1. Bexar County Mental Health Department
Behavioral Healthcare from a Community Perspective

2. Mental Health Department
Mission: Improve, coordinate, and increase mental health services.
Vision: Transform Bexar County to a National model of a mentally healthy community.
Initial Priorities:
Identify gaps
Increase capacity
Identify best use of County dollars
Who we are:
Gilbert Gonzales ; Director Mental Health Dept.
Velma Muniz MA, LPC-S ; Department Program Coordinator
Melissa Lucio; Senior Program Analyst

3. Focus Improve services for Bexar County citizens- build capacity
Improve mental health screening and access
Establish systematic approach to continuously assess mental
health needs
Reduce stigma of mental illness
Strengthen the public safety net through an expanded mental health system of care
Receive community feedback from citizens and stakeholders
Address and support the mental health legislative agenda

4. Mental Health Consortium
What we are doing
Criminal
Justice
Coordinating
Council
Mental Health Consortium
Smart Justice
Central
Magistration
Dedicated
Mental
Health
Department
within
Judicial
Services
Strengthen Mental Health
System
Implement proven cost
effective strategies
Identify gaps
Increase capacity
Integrate services
Educate and inform
Community
Creation of a comprehensive
Bexar County Resource
Directory for Community Use
Build responsive system of care
Identify community priorities
Build model Mental Health System of care
Address gaps in service
Improve coordination of care
Address stigma
100% screening
Law Enforcement screening questions
Pretrial, clinical and Public Defenders
integration
Clinical assessments/treatment plans
Direct access to treatment with approval
Independent Public Defender
Facilities Renovation
Joint City/County
Coordinating council
led by Mayor and County
Judge
Review criminal justice
issues
Receive progress reports
Identify priorities

5. Successes, Challenges & Opportunities
Initial screening by Law Enforcement – implemented July 2015
Improved Pre-trial screening process
Onsite Pre-trial and Mental Health coordination
Licensed Clinical Assessors seven days a week
Access to State MH Database and
Use of Best Practice Brief Jail MH Screen
Direct treatment access for justice involved – OUTCOMES: reduced Recidivism
Promoting Integrated Mental Health as integral part of Judicial Services
Supported Proven Programs
Crisis Intervention Training (CIT)
Children's CIT
Treatment alternatives
Residential treatment options
Providing Ongoing Mental Health Attorney Training

6. Successes, Challenges & Opportunities (cont.)
Strengthen Mental Health System
Implement proven cost effective strategies
Identify gaps
Increase capacity
Local Community Services
Haven for Hope Homeless Campus
Crosspoint Programs
SA Behavioral Health, et al
State - Texas Council on Offenders with Mental and Medical Impairments
Federal
Strengthen continuity of care,
Divert to treatment versus incarceration
Identify best use of County resources; Inform and educate Stakeholders
Integrate Behavioral Health, Criminal Justice, and Health

7. Successes, Challenges & Opportunities (cont.)
Chronicity of Illness
Access to treatment resources
Criminal Justice System forced to fill the gap
Criminalization of non-violent persons with mental illness
Poor screening for mental illness at pre-booking stage
High recidivism rates for persons with mental illness
Stretched Capacity
Increasing Cost

9. Bexar County Smart Justice Initiative
Counsel of State Governments: Dr. Tony Fabelo
Initial Detention
Sequential Intercept 2
Expanding Mental Health assessments, early identification
100 % Screening
Four Mental Health Questions asked by all law enforcement
Suicide Screening and Assessment
Magistration
Introduction of Public Defender
Integration of Pretrial Services, Public Defender, Mental Health and Hospital District
Team Presentation to Judge
Direct transfer to treatment Services

10. Diversion 1.0 Diversion 2.0 Diversion 3.0
2003 to 2017 Community Medical Directors Roundtable - Monthly Reports
2004 Measuring Potential and Economic and Societal Benefits
2007 Cost Analysis of the Bexar County, Texas, Jail Diversion Program
2008 to 2016 Report of Success; Annual
2014 Bexar County Pretrial and Mental Health Improvement Process
2015 Bexar County Smart Justice: Implementation Year One Progress
2016 Council of State Governments Intake Process and
Recommendations for Change
2015 Bexar County Consortium – Community Mental Health Model
2016 MHM/Meadows – Bexar County Mental Health Systems Assessment
2016 MHM/Capital Healthcare Planning – Bexar County High Utilizers/Homeless
Healthcare Analysis (Cost)
2017 Law Enforcement Medcom Navigator funding secured
2017 CMAG Substance Use program launched
2017 Southwest Texas Crisis Collaborative created, strategic initiative launched

11. Diversion 1.0 Diversion - Pre Arrest Early Intervention
Sequential Intercept 1
Crisis Intervention Training for Law Enforcement and First Responders
40 hour Community based, no charge
Co-taught by San Antonio Police and the Bexar County Sheriff’s Office
Mandated training for Patrol by Sheriff and SAPD
Mobile Outreach Teams
Over 4,000 Officers Trained
Psychiatric and Substance Use Crisis Services
Medical Clearance for Law Enforcement
Sobering Center
Detox Center
Over 18,600 Accessed Services at the Restoration Center in FY 15
Diversion - 24/7 Drop Off (Restoration Center)
Sequential
Intercept 1

12. Diversion 2.0 Magistraton
Counsel of State Governments: Dr. Tony Fabelo
Initial Detention
Sequential Intercept 2
Expanding Mental Health assessments, early identification
100 % Screening
Four Mental Health Questions asked by all law enforcement
Suicide Screening and Assessment
Magistration
Introduction of Public Defender
Integration of Pretrial Services, Public Defender, Mental Health and Hospital District
Team Presentation to Judge
Direct transfer to treatment Services

13. Bexar County Smart Justice Initiative Summary:
Challenge - The largest unmet need in Bexar County is mental health 
21% of persons in jail have significant mental health issues
Recidivism for persons with mental illness, especially those charged with misdemeanors is high
Early identification and process for diversion is complex
Treatment access limited
Challenge – Central Magistration (CMAG; a pre booking facility)
95% of all detainees booked at CMAG were not screened for MH needs
Screening for MH at CMAG was based on observation and staff report
Screening available for 8 hours, Monday through Friday only
Timeline:
2014
Commissioners create County Mental Health Department
Bexar County Smart Justice recommendations endorsed by County Officials
New CHCS Contract to include mental health clinicians
NACo initiative to address the mentally ill in jail presented  
2015
Commissioners create Independent Public Defenders Office
City/County establish joint coordinating council and begins bi-monthly meetings to review criminal justice issues
CMAG improvements include expanded screening and full assessments, public defender presence and law enforcement administered mental health questionnaire for all brought to CMAG
CMAG-Pretrial 100% screening for MH needs, mental health clinician available 16 hrs per day, 7 days a week
Bexar County participates in Meadows Mental Health Policy Institute, State wide Smart Justice Task Force informing Texas Legislature on Mental Health and Criminal Justice issues
NACo, Council of State Governments Justice Center and the American Psychiatric Association launches “Stepping Up Initiative” to Reduce the Number of People with Mental Illnesses in Jails
Commissioners Court issues proclamation in support of Stepping Up Initiative
Bexar County invited to present at April 16, 2016 National Summit in DC.
 2016
CMAG Facilities and staffing improvements continue; Re-entry Center and Video Visitation Center to open in April
2017
Jail remodel to include expanded work release capacity and re-entry programing
Law Enforcement Medcom Navigator funding secured
CMAG Substance Use program launced
Southwest Texas Crisis Collaborative created, strategic initiative launched

14. Community Activities
Create, leverage, encourage, and support ongoing mental health treatment services
Identifying community resources and capacity
Conducting gap analysis
Community Education
Attorney Mental Health training
World Mental Health Celebration
Pathways to Hope: Faith based Initiatives
Health Behavioral Health Fairs
Mental Health Consortium
Community stakeholders meet to address the needs of the community
Medical Directors Roundtable
Bi Monthly Consortium City-County Wide update

15. Community Mental Health Continuum Model
Cross
System s
Crisis
Sick Care
Wellness
Intervention
Coordination of Care
Prevention - Wellness
Supportive Employmt
Quality of Life
Housing
Community
Judicial
Trauma Informed
Guardianship
Care
Intensive Outpatient
Outpatient Services
Medication - access
911, CIT, Fire/EMS
Secure Facilities
Transitional Care
Residential Levels
Community Support
Stabilization
Transitional
Transportation
ER-Hospital
Crisis
Jail
Target Areas:
1. Navigator: Coordination Portal (Law Enforcement/Community)
2. Continuity of Care with focus on Residential Continuum/Supportive Housing
3. Outpatient Access- Gaps , Sharing information
4.Public Service Announcements
5.Evaluation
Child-Family
Adoles-Family
Adult-Family
Older Adult-Family

17. Mental Health Navigator
Concept: To develop a central coordinating entity to ensure the most appropriate service is provided. Due to the varying needs of law enforcement and the general public, it was determined that two different navigators would be needed: Law Enforcement Navigator and Community Navigator.
Goal: Assess the caller’s need(s) and direct him/her to the most appropriate provider to ensure the best mental health continuum system of care.
Law (LE) Enforcement Mental Health Navigator
As LE call in, look up the individual’s Emergency Detention (ED) history to divert the individual to the most appropriate setting.
Community Mental Health Navigator
Assess the caller’s needs and direct him/her to the most appropriate service provider that best fits their needs, including crisis care, sick care and wellness.

18. MENTAL HEALTH DEPARTMENT Contact Information
Paul Elizondo Tower, 101 W. Nueva, Suite 310
San Antonio, Texas 78205
Gilbert Gonzales - Mental Health Department Director
(210)
Velma Muniz MA, LPC-S – Department Program Coordinator
(210)
Melissa Lucio- Senior Analyst
(210)