Public Health Committee (PHC) meeting Transcript – 5/10/2023 Title: ATXN-1 (24hr) Channel: 1 - ATXN-1 Recorded On: 5/10/2023 6:00:00 AM Original Air Date: 5/10/2023 Transcript Generated by SnapStream ================================== Please note that the following transcript is for reference purposes and does not constitute the official record of actions taken during the meeting. For the official record of actions of the meeting, please refer to the Approved Minutes. [10:01:35 AM] It is. 1001. Good morning, everyone. Ann Vanessa Fuentes, chair of the public health committee. And I'm calling the meeting to order at 1001, I'm joined by vice chair Velasquez and mayor Watson. Today and let's see. Okay. So our first call to order, our first order of business is, is to see if there's any citizen comment. Do we have anyone signed up? Madam chair, there is no sign up at this time. All righty. Thank you. Okay. Next we're going to approve the minutes from the public health committee meeting on April 12th. Is there any objection to approving it? Nope. Okay. So moved and approved. Next up, we're going to take some of our discussion items a little out of order and recognizing that we do have our county Bartz county counterparts with us today. And so I wanted to bring up briefing number five. Up first, that is a briefing on the mental health diversion program from pilot [10:02:35 AM] Sanchez county executive and with Travis county health and human services. And we are joined by our county judge, Andy brown and also, I believe we have commissioner Ann Howard joining in virtually. Is that right? Yeah, she should be joining. And I believe the judge is going to open with comments first. Good deal. Yes. Thanks for having me. This is the first time I've appeared in front of a council committee or here at all. I think as judge. So very exciting and a very important topic. Thank you so zo. Thank you. Thanks for having me. I'm Andy brown. I'm the Travis county judge and I want to thank chair Fuentes, vice chair Velasquez, the mayor and other members of this committee for inviting the county to be here to talk about this important work that Travis county has been working on and that we are going [10:03:36 AM] to work on together to end the cycle of incarceration for people with serious mental illness or substance use disorders. I'm joined virtually by commissioner Ann Howard and here in person by county executive Pilar Sanchez. Kathie Mclarty with our justice and public safety department and others, people with living with mental health and substance use disorders too often land in the criminal legal system because of disruptive or erratic behaviors caused by these conditions that lead them to get arrested. In many cases, even if no criminal intent existed, laws were broken , and this produces a disproportionate number of people with mental health disorders languishing in our jail. When treatment in the community would have been a better option. As this body is all too aware, the state of Texas woefully under-invest in mental health care and the state mental health hospital system, something that they're supposed to do more of. As a result, our county jails the largest mental health facility in the county and this is an unacceptable state of affairs in that county jail. Before covid, we had about [10:04:38 AM] 20% of the population that responded as to our survey that we do when people come in to having an unmet mental health need that has now doubled since covid. So it's over 40% at this point. And I think that number is actually low. And I think we'd all probably agree that it's probably closer to 70% of the jail population that has a mental health need. About a year ago, in April of 22, the commissioners court approved a contract with Dr. Steve Stachowski with the Dell medical school to lead stakeholders, including people with lived experience, butts mental health and legal experts and judicial leaders. Law enforcement and community advocates in a ten month, solution driven process to create actionable recommendations to address these complex issues. We had a lot of city partners who joined us in this work, including chief Chacon and Diana gray. So thank you for that. The culmination of that work was a report that identified many gaps, many resources, and ultimately five priority recommendations. Burns include the creation of a diversion center to decrease the number of people with mental [10:05:39 AM] illness and substance use problems entering jail. Help them exit jail and keep them out of jail. Today, a total of 2231 I'm sorry, a total of 2231 potential individuals were identified. Eid. And within this total sample, we identified 106 people, each with between three and 89 arrests who typified people cycling in and out of jail. Most of those arrests were for misdemeanors, for example, criminal trespass accounted for 55% of those multiple arrests had alternative interventions been in place, many of these individuals might have received care for their mental health disorder in a therapeutic and less restrictive setting than jail and not had the residual barriers that interactions with the criminal legal system create , such as housing, education and employment challenges. You should not have to go to jail in Travis county to get the mental health care that you need or a safe place to sleep. Our team here is going to provide some more context and details about our plan. But the key here is it does not have to be this way. [10:06:41 AM] And we have all committed to building our mental health, safety net together. Thank you all very much. Paige so I think we may have as commissioner Howard online somewhere this would be the ideal time for that . Not there. And if not, then you all could maybe step in until she's ready. Okay. Thank you. Okay. Okay so covering the agenda today, judge brown has already made his introductory remarks. Hopefully, commissioner Howard will join us. We have three sections on this agenda to enhance and further develop an effective diversion system is our first topic, and then we'll move to the county action to [10:07:42 AM] support an effective diversion system. We'll be covering both a diversion center and pilot. And then finally conclude with next steps on collaboration and partnership. We also know we do have a limited time, so I'll be trying to keep speakers moving to stay within our 15 minutes. Thank you. Some good morning. My name is Kathie Mclarty. I'm with Travis county justice and public safety and if you could go to the first of my slides. Okay. And I'm going to be speaking on behalf of Vicki Ashley. She's the interim county executive for Travis county justice and public safety. She's unable to be with us today. I'm going to be speaking briefly to the section on enhancing and furthering the development of an effective diversion center. Next slide. Okay. So the question is, what is diversion and diversion is a really broad term. And it refers [10:08:43 AM] to the idea that a person who gets involved in our criminal justice system at any point that they enter our criminal justice system, they can be diverted away. As it shows here on this slide, there are exit ramps that would move people away from the criminal justice system. It can happen early. It can happen midway. It can happen later. What's really important to know is that diversion Ann programs target what caused a person to become involved in the justice system in the first place, whether it's food or housing insecurity, not having a job, lack of educational resources unmet physical, mental health or substance abuse needs. That's what the programs need to do. It's to get the person out of the criminal justice system and to keep them hopefully from reentering. Next slide. And this right here, it's a really busy slide, but essentially, this is our sequential intercept model. And we've used it to map out our criminal justice system. It shows different intercepts. And these are the points of entry where an individual can enter or become involved in the criminal justice system. You know, you've got all the way from intercept [10:09:44 AM] zero, which is ideal, which would be pre involvement with law enforcement. You can really deflect a person at that point. But then you've got law enforcement, you've got your courts, you've got reentry, reentry and reintegration. And at any point that a person, again enters a criminal justice system, they can exit. But when they exit, you want to have them exiting to support services. And those support services are going to be a menu that can include clinical medical services, legal services, addressing their housing. Any sort of wraparound services, including case management, workforce development and all of this can really be bound together by providing peer support to these individuals to ensure that they are successful and again, do not reenter the criminal justice system. Next slide. Eid we want to build on our current diversion system resources. We have many. It's robust. There's always room for improvement. Some of the elements of the diversion system, which are already in place are our crisis services, is our co-responder teams, our specialty courts, [10:10:46 AM] peer support and supportive housing and the vouchers that go with that. The work ahead and it's big work is expanding and implementing these existing services, aligning and linking these multiple diversion resources and the heavy lift which will be building a diversion center. Next slide. We can really learn from our peer communities and a lot of the key stakeholders within the county and the city have taken the opportunity to visit some of the national models, including sites in Harris county, Beyer Nash, Nashville, Tucson and Miami Dade . And there was there were a lot of takeaways days. We have a lot of things that we can emulate from these different programs. But the one thing we need to keep in mind is although there are similarities and there are things we can use, Austin Travis county is a unique community and we need to create a program that meets our needs so we can take these elements and make them work for us. Next slide, please . And as judge brown referenced [10:11:49 AM] earlier, the forensic mental health project resulted in a very thorough report that had five key takeaways. And those takeaways are one of them is surrounding data use agreements, technology, updating data, sharing the creation of a diversion center, establishing a wide range of housing options, expanding our certified peer programs and our council at first appearance program. What we're really focusing on today is the diversion center. But the one thing that we want to let everybody know is this this is not a menu. These programs link together. You can't have one without the other. Next slide, please. And I am now going to pass this over to Pilar Sanchez . She is the county executive for health and human services. Thank you, Kathie. Next slide, please. So as you all know, the Travis county commissioner court passed a resolution on March [10:12:49 AM] 21st directing staff to begin the work of building a diversion center that includes putting together a timeline and a phasing plan. As you can see and can just imagine that there will be a lot of phases involved with building a diversion center and preparing for that. And it will include designing and constructing an actual new center that will include our central booking intake and the actual diversion center. We'll have to identify funding streams and Eid ways that we can include pre and post arrest services. Just like Kathie mentioned there are several intercepts throughout the Sims model. We want to make sure that we cover all of those is we want to build and strengthen the local behavioral health crisis response continuum, which she mentioned a few of the parts of that. And because we have several of those in place, that is a really great beginning and foundation to build on. But [10:13:51 AM] there's still a lot to do within that continuum to expand and improve that it is to improve our public safety and to reduce the jail population will be we have applied for a department of justice technical assistance grant and we will be receiving that at and again, this is why we're here. Part of our direction is to create a partnership with you, the city of Austin, central health integral care community care, and other public and private entities that are interested and have the expertise to assist. Next slide, the key elements of a diversion center that we've identified thus far schiera, will include pre and post arrest services. We visited several peer communities that are doing this. Some of them have pre services, pre arrest services, and others have post. We want to be able to build on both of those. We want to increase the number of beds that are available for those experiencing behavioral health crisis and [10:14:53 AM] challenge Luz and to help them stabilize and include connections to support services. Just like Kathie mentioned. And that how we've learned from several of our peer communities that with you can't just divert somebody from jail. You have to be able to provide continued and long lasting supports to be able to help them be successful and not reenter into the criminal justice system. So helping those who successfully complete the clinical treatment not be prosecuted for any legal issues related to the underlying behavioral health issues. That is key to what we are trying to build here is to help to those that go through our treatment to stay away from the criminal justice system and not be prosecuted and to focus on decreasing the number of people with behavioral health needs entering jail help them exit success early, and to successfully stay out of jail. [10:15:56 AM] In addition, a key element to our central booking center. We want to make sure that there is sufficient space butts in that center for first appearance clinical personnel, peer support specialist Bartz and the other innovative practices that we will find from this exercise of working with you, our partners, the community and the experts in this area. Next, I'll pass it over to Laura chito, who is our division director in health and human services. Next slide. All right. We our main goal is the diversion center. But Travis county asks what can we do now? What can we do immediately to impact our residents, those that are experiencing mental health challenges? How can we start divert them from the jails and into appropriate mental health services? And so with that, the county is working with the city of Austin, an integral care and [10:16:56 AM] other community partners to pilot diversion Ann focused services and housing. And with that, we want to leverage our existing resources and programs and create pathways to the medical clinical care, support services and housing. The idea behind this is to really test and refine this work to make sure we understand what this work should look like within a diversion center so that we can utilize our expertise currently available to us as well as start this work now. We want to have the impact of reducing our jail population and meeting behavioral health needs. And again, we want to do this work now while we work towards and build the diversion center. The other goal would be to reduce the number of unsheltered individuals on the street in the jails, because we know our unsheltered population has a high propensity of mental health issues that contribute to their unhoused state. And so we want to address those mental health needs. We want to bring those individuals off the street and into treatment. And we want to [10:17:56 AM] use and expand our existing resources. And we know to do this, we also have to collaborate and coordinate our work together, which means our we need to modernize our data and our technology and what a better city to do that. We have incredible resources and brains in this city that can help us do that work as we move forward. Next slide. When we look at piloting the diversion, which is focused on the services and the housing, we're going to look at expanding our psychiatric emergency services to 24 over seven. So that means anyone that's experiencing a mental health crisis will be able to access the resources and supports they need regardless of when they have that crisis. We're looking at accepting those referrals at multiple entry points. So we want to be able to support people pre-arrest and post- arrest. So we are again using those exit ramps that Kathy mentioned earlier at all points. We want to make sure that we're providing short term stabilization. We want to end the revolving door Wright we bring individuals in, we stabilize them, we release them, they go back to the street, they [10:18:57 AM] reoffend, or they have another mental health crisis. We need to do better. And doing better means having longer stays where people can become more stable. We're looking at doing that through re- envisioning our the center at 15th street and the N as well. So again, using existing resources, repurposing them to meet the current needs of our community, we could look at capacity of 25 beds, 30 to 90 days, and then an array of services to support those individuals. Next slide. All right. So from there, I want to turn it over back to judge Andy brown, who's going to highlight the next steps. Judge brown. And there's one more slide, please. There's one more. There's one more commissioner Howard up yet ? Qureshi. Is she on. So while we're working on that, so over [10:19:58 AM] the next we're trying to get to kind of what we're doing short term like Laura talked about, and then what we're also doing long term simultaneously. And so commissioner Howard may talk about the short term thing that we're doing while she's getting loaded in. I just want to address one thing. So yesterday we voted to raise the salary of people that work in the jail and the corrections officers there by a significant amount. We've done a raised a very significant amount since 2021, but we're still having trouble recruiting people to work in the jail. But if today if we had a mental health diversion center up and running today, I think, you know, the mental health population that I mentioned earlier is about 8 or 900 of the 2200 people who are in the jail today. So if we could remove that population or a significant number of that population Ann to diversion Ann resources, supportive housing, reduced recidivism, that that the mental health diversion center offers and has been proven to offer in Nashville, for example, that would help so much on so many [10:20:59 AM] things that we're doing at the county. It would lower the requirement of staffing in the jail and frankly would make this community a safer place. Commissioner Howard, I see you there. If you want to talk kind of about we're in the next steps part. If you want to talk about maybe what we're doing Shaw term , can you? Thank you, judge. I'll let you. Thanks. Can y'all hear me? Yes good morning from Dallas, Texas. I'm here working with a group from across the country on affordable housing. You know, just wanted to thank you guys for tuning in with us. I think in the next steps, we want to really be working together, not only with, you know, the city and the county, but also our health care partners and, you know, lawyers and judges who really understand the play between law enforcement and lock up and health care needs. Andy, I'm going to I'm going to I'm not sure what the [10:21:59 AM] next steps that we were supposed to be talking to this group today about that. But I wanted to reiterate, you know, over the last decade when our community has worked closely Leslie across the health care, housing, health and nonprofits and government to address homelessness, I think we're at an inflection point where our we need to shore up all the, components to make the system work. And we're expanding housing, we're expanding shelter, and we've got to expand the crisis. Luz need to address the crisis needs of these folks and their health care needs. And this has been a piece that we've been missing. How to help people stabilize with their mental health. So they can enter our housing system and stay out of [10:23:01 AM] our legal system and so I'm really excited that we have committed federal funding. Our arpa dollars to this and Eid, I know a lots of folks have spent all their arpa funding, but we're going to have to figure out how to shore up this pilot so that we make the best use of the new diversion center when we build it. Andy, are you prepared to talk about like the June meeting or. I'm not sure what you want to cover next? Wright. I'll fill in. Well I know that we're over time, so I want it to sort of just wrap up with the, the last bullets in this slide. There are a lot of opportunities for us to work together and the areas that we would really like to see some assistance is identify Ann working groups on [10:24:02 AM] your end that could work with us . We'll start with a summit on June 5th. It'll be an all day summit where we'll get together with all the entities that might be involved if a working group could be identified to help us bring decision points to the Travis county commissioners court and to the city council. Finding ways to create a governance structure and building on how we can share data to make this successful. If we can find a way where APD and the sheriff's office can immediately see a flag on the system when they arrest somebody, that's been identified, somebody with a mental health challenge, Paige, then we can immediately start diverting them versus arresting them even even if it's post arrest, knowing that they have a mental health challenge, then we can start working them in a different fashion to help them successfully exit that system. So through operations policies, [10:25:06 AM] helping us, finding funding, governance S so we can have that partnership, it would be great for us to work together well, thank you so much, colleagues. One thing that I should have started the meeting off with is acknowledging that may is mental health awareness month. And so today's public health committee meeting is focused on mental health. So all of our agenda items line up with both with the county and the city are doing to support mental health in in Austin, I want to thank the county for being here with us today. I just wanted to flag that we have about, 15 minutes for questions on on this section. And I guess my first question is, one, I just want to acknowledge and recognize your leadership, judge brown and commissioner Howard Eid and miss Sanchez for bringing this forward. It certainly is needed in our community. I'm surprised it's taken us this long to move forward with the diversion center. I appreciate the last slide where you highlighted what we can do specifically in terms of policies that we might bring [10:26:08 AM] forward. But I guess just to make it just a punctuate, what is the number one thing that the city of Austin can do to help support the mental health diversion center? I think by by joining with us and becoming partners and the meeting on June 5th, where we're going to bring some folks in from Miami to help us figure out what that first step is that we take together. Would be the best way. And I know that commissioner Howard and I are working together on her. Her motion that got $6 million basically to start on the pilot of this effort. And so putting all our heads together to figure out what does that pilot do exactly? Do we reserve five beds for post arrest diversion, five beds for pre arrest diversion Ann trying to figure out what what works while at the same time making a difference in our community quickly while we wait for the diversion center itself to be built over the next ideally two. But more likely probably three years based on how how things go with bidding and stuff. So [10:27:08 AM] joining up as partners to us in this effort. And when is the pilot program slated to commence ? As soon as we know what to do with it. And commissioner Howard, let me pass it to you if you have any thoughts on on that question. Yeah, we've had really good success in Austin of doing 100 day challenges where we just say we're going to make this happen. And you know, at the end of 100 days. So I think I'm I'm looking at the June 5th is the kickoff. And we really take the summer months. And I know we all need a vacation, but, you know, the next 100 days to figure this out. Integral care has offered up, you know, some space that they currently rent from the city, as well as their psychiatric emergency services. So we have some nuts and bolts to work with. It's a matter of, you know, I think us as leaders, working with experts in the community to figure out what we what we want to do and make it [10:28:09 AM] happen. Good deal. And you know, one thing that I appreciate from the county, I saw that you all recently shared out with the community how you've allocated the remaining funds of your American rescue act relief dollars. The city we've we earmarked and allocated our pot of dollars last year I believe it was. Yeah these pandemic years they feel long but I think it might be time for us to revisit how the city has allocated our arpa dollars to see if there's any you know, any ability for us to be flexible in how we allocate. So it might be good for the city to see where we're at with those, with those allocation, if we have any remaining Singh unused funds or if there have been any shifts in the needs that we have that would lend itself for us to allocate from from there. And then I know councilmember alter, you and councilmember qadri brought forward a resolution on council that that demonstrate Eid and directed our city [10:29:10 AM] manager to, to identify additional revenue sources to support this pilot program. Colleagues any additional questions. Nope. All right. Thank you so much. Awesome thanks. And thanks so much for the participation. I know in these visits we're framing it as a county thing, but we've had like APD has come other folks from the city have come on these visits to the different places and so just really thankful for the partnership and look forward to working together on this effort. Thank you. Thank you all . Thank you. Thank you. Okay, colleagues, next, we're going to move on to our briefing from Mario Alvarez, the executive director of the community advancement network on cans mental health priorities and initiatives as Ralls makes his way to the podium. I also wanted to highlight that we do have an action item on the agenda that I want to consider first to ensure [10:30:12 AM] that we still have our quorum. And thank you, councilmember Ryan alter, for joining our committee. So I want to draw your attention to the proposed resolution that you should have a printed copy in front of you. This is regarding the mental health first aid initiative that I, along with Ken, launched earlier this morning. And it is a mission to train 1000 austinites to get certified Eid with mental health first aid. It's an eight hour course. We have an incredible commitment from our city of Austin that will share here shortly what the city will be doing and offering this course to city employees. The county is also committed and pledged to train county employees and was going to talk us through the community partners and the program itself. But this resolution Ann that I have here before you just reiterates and demonstrates the city's commitment to the mental health first aid initiative and shows our support for elevating the conversation of mental health in Austin. So I would [10:31:12 AM] like to move adoption of this resolution. Can I have a second? Yes. Mayor seconds, any objections to adopting this resolution as a or do you have a discussion? All I wanted to point out and I think councilmember Ryan alter remembers this, one of the things that we did, we did just this sort of thing in the senate office when I was in the senate. And it was such a success that we decided to offer it at the capitol and we had a big turnout for it at the capitol. And it is a it's a really good program. People learn a lot from it and they do make a difference. So I'm pleased to see that we're doing this. And with specific experience that was very gratifying. So good deal. Thank you. I was just going to add, I'm not allowed to vote on it here, but I can't wait to support it. When we get to the full council. So thank you for doing this. That's great. Thank you. Okay. Any objections to [10:32:13 AM] adopting this resolution? Good. Wonderful. So this will come as a it will come before council as a recommendation from the public health committee. Thank you. Okay. So with that, we'll toss it over to Raul Alvarez for a briefing on the mental health first aid initiative. Well thank you for approving that and my work here is done, but thank you , madam chair and council pool mayor, council members for the opportunity to talk a little bit about the work can is doing around mental health. And if you could go to the first slide as you know, we published an annual community indicators report. One more and we're not going to talk about all these. There's a lot of stuff in that presentation that you all can look at at your leisure. We're going to get to the mental health first aid piece, but but did want to let you know that again, we have this data available and it does show, you know, if you look at the five year trend here is where we are with individuals reporting poor mental health and just kind of where we were in [10:33:13 AM] 2017, where we are now. And just the trend that is very apparent and I'm just going to share a couple slides very, very quickly. Next slide. Again, we, you know, try to break down the numbers by different demographics. Right? Because again, if you see one one data point, it's hard to draw conclusions. But here you see sort of the trends by race, you know, over the last five years. And you see that, you know, across all races, really, this has been a more challenging times post covid and right now, the highest rates are for hispanics. If you see that. But it's important, I think, to look at the trend, not just look at one year in time. The next slide is, is again looking at it by, you know, sex men versus women. There's a little despair city there. And say little just because you're about to see ones where there's great disparity. I don't want to belittle the disparity shown here. The next one is the next slide, please [10:34:15 AM] would be by employment status again, you know, not surprising . Right? There is a disparity there by folks who are employed and not employed. Next slide by age, this is the one that's kind of very stark. And you see there the very tall blue line, most recently, which is for that 18 to 29 category sherry and it's not even going deeper than that, which is to our young people, which we know all the data shows that that mental health needs are very high. But even in this 18 to 29 category, you see a great need for support. And the next slide, I think it's a couple more slides. One is by education level, you know, you see folks with high school diploma or less, right? Have some of the highest reported. You know, mental health challenges or at least reporting poor mental health, I should say . The next slide is, again, a lot of these they start pushing 50% Wright. So anybody who falls in this group, one out of two, [10:35:16 AM] you're seeing, you know, reporting, you know, these challenges for our members of our lgbtq community. Again you see very high reported rates of poor mental health. And in the also for the last slide, I believe the data here is for individuals who who are disabled . If you go to the next slide, have a disability. Right. Again, you see very big disparities and again, already pushing over that 50% mark. And if we go to the next slide, maybe, and this is again just a couple of suggestions as we as we proceed with the next slide from our community council, who's just published their second report on mental health to give our can board some ideas for how to move forward around addressing these needs. And I'll mainly talk about this first slide here, which is peer support specialists, you know, which again, the community council has said that they feel this is a great resource to expand, you [10:36:19 AM] know, because not everyone will be able to get an appointment Wright with a clinician, right, because there's already waiting lists. But not everyone also needs a clinician, right? So how do we kind of create other opportunities to get support? And they, they felt that peer support is one. And again, you can target your training of peer support specialists to the communities that need it, whether it's hispanics or African Americans or the lgbtq community or the disabled community. Again, you can target your resources to address the needs of parents in the data. And I'll go to the next slide. And here's just a list of some peer support programs. Again, part of it is before you decide to invest more resources, you got to know kind of what's out there. So this is kind of to help in that regard. And the next slide is just again, the return on investment, right? If you invest in peer support, what does it do? Right? And those bullets at the bottom kind of talk about that, you know, reduce re hospitalization, you [10:37:19 AM] know, reduce days, inpatient, overall costs, etcetera, etcetera. Next slide. And then again, there's a lot of recommend actions in the report. And that report will be finalized, I think, on Friday and we'll get it to you so you can read it in more depth. But I'm not going to go into that very directly. But you'll see talks about peer support and it talks about mental health first aid, and it talks about what we as employers, what can we do to support our employees. Right. Especially if you have a large number of employees, Luz and you know that folks who have a high school diploma or less and need help, well of your employees, can you do an outreach to them or outreach to the folks who have a disability or who are lgbtq? Again, as a large employer, you can also zo look at your your employees, right? As a way of targeting support. And if we go to the next slide and keep going till we get to, I think the last slide which has a second to the last slide and again, this is getting back to the mental health first aid. And [10:38:20 AM] the reason we're trying to put a context to mental health first aid. One more slide, please. Is that again mental health first aid is another approach that you can use to, again better identify and respond to mental health needs, better serve communities and target resources. Right. I think that's part of why it's again, if we want to train more folks in the hispanic community around mental health first aid or in the lgbtq community, you know, again, it's another tool like peer support where you can target the resources in a way to provide support to those in highest need. And we just announced a campaign Ann to train 1000 Ken employees of Ken member organizations. Right. Because with all this is, you know, it's such a daunting task, but how can we not be paralyzed by the extent of the task? But so you identify what you can do, right? So as Ken, we're 25 partner organizations, so how can we challenge our own partners, right? To train their employees, which again improves the [10:39:23 AM] workplace, more supportive workplace. But it also, since most of our partners are service providers, right? It improves the ability of that workforce to better serve the needs of the clients. And so that's Kan's commitment, that's Kan's challenge, right. That we've taken on and that we announced today and that we will be figuring out how to deliver Wright 1000 Ken employees or employees of Ken member organizations trained on mental health first aid. And I'll just end real quick, but with that, lessons learned is then how do we transform that into a community wide challenge right? For training X thousands don't want to commit our Ken partners to a big number. But again, with our learnings, again, how do we figure out what resources we need to take it up another notch ? So I'll end there. I know we have some time for q&a. Sorry for going over a little bit, but very excited to be with you today and for the announcement today. Thank you. Council member for your leadership. Thanks to [10:40:23 AM] our colleagues at Paige and Travis county HHS, who are very integral to this effort as as is integral care and all our other hand partner organizations. Thank you, madam chair. Thank you, mayor. Councilmember. Thank you, Raul. Colleagues, I'm going to call up Laura de la Fuente. Did I say that right, or is it la Fuente? Laura la Fuente. Who's going to present and share with us what the city of Austin will be doing? Sure can pull up the presentation, please. Good morning. Laura la Fuente with Austin public health and I am pinch hitting for Stephanie Hayden. Stephanie hayden-howard. So the city of Austin, what are we doing as a city? We do believe in the importance of staff development, both for our internal and external customers as we're working kind of and particularly at Austin public health. We know with the pandemic kind of the isolation and other, you know, because of the pandemic, we know that people are experiencing issues with their mental health. So one thing we want to do is we want [10:41:24 AM] about to celebrate the staff that have completed the training and doing some research behind mental health first aid. We identified that over 700 city of Austin employees had already been trained. And we also identify Eid that we actually had some trained the trainers within the city that were employed by the city that were providing this training. At the directors meeting in April. On April 12th, we did present mental health first aid and reminded all the directors of the city of Austin departments that may was mental health awareness month and we wanted to provide them the information of the benefits to themselves, to the staff, to the public and how this tool could be helpful for them in doing that training. And I will say after that training the next day I got a call from someone from the department that said, hey, I just talked to someone who sounded like they might be a little suicidal. What do I do? Zo and I was able to reach out to integral care and be like, here's a number, here's a tool, here's what you can do. And in the event that that happens again, so I think these are real life scenarios when we're talking about individuals that interact with the public on a day to day basis or just interact with each other when [10:42:24 AM] they might hear something, see something that might provide them some support. And as I mentioned, we do have departments that have staffs trained to be trainers at Austin public health. We have, I think, 120 employees set to start doing the training if they haven't already started between now and June. But we are looking to how we can expand additional training to our staff. My understanding is that ems also has plans to have another staff trained to be a trainer so that we can continue on beyond this initial training. But as we have new staff come on board, as we do refreshers, wanting to ensure that we have this mental health first aid training available to our staff. Next slide, please. So our training initiatives are advertised through the following mechanisms. So there is a quarterly human resource update that goes out. There is an organized personal development intranet site to let department and staff know about the different trainings that are offered. We also have distribution lists based on previous class attendance to remind people of the training. We will distribute information through learn Singh community [10:43:25 AM] through each department's point of contact and all employee communicate actions and memos and also the city news to let people know to contact Taylor Johnson at Cagle care if they're interested in going to a training, paying for a training or hosting a training specifically for that department or those particular units. Next slide, please. And again, so city news will be sending out information. We're also working with our human resources organizational development to send out message to department department point of contacts, to coordinate with integral care, to be able to track the number of staff trained so that we can contribute towards the overall Ken goal to get 1000 individuals trained in mental health first aid. Thank you. Thank you, miss Lafuente. Colleagues, any questions? Comments only to make a comment that I'm really pleased to see all of this. I look forward to Friday or actually I probably won't look [10:44:26 AM] at it this weekend. So Friday or Monday. Getting the full report because I think that's I love the goal. This training is like if you if you saw somebody that was having a heart attack and you want to we immediately pay attention to that we a lot of people are trained in that but they're not trained in it when it comes to brain health. And so I really love that there's a program that we're going to take off on that. And I think the goal, while we stand here today thinking it's aspirational for a thousand, I think that's good to have that aspirational goal. And so I appreciate it both from from Ken and from the city report. So thank you all for that welcome. Thank you. Mayor and thank you, Mr. Alvarez, for joining us today, for representing Ken and for sharing out what can is working on. Thank you all right. Well, we are just flying through these items. Our last agenda item is a [10:45:28 AM] briefing on community health paramedics, mental health response program. We'll have clinical specialist Kenny pails and division chief Steve white join us for this presentation. Colleagues, I do want to highlight that we usually have Diana gray. Our homelessness strategy officer. Join us for an update on on our homelessness effort. And while she was not able to be here with us today, given our packed agenda, I did request that a memo be provided to us with an update on on the latest. Thank you. Good morning . My name is Steven white. I'm the division chief of integrated services, which includes our community health paramedic program. And I'd like to thank the committee for giving us a little bit of time to give you an update on this program that it's very exciting. It's a great success story. It's very innovative and we're very excited to share it with you. We'll go to the next slide. [10:46:29 AM] Austin Travis county ems sits in a very unique position where we intersect with mental health patients that are often in crisis as this department moves beyond its traditional scope of just responding with ambulances . And we're focusing more on bringing the right resource to the right patient at the right time about two and a half years ago, we developed our mental health first responder program that is contained within our community health program and we're able to bring the right resource source, which is a highly trained mental health professional, to a patient in crisis at the time of the 911 call, ambulances, much like emergency departments and emergency rooms, are really set up best for life threatening emergencies like heart attacks and strokes and severe trauma. It was very important that we start really focusing in on crisis, mental health and providing the right resources to those patients prior to them [10:47:30 AM] going to an emergency room, which may not be the best equipped or the best option for them at that time. So when we developed this program, we kind of took a three pronged approach to it. The mental health first response under response funds to these crisis moments at the time of the 911 call, usually an ambulance also responds and then the community health paramedic responds with them and then if the ambulance is needed for any other issues that they may identify on scene, then the ambulance can transport. If not usually about 75% of the time the community health paramedic can find an alternative diversion for that patient to go to or provide treatment right there on the scene. We've also developed a partnership and a collaboration with some of our partner agencies for the Austin cares team to address our mental health crisis proactively. And we'll talk a little bit more [10:48:31 AM] about that and then we also participate with integral care on the call center, our clinician program, the C three inside of the 911 center. So zo Austin is unique in the fact that when you call nine 111, you can ask for a police fire, ems or mental health. We'll go to the next slide. We took the approach Paige at Austin, Travis county ems that mental health care is health care in a crisis situation. We frequently find ourselves treating the symptoms of a mental health care crisis instead of the mental health care issue itself. And so that's what we focused on with the training of this program for these responders to recognize is past the symptoms that we're seeing on scene and actually try to provide care to the base mental health issue. We want to find the best solution Ann for these patients in their time of [10:49:31 AM] crisis. There solution is not always an emergency room. It may be treatment there on scene where we can bring them back down to a level and then connect them to services as it may be going into an end treatment type facility. We have a lot of options and Eid these these team members are very well versed in how to navigate that system. And then we took another goal. Our tertiary goal of we want to support our law enforcement partners ships and try to limit their involvement in these mental health crisis because we view this as a health care crisis and as austin-travis county ems is responsible for people's health care in the 911 system, we want to take that same approach to these mental health crises as well. Then we also want to find new and new alternatives and new ways to address these crisis issues and really push our industry in ems [10:50:32 AM] further into this realm so that we can provide better services for our patients and do the right thing by them and just offer them the right services at the right time, give them as many options as they can. We really focus on patient centric care, where people have choice and they have options. This program is excellent for that clinical specialist Kenny Powell is here next to me. He helped design this program. He's helped build this program. He currently trains our current team members. I wanted to give him an opportunity to kind of tell you what that training looks like. If you go to the next slide. Thank you, chief. I'm very excited and proud to say that I'm a part of this team, which I think has been able to, as chief said, innovate and change how our city responds to people in mental health crisis. Just like chief said, it really was a pretty big, to use an overused phrase, paradigm shift for us. Traditionally paramedics did not have a great depth of training [10:51:34 AM] in mental health care specifically. So we created what we really think is, is possibly a first of its kind in the nation training program. We of course, leaned on, leaned heavily on some of our partners with expertise to create the material. But now members of our team receive three weeks of intensive and classroom training , subject matter, subject material includes some really foundational concepts like trauma, informed care, appropriate de-escalation, suicide prevention, more in depth, suicide assessment than a paramedic would typically do. We also, of course, are very focused on a lot of the other issues we've heard some of our community partners mentioned today substance use disorder assessed for substance use and even treatments for that and psychosis is one of the things chief mentioned a second ago is how we're trying to innovate and push our profession forward. And [10:52:34 AM] that includes the fact that one of our team members saw an opportunity and you may have seen this in the news to add a new treatment to our team, which is the use of zyprexa and antipsychotic medication. We're using that in a way nobody else in the nation is. Also, we're using that to treat people, experience Singh psychosis or agitation in the community and make it safe for them to remain in the community again, as has been said many times in the past, the model for ems really was just we arrive with an ambulance and we either take you to the E.R. Or we don't. And now with this program, we've identified 42, actually over 42 alternatives to those dispositions burns. So getting our folks to a point where they can safely and effectively move people to one of those dispositions takes takes training like this. So in addition to the three weeks of classroom training, can I interrupt you? Yes, sir. So sorry. I only want to interrupt you to highlight something that you just said described, and I [10:53:36 AM] think it's incumbent upon all of us to point out the work that gets done is really he's used the word treatment several times . I mean, we keep talking about treatment. We're providing health care. And in this case, brain health care through the services that are being provided here. And that's different than, as you just pointed out, just putting somebody in the back of a ambulance and taking them so that that's where they get treatment. Even up to and including I don't recognize the name of the drug that you mentioned, but the antipsychotic medication Ann that allows people to stay in the community and not end up in our emergency rooms because of the treatment they're receiving. I don't think that gets said enough. I don't think it gets emphasized enough. So I congratulate you on having a public health meeting that focuses on mental health. I think that's. But that's a very important part. And so I'm sorry [10:54:37 AM] to interrupt you, but it scratches a strong itch of our community. And I appreciate you you saying it. Thank you, mayor. No I'm with you on that. Our city does so much when it comes to mental health care. I'm really proud to have a city of Austin that prioritized mental health. The fact that when someone calls 911, the dispatcher says, is this a mental health emergency? And having that included into our system is incredible. So I appreciate the work that you all are doing and having this opportunity to really elevate city services. Oh, please don't apologize for that interruption. That was wonderful. And on behalf of my team, thank you for that. We obviously needed to do some more innovation to get to a point where we could do things like that. You know, treating people in a community, leave them safely in a community. So zo, without getting into too much of the too many of the details, that does include a very detailed Eid assessment [10:55:38 AM] that we also think is innovative and first of its kind in the country. It's a lot for the city to be proud of in the last two and a half years that this team is has accomplished the again, one thing I want to emphasize is that all of this is through the lens of medical practice. It's through we are viewing these as patients, as we are always this is why it's important for paramedics to be involved. We are always assessing these people for the potential that there is also a co-morbid medical need and we ensure we're ensuring that they're getting access to appropriate care for that as well. The rest of the training involves some familiarization with other things our team does. That's access to social services and some of the things you heard earlier about things that affect people's downstream Singh chance and risk for incarceration, substance use, that sort of thing. And about over half of [10:56:38 AM] our training actually involves training with the mental health paramedics who have been on the team for the last two years and have developed these practices so that we can assure new team members are doing things not just effectively but safely. So no small part of this. Of course, I would be really remiss if I didn't mention we have a very close relationship with our medical directors and the office of the chief medical officer. They are very supportive of this team. They're very involved in our training and they also are developing appropriate credentialing. Of course, we're working under their license. So that makes sense. Next slide, please. The another component that of our city's response or our city's approach to mental health, that our team is involved in is the Austin cares team. This is a multi-agency team. So there's law enforcement . Austin, Travis county, ems and integral care or local mental health authority. This is an approach to something actually that law enforcement has has [10:57:38 AM] really been doing on their own for quite a while. The APD, cit team has has always had officers that have taken referrals from patrol officers for folks that may be officers identified, need more in depth mental health care or mental health that have concerns for their mental health . Now, instead of just the officers. Then following up, we have this multi-agency team that goes and really it's collaborative, it's problem solving and it's been very effective. And one of the areas that they really focus on are identifying people who are high utilizers. Of the 911 system, and they've had just a lot of success, obviously with great respect for people's privacy. I can't tell you some of the stories, but there are people that are known very well to people within our system that we have seen moved away from using just 911 as their first call for help or only call for help and into more appropriate places. So [10:58:42 AM] that's been a very effective program. I think in our team is really involved in that to the last of the three pronged approach to changing our city response to mental health care is the c3, which is integral care actually has a qualified mental health provider. So this is usually somebody with a master's degree and a license at the 911 call center. So when we keep saying that when you call 911 and you're asked, you need police, fire, ems or mental health, what if that answers mental health? And the call taker has screened this and assured that it's not a public safety issue issue or a medical issue. It goes to that qualified mental health provider. And they will find Eid alternative dispositions as well that don't involve law enforcement or ems or or they sometimes do refer it back to ems and try to bring our team in specifically. One thing [10:59:43 AM] that I think is a is a kind of useful statistic that isn't in our slide. But I'd like to say when we talk about these alternative dispositions, we did an internal study of our own response is and found that over 75% of the time that our team responds to somebody in mental health crisis, we are not putting them on an ambulance and taking them to an E.R. So that's not only a tremendous benefit to the patient, but you can understand that's a tremendous benefit to our public safety system. We're creating much better efficiency for all of our resources. There's some similar statistics for use of law enforcement that I think chief is going to talk about. And you'll really see what you're looking at is how what is currently a very small team is really a force multiplier for our entire public safety system . 75% for ambulance diversion. And now you're going to see the law enforcement side. Thank you . Next slide, please. Sorry. So [11:00:48 AM] when we're talking about how often this team is being used, we're we're on pace to hit about five and a half to 6000 calls for our mental health crisis. This year on our last data pool, we have the potential for 8000 calls per year. So if we're looking at if we're making a difference, we we're taking 75% of the calls and we're diverting them away from an ambulance. Let's take a look at law enforcement involvement in those mental health crisis calls. We continually average between 90 and 95% of these mental health calls do not require law enforcement involvement. That is a significant number. And the potential is there to make that even better for that is something that we are very, very proud of at the at Austin, Travis county ems, this is a [11:01:50 AM] significant, significant success. I will say that mental health is a daunting thing to take on. It takes a lot of the training that we were talking about today. It is not an easy thing to do and it is not something that austin-travis county ems can even come close to doing on its own. We were everything that we do as a collaboration, everything that we do is a partnership. We work hand in hand with integral care Shaw we learn from our partnerships and we learn from our collaborations. And we are looking forward to collaborating on many more things in the future because I really feel like we sit in a very unique position where we intersect with these patients when they're having their worst day, and we can see by the numbers and we can see by the success of this program that we have a lot to offer. Shaw. The city leadership has been very supportive of this [11:02:50 AM] program. We're very appreciative for that. We are making efforts to get four responders per day for a 24 hour shift up and running that I think would get us to that full potential of about 8000 calls per year. We are onboarding Singh, not just us. All of our partnerships have made it a goal to onboard as many on call prescribers as possible so that when we find these patients in crisis, we can actually get them connected to a prescriber that can fill some of their needed medications. And then I just wanted to make a promise to this committee that Austin Travis county ems will continue to strive to push this initiative, even further into this space and do as much as we can to make a difference for our patients and our community. Thank you. And then we'll take some questions. If you have any questions. Wonderful. Thank you [11:03:51 AM] so much. I really appreciate that. Today's presentation and I want to make sure I understood this correctly. You said that the community health paramedics have the capacity to serve about 8000 calls. And up until this point, already here we are in may, you've already served between 5000 and 6000 calls, is that right? No, we're on track for 5 to 6000 for this year. For this year. Okay. Correct we currently can average. Paige between 2 and 3 responders on per day. The onboarding takes a lot of time. That's an 11 week training process. When we reach for our responders per day, that's when we'll be able to meet about 8000 per year. Gotcha thank you. And I do want to take a second to recognize assistant chief Hopkins and chief of staff Theresa Gardner, who are in the audience today. Thank you for joining us. Colleagues any questions or comments? Vice chair Velasquez I had a question about the zyprexa. You said that [11:04:52 AM] we're using it unlike anybody else in the nation. Is that correct? Can you and can you elaborate on that a little bit more? Yes, sir. Yeah. Zyprexa the olanzapine Ann is the name of the medication. We use it when somebody when there's a clinical indication for it. Usually that's agitation or psychosis. Maybe somebody experiencing Singh auditory hallucinations, Luz voices in the past, the only option was really to take somebody to the E.R. And it was a very common medication administered in the E.R. That often resulted in a pretty short stay in the E.R. And discharge. What other ems systems are doing that have olanzapine is using it for treatment during transport to the E.R. So the way in which we believe we're the only ones using it is that we will treat stay with somebody in sure. That it's been effective and that they're safe and leave them in the community if that's appropriate. About how long does that take that process? Oh, it's [11:05:52 AM] very quick, 20 to 30 minute action or onset of action and pretty good duration. Ann 12, 24 hours of duration. We've had a lot of success. It's not just giving them the medicine, watching them and then leaving. We actually and a real important facet of this is that we're connecting them to follow up care. So again, like part of why this is just the small team doing this and not just every ambulance is it does require a good in-depth ability to assess somebody's mental health, their safety. Of course, that suicide assessment and then understand and what resource to connect them to which which involves a lot of things as well. Thank you all for your service. That's phenomenal. Yeah. Thank you. Thank you. Thank you again. Colleagues, any next. Our last item is future items. Any thoughts comments on any future items for committee to consider? Okay. Well with that we will stand adjourned at 11:06 A.M.