At Travis County Correctional Facility, mental health diversion is an alternative. (Photo: John Anderson)
Travis County’s mental health diversion experiment, aimed at providing underserved people with psychiatric care instead of jail time, has been in the works for a year and is finally set to launch later this summer. While the actual diversion center won’t be built until at least 2029, programmatic changes to the county’s mental health services are much closer.
By the end of August, Integral Care will expand its Psychiatric Emergency Services (PES) walk-in clinic on Airport Boulevard to 24/7 care, increasing access to peer support services and doctors who can prescribe psychiatric medications. Integral Care will also add a new 23-hour observation service for those at risk of harming themselves or others. The county will repurpose the former Ronald McDonald House on 15th Street as a 25-bed, 90-day residential Treatment Diversion Program (TDP) for further stabilization, housing and connection to services.
Marisa Malik, director of crisis services at Integral Care, says paramedics use the PES as a “gateway,” where they undergo a clinical evaluation to determine the next step in care, which could mean immediate discharge, 23 hours of observation (for people in extreme crisis), or moving to a 90-day hospital stay in a TDP if the risk of harm is low.
The county’s mental health agency, Integral Care, has worked with APD since 2014 to mobilize its Expanded Mobile Crisis Assistance Team (EMCOT) and 911 call center clinicians to respond to mental health crisis calls. There are already two buildings where police can take people in crisis for short-term stabilization: the Guy Herman Center and Inn. Inside the jail, Integral Care helps connect inmates to continuing care after release.
“[It’s] It’s pretty light, providing people with medical care, a place to stabilize and a place to live for 90 days.”– County Judge Andy Brown
So what will change? Malik says services will be available 24/7. Currently, EMCOT does not have the staffing or funding to take police referrals 24 hours a day. If EMCOT is closed, officers either take patients to an emergency room or central booking center, or leave them in the community. This increases the chances of another contact with police and an unnecessary jail stay. With PES, patients can connect with a doctor and get services right away.
Integral Care hopes to open both facilities by mid-August after hiring 22 additional staff at PES, about 17 positions at TDP, a jail liaison and outreach positions with landlords to help get people housing. They also plan to train APD, the Travis County Sheriff’s Office and EMS on suitable personnel for the programs.
The program is 100% voluntary, Malik said, but there are many ways to get involved. [first responders] “They will initially be taken to an emergency department but may be transferred to PES or, if they are too intoxicated to be meaningfully assessed, they will go to a sobering centre and then be transferred to PES.” If after 23 hours of detention they still pose an imminent risk of harm, they will be transferred to more advanced inpatient care.
So, do not have Who is eligible for this program? County Judge Andy Brown stresses that this is “not a place for people who are in a serious mental crisis.” Those people are served by the second phase of the diversion program, which may involve involuntary hospitalization. This first phase “is pretty mild, it gives people medical care, a place to stabilize, a place to live for 90 days,” Brown says. “So what solves this problem?”
And in the future, Malik said, Integral Care is working with county prosecutors’ offices to allow people to enter the program directly from jail. While mental health public defenders and county prosecutors’ offices are already making “cooperative release” referrals, there are thousands of people in county jails across the state who have been deemed incompetent to stand trial and are waiting for treatment at Austin State Hospital. The state mental hospital recently completed a major renovation, but it hasn’t added any beds, so the waitlist problem hasn’t been solved yet. Fortunately, Malik said, counties can use TDP for competency restoration in the future. And for those released from jail, Integral Care is currently negotiating grants with the Texas Department of Health and Human Services, which could bring in more funding by August.
For now, Brown said the goal of this first phase is to “track the data and understand what the situation is.” “We’re really just trying to learn from this.”
