARCHMAN ACT
TRANSPORTATION
Sgt. Leslie Weidenhammer, Collier County Sheriff’s Office
PRIORITY:
BUILD SUSTAINABILITY FOR
CRIMINAL JUSTICE, MENTAL HEALTH, &
SUBSTANCE ABUSE REINVESTMENT GRANT
Sgt. Leslie Weidenhammer, President
CJMHSA Planning Council
PRIORITY:
•Criminal Justice, Mental Health & Substance Abuse Reinvestment Grant
•Collaboration among Sheriff, NAMI, Armor, David Lawrence Center, Collier County Gov’t.
•Forensic Intensive Reintegration Support Team (FIRST) improves quality of life,
and reduces arrest among people with mental illnesses with history of multiple arrests.
•Funded by State of Florida, approximately $350,000/year. Currently in 7th Year
•FIRST recidivism rate is only 22%; of 313 served 2014-2017 only 69 re-arrests
❖Continuation of the successful FIRST program is a strategic priority
PUBLIC COMMENT &
COMMISSIONER DISCUSSION
NEXT STEPS, MOVING FORWARD
Commissioner Andy Solis, Chair
Collier County Board of County Commissioners