President and Chief Executive Officer
The Center for Health Care Services
For the past thirty seven plus years, Leon Evans has provided extraordinary leadership and has demonstrated a tireless passion for and commitment to engaged advocacy for persons with mental health, substance abuse and developmental disabilities.
As Chief Executuve Officer of the Center for Health Care Services, his goal has been to address the challenges found within the public mental health system. He has fought to address a growing problem, which is that persons with severe mental illnesses, who are for the most part non violent, find themselves caught up in the criminal justice system. Many persons with mental illness are over represented in in-appropriate settings such as emergency rooms, jails and prisons. In this battle, Mr. Evans continues to spearhead a local, State and National transformation.
In April of 2000 Mr. Evans began to institute a dramatic system change which focused on reducing inappropriate incarceration and hospitalization of persons with mental illness and other disabilities. Policy change at the local and legislative level was accomplished as a direct result of Leon’s advocacy for persons and their families who while suffering from mental illness, came in contact with law enforcement. In 2003 Leon called for legislation which would require the support of and development of statewide jail diversion for all Texas counties Texas. This occurred when Texas Senate Bill 1145 was the first legislation of it’s kind to be passed in the United States.
Continuing to develop a series of firsts, Leon brought community stakeholders and a management team which nurtured the development and implementation of the Crisis Care Center, a 24/7 psychiatric facility which provided health and behavioral health services in one service location providing special assistance to law enforcement. A collaborative Crisis Intervention Team pairing local law enforcement and mental health professionals as response teams was formulated under a community partnership with Police and Sheriff. Corresponding community based crisis intervention training (CIT) training was also developed resulting in both organizations mandating the CIT training for their departments. Law enforcement officers would now have the option of taking people to treatment rather than to automatic incarceration. Over 11,000 persons would be screened since the facilities opening. Continuing in reaching out Mr. Evan’s principle support will bring over 1,000 CIT organizations from across the Country and from foreign nations will gather in San Antonio in June of 2010 to be a part of the first International CIT Conference to be hosted by the Center for Health Care Services with local, state and national stakeholders.
Addressing the silos dividing substance abuse treatment and mental health services Mr. Evans fostered the creation of the Restoration Center where sobering, detox and intensive substance abuse services are provided for persons suffering from both mental illness and substance abuse. Today the Crisis Care Center and the Restoration Center see a combined average of 1,000 persons per month. The immediate results are increased access to treatment and appropriate placement in a least restrictive service location.
The Center has also been visited by 26 state delegations and three countries and is considered to be the nation’s most successful jail diversion program by the Federal Substance Abuse and Mental Health Services Administration (SAMHSA). Most recently, the National Leadership Forum on Behavioral Health/Criminal Justice Services (July 2009) listed the Bexar County Program a prime example of a recommended “ Essential System of Care”. The report goes on to state:
“San Antonio Texas has become a national model with a highly integrated system of care that reflects strong
behavioral health and criminal justice partnerships that have resulted in a centralized police drop off that directly
links persons to case management, medications, housing, and peer support.”
Mr. Evans maintains a rigorous schedule of advocacy at the State and National level traveling across the Country for improved system design and collaboration in improving treatment services. Mr. Evans has also been asked to testify the Texas Legislature and before the U.S. Congress on behalf of a Federal Jail Diversion Bill.
Professionally, he is a member of the Texas Council Executive Directors Consortium, the Texas Strategic Health Partnership Steering Committee on Mental Health and Substance Abuse, the NAMI Texas Board of Directors, the Foundation for American Healthcare Leadership, Mental Health Corporation of America, the National Association of Counties Justice and Public Safety Steering Committee and the Youth Aging Out of Foster Care Task Force, a Board Member of the Friends of SAMHSA, past President of the National Association of County Behavioral Health and Developmental Disability Directors (NACBHDDD), member of the NACo Veterans/Military Task Force and member of the Bexar County Community Justice Task Force.
In his own words: Leon Evans writes
“Due to the lack of funding, poor communications between hospital emergency rooms and law enforcement, no specialized training and the lack of a system designed to overcome these barriers, hundreds and thousands of persons with severe mental illness were inappropriately ending up in our emergency rooms, jails, prisons or homeless on our streets.”
Jumping a few years forward, today we have several community collaborations; partnerships with Medical Directors, Judges, Law Enforcement, Families and Consumers addressing these issues. We are currently screening and diverting almost a thousand persons a month from emergency rooms, jails, prisons and the streets into treatment and recovery.
We have received several national awards, the American Psychiatric Association Gold Award, the National Council of Community Behavioral Health Center’s top award, and I also recently testified before Congress on the Mentally Ill Offender’s Act. We have had representatives from twenty states and two countries visit our services. We have also had two independent medical economists conduct independent cost benefit analysis. I, as one of our team members, speak all over the country about our services and the great outcomes. The Texas legislation appropriated 82 million dollars last session for crisis services largely due to our outcomes. We have taken special attention to be outcome driven and to ensure that we develop one of the most responsive public safety nets possible.
The following provides background for the Bexar County Jail Diversion program and some of it’s major components:
The Bexar County Jail Diversion Program
The BEXAR COUNTY JAIL DIVERSION PROGRAM (BCJDP) has been designed and developed, through an expansive collaborative effort of community leaders and stakeholders, to meliorate the practice of utilizing the jail system for the inappropriate “warehousing” of individuals with substantial mental health issues and to minimize the use of the arrest/booking process of adult offenders with mental illness who by their conduct, are subject to being charged with a minor non-violent criminal offense. The program also addresses overcrowding and law enforcement wait times within the county’s emergency rooms. Multiple initiatives have been identified and operationalized along 46 separate and distinct penetration points in the current “arrest-detention process” within the criminal justice system. In Bexar County, jail diversion is an active daily occurrence which includes a broader range of comprehensive screening, increased access, continuity of care and cost savings to the community.
In a preliminary study, interim results during Fiscal Year 2004 showed an estimated range of $3.8 million to $5.0 million dollars in avoided costs within the Bexar County Criminal Justice System. As of September 2003, over 4,000 persons suffering from mental illness were diverted from jail. The success of the program spurred the support of successful legislation requiring the provision of State approved Jail Diversion plans for all community mental heath centers in Texas.
The Crisis Care Center
The Bexar County Jail Diversion program opened a new centrally located psychiatric Crisis Care Center operating 24/7 providing medical and mental health screenings. Averaging over 650 screenings per month this center began full operations with joint medical and psychiatric screening as of August 29, 2005. Within three months of operations the new Crisis Care Center reduced wait times for medical screenings for Law Enforcement Officers from nine (9) hours to 45 minutes and further reduced wait times for combined psychiatric and medical screenings from 12 hours to 65 minutes.
Working to strengthen the partnership between law enforcement and mental health our jail diversion program has established the Deputy Mobile Outreach Team partnering Sheriff Deputies with Mental Health Professionals for community crisis intervention, assessment and outreach. Additionally, specific training is conducted through an established Crisis Intervention Training Program in partnership with the San Antonio Police and Sheriff’s Office resulting in a community supported 40 hour CIT training cycle for local law enforcement.
Within the jail, early and preventive therapeutic intervention occurs through the establishment of the daily cross reference of local jail booking activity with local and state wide mental health data resulting in the identification of screening, assessment and treatment needs for inmates with prior state wide mental health indicators. Inmates have access to a special mental health docket addressing the special needs of the mentally ill inmate. Results have demonstrated a significant reduction in the re-arrest rate for of misdemeanor offenders.
Treatment beyond incarceration has been achieved through the implementation of 60 bed residential mental health jail “step down” program and a 200 bed drug abuse treatment facility in partnership with the Texas Probation Department. Additionally, the establishment of an “Involuntary Outpatient Commitment” program within Civil Probate Court has provided a vehicle to provide treatment to repeatedly come to the attention of the courts and who are in danger of deterioration. When comparing one year prior to program participation and one year post participation an initial review of the first 14 participants showed a 79% reduction in state hospital bed day utilization.
The Restoration Center
Homeless individuals struggling with alcohol and drugs and persons experiencing severe mental illness can now find help at the newly constructed detox center known as the Restoration Center.
The Restoration Center, 601 N. Frio St., would not be a reality in this community were it not for the vision of many who recognized that there are countless homeless in our community with substance abuse who need a place, other than jail or hospital emergency rooms, that offer them help and hope in the treatment of this disease.
Already the Restoration Center is proving to be cost effective. In the first 180 days in operation, it has served 395 homeless individuals who have been diverted from jail for a cost savings of $766,530 to the taxpayers through Dec. 31, 2008. The sobering unit has admitted 1,627 individuals in the last 162 days. Had it not been for the Restoration Center, 1,158 of them would have been admitted into the municipal court detention area at a cost of $2,657,610 in this short period.
An additional $703,500 was saved when law enforcement officers took 469 people to the Restoration Center instead of to hospital emergency rooms prior to incarceration. Moreover, officers are spending less time in ER waiting rooms, thereby allowing them to return to community policing.
Admissions to the detox unit stem from multiple referral sources such as courts, the sobering unit, the crisis care unit, Haven for Hope partners and homeless walk-ins.
The Restoration Center continues to merge critical services and improve access and treatment available for our homeless with increasing success. Through the dedicated efforts of our state and local community champions who recognized that these persons were inappropriately overcrowding our jails and hospital emergency rooms, this new facility that includes sobering and crisis care, will allow thousands of persons to recover and restore their lives.
This is how government should really work. Finding a local solution through community collaboration by braiding and blending federal, state and local dollars in the most effective and efficient way. It is the only way this community will be able to address our huge problems and assure the best outcomes.
This community investment in this Restoration Center by our state, Commissioners Court, City Council and community leaders will reap untold benefits that will serve us by transforming lives and our communities.
To view a recent presentation please click on Enlightened Alternatives: How CIT and Diversion Programs Can
Strengthen Your Public Safety Net.