Agenda 12/10/2019 Item #11C (Mental Health & Addiction 5-year Plan)12/10/2019
EXECUTIVE SUMMARY
Recommendation to approve the Mental Health and Addiction Services Five Year Strategic Plan
from the Collier County Mental Illness and Addiction Ad Hoc Advisory Committee.
OBJECTIVE: To approve the five-year strategic plan on mental health and addiction services from the
Collier County Mental Illness and Addiction Ad Hoc Advisory Committee.
CONSIDERATIONS: On December 11, 2018 the Collier County Board of County Commissioners
approved Resolution 2018-232 establishing the Mental Illness and Addiction Ad Hoc Advisory
Committee (“Advisory Committee”). The Advisory Committee was charged with making
recommendations regarding the County’s role in providing assistance and treatment of adults with mental
health and substance use disorders.
The Resolution defined the purpose of the Advisory Committee to include “providing input from all
entities involved in providing assistance to, and the treatment of, persons with mental health or addiction
issues, both public and private, as well as members of the public, to identify existing mental and
behavioral health services issues in the community to ensure the inclusion of all possible services,
treatment, and public and private assistance for county residents struggling with mental illness and/or
substance use disorders.”
Members of the Advisory Committee included:
Mr. Scott Burgess (chair), David Lawrence Center
Dr. Pamela Baker (vice-chair), NAMI Collier County
Lt. Leslie Weidenhammer, Collier County Sheriff’s Office
Council Member Michelle McLeod, Naples City Council
The Honorable Janeice Martin, County Judge, 20th Judicial Circuit
Ms. Caroline Brennan, Collier County Public Schools
Mr. Michael Overway, Hunger & Homeless Coalition
Ms. Susan Kimper, NCH Healthcare System
Mr. Dale Mullin, Wounded Warriors of Collier County
Dr. Paul Simeone, Lee Health
Ms. Trista Meister, Mindful Marketing
Ms. Pat Barton
Ms. Janice Rosen
Dr. Jerry Godshaw
Dr. Michael D’Amico
Dr. Thomas Lansen
Mr. Russell Budd
Mr. Reed Saunders
The Advisory Committee was organized and convened for the first time on January 4, 2019. Ultimately
the Committee met 21 times over the course of the year, including 18 regular meetings and 3 half day
workshops to organize the information included in the Mental Health and Addiction Five Year Strateg ic
Plan (“Plan”).
The Plan identifies six (6) priorities that we recommend receive ongoing attention and support by the
Board over the next five years. Some priorities will require substantial financial support, while others
will require little funding, but will require the involvement of County staff working in collaboration with
community partners. Financial considerations are discussed in Appendix A of the report.
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The priorities, ranked in order of their relative importance by the Committee, are:
1. Build and Operate a Central Receiving Facility/System to Serve Persons Experiencing an Acute
Mental Health or Substance Use Crisis;
2. Increase Housing and Supportive Services for Persons with Serious Mental Illness and/or
Substance Dependence;
3. Establish a Mental Health and Substance Use Disorder Data Collaborative for Data Sharing,
Collection and Outcomes Reporting;
4. Increase the Capacity and Effectiveness of Justice System Response for Persons Experiencing
Serious Mental Illness and/or Substance Use Disorders;
5. Revise and Implement Non-Emergency Baker Act and Marchman Act Transportation Plans, and;
6. Improve Community Prevention, Advocacy, and Education Related to Mental Health and
Substance Use Disorders.
On October 29, 2019, the Board reviewed the Plan in a workshop format with the Advisory Committee.
The Board requested staff to:
1. Provide data on the costs of construction and operation of other Community Receiving Facilities
in the State and how both activities were/are funded.
a. Note: Staff is moving forward with a site feasibility and cost assessment study for the
final location of the Central Receiving Facility. The findings of the study will be brought
back to the Board for final direction before proceeding with construction. The operational
cost and impact to existing programs will be considered with the future facility study and
will be evaluated concurrently with stakeholders.
2. Provide an analysis on the cost savings and avoidance benefits associated with undertaking the
various measures.
Discussion occurred on the timeline for adopting the plan with some noting it may be advantageous to
delay the item until the above items are available, while others noted those factors may be considered
after the plan is adopted (during the implementation phase) which will be a long-term endeavor. The
Board ultimately directed staff to schedule the Plan for consideration at the December BCC meeting. A
supplemental memorandum is included with the item to provide some information the Board requested at
the October workshop.
FISCAL IMPACT: No immediate fiscal impact is associated with adoption of this strategic plan.
Consulting services associated with the plan were funded by a philanthropic donation from the
Community Foundation of Collier County.
Should the Board adopt this strategic plan, individual priorities brought forward for implementation will
require Board action, at which time the fiscal impact will be fully defined. A comprehensive strategy to
leverage Federal, State, County, and private funds will be used to implement the plan.
GROWTH MANAGEMENT IMPACT: There is no growth management impact associated with
adoption of the strategic plan.
LEGAL CONSIDERATIONS: This item has been reviewed by the County Attorney, raises no legal
issues at this time, and requires majority vote for approval. -JAK
RECOMMENDATION: That the Board approve the Mental Health and Addiction Services Five Year
Strategic Plan from the Collier County Mental Illness and Addiction Ad Hoc Advisory Committee.
Prepared by: Sean Callahan, Executive Director, Corporate Business Operations
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ATTACHMENT(S)
1. Mental Health and Addiction Services 5-year Strategic Plan BCC (PDF)
2. 1210 BCC Supplemental Information Memo (PDF)
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COLLIER COUNTY
Board of County Commissioners
Item Number: 11.C
Doc ID: 10938
Item Summary: Recommendation to approve the Mental Health and Addiction Services Five
Year Strategic Plan from the Collier County Mental Illness and Addiction Ad Hoc Advisory Committee.
(Sean Callahan, Executive Director Corporate Business Operations)
Meeting Date: 12/10/2019
Prepared by:
Title: – Corporate Business Operations
Name: Sean Callahan
11/20/2019 9:13 AM
Submitted by:
Title: County Manager – County Manager's Office
Name: Leo E. Ochs
11/20/2019 9:13 AM
Approved By:
Review:
Corporate Business Operations Sean Callahan Additional Reviewer Completed 11/26/2019 10:52 AM
Office of Management and Budget Laura Wells Level 3 OMB Gatekeeper Review Completed 11/26/2019 10:54 AM
Budget and Management Office Mark Isackson Additional Reviewer Completed 11/26/2019 1:11 PM
County Attorney's Office Jeffrey A. Klatzkow Level 3 County Attorney's Office Review Completed 11/26/2019 4:20 PM
County Manager's Office Leo E. Ochs Level 4 County Manager Review Completed 12/02/2019 11:44 AM
Board of County Commissioners MaryJo Brock Meeting Pending 12/10/2019 9:00 AM
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Mental Health and Addiction Services
Five Year Strategic Plan
2020-2024
Collier County Mental Illness
and Addiction Ad Hoc
Advisory Committee
October 29, 2019
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Introduction
Starting in 2017, an informal group of community stakeholders began to meet with the
goal of improving the continuum of care around mental health and addiction services in
Collier County.
Throughout this process, the group identified many strengths in the community,
including agencies and stakeholders exceptionally dedicated to supporting each other in
collaborative efforts and ideas. Communication thrived as issues were discussed, and the
group worked to eliminate silos and better coordinate services.
Programs were identified, created, and enhanced through partnership efforts. The Collier
County Sheriff’s Office has invested considerable resources in its Mental Health Bureau,
and the County’s three problem-solving courts continue to see improved results in
recidivism and cost-avoidance. Law enforcement, corrections, local government and the
courts take an active role in providing substance use and mental health intervention and
treatment, including crisis response, diversion, treatment services in the county jail.
The David Lawrence Center and other community providers have enhanced the services
being provided in the County, but demand continues to grow as the population and
mental health awareness expands. Collier County Government has continually increased
the resources provided to law enforcement, the courts, and community health care
providers during this same time period.
Several collaborative working groups are in place that align well with this Mental Health
and Addiction Services Strategic Plan and should be complementary in its advancement
such as: Blue Zones, Collier County Public Safety Coordinating Council, Criminal Justice,
Mental Health, and Substance Abuse Planning Council, Community Behavioral Health
Advisory Committee, and community groups such as the Community Foundation of
Collier County and Richard M. Schulze Family Foundation.
Providers of treatment for substance use disorders and mental illness work
collaboratively to refer individuals to the appropriate treatment modality based on
diagnosis. They identify high service utilizers for enhanced services. They are committed
to utilizing evidence-based practices that have emerged in recent years to improve
care. These practices include medication assisted treatment, assisted outpatient
treatment, problem-solving courts, housing first and the use of both mental health
professionals and trained peers.
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The greater Collier County community supports increased access to treatment for
substance use disorders and mental illness as evidenced by voter approval of the Collier
County Infrastructure Sales Surtax, which included $25 million for the Central Receiving
Facility/System.
A strong sense of community is also reflected throughout the philanthropic efforts of
Collier County. The Committee would like to acknowledge the financial support of the
Community Foundation of Collier County, as well as the countless hours that our
residents donate to improving outcomes and service within, Collier County.
All these aforementioned strengths have come together in the creation of the Collier
County Mental Illness and Addiction Ad Hoc Advisory Committee and are reflected
throughout the five-year strategic plan.
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Committee Origin, Membership, and Charge
On December 11, 2018 the Collier County Board of County Commissioners approved
Resolution 2018-2321 establishing the Mental Illness and Addiction Ad Hoc Advisory
Committee. The Advisory Committee was charged with making recommendations
regarding the County’s role in providing assistance and treatment of adults with mental
health and substance use disorders.
The Resolution required that Committee membership not exceed 19 individuals
appointed by the Board with consideration given to ensure geographic and background
diversity. Special qualifications for membership included:
• representative designated by a Veteran services organization;
• representative designated by the Collier County Sheriff’s Office;
• representative designated by a Collier County grantor entity which provides
funding to providers of services for mental illness and substance use disorders for
adults;
• psychiatrist, licensed to practice in Florida;
• behavioral health professional, licensed to practice in Florida;
• medical health professional;
• representative from a homelessness advocacy organization;
• representative of the David Lawrence Center, Inc.;
• representative from the National Alliance on Mental Illness;
• a certified peer specialist;
• representative from the recovery community;
• representatives from the local business community; and,
• representatives at-large with experience or demonstrated interest in mental illness
and substance use disorders.
The Resolution defined the purpose of the Committee to include “providing input from
all entities involved in providing assistance to, and the treatment of, persons with mental
health or addiction issues, both public and private, as well as members of the public, to
identify existing mental and behavioral health services issues in the community to ensure
the inclusion of all possible services, treatment, and public and private assistance for
county residents struggling with mental illness and/or substance use disorders.”
The Committee was charged with development of a five-year strategic plan for mental
health and addiction services. Following review and adoption of this strategic plan by
the Board of County Commissioners, the Collier County Mental Illness and Addiction
Ad Hoc Advisory Committee will sunset, per Resolution 2018-232. In order to ensure
follow through on this plan’s priorities, the Committee recommends exploring an
1 Appendix B
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arrangement with community non-profits and private sector partners to drive, monitor,
and evaluate implementation of the recommendations in the plan. This group, meeting
quarterly, should be coordinated through existing channels and established committees,
such as the Collier County Public Safety Coordinating Council and/or Criminal Justice,
Mental Health, and Substance Abuse Planning Council.
Members of the Ad Hoc Advisory Committee would be invited to attend along with
interest members of these and other groups that touch no topics related to mental health
and substance use disorders. The Community Foundation of Collier County is seen as a
potential convener/host of these quarterly meetings. The Committee also recommends
that an external evaluation of progress toward plan and priority implementation be
completed and reviewed by the Board of County Commissioners during the fourth
quarter of 2021.
Mission Statement
The Committee adopted the following mission statement:
“The Committee will collaboratively plan for and support a coordinated effort for a full
array of evidence informed services to improve the lives of adults with mental health and
substance use disorders and overall quality of life in the Collier County community.”
Collier County Committee Work and Report Development
The Mental Illness and Addiction Ad Hoc Advisory Committee was organized and
convened for the first time on January 4, 2019. Ultimately the Committee met 21 times
over the course of the year, including 18 regular meetings and 3 half day workshops to
organize the information included in this report.
The Committee utilized its meeting time to gather information and develop strategies to
implement the priorities established in the Mental Illness and Substance Use Strategic
Plan submitted to the Board of County Commissioners in June 2018 and included as
Appendix D to this report. External subject matter experts made presentations to the
Committee on issues related to Housing, Veteran Services and the design of a Data
Collaborative. The knowledge gained from study of those priorities was applied in 4-
hour planning workshops held on August 10, September 12 and October 8. During these
workshops the Committee restated those priorities and established the goals, objectives
and an action plan for the implementation of each priority that follows in this report.
In preparing this report the Committee used the format employed by the Substance
Abuse and Mental Health Services Administration (SAMHSA) in its most recent Strategic
Plan. SAMHSA is the federal agency that promotes a vision for the United States
behavioral health care system, establishes national policy directives along with other
Federal partners and allocates Mental Health and Substance Abuse funding to states and
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local communities through block and discretionary grant programs. In the spirit of
recovery, the Committee recognizes SAMHSA’s working definition of recovery from
mental disorders and/or substance us disorders that was developed by dozens of
stakeholders as: “A process of change through which individuals improve their health
and wellness, live a self-directed life, and strive to reach their full potential”. There are
four major dimensions that support a life in recovery: Health, Home, Purpose and
Community. With those four pillars, there are 10 Guiding Principles of Recovery:
1. Recovery emerges from hope
2. Recovery is person-driven
3. Recovery occurs via many pathways
4. Recovery is holistic
5. Recovery is supported by peers and allies
6. Recovery is supported through relationship and social networks
7. Recovery is culturally-based and influenced
8. Recovery is supported by addressing trauma
9. Recovery involves individual, family and community strengths and responsibility
10. Recovery is based on respect
This report attempts to replicates SAMHSA’s approach, then summarizes our
recommendations for each priority through action plans. Selected SAMHSA evidenced-
based practices tool kits and best practices guidelines that align with the plan are
included in Appendix C of this report.
This report identifies six (6) priorities that we recommend receive ongoing attention and
support by the Board of County Commissioners over the next five years. Some priorities
will require substantial financial support, while others will require little funding, but will
require the involvement of County staff working in collaboration with community
partners. Financial considerations are discussed in Appendix A of this report.
The priorities, ranked in order of their relative importance by the Committee, are:
1. Build and Operate a Central Receiving Facility/System to Serve Persons
Experiencing an Acute Mental Health or Substance Use Crisis;
2. Increase Housing and Supportive Services for Persons with Serious Mental Illness
and/or Substance Dependence;
3. Establish a Mental Health and Substance Use Disorder Data Collaborative for Data
Sharing, Collection and Outcomes Reporting;
4. Increase the Capacity and Effectiveness of Justice System Response for Persons
Experiencing Serious Mental Illness and/or Substance Use Disorders;
5. Revise and Implement Non-Emergency Baker Act and Marchman Act
Transportation Plans, and;
6. Improve Community Prevention, Advocacy, and Education Related to Mental
Health and Substance Use Disorders.
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Special Considerations
The Committee identified Veterans as a population that we recommend receive special
consideration. Specific attention must be paid to the unique needs of Veterans in all
activities related to these priorities, ensuring that there is easy access to treatment and
specialized programs to assist Veterans experiencing Post Traumatic Stress Disorder and
Traumatic Brain Injury both in community programs and from the Veterans
Administration.
The Committee also received input from the public regarding the special needs of Senior
Adults, particularly those in cognitive decline who experience profound changes in their
behavior and emotional stability as a result of their illness. These individuals require
specialized care very different from that provided in Baker Act Receiving Facilities that
primarily treat individuals in crisis from a mood or thought disorder.
In addition, all services, programs and activities related to the identified Priorities and
special populations must be grounded in the best available Evidence Based or Evidence
Informed Practices in order to ensure maximum quality and cost effectiveness in services
provided to the community. See Appendix C for a more detailed discussion of the
importance of utilizing evidence based or evidence informed practices.
Limitations
It should be noted that this planning process was limited in scope to issues related to
mental health and substance abuse disorders exclusively among adults age 18 and older,
except for the Committee’s prevention priority. The provision of mental health and
substance use disorder treatment to children and adolescents younger than age 18
involves a substantially different set of issues, diagnoses, and community providers in
domains that include schools, child welfare agencies, juvenile justice programs, and
treatment providers. In recent years, there has been substantial expansion in both
preventative and interventional programs offered to children and adolescents in
response to multiple issues including the increasing number of children requiring
protective services, human trafficking, and mass casualty events in schools that have
occurred across the country, including nearby Parkland, Florida. The Committee
anticipates that the Prevention activities proposed in this plan will be both supportive of
and integrated with these new services and programs for children and adolescents.
Further we would encourage a similar community wide planning effort in support of
even more comprehensive mental health and substance use disorder services for Collier’s
children and adolescents.
Acknowledgements
The Committee would like to thank and acknowledge the numerous county and agency
staff, presenters, guests, volunteers, and members of the public who provided input and
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participated in the planning process, as well as the generous financial support of the
Community Foundation of Collier County.
On the following pages find the Committee’s recommendations regarding the six plan
priorities that emerged from its deliberations, including goals, objectives and outcomes
anticipated for each. Action plans for each priority are also provided in Appendix F,
offering an “at a glance” overview of the inputs required, activities to be conducted and
outcomes anticipated for each priority.
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Priority #1
Build and Operate a Central Receiving Facility/System to Serve Persons
Experiencing an Acute Mental Health or Substance Use Crisis
Overview: A Central Receiving System consists of a designated central receiving facility
with 24 hour assessment, inpatient and related services that serve as a single point or a
coordinated system of entry and treatment for individuals needing evaluation or
stabilization under section 394.463 (Baker Act) or section 397.675, (Marchman Act)
Florida Statutes, or crisis services as defined in subsections 394.67(17)-(18), Florida
Statutes. The Collier County Community Needs and Assets Assessment (2017) noted the
need for additional inpatient beds and more than 80% of its health focus group
participants identified mental health and substance use issues as major public health
problems.
It should be noted that currently there is no local provision for involuntary inpatient
evaluation or stabilization under the Marchman Act. Due to this service deficiency all
persons requiring such services are treated at the Collier County Jail, a facility neither
designed nor appropriate for that purpose. The Central Receiving System will include a
secure inpatient Addictions Receiving Facility to address this major deficiency in our
local system of substance use disorder treatment.
CCSO Baker Acts (2001 – 2018)
Behavioral Health providers like the David Lawrence Center continue to see dramatically
increased demand for services, as evidenced by CCSO data that shows Baker Act cases
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increased from 1,182 in 2013 to 1,570 in 20182, or an increase of approximately 33%. Total
services from DLC provided to adults and children also increased from 165,062 in FY 13
to 276,989 in FY 19, or approximately 68%3.
The Collier County Infrastructure Sales Surtax will provide $25 million to build a new
facility that will house these services and increase capacity. While the Surtax will provide
the infrastructure necessary to expand facility capacity, additional funds will be required
to provide the human resources and other ongoing operational costs associated with the
central receiving system.
Funding to support operations, estimated at $2 Million - $3 Million annually, will require
federal, state, and local funding. In 2016-2017 the Florida Legislature authorized the
Department of Children and Families to support central receiving systems and awarded
funding to 3 Florida communities. A Legislative Budget Request closely aligned with the
requirements of the FY 16-17 appropriation and supported with matching dollars from
Collier County appears to be a logical approach for obtaining the needed operational
funds.
The County will study multiple options on where to locate the facility, including the
current site of the David Lawrence Center. Another potential option is to co -locate the
facility with other existing government services, such as the Collier County Government
Center. The location of the facility is an important decision that must take into account
the comprehensive system of services outlined in this plan, existing demand, and future
growth.
Goal: Ensure that there is a coordinated system and adequate capacity to assure that
citizens in crisis will be able to access emergency mental health and substance use
disorder services over the next 20 years.
Objectives:
• Design, build, staff, and operate Central Receiving Facility/System including an
access center and follow-up recovery-oriented treatment services in the
community by 2022
• Assure sustainable funding to ensure ongoing Central Receiving operations over
the next 20 years
• Provide both co-occurring Baker Act (Crisis Stabilization) and Marchman Act
(Detoxification) services as part of Central Receiving Facility/System
• Explore the feasibility of providing primary integrated healthcare at the new
facility
Outcome/Impacts:
2 Information provides by the Collier County Sheriff’s Office
3 Presentation to MHAAHC, September 2019
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• Increased access to mental health and substance use disorder crisis care
• Improved crisis care by offering a full range of mental health and substance use
crisis services and by providing direct linkage and a warm hand off to community-
based services following crisis care
• Reduced law enforcement processing time for an immediate drop-off
• Provide appropriate jail diversion options and services
• Reduced transfer time from local hospitals
• Improved patient satisfaction with access to and quality of care in crisis services
Data elements required to assess outcome and impact:
• Episode of care data
• Baker Act and Marchman Act Data – Both public and private facility data from
residents and non-residents of Collier County
• Law enforcement time in drop off data
• Hospital transfer referral data
• Crisis Intervention Team (CIT) data
• Jail Diversions as a result of the Central Receiving System
• Client satisfaction questionnaire at discharge
Workgroup: Scott Burgess, Susan Kimper
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Priority #2
Increase Housing and Supportive Services for Persons with
Serious Mental Illness and/or Substance Use Disorders
Overview: For people with mental health and substance use disorders, housing is
considered a ‘golden thread’, providing the foundation through which all aspects of
treatment and recovery are possible. When this basic need isn’t met, people cycle
tragically in and out of homelessness, jails, shelters, and hospitals at a high cost to
individuals and society. The Urban Land Institute’s 2017 report on housing, land use, and
real estate issues in Collier County noted that an area of concern was the lack of
residential mental health care and support services. Further, the recent Collier County
Needs Assessment Survey identified housing as the number one community need. While
this need extends beyond those with severe mental illness or substance use disorders, the
housing shortage exacerbates the problem for these especially vulnerable individuals.
Due to low incomes (typically less than $800 per month), discrimination, and difficulties
in daily functioning, persons with serious mental illnesses and substance use disorders
generally cannot compete for market rental housing. Additionally, affordable housing
units and supported housing programs have long wait lists and few in need can access
them.
To be successful, housing supports should follow evidence-based and evidence-informed
practices, including the use of the SAMHSA Permanent Supportive Housing Tool Kit; a
‘Housing First’ philosophy and model in which housing is a right, not a privilege;
eligibility is not dependent on psychiatric treatment compliance and sobriety; and
housing units are integrated within the community. An array of options should include
rental assistance vouchers, rapid re-housing, recovery housing, transitional housing, peer
run respite, and permanent supportive housing, each bundled with appropriate levels
and choices of services and supports.
Goal 1: Increase availability and accessibility of a variety of housing options and
supportive services for persons with mental health and substance use disorders.
Objectives:
• All Collier County-approved affordable housing should include a required set-
aside for persons with a mental health and/or substance use disorder, which may
require Board of County Commissioners action
• Increase number of private landlords accepting rental assistance vouchers
• Increase number of supportive housing and supported employment providers or
agencies
• Increase individual incomes beyond disability amounts to ensure long term
stability
• Ensure supportive housing rents are limited to 30% of the individual’s income
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• Implementation of a high fidelity Permanent Supportive Housing Evidenced-
based program
Goal 2: Homelessness among persons with mental health and substance use disorders is
rare, brief and one-time.
Objectives:
• 100% of people who are chronically homeless who are diagnosed with a severe
mental health disorder will be housed within 7 days of enrollment in coordinated
entry
• 100% individuals who are homeless will have immediate access to low-barrier
emergency shelter
• 100% of persons with a serious mental health disorders identified annually during
the Point in Time count will not meet the definition of chronically homeless
• Increase number of SOAR (SSI/SSDI Outreach, Access and Recovery)-trained staff
and number of dedicated staff hours to facilitate attainment of Social Security
benefits for eligible individuals
Outcomes/Impact:
• Increased number of affordable housing units available to persons with a mental
health and/or substance use disorder
• Increased number of persons receiving rental assistance/low income
housing/housing voucher
• Increased number of persons attaining SSI/SSD and accompanying Medicaid or
Medicare benefits
• Increased number of peer specialists employed in variety of roles in mental health
and substance use programs
• Increased number of days that residents are in stable housing in the community
• Increased number of days that housing residents worked for pay
Data elements required to assess outcome and impact:
• Number of agencies/providers
• Increased capacity/number of available housing units
• Number of hours of supportive services provided
• Number of persons or months on housing wait lists
• Number of persons who are chronically homeless identified during annual Point
in Time count
• County annual housing report
• State SAMH and Medicaid data systems
• Drug Court Case management system
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• Number of people accessing supportive housing upon reentry from county jail
and mental health or Veterans treatment court
• Local data collaborative reports
• Cost effectives report on permanent supportive housing after implementation; and
• Qualitative analysis from the residents served in supportive housing services;
using individual and focus group methods
Workgroup: Dr. Pam Baker, Cormac Giblin, Dr. Jerry Godshaw, Michael Overway
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Priority #3
Establish a Mental Health and Substance Use Disorder Data
Collaborative for Data Sharing, Collection and Outcomes Reporting
Overview: Chapter 163.62 F.S. authorizes governmental and certain private agencies to
share information. The mission of a mental health and substance use disorder data
collaborative would be enhancing the delivery of mental health programs to Collier
County residents by encouraging communication and collaboration among all related
community providers, organizations, interested government agencies, and educational
institutions. Potential partners would include, among others, the Collier County Board
of County Commissioners; Clerk of Circuit Court; Collier County Sheriff’s Office; the 20th
Judicial Circuit; Central Florida Behavioral Health Network; David Lawrence Center;
NAMI; Collier County Public Schools; Florida Department of Juvenile Justice; and the
University of South Florida (USF) Department of Mental Health, Law and Policy (Louis
de la Parte Florida Mental Health Institute); although not exclusive, those agencies would
be the primary members of the collaborative.
Goal: Create a data collaborative that will collect and analyze data from all stakeholders
that provide services to persons experiencing a mental health and/or substance use
disorder and use that information to continuously improve program quality and patient
outcomes.
Objectives:
• To inform the planning and delivery of mental health and substance use
prevention and treatment among all related community organizations.
Multiple sources will collect internal data and share with other entities,
providing a process for comprehensively using relevant data, both at the
system and clinical levels.
• Collect aggregate data for use in planning, quality improvement, program
evaluation, and grant applications. A repository, along with staff, is required
to maintain, aggregate, and disseminate reporting on the data collected.
Data elements required to assess outcome and impact:
A centralized data collaborative could collect information from entities including the
David Lawrence Center, National Alliance on Mental Illness, hospitals, courts, law
enforcement, community providers, including but not limited to:
• Numbers and demographics of persons served by each cross-system
and provider
• Calculation of the cost or persons served by each payer system, DCF,
Medicaid, County Jail, Medicare/Medicaid, Department of Corrections,
housing etc.
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• Demonstration of cost avoidance in criminal justice involvement
through jail diversion and reentry activities
• Justification for efficient distribution of public funding
• Number of days acute care units are at or over capacity
• Other metrics used to gauge effectiveness and efficiencies of the
community health system
Action Items:
• Start with a list of data points to report on – including frequency, length of
treatment, outcomes, granularity, and sophistication of data efforts can be
leveraged from those employed in other communities
• Consult with the USF Department of Mental Health, Law and Policy about existing
data collaboratives and permissions necessary to access public data
• Draft MOUs for each participating entity surround collection and distribution of
data
• Establish a steering committee to guide the project development
• Design a project plan to establish the database to house collaborative data
• Begin to collect data and report on a routine basis
Workgroup: Sean Callahan, Dr. Jerry Godshaw, Michael Overway
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Priority #4
Increase the Capacity and Effectiveness of Justice System Response for Persons
Experiencing Serious Mental Illness and/or Substance Use Disorders
Overview: Persons with mental health disorders and/or substance use disorders are at
disproportionate risk to experience involvement with the criminal justice system.
Predictably, traditional justice responses such as jail or prison have done little to address
what is ultimately a treatable medical problem. Communities have been frustrated by
poor outcomes among this population in traditional justice settings, as persons with these
disorders have cycled in and out of jails at great expense, with no discernible benefit to
the individual or the community.
Enter the Problem-Solving Court movement, now an international effort, which began
when Miami-Dade County created the first drug court in 1989. The Problem-Solving
Court model has evolved to recognize certain key components, and corresponding
standards have been developed to ensure that all courts incorporate those components.
Simply stated, the model involves a multi-disciplinary team, led by a judge, serving a
targeted population within the criminal justice system which has an identifiable and
serious need for treatment intervention. The team aims to identify, as early in the process
as is possible, those persons in the justice system for whom a program of intensive
treatment, supervision and accountability can reasonably be expected to end the justice
involvement successfully, restore the individual to wellness and self-sufficiency, and
facilitate a lasting recovery from the disorder(s) that contributed to the criminal conduct
in the first place.
The Supreme Court of Florida has promulgated standards for drug courts and is
preparing to promulgate standards for mental health courts and Veteran treatment
courts. Additionally, the Supreme Court is working on a certification process for these
courts, which will ensure fidelity to the promulgated standards and maximize chances
for the best possible outcomes across a variety of populations in the state. Further, the
Legislature has created a dedicated and recurring funding source for these courts, with
funding expected to be tied into the upcoming certification process.
Now is the time for significant advancement of these powerful courts, and communities
are wise to commit themselves to positioning their courts to take advantage of these
developments for the best possible service of their population’s needs. Collier County has
long been a leader among counties in this regard, and has had a drug court since 1999, a
mental health court since 2007, and a Veteran treatment court since 2012. Significant steps
need to be taken in order to ensure the sustainability of these courts, as well as to continue
to grow and improve them.
Recidivism rates are notably lower for graduates of problem-solving courts, nationally
12-40%, compared to recidivism rates from the Florida Department of Corrections of
around 65%. For 2018, and through September 2019, graduation rates for Collier County’s
three problem-solving courts were:
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• Drug Court – 60% successfully graduated
• Mental Health Court – 63% successfully graduated
• Veterans Treatment Court – 75% successfully graduated
Immediately following the June 2018 Board of County Commissioners’ workshop on
mental health and addiction, a Rapid Response Team was formed in the 20th Judicial
Circuit to address profoundly mentally ill persons in jail facing misdemeanor charges.
Since then, fourteen individuals have been served, of which three are currently active.
For the other eleven, only one has had a negative outcome, having failed to remain
connected to services and being re-arrested. All others have been considered successful
outcomes.
In addition to problem-solving courts, there are a variety of related and complimentary
opportunities for increasing the capacity and effectiveness of the justice system’s
response to this population. Persons with mental health and substance use disorders are
not only disproportionately represented in the criminal divisions of the justice system,
but also in the family, domestic violence and dependency divisions. Expanding
behavioral health training for judges and practitioners within each of these divisions will
ensure that persons in need of treatment will be assisted in accessing it, and outcomes
overall will benefit from this holistic approach.
Goal 1:
Expedite deflection and diversion of persons with mental health and/or substance use
disorders prior to arrest and from jail to treatment, thereby reducing recidivism,
improving community safety and directing resources to optimize outcomes.
Goal 2:
Expand trauma-informed and trauma-responsive practices to all divisions of the justice
system and incorporate the use of court-supervised clinical assessments and treatment
plans as appropriate in each division.
Objectives:
• Ensure the sustained commitment of dedicated resources from each of the
disciplines represented on the multi-disciplinary teams for each problem-solving
court
• Ensure the achievement and maintenance of certification status for each problem-
solving court, so that stable funding can be obtained, and the overall sustainability
of these courts can be secured
• Ensure the collection and analysis of robust data in connection with the operation
of the problem-solving courts so that proper periodic evaluation and adjustment
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of the courts can be made to optimize efficacy, and so stable funding can be
obtained and maintained
• Expand capacity of existing problem-solving courts, including the case
management services to support persons served by the court in the community.
• Increase the accuracy and speed with which all incarcerated persons are screened
for mental health and substance use disorders
• Ensure that incarcerated persons who have been identified as having mental
health and substance use disorders are referred to appropriate jail-based or
community-based treatment services, as appropriate, and that they are referred
promptly to an appropriate jail diversion program or problem-solving court.
• Expand capacity of jail diversion programs for persons with the most severe and
persistent mental health disorders, including the case management services to
support persons served by the court in the community
• Implement medication assisted treatment in Collier County Jail and ensure
continued access to same in the community upon re-entry, regardless of whether
an individual is involved with a problem-solving court or diversionary program.
• Increase training for judges, attorneys, probation officers, investigators, case
managers, law enforcement officers and all other justice personnel in the causes
and treatment of both mental health and substance use disorders, and in topics
related to trauma, adverse childhood experiences, and trauma-informed and
trauma-responsive practices
• Encourage judges across all divisions to employ trauma-informed practices in
addressing parties who come before them, and to ensure that courts are set up to
be trauma-responsive whenever possible
Data elements required to assess outcome and impact:
• Reduced number of arrests and re-arrests
• Increase number of incarcerated persons who are screened for mental health and
substance use disorders
• Identify the number of people with co-occurring mental health and substance use
disorders, also in need of primary health care
• Conduct an analysis of the number and percentage of people served by the court
who have any type of health insurance
• Improved symptoms
• Improved child and family reunifications with supports
• Reduce time between removal of at-risk or dependent children from parents and
reunification of the family unit
• Increase number employed
• Increase number receiving additional education and training
• Increased independence and self-reliance
• Maintenance of sobriety - number of days sober
• Reduce relapse rates
• Increase medication adherence rates
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• Reduce time between arrest and screening for mental health and substance use
disorders
• Reduce time between arrest and referral to an appropriate problem-solving court
or diversionary treatment program
• Increased stable housing
• Increased number of treatment services
• Increased number of appropriate referrals into diversion
• Increased capacity of each diversionary court program
• Increased graduation rates
• Increased pathways to treatment (new programs)
• Reduce the number of adverse childhood experiences for children of adults
involved in the justice system, and increase opportunities to build resilience for
them
Workgroup: Judge Janeice Martin, Trista Meister, Janice Rosen.
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Priority #5
Revise and Implement Non-Emergency
Baker Act and Marchman Act Transportation Plans
Overview: In the continued best interest of persons in need of behavioral healthcare in
Collier County, there is a need to establish a non-emergency transportation plan for
individuals receiving involuntary evaluation and/or treatment under either Chapter 394
or 397 F.S. (Baker Act/Marchman Act) who are transferred between local receiving
facilities and local hospitals. The plan will ensure the coordination of services among
providers in Collier County and provide timely access to care for persons experiencing a
mental health/substance use crisis. Emergency transports of individuals having a mental
health/substance use crisis will still be completed by law enforcement.
The impact of law-enforcement non-emergency transport of individuals in severe mental
health or substance use crisis adds to the criminalization of mental illness/substance use.
It can also project a perception of adverse consequence(s) for the individual(s) seeking
help and delays access to timely treatment. Law enforcement involved in non-emergency
transportation can also cause further trauma to an individual.
The benefit of a coordinated system of care is less fragmentation of services and a more
human, efficient and cost-effective method of providing transport. The Collier County
Sheriff’s Office has spent a considerable amount of time and money providing non-
emergency transport of individuals with mental illness and/or substance use issues from
facility to facility. The amount of time law enforcement has spent in non-emergency
transports of people in crisis between facilities sums up to over 2,150 hours since 2017 at
a cost of approximately $250,000. A non-emergency transportation plan will free up law
enforcement to provide service and safety to our community. The plan will largely
eliminate non-emergency transport by law enforcement, providing a more dignified,
humane, and timely method of transportation to and from acute care facilities.
Hillsborough and Sarasota County have implemented non-emergency contractual
transportation plans with external transportation companies that pays for indigent care
to reduce the demand on law enforcement transportation. The transportation providers
may bill individual’s private insurance or Medicaid/Medicare. Collier County can utilize
the design and experience of these non-emergency plans in design of our non-emergency
transport plan.
Goal:
Whenever possible, the transportation of an individual under the Baker Act or the
Marchman Act from a medical facility to a receiving facility will be completed by a non-
emergency transportation provider.
Objectives:
• Implement a transportation plan that utilizes non-emergency transportation
companies (Ambitrans, MediCab, David Lawrence Center approved staff, or
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hospital-approved transportation) to transfer individuals being evaluated to
treated under the Baker Act or Marchman Act from a medical facility to a receiving
facility
• Establish safety provisions that include appropriate medical equipment or safety
equipment to meet client needs
• Establish appropriate level of supervision to ensure safety and prevent elopement
Outcome/Impacts:
• Provide a dignified, humane, and streamlined method of transportation to and
from acute care facilities
• Patient satisfaction with quality of care between receiving facilities
• Enhance the ability to fully utilize the capacity of acute care services in the county
and reduces the unnecessary delay of transfers between facilities
• Reduce the time that law enforcement is diverted from its primary duties to
transport a person being evaluated or treated under the Baker Act or Marchman
Act between receiving facilities and local hospitals
• Law enforcement and Collier County EMS will continue to transport Emergency
Baker Act or Marchman Act individuals to the appropriate receiving facility; and
• Enhanced continuity and care coordination among providers
Data elements required to assess outcome and impact:
• Collier County Sheriff's Office non-emergency Baker Act and Marchman Act
transport calls for service to David Lawrence Center
• Collier County Transportation Plan 2017-2020/Suncoast Region Substance Abuse
and Mental Health MOU
Workgroup: Lt. Leslie Weidenhammer, Susan Kimper
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Priority #6
Improve Community Prevention, Advocacy, and Education Related to
Mental Health and Substance Use Disorders
Overview: Preventing mental health and/or substance use disorders and related
problems is critical to our community’s behavioral and physical health. Prevention and
early intervention strategies can reduce the extent and impact of mental health and
substance use disorders in Collier County. Prevention approaches focus on helping
people develop the knowledge, attitudes, and skills they need to make good choices or
change harmful behaviors. Substance use and mental disorders can make daily activities
difficult and impair a person’s ability to work, interact with family, and fulfill other major
life functions. Mental illness and substance use disorders are among the top conditions
that cause disability in the United States. In addition, drug and alcohol use can lead to
other chronic diseases including diabetes and heart disease.
In 2017, 11.2 million Americans 18 years or older had a serious mental illness and 19.7
million people reported having a substance use disorder in the past year. Many
individuals experiencing a diagnosable mental health or substance use disorder do not
know they have one and do not seek help. For almost all mental health disorders, people
delay getting help, the median delay is 10 years, and of those who have been diagnosed
with a mental illness, only 41 percent of persons access mental health services in a given
year.
Collaborative and coordinated community efforts to provide awareness, education,
prevention and advocacy are critical to reducing the stigma associated with and the
myths surrounding mental illness and substance use disorders. A greater understanding
of mental illness and substance use interventions can offer the community invaluable
information on access to resources and better methods to support those who may be
experiencing these challenges. Implementation and supportive delivery of evidence-
based educational opportunities will allow individuals, community and family members
and businesses to better identify when someone may be experiencing mental health and
substance use issues and seek help sooner. Targeted public service information and
resources around mental illness and substance use will further contribute to stigma
reduction and expand awareness of educational opportunities offered in the community.
Goal:
Provide evidence-based education and training on mental health and substance use
disorders to the community at large.
Objectives:
• Create an ongoing mental health and substance use disorder educational program
for community businesses and organizations to increase knowledge and public
awareness
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• Make available ongoing education to 100% of the Collier population to increase
access to services and reduce stigma related to mental health and substance use
disorders
• Develop prevention and education activities in collaboration with SW Florida Blue
Zones Project and other health focused community organizations
• Expand the delivery of Mental Health First Aid Training in the community
Outcomes/Impact:
• Increase knowledge and awareness of mental illness and substance use disorders
to increase access to services
• Increased awareness and education can also increase availability of funding for
programs (private donor, grants, etc)
• Reduced loss of life and overdose due to substance use and suicide in Collier
County
• Decreased percentage of those experiencing symptoms of mental illness and/or
substance use enrolling in healthcare services
Data elements required to assess outcome and impact:
• Number of participating businesses and organizations in Collier County
• Number of educational programs provided
• Number of attendees
• Assess how the training was implemented
• Survey assessment of increased knowledge
Action Items:
• Establish or identify the evidence-based programs to utilize for trainings and
certification processes (ex. Adult and Youth Mental Health First Aid, Trauma
Informed Care, Suicide Awareness and Prevention, Substance Use Prevention and
Treatment)
• Identify collaborative organizations/agencies and staff to provide education and
awareness programs and materials
• Identify businesses, organizations, professionals and communities for roll out
(stages, communities, workplaces)
• Identify Public Service Announcement opportunities and methods of delivery
(TV, social media, brochures, town halls, ads)
• Develop and disseminate materials (how, where, to whom)
• Evaluate effectiveness of programs/materials utilizing pre/posts/surveys and
data from Community Health Needs Assessments
Workgroup: Caroline Brennan, Council Member Michelle McLeod, Pat Barton, Dr.
Michael D’Amico
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Special Consideration #1
Improve Services to Veterans Experiencing
Mental Health and/or Substance Use Disorders
Overview: Veterans make up approximately 10% (26,094) of the adult population in
Collier County, and an estimated 3,200 are post-Gulf War Veterans. As a country, and
community, we have a responsibility to help these Veterans and their families, who from
time to time are in need of an array of programs and services that cannot be solely
provided by the Department of Veterans Affairs (VA). Veterans receive the best care
when local communities work collaboratively with the VA to provide a variety of
supportive services.
Within this population the most significant issues are Post Traumatic Stress Disorder
(PTSD), traumatic depression, Traumatic Brain Injury (TBI), military sexual trauma, and
Veteran suicide. Nationally twenty (20) Veterans a day die by suicide, which is twice the
rate of the non-Veteran population. In addition, it is estimated that over 40% of Veterans
are returning home with PTSD and/or TBI. The primary reason is due to multiple tours
of duty which are unique to this generation of warriors, and the exposure to “Blast”
trauma to the body. These invisible wounds of war present create unique health and
transitional issues for Veterans that result in mental health and substance use issues. The
impact can be devastating for the Veterans and their families.
There is a need in our community to design and implement services and programs to
meet the unique needs of our Veteran population.
Goal:
Make the public and the Veteran community aware of the transitional, mental health,
substance use, housing, and employment needs of post-combat Veterans and mobilize
resources to address these issues for Veterans and their families.
Objectives:
• Reduce Veteran suicides – ensure that trackable data exists for Collier County
• Reduce Veteran substance use – 274 Collier County Veterans were treated by the
VA in 2018
• Reduce the number of Veterans arrested in Collier County, currently
approximately 100 per year
• Continue to keep accurate data on Veterans who are homeless and have mental
health and substance use issues to advocate for various grant programs, to include
VA’s Homeless Providers Grant and Per Diem Program, the VA’s Supportive
Housing (HUD-VASH), Low Demand Safe Havens, Substance Abuse Treatment
Programs and Community Resource Centers for Veterans
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• Increase the participation rate of Veterans in the diversion program provided by
the Veteran Treatment Court
• Reduce the number of homeless Veterans. A count conducted in July 2019
identified 40 plus homeless Veterans living in Collier County
• Include a part-time social worker in the staffing of the Central Receiving System
to interact with and ensure that Veterans are linked with specialized services to
meet their unique needs
• Employ a full-time social worker or other liaison as part of the Collier County
Veterans’ Service Office responsible for coordination of mental health public
education, outreach to Veterans and families, coordination with services at Bay
Pines, VA, Hunger and Homeless Coalition, Home Base and other service
providers
• Increase access to combat related unique treatments
• Educate and advocate on behalf of Veterans regarding size and demographics of
this group in our region
• Make Veterans and their families aware of and engaged in the programs and
services
Data elements required to assess outcome and impact:
• Number of homeless Veterans; number offered housing
• Number of Veterans arrested annually
• Number of Veterans enrolled in treatment
• Veteran treatment outcomes
Workgroup: Dr. Thomas Lansen, Dale Mullin
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COLLIER COUNTY MENTAL ILLNESS AND ADDICTION AD HOC COMMITTEE
MEMBERSHIP
Mr. Scott Burgess (chair), David Lawrence Center
Dr. Pamela Baker (vice-chair), NAMI Collier County
Lt. Leslie Weidenhammer, Collier County Sheriff’s Office
Council Member Michelle McLeod, Naples City Council
The Honorable Janeice Martin, County Judge, 20th Judicial Circuit
Ms. Caroline Brennan, Collier County Public Schools
Mr. Michael Overway, Hunger & Homeless Coalition
Ms. Susan Kimper, NCH Healthcare System
Mr. Dale Mullin, Wounded Warriors of Collier County
Dr. Paul Simeone, Lee Health
Ms. Trista Meister, Mindful Marketing
Ms. Pat Barton
Ms. Janice Rosen
Dr. Jerry Godshaw
Dr. Michael D’Amico
Dr. Thomas Lansen
Mr. Russell Budd
Mr. Reed Saunders
Staff Liaison: Mr. Sean Callahan, Collier County
Consultant: Mr. Chet Bell
Technical Review: Mr. Mark Engelhardt, University of South Florida, Department of Mental
Health, Law and Policy, Louis de La Parte Florida Mental Health Institute
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APPENDIX A: FINANCIAL CONSIDERATIONS
One of the items that will need to be considered is the cost of the services outlined in this
five-year strategic plan. With the increased demand for mental health and substance
abuse services in Collier County, the Board of County Commissioners has continued to
increase the amount of funding available and is planning to appropriate over $2.3 million
for David Lawrence Center in FY 19-20. This would represent an increase of roughly
$950,000 in County funding to DLC compared with FY 15-16. Over this same time period
DLC operating expenses, associated with growing programs and services to meet the
increased demand in Collier County, have also significantly increased and are projected
to grow in FY 19-20 by almost $3.9 million compared to FY 15-16. While the County has
increased funding, the State of Florida continues to be one of the worst funders in the
nation for mental health and substance use funding4 , has higher uninsured rates than the
national average (approx. 13% vs. 9%) and Collier County has one of the highest
uninsured rates in our region (16.8%).
With the passage of the Collier County Infrastructure Sales Surtax in 2018, $25 million in
funding is now available for the construction of a Central Receiving Facility. This funding
is limited in scope to be used only for infrastructure improvements and construction,
which leaves the funding of operations of the facility to be determined, estimated at $2
million - $3 million per year.
Should the Board of County Commissioners adopt this strategic plan as presented in this
report, the remaining items will also need to have funding identified for implementation.
This plan cannot solely rely on increased funding from the County and will need a
comprehensive strategy to leverage federal and state funding, along with private funding
to be raised from the community.
However, in addition to the hard costs associated with the plan’s implementation, a
successful continuum of care for mental health and substance use issues will drastically
reduce costs to the County. For example, cost avoidance analysis has revealed that
nationally $3.33 in “hard” justice (e.g. incarceration) costs are saved for every $1 invested
in Drug Courts, and number goes up to $27 when “soft” (e.g. reduced child welfare,
reduced ER visits, increased employee productivity, increased tax revenue, etc.) costs are
mixed in.
In 2015, the Pinellas County Board of County Commissioners committed funding to
address the needs of residents with serious behavioral health concerns who are
frequently hospitalized or incarcerated. The Pinellas County Empowerment Team
(PCET) pilot program was developed to respond to these issues and began delivering
services in June 2016 to a select group of individuals who represent some of the highest
service users in Pinellas County. In the “Year Two Cost Analysis,5” it was found by the
4 https://www.news-press.com/in-depth/news/local/2019/05/05/crisis-without-end-florida-ranks-last
5 PCET Empowerment Team High-Utillizer Behavioral Pilot, Year Two Cost Analysis, 2019, USF
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USF Department of Mental Health, Law and Policy, (PSRDC - Policy and Services
Research Data Center) that total costs for these systems decreased by 58.8% ($610,682) in
the first year and 56% ($580,321) in the second year for a total savings of $1,190,603.
Similar results in cost reductions can be expected in Collier County if this strategic plan
is implemented and will be tracked through the implementation of the data collaborative
outlined in the plan. This will lead to a better system of care for Collier County residents,
as well as recoup some of the initial investments made in the plan.
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APPENDIX B: RESOLUTION 2018-232 AND EXECUTIVE SUMMARY
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APPENDIX C: EVIDENCE-BASED PRACTICE AND SAMHSA TOOLKITS
Evidence-based practice (EBP) began as a movement when the concept was formally
introduced in medicine in 1992. This represents an attempt to systematically address the
research-to-practice gap that exists in areas of clinical practice, operations and policy-
setting, leading to the adoption of more rigorous, proven, and effective methods. Since
then, the methodology underlying EBP has been applied to various allied health
disciplines, along with spreading to other fields such as management, education and law.
When this occurs, the evidenced-base/informed approaches implemented are often
referred to as “best practices” in any given application or field.
At its most basic level, EBP bases systematic decision-making - in operations and clinical
practice - on existing science to reduce variation, improve outcomes and reduce cost.
Moreover, wherever possible, it also takes into consideration critical population
parameters, extant values, preferences, and available resources, along with
environmental and organizational contexts relevant to EBP implementation. A
distinction is often drawn between “evidenced- based” practices, where the benefits of a
process or treatment are delivered under highly controlled conditions, versus
“evidenced-informed”, which describes the modification of EBP to be used under less
ideal circumstances. The latter represents the modal use of EBP practices and is regarded
as a sensible place to start when such ideal circumstances do not exist.
The Transdisciplinary EBP model (Satterfield et al., 2009) depicted below illustrates an
optimal process where decision-making (and clinical practice) takes all of these variables
in to account, against the backdrop of the best available research evidence, to deliver
context-relevant, “best practices.”
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The use of evidence-based or informed practices and services in the implementation of
this strategic plan’s Priorities will enhance quality and cost effectiveness for the targeted
mental health and/or substance use disorders programs and services proposed.
Therefore, the Committee recognizes the importance of using SAMHSA’s Evidenced-
based Program (EBP) Tool Kits, Best Practices and Guidelines. A full list of SAMHSA’s
EBP’s can be found at the SAMHSA EBP Resource Center:
https://www.samhsa.gov/ebp-resource-center
In alignment with the Priorities in this strategic plan, use of the following EBP Tool Kits
in program implementation are recommended:
• Permanent Supportive Housing;
• Supported Employment;
• Integrated Treatment for Co-occurring Disorders; and
• Assertive Community Treatment
The following Guidelines are useful best practices for the implementation of this Strategic
Plan and are also recommended:
• Principles of Community based Behavioral Health Services for Justice Involved
Individuals: A research-Based Guide;
• Medicated Assisted Treatment in the Criminal Justice System: Brief Guidance to
States;
• Recovery Housing: Best Practices and Guidelines (Substance Abuse); and
• Crisis Intervention Team (CIT) Methods for Using Data to Inform Practice.
Outcomes/impacts of utilizing EBPs: Patient-centered metrics
• Decreased symptoms per targeted disorder (e.g., anxiety, SUD, trauma) leading to
improved global functioning;
• Increased # of days of work for pay;
• Lower arrest/incarceration rates;
• Decreased number and severity of medical co-morbidities (Congestive Heart
Failure, Diabetes);
• Decreased number and severity of negative social determinants of health (housing,
income, safety, education, access to health services); and
• Increased patient satisfaction.
Outcomes/impacts: Operational Metrics
• Increased training opportunities negotiated and initiated;
• Increased number of staff trained in evidence-based treatment/practices;
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• Increased number and percentage of patients referred to evidence-based treatment
as opposed to treatment as usual;
• Higher treatment adherence and completion rates of patients in evidence-based
treatment as opposed to treatment as usual;
• Lower “no show” rates in evidence-based treatment as opposed to treatment as
usual;
• Increased number of patients screened for various mental health/substance use
disorder problems;
• Decreased admission/readmission rates pre/post implementation of evidence-
based practices;
• Reduced number of ED visits pre/post; length of stay in outpatient treatment;
medication compliance; and
• Increased number of case management contacts with peer specialists and care
managers.
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APPENDIX D: 2018 DRAFT STRATEGIC PLAN
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APPENDIX E: CCSO MENTAL HEALTH BUREAU DATA
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APPENDIX F: ACTION PLANS
Priority: _____Central Receiving Services_____ ACTION PLAN
Goal: Ensure that there is a coordinated system and adequate capacity to assure that citizens in crisis will be able to acce ss emergency
mental health and substance use disorder services over the next 20 years.
Inputs Required
(Resources)
Outputs Outcomes -- Impact
Activities Participation Short- 1 year Long 2-5 year
$25 Million for construction and
related capital purchases for
Central Receiving Services
structure(s)
$2-3 Million annual state and
local government appropriation
for Central Receiving Services
operations
Determine site. Define terms
and processes regarding
ownership, design,
construction and funding of
Central Receiving Services
structure(s) and Furnishings,
Fixtures and Equipment.
Multiple activities related to
design and construction of
Central Receiving Services
structure(s) and identification
and procurement of FFE.
Develop an operational
budget and plan for
sustainable funding for
operations.
Collier County BOCC
and David Lawrence
Center
David Lawrence Center
Collier BOCC, Collier
Legislative delegation,
David Lawrence
Center.
Completion of all pre-
construction activities and
initiation of construction.
Submit a Legislative Budget
Request to partially fund
operations.
Secure funding from Collier
County to use as match to
support Legislative Budget
Request.
Completion of Construction.
Increased inpatient capacity
over baseline.
Central Receiving Services
utilized as single point of
access for persons in crisis
as a result of a Mental
Health and/or Substance
Use Disorder
Secure state funding and
matching county funds to
sustain Central Receiving
Services operations in
perpetuity.
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Priority: _____Housing and Supports________________ ACTION PLAN
Goal: Increase availability and accessibility of a variety of housing options for persons with mental health and substance u se disorders.
Homelessness among persons with mental health and substance use disorders is rare, brief and one-time.
Inputs Required
(Resources)
Outputs Outcomes -- Impact
Activities Participation Short- 1 year Long 2-5 year
Ensure that Ch 420 F.S. 10%
Housing set aside for special
populations is implemented
Provide Incentives to
Landlords, builders,
developers
Increase available Affordable
Housing units
Existing Rental Vouchers
Assure a source of
income/healthcare for
chronically homeless with
severe mental illness
Funding from local, state and
federal grant opportunities
Funding from private charitable
foundations that support
housing initiatives
Legislative Advocacy
Community Education
Identify and amend any
prejudicial local zoning
language
Recruit at least one non-
profit developer, determine
site
Ensure Vouchers are
provided to eligible persons
who are chronically
homeless and severely
mentally ill
SOAR applications
# Supported Employment
providers and # hours
Respond to grant
opportunities and submit
proposals to private
charitable foundations
Homeless COC,
State SAMH, Housing,
State Legislators
County Housing and
Community Services,
Board of County
Commissioners
County Housing and
Community Services,
Board of County
Commissioners
County Housing and
Community Services
Employment agencies:
Goodwill, Voc Rehab
Collier County, local
homeless service and
mental
health/substance
abuse provider
agencies
County approves % set aside
specific to Chronically
homeless w/ Severe Mental
Illness
Discrimination / prejudicial
language in local zoning docs
Identify new non-profit
developer
# SOAR applications
# SMI on SSI/SSDI;
Medicaid/Medicare
# Community education
sessions, op eds, news
articles
# Providers and volunteers
trained in Supported
Employment, Supportive
Housing and SOAR.
# of grant and foundation
proposals submitted and #
awarded
# days to enroll in
programs
# days to obtain
Transitional housing from
jail, hospital or
homelessness.
# days to obtain
permanent housing
# employed
# homeless SMI
0 Wait lists for housing
and services
0 New homeless in CoC
PIT count
Days in Community/
Housed (not hospital, jail,
shelter)
Days worked for pay
# on SSI/SSDI
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Priority: _____Data Collaborative______ ACTION PLAN
Goal: Create a data collaborative that will collect and analyze data from all stakeholders that provide services to persons experiencing a
mental health and/or substance use disorder and use that information to continuous improve program quality and patient outcomes.
Inputs Required
(Resources)
Outputs Outcomes -- Impact
Activities –
What we will do Participation Short- 1 year Long 2-5 year
Assignment of county staff to
provide leadership and direction
to development of the data
collaborative.
Identify and secure participation
of essential governmental, non-
profit and for profit organizations
to participate in and share data
with the collaborative
Identify and recruit data
collaborative members
Define data elements to be
collected and shared by
collaborative members
Define standard reports,
reporting frequency, and
mechanism of report
distribution.
Data collaborative members
utilize shared data to identify
and report on emerging
issues related to program
quality and patient outcomes.
Data collaborative members
utilize shared data to provide
data for grant opportunities
and new programming
Active participation by
75% or more of
recruited members.
100% of data elements
and collected and
shared by collaborative
members.
100% of Standard
reports are prepared
and distributed on time.
Analysis of data to
identify trends and
emerging issues is
reviewed and reported
by data collaborative
members at least
annually.
Data collected and
reported by data
collaborative is used 4
or more times annually
in materials prepared in
response to funding
opportunities or to
justify new or revised
programming.
Data Collaborative is organized,
meeting, collecting data and
issues a baseline report on data
collected.
Data Collaborative releases
data according to a
schedule agreed upon by all
members.
Data Collaborative identifies
at least one emerging issue
annually.
Data Collaborative provides
data that assists in
obtaining new funding or
reinvestment of existing
funding to address
emerging community needs
in mental health and
substance use disorder
treatment.
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Priority: _____Justice System Response________________ ACTION PLAN
Goal: Expedite deflection and diversion of persons with mental health and/or substance use disorders prior to arrest and fro m jail to
treatment, thereby reducing recidivism, improving community safety and directing resources to optimize outcomes.
Inputs Required
(Resources)
Outputs Outcomes -- Impact
Activities Participation Short- 1 year Long 2-5 year
Pre-Arrest Diversion
Educate Law Enforcement
Expand Mental Health Unit
Increase capacity of treatment
providers
Jail Diversion
Implement Medication Assisted
Treatment at Collier County Jail.
Expand Project Recovery
Increased number of community
based and in jail mental health
and substance use counselors
Develop alternative in-jail
treatment program for inmates
already receiving Medication
Assisted Treatment prior to
incarceration.
Expand court ordered assisted
outpatient treatment to circuit
court.
Utilize Mental Health Unit to
train road deputies in
deflection processes.
Seek CJMHSA Reinvestment
Grant funding to implement
Medication Assisted
Treatment in the County Jail.
Seek County, State and
Federal funding to support
additional judicial and
treatment team positions for
court based diversionary
programs including drug
court, veteran’s court and
assisted outpatient
treatment.
Mental Health Unit,
Collier Sheriff’s
Deputies, David
Lawrence Center staff
Criminal Justice
Planning Council
Collier Legislative
delegation, Collier
County government,
U.S. Department of
Justice, U.S.
Department of Health
and Human Services,
private foundations.
# of law enforcement trainings
provided.
Decrease in arrests for drug
possession.
Increase in number of referrals
to treatment directly from law
enforcement.
Increase in the number of
treatment referrals either in
custody or through transfer to
community based programs.
Decrease in jail days for inmates
whose crimes are directly
related to their mental health
and substance use disorders.
Decrease in recidivism among
inmates who participate in jail
diversion programs.
Continued decrease in
possession arrests and
continued increase in
number of referrals to
treatment year over year.
Quicker response team in
diverting from jail or
enrolling in jail based
programs.
Year over year decreases in
recidivism among inmates
who participate in jail
diversion programs.
Year over year Increases in
the number of treatment
referrals either in custody or
through transfer to
community based
programs.
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Priority: ____Non-Emergency Baker Act/Marchman Act Transportation___ ACTION PLAN
Goal: Whenever possible, the transportation of an individual under the Baker Act or the Marchman Act from a medical facility to
receiving facility will be completed by a non-emergency transportation provider.
Inputs Required
(Resources)
Outputs Outcomes -- Impact
Activities Participation Short- 1 year Long 2-5 year
tablish Transportation
Workgroup consisting of
involved partners – CCSO,
Collier County Government,
David Lawrence Center, NCH,
and other interested parties
Funding to support
transportation plan and costs of
transport vehicles and drivers.
Develop answers to who,
what, when and where
questions that will drive the
structure of the transportation
agreement.
Prepare a cost analysis that
includes current costs for all
partners, the annual number
of transports provided, the
annual number of patients
transported and a projection
of future need.
Develop a share cost
agreement among partners
to be either included in the
Transportation Plan or
included by reference in the
plan.
Transportation
Workgroup
Transportation
Workgroup
Transportation Plan written and
signed off by all partners.
Identification of Transportation
Provider or Providers
Cost sharing agreement
developed and signed off by all
partners.
Law enforcement agencies
no longer providing non-
emergency transport except
in cases of unstable
individuals at high risk to
harm self or others.
Increased patient
satisfaction regarding
quality of care in
transportation.
Law enforcement agencies
re-allocate time previously
spent in transportation to
other public safety activities.
Transportation Contract (s)
in force and functioning.
Transportation Workgroup
continues to meet to review
data and address any inter-
agency issues that may
develop.
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Priority: _____Prevention________________ ACTION PLAN
Goal: Provide evidence based education and training on mental health and substance use disorders to the community at large.
Inputs Required
(Resources)
Outputs Outcomes -- Impact
Activities Participation Short- 1 year Long 2-5 year
Identify collaborative agencies
and personnel that provide
evidence based prevention
programs. Including, but not
limited to, Drug Free Collier,
NAMI, Mental Health providers,
Blue Zones, Chambers of
Commerce, local religious
groups, and any other local
organization with an interest in
drug abuse prevention and
education regarding substance
use and mental illness
Develop Collaborative
Partners in Prevention
Identify evidence based
programs available.
Develop speaker’s bureau
to present evidence based
prevention programs
Develop or adopt an App
that can be marketed in the
community to support local
substance abuse
prevention and awareness
of mental health disorders
Create public service
announcements for print,
electronic and social media
Develop resource center
that can provide materials
and programs to the
community.
Drug Free Collier
NAMI
Mental health providers
Chambers of
Commerce
Religious groups
SW Florida Blue Zones
Project
Collaborative group of providers
organized and meeting regularly
Collaborative Partners in
Prevention provides training for
agencies and community
responders
Identify funding
Linkage with print and electronic
media
Funding and staffing to
support education and
prevention
Relationship to 211.
App implementation
resulting increased access
to recovery services
Annual Awareness/
Prevention/Education
campaigns
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Packet Pg. 1024 Attachment: Mental Health and Addiction Services 5-year Strategic Plan BCC (10938 : Mental Health
TO: Board of County Commissioners
FR: Collier County Mental Illness and Addiction Ad Hoc Advisory Committee
DT: November 20, 2019
RE: Supplemental Funding, Cost Avoidance and Reduction Information
Purpose of Memo
This memo begins to discuss information requested by the Board of County
Commissioners at the October 29, 2019 BCC workshop with the Mental Illness and Addiction
Ad Hoc Advisory Committee (“Advisory Committee”), during consideration of the Mental
Health and Addiction Services Five Year Strategic Plan (“Plan”).
Background
On October 29, 2019, the Board reviewed the Plan in a workshop format with the Advisory
Committee. The Board requested staff to:
1. Provide data on the costs of construction and operation of other Community Receiving
Facilities in the State and how both activities were/are funded.
2. Provide an analysis on the cost savings and avoidance benefits associated with
undertaking the various measures.
Discussion occurred on the timeline for adopting the plan with some noting it may be
advantageous to delay the item until the above items are available, while others noted those
factors may be considered after the plan is adopted (during the implementation phase), which
will be a long-term endeavor. The Board is considering the Plan at the December 10, 2019 BCC
meeting.
Should the Board adopt this strategic plan, individual priorities brought forward for
implementation will require Board action, at which time the fiscal impact will be fully defined. A
comprehensive strategy to leverage Federal, State, County, and private funds will be used to
implement the plan.
Legislative Programs – 2015 & 2016
In both 20151 and 20162, the Florida Department of Children and Families (DCF)
awarded funds to communities to fund centralized receiving facilities following a competitive
1 2015-2016 FL State Budget, Special Categories, Grants and Aid
2 2016-2017 FL State Budget, Special Categories, Grants and Aid
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grant process. In 2015, awards were made to seven communities with the amount of the three-
year awards ranging from $1.045 million to $5.4 million. In 2016, awards were made to three
communities with the amount of the five-year awards ranging from $6.252 million to $21.795
million.
It should be noted that the while Florida Legislature funded Central Receiving System
expansion in its 2015 and 2016 sessions, there has been no further expansion funded since that
time. The funding provided in 2015 was for up to 3 years; the funding provided in 2016 was for
up to five years.
Example: Volusia County – SMA Health Care
Prior to 2016, SMA’s Healthcare’s Crisis Unit in Daytona Beach included the following
services:
• 30 Adult Baker Act/Crisis Stabilization Beds
• 19 Adult Marchman Act/Detox Beds
• 24 Hour Screening/Assessment
In FY 2016-2017, SMA received a five-year Central Receiving System award from the
Florida Department of Children and Families following a competitive procurement process. The
amount of the five-year award was $11,808,575 or $2,361,715 annually. $1,180,858 ($1 for
every $2 in state funding) was required annually as local match. Match was provided by Volusia
County and a local hospital taxing district - the West Volusia Hospital Authority.
The breakdown of how these funds were allocated by SMA to enhance its crisis services
included:
• 14 additional Adult Crisis Stabilization Beds
• Creation of a coordinated System of multiple entry points to crisis and
outpatient services at SMA’s Crisis Unit, Halifax Health’s Emergency
Department and Adult Behavioral Health Inpatient Unit, and SMA’s Crisis
Triage and Treatment Unit in neighboring Flagler County.
• New Case Management services at SMA’s Crisis Unit, Halifax Health’s
Emergency Department and Adult Behavioral Health Inpatient Unit to ensure
continuity of care from crisis services to ongoing outpatient care.
Legislative Appropriations 2019 & Future
Although new funding has not been provided in the competitive system since 2016,
individual legislative appropriations have been successfully sought for behavioral health
initiative and facilities since. 26 requests were funded through non-recurring general revenue
during the 2019 Regular Session ranging from $100,000 to $3.5 million. A full list of these is
provided as an appendix to this memo3.
3 Appendix A
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With the passage of the Collier County Infrastructure Sales Surtax in 2018, $25 million in
funding is now available for the construction of a central receiving facility. This funding is
limited in scope to be used only for infrastructure improvements and construction, which leaves
the funding of operations of the facility to be determined.
The Committee recommends pursuing state legislative funding for the Central Receiving
Facility operations through the following two methods:
1. Revival of earlier DCF funding programs to provide a multi-year funding stream for
operations.
2. Pursue a legislative appropriation through non-recurring general revenue to fund the
operations of the facility.
Overall Funding – CRF/S
Most central receiving facility/systems and crisis stabilization units receive a combination
of State funding, Federal Grants, County and other local funding, as well as through private
insurance and other program reimbursements.
Example: David Lawrence Center
For example, the David Lawrence Center (DLC) provides the only crisis stabilization unit
in Collier County. As a not-for-profit organization, the DLC relies on a variety of funding
sources. The Center is funded in part by the State of Florida Department of Children and
Families (DCF), various Federal grants, Collier County Community & Human Services Division
through General Fund appropriation and grant pass throughs, and private donations made
through fundraising efforts.
Last Fiscal Year
Collier County + Low Income Pool Funding: $2,403,498
DLC Grants and Donations (Jul 2018 – Jul 2019): $2,552,334
$4,955,832
FY 19-20 State of Florida Contract: $10,014,888
Total Funding $14,970,720
The remainder of DLC’s annual budget is made up from insurance and general
reimbursements and other private revenues.
While the County has increased its funding to DLC, the State of Florida continues to be
one of the worst funders in the nation for mental health and substance use funding4 , has higher
uninsured rates than the national average (approx. 13% vs. 9%) and Collier County has one of
the highest uninsured rates in our region (16.8%).
4 https://www.news-press.com/in-depth/news/local/2019/05/05/crisis-without-end-florida-ranks-last
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Funding to support operations of the CRF/S once constructed, is estimated at $2 Million -
$3 Million annually, and will require federal, state, and local funding.
Cost Avoidance/Reduction
In addition to the hard costs associated with the plan’s implementation, a successful
continuum of care for mental health and substance use issues will drastically reduce and avoid
costs to the County. For example, cost avoidance analysis has revealed that nationally $3.33 in
“hard” justice (e.g. incarceration) costs are saved for every $1 invested in Drug Courts, and number
goes up to $27 when “soft” (e.g. reduced child welfare, reduced ER visits, increased employee
productivity, increased tax revenue, etc.) costs are mixed in.
Example: Pinellas County
In 2015, the Pinellas County Board of County Commissioners committed funding to
address the needs of residents with serious behavioral health concerns who are frequently
hospitalized or incarcerated. The Pinellas County Empowerment Team (PCET) pilot program was
developed to respond to these issues and began delivering services in June 2016 to a select group
of individuals who represent some of the highest service users in Pinellas County. In the “Year
Two Cost Analysis,5” it was found by the USF Department of Mental Health, Law and Policy,
(PSRDC - Policy and Services Research Data Center) that total costs for jail, medical, treatment,
shelter, insurance and other systems decreased by 58.8% ($610,682) in the first year and 56%
($580,321) in the second year for a total savings of $1,190,603. The full report on this is included
as an Appendix6.
Example: Miami-Dade County
Analysis by the Louis de la Parte Florida Mental Health Institute at the University of
South Florida examined patterns of arrest and inpatient treatment among 97 “heavy users” of
acute care and institutional services in Miami-Dade County7. Most individuals were homeless,
and most were diagnosed with schizophrenia. Over a five-year period, these individuals
accounted for:
• 2,200 county jail bookings.
• 27,000 days in county jail.
• 13,000 days in crisis units, hospitals, and emergency rooms.
• Each “heavy user” was booked into the county jail, on average, 4.5 times per year, and
spent nearly a quarter of each year incarcerated or in other institutional settings.
• The cost to taxpayers for these services is conservatively estimated at $13.7 million
(outlined below) with little impact on reducing recidivism and virtually no return on
investment.
5 PCET Empowerment Team High-Utillizer Behavioral Pilot, Year Two Cost Analysis, 2019, USF
6 Appendix B
7 GOB Project 193, Miami-Dade County
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Miami-Dade County:
Heavy User Data
Analysis
Total events
over 5 years
Average
per
individual
Average
per diem
cost
Estimated
total cost
Arrests 2,172 22 - -
Jail days 26,640 275 $178 $4.7 million
Baker Act initiations 710 8.6 - -
Inpatient psychiatric days 7,000 72 $291 $2 million
State hospital days 3,200 33 $331 $1 million
Emergency room days 2,600 27 $2,338 $6 million
Total jail, inpatient, hospital &
ER days
39,440 407 - $13.7 million
In 2016, Miami-Dade County implemented a project, GOB Project 193 for a mental
health diversion facility, where initial estimates were expected to generate an annual county cost
avoidance of $14.3 million. The full project fiscal impact outlined is included as an Appendix8.
Collier County Application
The purpose of the CRF/S in Collier County is to create a comprehensive and cost-
effective system of care for individuals with serious mental illnesses who account for
disproportionate public expenditures in the criminal justice, homeless services, and acute care
medical and mental health treatment systems.
Anticipated outcomes include decreased reliance on local taxpayer dollars, improved
public safety and health, decreased chronic homelessness, and improved quality of life for
county residents and visitors.
For example, from data provided by the Collier County Sheriffs Office, a day in jail
comes at a cost of $159. In the October 29, 2019 BCC workshop, the Advisory Committee
estimated that there were approximately 100 inmates per day who have mental health issues
and/or co-occurring substance abuse issues. In addition, another 822 individuals were in the
Collier County Jail under the Marchman Act for years 2017 and 2018, while NCH Healthcare
System is projecting to petition another 60 individuals under the Marchman Act in 2019. Based
on this data, other County studies, and the cost of per diem for a day in jail, conservative
estimates could show the ability to generate an annual county cost avoidance of $1.5 - $2 million
in diversion from the County jail.
Data to project and track these will be aggregated in a County-run Data Collaborative,
which is a priority outlined in the Advisory Committee Plan. This data can data will be available
for use in planning, quality improvement, program evaluation, and grant applications.
8 Appendix C
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Packet Pg. 1029 Attachment: 1210 BCC Supplemental Information Memo (10938 : Mental Health Strategic Plan)