Mental Health Diversion Pilot to Begin by August

The Travis County Correctional Complex, which mental health diversion provides an alternative to (photo by John Anderson)

Travis County’s mental health diversion pilot – aimed at providing psychiatric care instead of jail time for people without access to services – will finally begin later this summer, after a yearlong process of development. The actual diversion center won’t be built until at least 2029, but programmatic changes to the county’s mental health services are much closer at hand.

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 peer support services and access to doctors that can prescribe psychiatric medication. Integral Care will also add a new 23-hour observation service for people 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-stay Therapeutic Diversion Program (TDP) for further stabilization, housing, and connection to services.

First responders will use PES as “an entry point,” says Marisa Malik, Integral Care’s director of crisis services. There they’ll receive a clinical assessment to determine the next step in care. That could mean immediate discharge, a 23-hour observation (for people in extreme crisis), or transfer to the 90-day stay at TDP if they are at low risk of harm.

Integral Care, the county’s mental health authority, has been responding with APD to mental health crisis calls since 2014 with its Expanded Mobile Crisis Outreach Team (EMCOT), along with clinicians at the 911 call center. There are already two buildings that law enforcement can take people in crisis to for short-term stabilization – the Guy Herman Center and the Inn. Within the jail, Integral Care helps connect incarcerated people with ongoing care upon release.

So what’s changing? Access to services 24/7, says Malik. Currently, EMCOT lacks staff and funding to take referrals from law enforcement at all hours. When they’re closed, officers either take the person to an emergency room, to Central Booking, or leave them in the community – increasing the likelihood of repeat contact with law enforcement or an unnecessary jail stay. At PES, they’ll have immediate access to a medical prescriber and connection to services.

Integral Care hopes to open both facilities by mid-August, after hiring 22 additional staff at PES, roughly 17 positions at TDP, a jail liaison, and a landlord outreach position to fit people with housing. They’ll also train APD, the Travis County Sheriff’s Office, and EMS on who is a good fit for the program.

The program is 100% voluntary, says Malik – but there are many ways someone could access it. “If someone is experiencing a medical emergency, [first responders] would route them to the emergency department first, but they could get transferred over to PES. Or if they’re intoxicated to a point where they’re not able to meaningfully engage in an assessment, they would go to the Sobering Center, then be transferred to PES.” If after the 23-hour hold they’re still at imminent risk of harm, they’d be transferred to higher-level inpatient care.

So who is not a good fit for this program? County Judge Andy Brown stresses that this is “not the place for people who are having severe mental health crises.” Those will be served by phase two of the diversion program, possibly including involuntary commitment. For this first phase, it’s “a fairly light touch – providing people medical care, a place to stabilize, and a place to live for 90 days,” says Brown. “What does that do to solve this problem?”

Also down the line, Malik says Integral Care is working with the County Attorney’s Office to offer direct admission to the program from the jail. Mental health public defenders and the County Attorney’s Office already make referrals for some “coordinated releases,” but there are thousands of people in county jails across the state deemed incompetent to stand trial, but who are awaiting treatment at the Austin State Hospital. The state psychiatric facility just underwent an extensive renovation, but did not add any beds, meaning that the waitlist problem isn’t behind us. Luckily, Malik says the county could use TDP for competency restoration later on. And for jail releases, Integral Care is currently negotiating a grant with Texas Health and Human Services that could unlock more funding by August.

For now, Brown says the goal of this first phase is to “track the data and understand what the circumstances were. We’re really just trying to learn from this.”

Editor' Note Thursday, June 13, 10:32am: This story published with an incorrect byline. The Chronicle regrets the error.