the psychology of hoarding - tmcec · animals until they interfere with day‐to‐day functions...
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The Psychology of Hoarding
Stephen A. Thorne, Ph.D.Texas Municipal Courts Education Center
Austin, TexasFebruary 27, 2015
(512) 342‐1661 (ph) 512‐306‐9234 (fax)[email protected]
Research Assistant: Lauren Farwell, M.A.
Hoarding? Messy? Pack Rat? ADHD? OCD? Normal? Cat Lady?
Hoarding Defined
• Hoarding can be defined as:
– “the excessive collection and retention of things or animals until they interfere with day‐to‐day functions such as home, health, family, work and social life”.
(Fairfax County Hoarding Task Force Annual Report, 2009)
• Hoarding is a multi‐faceted problem that has a variety of psychological, physical welfare, economic, and public safety implications.
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Not a diagnosis, but…
“Hoarding” is NOT a DSM‐IV‐TR diagnosis and there are no universally accepted diagnostic criteria. Frost and Hartl (1996) do, however, offer the following hallmarks of hoarding:
• The acquisition of and failure to discard a large number of possessions that appear to be useless or of limited value.
• Living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed.
• Significant distress or impairment in functioning caused by the hoarding.
• Reluctance or inability to return borrowed items; as boundaries blur, impulsive acquisitiveness could sometimes lead to kleptomania or stealing.
Hoarding is NOT…
‐Being messy (lucky for me).
‐Collecting a bunch of “stuff”.
‐Having a lot of trash in your backyard.
‐A filthy/cluttered house.
‐Simply having too many of something.
‐Being a big‐time animal lover.
Hoarding IS…
Excessive and seemingly unreasonable keeping of things (i.e. animals, inanimate possessions), in such a way that significantly impairs/disrupts the day‐to‐day use of the residence. The need/desire to keep these objects assumes TOP PRIORITY (more important than anything else), and, as such, friends/family/loved ones (frequently children, elderly, disabled), animals, work, health, safety, and self‐care may be neglected and/or ignored.
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Hoarder Profiles
1. Good Samaritan
2. Disabled / Elderly Person
3. Cruel / Neglectful Person
4. True Hoarder
Kaup‐Fett, CCCHD (2010)
Good Samaritan Characteristics
• This person has taken on a burden in order to do a good thing but has become overwhelmed.
• Intervention by government officials may be perceived as threatening or insulting since their intentions are not to harm.
• This person is generally capable of correcting the problem with assistance.
• This person is generally willing to accept help in obtaining the desired end point as long as euthanasia is not an option for the animals.
Disabled/Elderly Person Characteristics
• This person has gradually decompensated, through disability, age or isolation, and is unable to manage his/her life and possessions. Intervention may be perceived as threatening and frightening.
• This person is generally capable of correcting the problem with help.
• This person is generally eager to accept help in obtaining the desired end point after they are reassured that no one is trying to force them into a home or euthanize their pets.
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Cruel/Neglectful Person Characteristics
• This person has allowed the environment to become unsafe and unsanitary through neglectful or purposeful means.
• This person may acknowledge your viewpoint, but will resist or refuse to correct the problem due to ulterior motives, such as:– money from the sale of purebred animals– sport– desire for “power” or displaced anger– a cruel and vindictive temper– reckless indifference to pain or neglect– drug abuse
True Hoarder Characteristics
• This person may feel threatened or insulted any type of intervention. He/she truly believes they are improving the condition of the animals (disease & starvation) within their household environment (in spite of overcrowding & unsanitary conditions).
• This person typically responds to intervention attempts with hostility and disinterest and may appear not to fully grasp the plight of the animals, his or her own health and well‐being, and on that of other household members.
• May often be disinterested or hostile to the negative effect of the animals or trash on the health and welfare of neighbors.
In short…
• Good Samaritan and Elderly/Disabled Person situations are fairly easy to resolve due to lack of ill intentions and good faith desire.
• Cruel / Neglectful Person typically requires enforcement to resolve their situation.
• The True Hoarder requires special attention, resources to successfully resolve their situation due to lack of insight and desire to change their situation.
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Where Does It Come From?
Hoarding appears to be a secondary symptom of one or more of the following problems:
• Delusional disorders and grandiosity
• Obsessive‐Compulsive Disorder
• Dementia/Cognitive deterioration
• Addiction and/or substance abuse
• Zoophilia
• Attachment disorders
• Depression/anxiety
Intervention: Sometimes Too Little Too Late
• Citizens do report compromised/ blighted properties, and neighbors do complain about residents that neglect property and create a public nuisance. That being said, interior hoarding conditions are rarely discovered until an emergency arises. A true hoarder may also be able to defend, hide or mask the severity of their living situation very well, and therefore serious situations may go unreported.
Levels of Hoarding
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Animal Hoarding
Animal Hoarder ‐ Definition
Any individual who possesses a large number of companion animals, fails to provide adequate nutrition and veterinary care, and keeps the animals in a severely overcrowded environment.
Fleury, 2007
Real Consequences…
• Many animal hoarders also neglect or provide inadequate care to humans (including self, children, elderly, disabled) in the home. Negative effects include complications from infection, inadequate nutrition, lack of water/electricity/bathroom. Fire hazards and insect infestations are also common. Animal waste toxicity produces an especially dangerous living situation.
• Animal victims also prone to psychological, behavioral, and/or physical problems, and, as such, have difficulty being placed or adopted. Many animal victims undergo euthanasia after being placed in shelter.
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Animal Hoarder Profile
• 76% are female.
• Most are unmarried and most live alone.
• 46% are age 60 or older.
• 65% keep cats. 60% keep dogs.
• 80% have dead or sick animals in the home.
• 69% have animal feces and urine in the living areas.
• 60% are repeat offenders.
• Most hoarded inanimate objects as well.» Clark County Health District, 2010
A few more stats…
• Cats, dogs, birds, and farm animals most commonly hoarded (Patronek, 1999).
• 80% hoarded inanimate objects (Patronek, 1999).
• Avg. # of animals per case – 39 (Patronek, 1999).
• Nearly 100% recidivism after prosecution (Patronek, 2006).
• 34% of animal hoarders found to have one or more dead animals in home (Berry, Patronek, & Lockwood, 2005).
Understanding the Animal Hoarder
Who?
Men, women, young, old, all SES, all nationalities, all education levels. Though not universal, many animal hoarders live a rather solitary lifestyle. Many animal hoarders also started collecting various items/objects as a child.
What?
Keeping/housing a larger than usual number of animals and providing them with inadequate care, while at the same time being unable to recognize/understand, or simply disregarding, the adverse effect of the environment on the health and well‐being of animals/humans in the home. Denial is a core feature.
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Why?
Hoarders, in general, often view their possessions as being a core component (if not the core component) of their identity. Animal hoarders care deeply about their animals/pets and find it extremely difficult to let them go. They typically cannot comprehend that they are in any way harming the animals and, in fact, truly believe they are improving the life of the animal and doing what “is right” for the animals, if not truly “saving them” (all the while believing others should respect/admire them for their actions). Hoarding” can provide them with self‐esteem and purpose. If their purpose/self‐esteem is challenged, this is when they tend to go to greater and/or more pathological means to defend their actions. Excuses and/or shifts of blame are common, and they generally lack insight (or interest) into the various negative effects of the hoarding behavior.
Intervention
Key word = multidisciplinary.
‐Human health and social services‐Housing authorities‐Legislators‐Community health professionals‐Animal welfare professionals
Fleury, 2007
The American Society for the Prevention of Cruelty to Animals hasdeveloped a “Hoarding Prevention Team” to assist hoarders.
Treatment?
• Psychopharmacological treatment.
Various antidepressants are prescribed to manage symptoms. This should not be viewed as a “cure”.
• Generally a consensus that psychotherapy is needed in conjunction with meds. Appears to be some empirical support for ERP as therapy modality. Remember, however, relapse rates for animal hoarders are extremely high, as truly addressing the denial and/or delusional thinking associated with hoarding can be quite the challenge.
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Behavioral Health Issues andCrisis Services
for Adults & Juveniles
Brettany H. Boozer, LCSW & Courtney Heard, Ph.D., LPC
TMCEC One-Day Clinic
Austin, Texas
Copyright © Heard, C. & Boozer, B. (2015)
What Is Mental Illness?
National Alliance of the Mentally Ill (NAMI) reports that a mental illness is a medical condition that disrupts a person's thinking, feeling, mood, ability to relate to others and daily functioning (NAMI, 2014)
Copyright © Heard, C. & Boozer, B. (2015)
Serious Mental Health Diagnoses
Some Serious Mental Illnesses Include:
Major Depressive Disorder
Schizophrenia
Bipolar Disorder
Post-Traumatic Stress Disorder (PTSD)
Copyright © Heard, C. & Boozer, B. (2015)
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Who Gets a Mental Health Diagnosis?
The reality is that any of us, at any time, given the right set of circumstances, can experience the
symptoms of a mental health diagnosis
Copyright © Heard, C. & Boozer, B. (2015)
Who Makes a Mental Health Diagnosis?
In Texas, individuals with the following licensure type can make a mental health diagnosis: Medical Doctor
Psychiatrist
Licensed masters-level counselor
Licensed masters-level social worker
Licensed masters-level psychological associate
Copyright © Heard, C. & Boozer, B. (2015)
Emotionally Disturbed
Since only certain professionals can make a mental health diagnosis, law enforcement has developed an appropriate descriptor of someone who might be experiencing a mental health diagnosis:
Emotionally Disturbed Person (EDP)
Copyright © Heard, C. & Boozer, B. (2015)
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Emotionally Disturbed?
Common Symptoms of Emotionally DisturbedWithdrawn IrritableUnreasonable ArgumentativeUnkempt LethargicEmotionally Volatile
Triggers for Someone Emotionally DisturbedTraffic TaxesTeenagers TraumaSubstance Use Mental Health Diagnosis
Copyright © Heard, C. & Boozer, B. (2015)
Effective Problem Solving
Think about a time you were really upset What would have helped you gather yourself together?
What worked?
What didn’t?
Copyright © Heard, C. & Boozer, B. (2015)
De-escalation
What is the most effective outcome of dealing with someone who is emotionally disturbed and may be experiencing a mental health diagnosis?
What do we want to have happen?
What works?
Copyright © Heard, C. & Boozer, B. (2015)
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Do’s and Don'ts
Do’s Remain Calm Speak in a measured
tone of voice Monitor body language Be ready to calmly
remove the individual from the situation
Provide reassurance and validation if needed
Don’ts Become agitated Speak loudly Appear threatening Be ready to “take down”
or “detain” the individual Take the “my way or the
highway” approach Spell out the
“consequences”
Copyright © Heard, C. & Boozer, B. (2015)
Communication Skills
Active Listening
Empathetic Responses: Maintain Non-threatening Eye Contact
Body Language
Volume and Validation
Copyright © Heard, C. & Boozer, B. (2015)
Validation?
Validation is not “agreeing” with someone. Validation is acknowledging that an individual’s experience makes sense to them “Being around a lot of people right now appears to be
concerning to you.”
“I imagine if my wife were taking me to court of child support, I’d be upset too.”
Copyright © Heard, C. & Boozer, B. (2015)
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It’s Not Working….
When do you call? Despite your attempts if the person is not or cannot be
re-directable
The person begins to actively be a danger to his or her self or others
Copyright © Heard, C. & Boozer, B. (2015)
Who Do You Contact?
Contact the Local Mental Health Authorities (LMHA) Crisis Hotlines are listed at
http://www.dshs.state.tx.us/mhsa-crisishotline/
Search the DSHS MHSA online database by city, county, or ZIP code: http://www.dshs.state.tx.us/mhservices-search/
LMHAs are listed at http://www.dshs.state.tx.us/mhsa/lmha-list/
Copyright © Heard, C. & Boozer, B. (2015)
Crisis Services: Jail Diversion
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Mental Health Diagnosis and Jail System
ADULTS:In Fiscal Year (FY) 2014, a total of 42,743 individuals were admitted to state prisons and 22,272 were admitted to state jailsAccording to the Texas Correctional Office of Offenders With Medical or Mental Impairments (TCOOMMI): As of 2009, there were a total of 665,940 individuals who had a previous
encounter with a Local Mental Health Authority (LMHA) or Local Behavioral Health Authority (LBHA) (i.e. Mental Health and Mental Retardation (MHMR) Centers) 37,865 of these individuals had a diagnosis of Bipolar Disorder, Schizophrenia,
or, Major Depressive Disorder This figure included individuals on probation, parole, and detained in correctional
institutional divisions
In 2010, the total number of individuals who had a previous encounter with an LMHA or LBHA decreased to 660,820 However, there was an increase in the number of individuals identified to
have a core mental illness to include Schizophrenia, Bipolar Disorder, and Major Depressive Disorder to 40,232
Copyright © Heard, C. & Boozer, B. (2015)
Mental Health Diagnosis and Jail System
YOUTH:There were 63,914 formal referrals to Juvenile probation departments throughout the state in FY 2014
TDCJ-TCOOMMI FY 2012
Served a statewide total of 1,983 juvenile probationers and Texas Juvenile Justice Department (TJJD) parole clients, which represents a small segment of those juvenile offenders with mental health diagnoses
FY 2013Estimated that 33% of youth in the juvenile probation justice system and 60% of TJJD institution admissions have a diagnosed mental health disorder
Copyright © Heard, C. & Boozer, B. (2015)
DSHS Diversion Initiatives-Adults
Assertive Community Treatment (ACT) Teams Interdisciplinary model of treatment
Psychiatrist
Nursing staff
Social workers
Mental health professionals
Target diagnosis: Schizophrenia
History of multiple psychiatric hospitalizations
Texas ACT ACT is the most intensive level of service provided by the LMHA or LBHA
Case-management caseloads of no more than 10
Each individual is provided services equating to an average of 10 hours a month
Copyright © Heard, C. & Boozer, B. (2015)
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DSHS Diversion Initiatives-Adults
Other ACT Services Forensic Assertive Community Treatment
Offer the intensity of services associated with ACT
Clients: Extensive arrest histories
Chronic symptoms of mental illness, and/or
History of multiple psychiatric hospitalizations
Referred to programming from criminal justice agencies
Non-engagement in services may include legal sanctions
Copyright © Heard, C. & Boozer, B. (2015)
DSHS Diversion Initiatives-Adults
Harris County Jail Diversion Program Senate Bill 1185 This program will operate for a period of 3 years Treatment must incorporate principles of Critical Time Intervention Program staff will provide community-based jail diversion services to
individuals with: Mental illness with or without substance abuse/use: Major Depressive
Disorder, Schizophrenia, Bipolar Disorder, and PTSD Current treatment in Harris County Sheriff’s Office (HCSO) Mental Health
Unit History of recurring psychotropic medication treatment in HCSO Must have one or more of the above criteria and 3 or more bookings within
the past 2 years
Program Goals: Reduce recidivism rates Reduce the frequency of arrests of individuals with mental illness
Copyright © Heard, C. & Boozer, B. (2015)
DSHS Diversion Initiatives-Adults
Outpatient Competency Restoration (OCR) Programs 80th Legislative Session DSHS allocated $4,000,000 to establish 4 OCR pilot programs
82nd Legislative Session Rider 78 mandated that 5 new OCR pilots be established
Treatment Contract with LMHAs and ValueOptions-NorthSTAR Provide restoration to competency Case-management Services Medication Supportive employment Housing Counseling Substance use treatment
Copyright © Heard, C. & Boozer, B. (2015)
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DSHS Diversion Initiatives-Adults and Children
Texas Correctional Office on Offender’s with Medical or Mental Impairments (TCOOMMI)
Contract with the LMHAs or LBHA
Program – 2 years
Treat people on probation or parole with severe and persistent mental illness
Provide intensive case-management services Supported employment
Permanent supportive housing
Co-occurring Psychiatric and Substance Abuse Disorders treatment
Cognitive Behavioral Therapy
Copyright © Heard, C. & Boozer, B. (2015)
DSHS Diversion Initiatives-Adults and Children
Partnering with county jails, the District Attorney’s Office, and the courts Texas Law Enforcement Telecommunications System
(TLETS) 80th Legislative Session, Senate Bill 839 When an individual is booked into any county jail, a TLETS query is
initiated First name, last name, date of birth, gender, race, and social security
number; Entered into the TLETS portal; and Matched against names that are in the CARE system operated through
DSHS If a partial or exact match is yielded The jail is notified and they notify the LMHA or LBHA LMHA or LBHA – conducts a screening The goal is to link the inmate to community mental health services
Copyright © Heard, C. & Boozer, B. (2015)
DSHS Diversion Initiatives-Children
Residential Treatment Centers (RTCs): Provides 24-hour care for children 18 years of age or less
Offers programmatic services such as transitional living or emergency care, or may offer treatment services for emotional disorders or primary medical needs
DSHS and DFPSDeveloped an RTC initiative
Provides an intensive service alternative for children/youth at risk for parental relinquishment of custody due to a lack of mental health resources
Children between 5 and 17 years of age are referred by DFPS’ Child Protective Services in collaboration with LMHAs and have “no finding” of abuse/neglect by the parents/guardians. LMHAs provide assessments and access to RTCs
Waco Center for Youth Residential Treatment Center: A state-operated, psychiatric residential treatment facility
Serves adolescents 13 to 17 years of age with significant or severe emotional difficulties and/or behavioral problems.
Serves approximately 70 youth from across the state and is located in Waco
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DSHS Diversion Initiatives-Children
Youth Empowerment Services (YES):
Serves youth 3 to 18 years of age
Services are geared towards children who would otherwise need an institutional level of care or whose parents would turn to out-of-home placement due to the child/youth’s serious emotional disturbance (SED)
Treatment is provided in a child’s home and local community
Individuals must be eligible for Medicaid and meet specific requirements to receive services
Services are currently available in Travis, Bexar, Tarrant, Harris, Cameron, Hidalgo, Willacy, Williamson, Burnet, and McLennan counties. The remaining Texas counties are anticipated to begin enrolling participants by September 2015
For More Information:
Courtney Heard, Ph.D, LPCDepartment of State Health ServicesProgram SpecialistEmail: [email protected]: 512-206-5081Fax: 512-206-5303
Brettany H. Boozer, LCSWDepartment of State Health ServicesProgram SpecialistEmail: [email protected]: 512-206-4563Fax: 512-206-5805
&
Copyright © Heard, C. & Boozer, B. (2015)
Questions
Copyright © Heard, C. & Boozer, B. (2015)
Crisis Services
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Behavioral Health Issues and Crisis Services for Adults and Juveniles
Brettany Boozer, LCSW & Courtney Heard, Ph.D., LPC
Texas Department of State Health Services
Heard, C., & Boozer, B. (2015, February). Behavioral health issues and crisis services for adults and
juveniles. Educational session presented at the Mental Health Issues and Procedures in
Municipal Courts, Austin, TX.
Jail Diversion involves collaboration between Local Mental Health Authorities (LMHA),
NorthSTAR, and judicial officials such as judges and representatives from the District
Attorney’s Office, and law enforcement. Jail Diversion in the state of Texas parallels the
Sequential Intercept Model published by the Substance Abuse and Mental Health Services
Administration (SAMSHA), with jail diversion occurring across five intercepts: law
enforcement, initial detention/initial court hearings, jails/courts, re-entry, and community
corrections (i.e.
http://gainscenter.samhsa.gov/pdfs/integrating/GAINS_Sequential_Intercept.pdf).
In Texas, there are two overarching methods of jail diversion (i.e., Adults and Children):
1. Crisis Response Services: Mobile crisis response and crisis facilities
2. Access to Ongoing Care: Characterized by interagency collaboration to provide linkage to
on-going mental health treatment which may occur pre-booking, or post-booking of an inmate.
For some, additional supports may be provided through the Texas Correctional Office on
Offenders with Medical or Mental Impairments (TCOOMMI) to avoid future interaction with
law enforcement.
The ultimate goal of jail diversion practices is to intervene at the earliest point of the intercept
model; thus, there is a primary focus on pre-booking interventions.
Crisis Response Services
Pre-booking activities are designed to provide an intervention to individuals arrested for
committing a crime prior to being booked in jail for the arrest. Pre-booking is the most
frequently employed jail diversion strategy. Two overarching pre-booking diversion strategies
are crisis response services and Crisis Intervention Training (CIT) for law enforcement officials.
Crisis response services. The 80th
Texas Legislature appropriated $82 million for the Fiscal
Year 2008-2009 biennium. Guiding the appropriation of these funds was the expansion of crisis
services in the areas of mental health and substance abuse. Services that were implemented, or,
Please address correspondences electronically to the presenters at
[email protected], or, [email protected].
enhanced included crisis hotline, Mobile Crisis Outreach Teams (MCOT), and Psychiatric
Emergency Service Programs, all of which are currently utilized for jail diversion purposes.
Crisis Hotline – Crisis hotline services are available 24/7 and serve as the first point
of contact for mental health crises in the community. Qualified staff determines if
mobile emergency services are required to further assess the caller’s needs.
MCOT – These services are available 24/7 and are often the result of a referral that is
obtained through the crisis hotline. MCOTs deploy to various sites in the community
where a crisis situation has been reported. Generally, they are accompanied by law
enforcement.
PESC Programs – PESC programs encompass facilities that are staffed with mental
health and medical professionals that offer assessment and psychiatric stabilization to
individuals with behavioral health issues. These sites can be used for jail diversion
strategies, as law enforcement is encouraged to utilize these services, to achieve
detainee stabilization as an alternative to jail booking. A variety of PESC programs
are available:
o Extended Observation Units (EOU) - Extended observation units are designed
to provide emergency stabilization to individuals in behavioral health crisis
for up to 48 hours.
o Crisis Residential Services - Crisis residential services provide short-term,
community-based residential crisis treatment to persons who may pose some
risk of harm to self or others, and who may have fairly severe functional
impairment. The recommended length of stay ranges from 1-14 days.
o Crisis Respite Services - In contrast with crisis residential services, crisis
respite services provide short-term, community-based residential, crisis
treatment to persons who have low risk of harm to self or others and may have
some functional impairment who require direct supervision and care, but do
not require hospitalization.
o Inpatient Hospital Services - Hospital services staffed with medical and
nursing professionals who provide 24-hour professional monitoring,
supervision, and assistance in an environment designed to provide safety and
security during acute behavioral health crisis.
o Crisis Stabilization Units (CSU) - Short-term residential treatment designed to
reduce acute symptoms of mental illness provided in a secure and protected
clinically staffed, psychiatrically supervised, treatment environment that
complies with crisis stabilization unit licensing requirements.
Please address correspondences electronically to the presenters at
[email protected], or, [email protected].
Crisis intervention training (CIT)/mental health deputy/peace officer programs (i.e., Adults
and Children). In 2005, the Texas Commission on Law Enforcement Officer Standards and
Education mandated that all cadets receive 24 hours of crisis intervention training. This mandate
has since been changed to 16 hours. However, through the development of CIT, officers have
the opportunity to enhance their awareness of intervening with behavioral health populations
through taking a 40 hour course. CIT or, mental health deputy officers are generally called upon
when there is an individual with behavioral health issues in a crisis requiring law enforcement
intervention. These officers generally have strong collaboration with LMHAs and other agencies
that treat behavioral health issues. As an alternative to booking the individual into county jail,
many of these officers will transport the individual to a local treatment facility as a jail diversion
strategy.
Critical time intervention (CTI): Harris County Jail Diversion Program (i.e., Adults). S.B.
1185 of the 83rd
Legislative Session mandated the development of a jail diversion pilot program
in Harris County to reduce recidivism and the frequency of arrests and incarceration among
persons with mental illness. The 2014-2015 General Appropriations Act, S.B. 1, 83rd
Legislature, 2013 (Article II, Department of State Health Services, Rider 95) allocates $10
million to the establishment of the program, to which Harris County must match the dollar
amount. Services provided to participants will include integrated medical, mental, and physical
treatment. Additionally, the bill mandated that treatment encompass CTI principles, which
include psychiatric treatment and medication management, money management, substance abuse
treatment, housing, and life skills training.
Forensic Commitments
Outpatient Competency Restoration (i.e., Adults). S.B.867 of the 80th
Legislature amended
Chapter 46B of the Code of Criminal Procedure: Incompetency to Stand Trial. These
amendments explicitly permitted the outpatient treatment of individuals found incompetent to
stand trial, and determined not to be a danger to the community, for the purpose of competency
restoration treatment (see Article 46B.072. a-1). The Department of State Health Services
(DSHS) was provided funding to establish pilot sites for the implementation of OCR programs,
through local mental health authorities (LMHA), in collaboration with local judicial officials.
Since 2008 there have been twelve OCR sites established:
Center for Health Care Services - Bexar County
Austin Travis County Integral Care - Travis County
ValueOptions – NorthSTAR - Dallas County
MHMR of Tarrant County - Tarrant County
Emergence Health Network - El Paso
Gulf Coast Center & Tri-County Services - Galveston and East Texas areas
Spindletop Center - Beaumont area
StarCare Specialty Health System - Lubbock
Please address correspondences electronically to the presenters at
[email protected], or, [email protected].
Behavioral Health Center of Nueces County - Nueces County
Andrews Center Behavioral Healthcare Center - Tyler area
Community Healthcore - Longview area
Heart of Texas Region MHMR Center – Waco
Jail-based Competency Restoration Pilot Program (i.e., Adults). S.B. 1475 of the 83rd
Legislative Session directed DSHS to pilot a jail-based competency restoration program. The
2014-2015 General Appropriations Act, S.B. 1, 83rd
Legislative Session, 2013 (Article II, DSHS
Rider 74) appropriated $3.05 million for this purpose. S.B. 1475 requires that this pilot:
employ similar clinical treatment provided as part of a competency restoration
program at an inpatient mental health facility;
provide weekly treatment hours commensurate to the treatment hours provided as part
of a competency restoration program at an inpatient mental health facility; and
assign a staff to participant/defendant average ratio of not lower than 3.7 to 1.
Access to Ongoing Care
TCOOMMI (i.e., Adults and Children). In Texas, post-booking diversion strategies are
representative of interventions applied during Intercept 5of the Sequential Intercept Model.
TCOOMMI provides funding to some LMHAs for the development of treatment programs for
individuals on probation or parole. These individuals are generally identified by the courts to be
in need of mental health treatment. As a condition of their probation or parole, they must engage
in mental health treatment provided through the LMHA. Treatment generally entails linkage to
the LMHA where they meet with a case-worker weekly, receive psychotropic medication
treatment via a psychiatrist, and receive additional services consistent with the DSHS Texas
Resilience and Recovery Utilization Management Guidelines (i.e. visit
http://www.dshs.state.tx.us/mhsa/trr/um/ click on Texas Resilience and Recovery Utilization
Management Guidelines – Adult Services). If the individual complies with treatment, charges
may be dropped, severity of the offense may be reduced, or the sentence may be reduced.
Extended Jail Diversion Strategies
The below strategies may not be considered programs with the specific intent of diverting
individuals with mental illness out of the criminal justice system; however, they are strategies
implemented in Texas that have both direct and indirect influences on existing jail diversion
initiatives.
Texas Law Enforcement Telecommunications Systems (TLETS) (i.e., Adults and Children).
DSHS in conjunction with the Department of Public Safety (DPS) utilizes TLETS, which
permits the sharing of data between DPS and various agencies. Every individual booked into a
county jail receives a Continuity of Care Query (CCQ). The DPS TLETS permits that individual
(i.e. based on first and last name, date of birth, sex, social security number, and race) to be
Please address correspondences electronically to the presenters at
[email protected], or, [email protected].
searched across the DSHS Clinical Management for Behavioral Health Services system (i.e. a
data warehouse system including treatment information for all individuals who have received
services at institutions funded through DSHS such as LMHAs or state hospitals) to establish a
match of identity. Once a match is identified, the county jail receives a report with that
individual’s name and the location of the last LMHA in which a service was provided. County
jail staff contacts the LMHA to conduct a screening and provide linkage to mental health
services provided in the community via the LMHA, or, additional agencies (i.e. please see
http://www.dshs.state.tx.us/mhcontracts/ContractDocuments.shtm click on Information Item T).
Harris County Jail Diversion Pilot Program (i.e., Adults). S.B. 1185 of the 83rd
Legislative
Session mandated the establishment of a jail diversion pilot program that will operate for a
period of three years and treatment must incorporate principles of Critical Time Intervention.
Program staff will provide community-based jail diversion services to individuals with mental
illness with, or, without substance use issues. These individuals must have received treatment in
Harris County Sheriff’s Office (HCSO) Mental Health Unit, a history of recurring psychotropic
medication treatment in HCSO, and have one or more of the above criteria, as well as, three or
more bookings within the past two years. Program goals include reducing recidivism rates and
reducing the frequency of arrests for individuals with mental illness.
Health Community Collaboratives (i.e., Adults). S.B. 58 of the 83rd
Legislative Session directed
DSHS to enhance or expand existing services to persons experiencing homelessness and mental
illness in the 5 largest metropolitan cities in Texas. DSHS was allocated $6.9 million for Fiscal
Year (FY) 2014 and $16.5 million for FY 2015 for the implementation and expansion of these
projects. An example of such a project is Haven for Hope located in San Antonio. Haven for
Hope is a hub for individuals who are homeless. Law enforcement officers may drop off
individuals who are homeless at this site for assessment and linkage to treatment services. While
residing at Haven for Hope, individuals are provided with employment and job readiness
training, substance abuse treatment, education, spiritual, and additional services. Haven for
Hope services are rooted in a holistic and recovery-based treatment focus. There are over 80
organizations who partner towards maintaining Haven for Hope, 40 of which are located on the
premises.
Supportive housing and intensive community supports (i.e., Adults). The 83rd
Legislative
Session appropriated $24,840,940 towards the expansion of supportive housing for people with
mental illness who are homeless or at risk for homelessness. Eighteen LMHAs were awarded
funding towards the implementation of supportive housing to help stabilize a high need
population at potential risk of incarceration.
A Community Support Guide
for Alternatives to Inpatient
Mental Health Treatment
Mental Health and Substance Abuse Division
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Hello from Lauren Lacefield Lewis, Assistant Commissioner It is estimated that one in five Americans will experience a mental health issue
during their lifetime and that one in 20 will develop a serious mental illness.
Mental illness is not a personality weakness; it is a disease like many other diseases, such as cancer or diabetes.
Our mission is to restore hope, resilience, and recovery for the people we serve. The good news is that
treatment works; recovery from a mental illness is possible; and help is available for Texans living with mental health issues and substance use disorders.
Inpatient care is an important part of the overall service array for people with mental illness. However, this guide is designed to educate the public about community treatment options that can be used to help
children and adults with behavioral health issues avoid inpatient treatment if a less intensive alternative is appropriate.
Beyond the behavioral health crisis system in Texas, there are numerous resources that can provide the support and treatment that people with mental illness may need to move toward recovery and avoid
psychiatric crises. Local Mental Health Authorities and NorthSTAR providers, located in the Dallas region, can help link people to these important services.
In addition, The Hogg Foundation for Mental Health has produced an overview of services across the
state. You may find this to be a helpful reference:
A Guide to Understanding Mental Health Systems and Services in Texas, Second Edition, 2014. https://hoggblogdotcom.files.wordpress.com/2014/12/mhguide_final-1.pdf.
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Table of Contents
About This Guide ........................................................................................................................ 1
Types of Services Available ........................................................................................................ 4
STATEWIDE RESOURCES
Northern Regions of Texas ......................................................................................................... 8
Local Mental Health Authorities: Betty Hardwick Center, Center for Life Resources,
Central Plains Center, Denton County MHMR Center, Helen Farabee Centers, Pecan Valley Centers for Behavioral & Developmental HealthCare, StarCare Specialty Health System,
MHMR Tarrant, Texas Panhandle Centers, Texoma Community Center, and NorthSTAR/Value Options
Counties: Archer, Armstrong, Bailey, Baylor, Briscoe, Callahan, Carson, Castro, Childress,
Clay, Cochran, Coleman, Collin, Collingsworth, Comanche, Cooke, Cottle, Crosby, Dallam, Dallas, Deaf Smith, Denton, Dickens, Donley, Eastland, Ellis, Erath, Fannin, Floyd, Foard,
Gray, Grayson, Hale, Hall, Hansford, Hardeman, Hartley, Haskell, Hemphill, Hockley, Hood, Hunt, Hutchinson, Jack, Johnson, Jones, Kaufman, King, Knox, Lamb, Lubbock, Lipscomb,
Lynn, McCulloch, Mills, Montague, Moore, Motley, Navarro, Ochiltree, Oldham, Palo Pinto, Parker, Parmer, Potter, Randall, Roberts, Rockwall, San Saba, Shackelford, Sherman,
Somervell, Stephens, Stonewall, Swisher, Tarrant, Taylor Brown, Throckmorton, Wichita,
Wilbarger, Wise, Wheeler, and Young
Eastern/Central Regions of Texas ...........................................................................................12
Local Mental Health Authorities: ACCESS, Andrews Center Behavioral Healthcare System, Austin Travis County Integral Care, Bluebonnet Trails Community Services, MHMR Authority
of Brazos Valley, Burke, Central Counties Services, Community Healthcore, Gulf Coast Center,
MHMR Authority of Harris County, Heart of Texas Region MHMR Center, Lakes Regional Community Center, Spindletop Center, Texana Center, and Tri-County Services
Counties: Anderson, Angelina, Austin, Bastrop, Bell, Brazoria, Brazos, Bosque, Bowie, Burleson, Burnet, Caldwell, Camp, Cass, Chambers, Cherokee, Colorado, Coryell, Delta, Falls,
Freestone, Fayette, Fort Bend, Franklin, Galveston, Gregg, Grimes, Guadalupe, Hamilton,
Hardin, Harris, Harrison, Hill, Henderson, Hopkins, Houston, Jasper, Jefferson, Lamar, Lampasas, Lee, Leon, Liberty, Limestone, Madison, Marion, Matagorda, McLennan, Milam,
Montgomery, Morris, Nacogdoches, Newton, Orange, Panola, Polk, Rains, Red River, Robertson, Rusk, Sabine, San Augustine, San Jacinto, Shelby, Smith, Titus, Travis, Trinity,
Tyler, Upshur, Van Zandt, Walker, Waller, Washington, Wharton, Williamson, and Wood
Southern Regions of Texas ......................................................................................................20
Local Mental Health Authorities: Border Region Behavioral Health Center, Camino Real
Community Services, The Center for Health Care Services, Coastal Plains Community Center, Gulf Bend Center, Hill Country Mental Health & Developmental Disabilities Centers, Behavioral
Health Center of Nueces County, and Tropical Texas Behavioral Health
Counties: Aransas, Atascosa, Bandera, Bee, Bexar, Brooks, Calhoun, Cameron, Comal,
DeWitt, Dimmit, Duval, Edwards, Frio, Gillespie, Goliad, Hidalgo, Jackson, Jim Hogg, Jim
Wells, Karnes, Kendall, Kenedy, Kerr, Kinney, Kleberg, La Salle, Lavaca, Live Oak, Maverick, Medina, McMullen, Nueces, Real, Refugio, San Patricio, Starr, Uvalde, Val Verde, Victoria,
Webb, Wilson, Willacy, Zapata, and Zavala
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Western Regions of Texas ........................................................................................................23
Local Mental Health Authorities: Emergence Health Network, MHMR Services for the Concho Valley, Permian Basin Community Centers for MHMR, and West Texas Centers
Counties: Andrews, Brewster, Borden, Coke, Concho, Crane, Crockett, Culberson, Dawson, Ector, El Paso, Fisher, Gaines, Garza, Glasscock, Howard, Hudspeth, Irion, Jeff Davis, Kent,
Loving, Martin, Mitchell, Midland, Nolan, Pecos, Presidio, Reagan, Reeves, Runnels, Scurry,
Sterling, Terrell, Terry, Tom Green, Upton, Ward, Winkler and Yoakum
Appendix A: Local Mental Health Authorities ..........................................................................25
Appendix B: Outreach, Screening, Assessment and Referral Centers ....................................29
Appendix C: Helpful Links ........................................................................................................30
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About This Guide
The purpose of this guide is to help people better understand mental health care in Texas. This guide provides basic information regarding the services available across the state and the organizations that
can help people get connected to these resources.
Local Mental Health Authorities:
Every community in Texas is served by a Local Mental Health Authority (LMHA). LMHAs help people understand what treatment options will address the challenges associated with their mental illness and
ultimately achieve recovery. LMHAs provide a wide array of treatment services and support, and also
connect people with resources unique to their community.
The map below helps identify the LMHA nearest you. In addition, the Department of State Health Services (DSHS) website can help you identify which LMHA serves your community. For a complete list of
LMHAs visit www.dshs.state.tx.us/mhsa/lmha-list, or review Appendix A: Local Mental Health Authorities.
ID Center Name ID Center Name ID Center Name
1 ACCESS 14 Community Healthcore 27 MHMR of Tarrant County
2 Andrews Center Behavioral Healthcare System 15 Denton County MHMR Center 28 MHMR Services for the Concho Valley
3 Austin Travis County Integral Care 16 Emergence Health Network 29 Texoma Community Center
4 Betty Hardwick Center 17 Gulf Bend Center 30 NorthSTAR/ValueOptions
5 Bluebonnet Trails Community Services 18 Gulf Coast Center 31 Pecan Valley Centers for Behavioral & Developmental HealthCare
6 Border Region Behavioral Health Center 19 Heart of Texas Region MHMR Center 32 Permian Basin Community Centers
7 Burke 20 Helen Farabee Centers 33 Spindletop Center
8 Camino Real Community Services 21 Hill Country Mental Health & Developmental Disabilities Centers
34 Texana Center
9 Center for Health Care Services 22 Lakes Regional Community Center 35 Texas Panhandle Centers
10 Center for Life Resources 23 StarCare Specialty Health System 36 Tri-County Services
11 Central Counties Services 24 MHMR Authority of Brazos Valley 37 Tropical Texas Behavioral Health
12 Central Plains Center 25 MHMR Authority of Harris County 38 West Texas Centers
13 Coastal Plains Community Center 26 Behavioral Health Center of Nueces County
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Available Services:
People don’t have to wait until they are in crisis to receive help. Services are available to assist people receive employment, find or keep safe housing, and get access to medications when needed. This guide
provides a description of such services. We hope this will help you better understand what an LMHA does and how these organizations can assist you or someone you know.
For many people, a crisis causes an initial request for help from the mental health system. That is why LMHAs have a variety of services to assist people in crisis – even if they are not yet connected with care.
Some services, like the crisis hotlines, are available in every community. Others, such as the various
types of crisis facilities, have been developed by communities to meet their local needs and may not exist in every area. This guide will help you understand what options are available where you live. It also
provides a description of the services and lists contact information for each provider.
What do I need? Are there any openings right now? LMHAs have mental health professionals available 24/7 to help people understand what kind of care they need and how they can receive services. LMHA staff knows what openings are available and what the
best options are if a person has to wait. Some programs are designed for walk-ins. However, LMHAs
work with people to ensure they arrive at the right program that has the space and staff available to meet their needs. We encourage people to reach out directly to their LMHA when assistance is needed.
Sometimes it’s more appropriate to call 9-1-1 or go directly to a hospital. For example, if an individual has
hurt themselves, calling 9-1-1 for an ambulance or going directly to a hospital for immediate care is the most appropriate means to access immediate services. LMHAs help people make the best choice possible
in difficult crisis situations.
How much will services cost?
Services provided by LMHAs are available on a “sliding fee scale,” meaning payment for services may be greatly reduced based on a person’s income. LMHAs also accept most forms of insurance.
Are there options for people who have been arrested? A number of services are available to people in the criminal justice system. Typically referred to as
“forensic services,” this guide lists the communities that offer community-based services to people who are unable to stand trial due to mental illness. LMHAs also partner with the Texas Correctional Office on
Offenders with Medical or Mental Impairments. Information regarding these specialized services is also
provided in this guide.
Services designed for people involved in the criminal justice system are noted by the symbol to the left.
NorthSTAR:
NorthSTAR is an integrated mental health and substance abuse managed care program that serves Collin, Dallas, Ellis, Hunt, Kaufman, Navarro, and Rockwall counties. NorthSTAR takes the place of an LMHA for
these communities. For more information visit: www.valueoptions.com/northstar/members/ resources/NorthSTAR_Provider_Directory.pdf
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You may find the following acronyms helpful:
ACT Assertive Community Treatment CSU Crisis Stabilization Unit
DFPS Department of Family and Protective Services
DSHS Department of State Health Services
EOU Extended Observation Units JBCR Jail-based Competency Restoration
LMHA Local Mental Health Authority MCOT Mobile Crisis Outreach Team
MHMR Mental Health and Mental Retardation Center (traditional name for the LMHA)
OCR Outpatient Competency Restoration Program
RTC Residential Treatment Center
PESC Psychiatric Emergency Service Center TCOOMMI Texas Correctional Office on Offenders
with Medical or Mental Impairments
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Types of Services Available
Crisis Services and Facilities
Across the state there is a wide array of crisis services available to individuals in crisis. A crisis may be a
period of intense difficulty where an individual may be experiencing severe symptoms related to mental
illness, be a danger to themselves or others, or feel extremely hopeless. In crisis situation where you or someone you know is in immediate danger, call 9-1-1. Otherwise, the first step is to call the crisis hotline.
The services listed below are in order from least intensive to most intensive treatment options.
Crisis Hotline: Provides information, support, referrals, screening, and intervention services 24/7.
Mobile Crisis Outreach Teams (MCOT): Provides immediate response to the location where a
psychiatric crisis is occurring. MCOT is available 24/7 and medical and mental health professionals respond to calls from the home, school, street, or clinic.
Crisis Intervention, Relapse Prevention, and Follow-Up: Provides services to individuals who are
not in imminent danger of harm to self or others, but require additional assistance to avoid reoccurrence
of the crisis event. Mental health professionals respond to crises to reduce symptoms and prevent admission of an individual to a more restrictive environment.
Crisis Respite: Provides short-term, community-based crisis care for individuals who have low-risk of
harm to themselves or others, but may have some functional impairment. This is the least intensive,
facility-based crisis option. Services occur outside of a person’s home and may be provided for a few hours or a few days. Many people served in these programs have experienced an event causing
significant distress, are having housing challenges, or have loved ones/caretakers who are seeking temporary support or supervision for the individual. Facility-based crisis respite services have mental
health professionals on-site 24/7.
Crisis Residential: Provides up to 14 days of short-term, community-based residential, crisis treatment
for individuals who may pose some risk of harm to themselves or others, have a fairly severe impairment in their ability to function, and demonstrate a psychiatric crisis that cannot be stabilized in a less intensive
setting. This is a more intensive, facility-based crisis option. Mental health professionals are on-site 24/7 and provide support and rehabilitative services.
Psychiatric Service Emergency Centers (PESC): Provides a combination of facility-based crisis care services, such as those listed above. PESCs must be available for walk-ins and provide immediate access
to assessment, triage and a continuum of stabilizing treatment for individuals experiencing a behavioral health crisis. PESCs are staffed by medical personnel and mental health professionals and provide care
24/7.
Extended Observation Units (EOU): Provide emergency services for up to 48 hours to individuals in
psychiatric crisis. Services are provided in a secure and protected, clinically staffed, psychiatrically supervised environment with immediate access to urgent or emergent medical and psychiatric evaluation
and treatment. Individuals seeking treatment in an EOU may pose a moderate- to high-risk of harm to themselves or others. A determination of whether the individual has stabilized or requires a psychiatric
hospitalization is made prior to the end of the 48-hour period.
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Crisis Stabilization Units: Provide short-term, residential treatment to reduce acute symptoms of
mental illness. Although it is slightly less intensive than a full psychiatric hospitalization, this is one of the most intensive facility-based crisis options.
Rapid Crisis Stabilization Beds: Provides very brief stays in licensed hospitals to relieve acute
symptomatology and restore an individual’s ability to function in a less restrictive setting.
Residential Treatment Centers (RTCs): Provides 24-hour care for children less than 18 years of age
and may offer programmatic services such as transitional living or emergency care, or may offer treatment services for emotional disorders or primary medical needs. Residential treatment centers are a
subset of General Residential Operations that serve only children needing treatment services for emotional disorders.
A specialized RTC initiative implemented through a partnership between DSHS and the Department of Family and Protective Services (DFPS) provides an intensive service alternative for children/youth at risk
for parental relinquishment of custody due to a lack of mental health resources. Youth reside in these facilities an average of 6 months. Children between 5 and 17 years of age are referred by DFPS’ Child
Protective Services in collaboration with LMHAs and have “no finding” of abuse/neglect by the
parents/guardians. LMHAs provide assessments and access to RTCs.
Waco Center for Youth Residential Treatment Center: A state-operated, psychiatric residential treatment facility that serves adolescents 13 to 17 years of age with significant or severe emotional
difficulties and/or behavioral problems. This is a unique facility that serves approximately 70 youth from across the state and is located in Waco.
Contact: Admissions Coordinator 254-745-5399, or Admissions/Aftercare Assistant 254-745-5302.
Outpatient Services
Across the state of Texas there are core services provided by LMHAs and NorthSTAR providers to help you or someone you know get better. Youth Empowerment Services (YES) is only offered in certain
counties for now, but, these services will be expanding to other parts of Texas soon.
Access to Benefits: When an individual is enrolled in services, the benefits officer may assist the
individual in applying for Supplemental Security Income (SSI) or Supplemental Security Disability Income (SSDI).
Case Management: Case managers are employed by LMHAs or NorthSTAR providers and help adults, children, or caregivers obtain needed services, such as employment, medication, and substance abuse
treatment.
Peer Services and Supports: Peer providers share their experience related to recovery; act as a model of hope and resilience to others; provide education, training, and interventions within the recovery
process; and promote integration with community resources. Peer providers have experienced mental
illness which makes them uniquely able to promote wellness, recovery, and an independent life in the community.
Medication and Medication Training: Physicians (and people who assist physicians, such as nurse
practitioners and physician assistants) assess whether medications would help adults and children
address symptoms, achieve stability, and ultimately recover. Physicians also work with treatment teams to provide education and guidance about these medications and their possible side effects.
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Counseling (Cognitive Behavioral Therapy and Cognitive Processing Therapy): Individual,
family, and group therapy works to reduce or eliminate an individual’s symptoms of mental illness and increase the individual’s ability to perform normal, daily activities. This evidence-based practice is
frequently recommended for people with diagnoses of major depression or post-traumatic stress disorder.
Rehabilitation and Skills Training: Provide evidence-base intervention services as a part of the
overall treatment planning process to facilitate recovery.
Supported Employment: This evidence-based practice builds upon rehabilitation services and works to help people choose, obtain, and maintain employment in regular community jobs.
Supported Housing: This evidence-based practice builds upon case management and rehabilitation
services to help people choose, obtain, and maintain regular, integrated housing.
Assertive Community Treatment (ACT): An evidence-based practice that is specifically designed for
those who have difficulty avoiding repeated admissions or long stays in inpatient psychiatric facilities. ACT provides a full array of intensive, in-home services and utilizes person-centered recovery planning to help
these individuals achieve stability and facilitate community living.
Youth Empowerment Services (YES): The YES program serves youth 3 to 18 years of age by
providing services in a child’s home and local community to children who would otherwise need an institutional level of care or whose parents would turn to out-of-home placement due to the child/youth’s
serious emotional disturbance (SED). Individuals must be eligible for Medicaid and meet specific requirements to receive services. Parental income is not included in financial eligibility determinations for
Medicaid, often resulting in eligibility for children/youth not otherwise Medicaid eligible. Services are
currently available in Travis, Bexar, Tarrant, Harris, Cameron, Hidalgo, Willacy, Williamson, Burnet, and McLennan counties. The remaining Texas counties are anticipated to begin enrolling participants by
September 2015, including the NorthSTAR area that is anticipated to begin offering these services in the spring of 2015. Visit www.dshs.state.tx.us/mhsa/yes for additional information.
Substance Abuse Services: LMHAs work closely with Outreach, Screening, Assessment, and Referral Centers (OSARS) to help people with issues related to substance use. Regardless of their ability to pay,
Texas residents seeking substance abuse services and information may qualify for services based on need. For a complete list of OSARS visit www.dshs.state.tx.us/sa/OSAR, or Appendix B: Outreach,
Screening, Assessment, and Referral Centers.
Services for People in the Criminal Justice System
Forensic Services
A number of services are available to people involved in the criminal justice system. Typically referred to as forensic services, this guide lists the communities that offer community-based services to people who
are unable to stand trial due to mental illness. LMHAs also partner with the Texas Correctional Office on Offenders with Medical or Mental Impairments. Information regarding these specialized services is also
provided in this guide.
Services designed for people involved in the criminal justice system are noted by the symbol to the left.
Outpatient Competency Restoration Program: Provided through an LMHA or NorthSTAR, this program offers a full array of mental health services to adults deemed incompetent to stand trial. This
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program also provides services and supports in a person’s home or community and is created as an
alternative to inpatient treatment for competency restoration at state mental health facilities.
Texas Correctional Office on Offenders with Medical or Mental Impairments Programs (TCOOMMI): LMHAs and NorthSTAR providers connect juvenile and adult offenders with special needs
to a full array of psychiatric and medical services upon their release on probation or parole. The Texas
Department of Criminal Justice, county jails, and Texas Juvenile Justice Division Institutions refer juvenile or adult offenders to this program. LMHA and NorthSTAR providers also work closely with parole and
probation officers to help the person comply with the conditions of his or her release, with a particular focus on engaging them in behavioral health treatment.
Contact: Texas Department of Criminal Justice – Reentry and Integration Division, Community Based Interventions, 512-671-2134
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Resources Available in the Northern Regions of Texas
Betty Hardwick Center (LMHA) www.bhcmhmr.org/
2616 S Clack St., Abilene, TX 79606 Main Phone: 325-690-5100 Crisis Hotline: 1-800-758-3344
Counties: Callahan, Jones, Shackelford, Stephens and Taylor
Crisis Respite Center: Population Served: Adults 18+ years of age
Address: 2616 S. Clack St., Abilene, TX 79606
Phone: 1-800-758-3344
Center for Life Resources (LMHA) www.cflr.us
408 Mulberry St., Brownwood, TX 76801
Main Phone: 325-646-9574 Crisis Hotline: 1-800-458-7788
Counties: Brown, Coleman, Comanche, Eastland, McCulloch, Mills and San Saba
Crisis Respite:
Population Served: Adults 18+ years of age
Address: 1200 3rd St., Brownwood, TX 76801 Phone: 1-800-458-7788
Central Plains Center (LMHA)
www.clplains.org
715 Houston St., Plainview, TX 79072
Main Phone: 806-293-2636 Crisis Hotline: 1-800-687-1300
Counties: Bailey, Briscoe, Castro, Floyd, Hale, Lamb, Motley, Parmer and Swisher
Crisis Respite:
Population Served: Adults 18+ years of age Address: 801 Houston, Plainview, TX 79072 and 2601 Dimmitt Rd., Plainview, TX 79072
Phone: 1-800-687-1300
Denton County MHMR Center (LMHA)
www.dentonmhmr.org/
2509 Scripture St., Denton, TX 76201 Main Phone: 940-381-5000 Crisis Hotline: 1-800-762-0157
Counties: Denton
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Crisis Residential Center:
Population Served: Adults 18+ years of age Address: 2519 Scripture St., Denton, TX 76201
Phone: 1-800-762-0157
Psychiatric Triage Center: Evaluations are provided to individuals in crisis. Walk-ins are accepted and referrals to other community resources are provided as needed.
Population Served: Adults 18+ years of age Address: 2509 Scripture St., Suite 100, Denton, TX 76201
Phone: 940-381-9965
Helen Farabee Centers (LMHA) www.helenfarabee.org/
1000 Brook, Wichita Falls, TX 76301 Main Phone: 1-800-669-4166 Crisis Hotline: 1-800-621-8504
Counties: Archer, Baylor, Clay, Cottle, Foard, Hardeman, Haskell, Jack, Knox, Montague, Stonewall,
Throckmorton, Wichita, Wilbarger, Young, Childress, Dickens, King and Wise
Crisis Respite and Rapid Crisis Stabilization Beds:
Population Served: Children/adolescents 6-17 years of age and adults 18+ years of age Crisis Respite – Address: 500 Broad St., Wichita Falls 76301
Phone: 1-800-621-8504
Rapid Crisis Stabilization Beds – Phone: 1-800-621-8504
Pecan Valley Centers for Behavioral and Developmental HealthCare (LMHA) www.pvmhmr.org
2101 W. Pearl St., Granbury, TX 76048
Maine Phone: 817-579-4400 Crisis Hotline: 1-800-772-5987
Counties: Erath, Hood, Johnson, Palo Pinto, Parker and Somervell
Green Street Crisis Respite: The Green Street Crisis Respite facility serves all six Pecan Valley Centers
counties and is open 24/7. Assistance with transportation is available. Individuals seeking services must not be actively suicidal or homicidal, must be medically stable and able to self-manage personal hygiene
needs. Eligibility and admission determination is made through a face-to-face assessment by calling the
Pecan Valley Centers Crisis Hotline. Population Served: Adults 18+ years of age
Address: 532 Green Street, Stephenville 76401 Phone: 254-552-2050 Crisis Hotline: 1-800-772-5987
StarCare Specialty Health System (LMHA)
www.StarCarelubbock.org
904 Avenue O St., Lubbock, TX 79401
Main Phone: 806-766-0310 Crisis Hotline: 1-800-687-7581
Counties: Cochran, Crosby, Hockley, Lubbock and Lynn
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Outpatient Competency Restoration (OCR) Program:
Population Served: Adults 18+ years of age deemed incompetent to stand trial Address: 904 Ave. O St., Lubbock, TX 79408
Phone: 806-766-0310
MHMR Tarrant (LMHA) www.MHMRtarrant.org
3840 Hulen St., Fort Worth, TX 76107 Main Phone: 817-335-3022 Crisis Hotline: 1-800-866-2465
Counties: Tarrant
Crisis Respite (Adolescents): Population Served: Adolescents 13-17 years of age
Address: 1520 Rio Grande Ave., Fort Worth, TX 76102 Phone: 1-800-866-2465
Crisis Respite and Residential (Men): Population Served: Males 18+ years of age
Address: 1350 E Lancaster, Fort Worth, TX 76102 Phone: 1-800-866-2465
Crisis Respite & Residential (Women): Population Served: Females 18+ years of age
Address: 815 S. Jennings, Fort Worth, TX 76104 Phone: 1-800-866-2465
Youth Empowerment Services (YES):
Population Served: Ages 3-18 years
Counties: Tarrant Phone: 817-569-5600
Website: www.dshs.state.tx.us/mhsa/yes
Outpatient Competency Restoration (OCR) Program:
Population Served: Adults 18+ years of age, deemed incompetent to stand trial Address: 3840 Hulen Tower North, Fort Worth, TX 76107
Phone: 817-335-3022 or 1-800-866-2465
Texas Panhandle Centers (LMHA) www.texaspanhandlecenters.org/
901 Wallace Blvd., Amarillo, TX 79106 Main Phone: 806-358-1681 or 1-800-299-3699 Crisis Hotline: 1-800-692-4039
Counties: Armstrong, Carson, Collingsworth, Dallam, Deaf Smith, Donley, Gray, Hall, Hansford, Hartley, Hemphill, Hutchinson, Lipscomb, Moore, Ochiltree, Oldham, Potter, Randall, Roberts, Sherman and
Wheeler
Rapid Crisis Stabilization Beds: Population Served: Adults 18+ years of age
Address: 901 Wallace Blvd, Amarillo, TX 79106
Crisis Hotline: 1-800-692-4039
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Texoma Community Center (LMHA) www.mhmrst.org/location.html
315 W McLain Dr., Sherman, TX 75092
Main Phone: 903-957-4700 Crisis Hotline: 1-877-277-2226
Counties: Cooke, Fannin and Grayson
Long-Term Residential:
Population Served: Adults 18+ years of age
Address: 102 (A) Memorial Dr., Denison, TX 75020 Phone: 903-957-4700
Crisis Hotline: 1-877-277-2226
Crisis Respite Facility: Population Served: Adults 18+ years of age
Address: 102 (B) Memorial Dr., Denison, TX 75020
Phone: 903-957-4700 Crisis Hotline: 1-877-277-2226
NorthSTAR/Value Options
www.valueoptions.com/northstar
1199 S. Beltline Rd., Ste. 100, Coppell, TX 95019
Main Phone: 1-888-800-6799 Crisis Hotline: 1-866-260-8000
Counties: Collin, Dallas, Ellis, Hunt, Kaufman, Navarro and Rockwall
Crisis Respite:
Population Served: Adults 18+ years of age Address: 233 W. 10th St., Dallas TX 75208
Phone: 214-941-3500 Crisis Hotline: 1-866-260-8000
Outpatient Competency Restoration (OCR) Program: Population Served: Adults 18+ years of age, deemed incompetent to stand trial
Counties: Dallas Phone: 214-653-3535
Athletes for Change-RTC Placement: Population Served: Ages 13-17
Address: 1205 E. Bear Creek Rd., Glenn Heights, TX 75154 Phone: 972-223-2011
Youth Empowerment Services (YES): Population Served: Ages 3-18 years
Phone: 888-800-6799 Website: www.dshs.state.tx.us/mhsa/yes
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Resources Available in the Eastern/Central Regions of Texas
ACCESS (LMHA) www.accessmhmr.org
913 N. Jackson St., Jacksonville, TX 75766 Main Phone: 903-586-5507 Crisis Hotline: 1-800-621-1693
Counties: Anderson and Cherokee
This community does not have any facility-based crisis options. See the LMHA for other crisis options.
Andrews Center Behavioral Healthcare System (LMHA)
www.andrewscenter.com
2323 West Front St., Tyler, TX 75702 Main Phone: 903-597-1351 Crisis Hotline: 1-877-934-2131
Counties: Henderson, Rains, Smith, Van Zandt and Wood
Crisis Respite and Psychiatric Service Emergency Center: Population Served: Adults 18+ years of age
Address: 959 Farm Rd., Tyler, TX 75705
Phone: 903-566-6410 or 1-800-374-6058
Outpatient Competency Restoration (OCR) Program:
Population Served: Adults 18+ years of age deemed incompetent to stand trial
Address: 2323 West Front St., Tyler, TX 75702-7747 Phone: 903-597-1351
Austin Travis County Integral Care (LMHA)
www.integralcare.org
1430 Collier St. Austin, TX 78704
Main Phone: 512-447-4141 24/7 Hotline: 512-472-HELP (4357) Crisis Hotline: 844-398-8252 TTY: 512-703-1395
Counties: Travis
24/7 Walk-in Psychiatric Emergency Services Clinic: Population Served: Children, adolescents, and adults
Address: 56 East Ave., Austin, TX 78701 Phone: 512-472-HELP (4357)
Website: www.integralcare.org/content/psychiatric-emergency-services-pes
Crisis Respite and Rapid Crisis Stabilization Beds: Next Step provides short-term psychiatric respite
services for adults residing in Travis County who are recovering from a psychiatric crisis. The Inn provides short-term community-based residential crisis treatment. The Inn offers residential services, medication
13
stabilization, around-the-clock nursing services, psychosocial rehabilitative skills training, case
management and group treatment. Population Served: Adults 18+ years of age
Rapid Crisis Stabilization Beds – Address: 56 East Ave., Austin TX 78701 Phone: 512-472-HELP (4357)
Crisis Respite – Address: 6222 N. Lamar, Austin, TX 78752
Phone: 512-472-HELP (4357)
Outpatient Competency Restoration (OCR) Program: Population Served: Adults 18+ years of age, deemed incompetent to stand trial
Phone: 512-472-HELP (4357)
Youth Empowerment Services (YES):
Population Served: Ages 3-18 years of age Phone: 512-255-1720
Website: www.dshs.state.tx.us/mhsa/yes
Bluebonnet Trails Community Services (LMHA) www.bbtrails.org
1009 N. Georgetown St., Round Rock, TX 78664 Main Phone: 512-255-1720 Crisis Hotline: 1-800-841-1255
Counties: Bastrop, Burnet, Caldwell, Fayette, Guadalupe Lee and Williamson
Crisis Respite & Extended Observation Unit: Population Served: Adults 18+ years of age
Address: 711 North College St., Georgetown, TX 78626 Phone: 1-800-841-1255
Extended Observation Unit: Population Served: Adults 18+ years of age
Address: 2713 E. Court, Seguin, TX 78155 Phone: 1-800-841-1255
Youth Empowerment Services (YES): Population Served: Ages 3-18 years of age
Counties: Burnet and Williamson Phone: 512-255-1720
Website: www.dshs.state.tx.us/mhsa/yes
MHMR Authority of Brazos Valley (LMHA)
www.mhmrabv.org/
804 S. Texas Ave., Bryan, TX 77802 Main Phone: 979-822-6467 Crisis Hotline: 1-888-522-8262
Counties: Brazos, Burleson, Grimes, Leon, Madison, Robertson and Washington
Rapid Crisis Stabilization Beds: Population Served: Adults 18+ years of age
Address: 804 S. Texas Ave., Bryan, TX 77802
Phone: 1-888-522-8262
14
Everyday Life, Inc. – RTC Placement:
Population Served: Ages 10-17 Address: 6955 Broach Rd., Bryan, TX 77808
Phone: 979-589-1885 Website: www.everydaylifertc.com/Home.html
Helping Hand Home for Children – RTC Placement: Population Served: Ages 13-17
Address: 3804 Avenue B, Austin, TX 78751 Phone: 512-459-3353
Website: www.helpinghandhome.org/
Pegasus Schools, Inc. – RTC Placement:
Population Served: Ages 10-17 Address: 896 Robin Ranch Road, Lockhart, TX 78644
Phone: 512-376-2101 Website: www.pegasusschool.net/
Burke (LMHA) www.myburke.org/
2001 S Medford Dr., Lufkin, TX 75901
Main Phone: 936-639-1141 Crisis Hotline: 1-800-392-8343 Counties: Angelina, Houston, Jasper, Nacogdoches, Newton, Polk, Sabine, San Augustine, San Jacinto,
Shelby, Trinity and Tyler
Mental Health Emergency Center (MHEC): MHEC provides assessment and/or brief treatment to individuals that are experiencing a mental health crisis. MHEC is comprised of two programs – extended
observation unit and crisis residential unit.
Population Served: Adults 18+ years of age Crisis Residential – Address: 105 Mayo Place, Lufkin, TX 75904
Phone: 1-800-392-8343 Extended Observation Unit – Address: 105 Mayo Place, Lufkin, TX 75904
Phone: 1-800-392-8343
Central Counties Services (LMHA)
www.cccmhmr.org
304 S. 22nd St., Temple, TX 76501 Main Phone: 254-298-7000 Crisis Hotline: 1-800-888-4036
Counties: Bell, Coryell, Hamilton, Lampasas and Milam
Crisis Respite: Designed to give individuals brief care to prevent a state of crisis that requires
hospitalization. Population Served: Adults 18+ years of age
Address: 207 N. Lutterloh, Gatesville, TX 76528 Phone: 254-217-1856
15
Community Healthcore (LMHA) www.communityhealthcore.com
107 Woodbine Pl., Longview, TX 75601 Main Phone: 903-758-2471 Crisis Hotline: 1-800-832-1009
Counties: Bowie, Cass, Gregg, Harrison, Marion, Panola, Red River, Rusk and Upshur
Crisis Residential, Extended Observation Unit, and Psychiatric Emergency Center: Population Served: Adults 18+ years of age
Address: 7470 State Hwy 154, Marshall, TX 75670
Phone: 903-927-1466
Outpatient Competency Restoration Program: Population Served: Adults 18+ years of age, deemed incompetent to stand trial
Address: 950 N. 4th St., Longview, TX 75601 Phone: 903-758-2471
Gulf Coast Center (LMHA) www.gulfcoastcenter.org
123 Rosenberg, Ste. 6, Galveston, TX 77550
Main Phone: 409-763-2373 Crisis Hotline: 1-866-729-3848
Counties: Brazoria and Galveston
Crisis Respite (Galveston County):
Population Served: Adults 18+ years of age
Address: 5825 Emmet Lowry, Texas City, TX 77591 Phone: 409-763-2373
Crisis Respite (Brazoria County):
Population Served: Adults 18+ years of age Address: 2320 East Mulberry, Angleton, TX 77515
Phone: 409-763-2373
Youth Empowerment Services (YES):
Population Served: Ages 3-18 years Phone: 409-763-2373
Website: www.dshs.state.tx.us/mhsa/yes
MHMR Authority of Harris County (LMHA)
www.mhmraharris.org
7011 Southwest Freeway, Houston, TX 77074 Main Phone: 713-970-7000 Crisis Hotline: 1-866-970-4770
Counties: Harris
Crisis Respite: Provides respite care. This facility has nine apartments with capacity for 16 residents.
Population Served: Adults 18+ years of age Address: 612 Branard St., Houston, TX 77006
Phone: 713-970-7070
16
Crisis Residential Unit: There are 18 beds at this facility.
Population Served: Adults 18+ years of age Address: 2627 Caroline St., Houston, TX 77004, Bristow Building, 1st Floor
Phone: 713-970-7070
Critical Time Intervention Program: This program assists homeless individuals with mental illness in their
transition from the streets, shelters, psychiatric hospitals, or criminal justice system into the community. Population Served: Adults 18+ years of age
Address: 9401 Southwest Freeway, 8th Floor, Houston, TX 77074 Phone: 713-970-7070
The Neuropsychiatric Center – Crisis Stabilization Unit: This inpatient stabilization unit is for people
experiencing a mental health crisis. It is open 24/7, 365 days per year; the average stay is three-five
days; and a doctor must refer clients. Population Served: Adults 18+ years of age
Address: 1502 Taub Loop (2nd Floor), Houston, TX 77030 Phone: 713-970-7070
Psychiatric Emergency Services: The Psychiatric Emergency Services Unit is staffed 24 hours a day with registered nurses, clinical social workers, licensed professional counselors and psychiatric technicians.
Each person treated receives an individualized clinical service plans that can include medication administration, reinforcement of coping skills, close observation by clinical staff, family meetings and
determination of appropriate community supports. Population Served: Screening available for individuals at any age
Address: 1502 Taub Loop (1st Floor), Houston, TX 77030
Phone: 713-970-7070
Youth Empowerment Services (YES): Population Served: Ages 3-18 years
Phone: 713-970-7212
Website: www.dshs.state.tx.us/mhsa/yes
Heart of Texas Region MHMR Center (LMHA) www.hotrmhmr.org
110 S 12th St. Waco, TX 76701
Main Phone: 254-752-3451 Crisis Hotline: 1-866-752-3451
Counties: Bosque, Falls, Freestone, Hill, Limestone and McLennan
Crisis Respite Population Served: Adults 18+ years of age
Address: 301 Londonderry, Waco, TX 76712 Phone: 1-866-752-3451
Psychiatric Emergency Service Center:
Population Served: Adults 18+ years of age
Address: 1200 Clifton St., Waco, TX 76704 Phone: 1-866-752-3451 (after hours and weekends)
17
Outpatient Competency Restoration (OCR) Program:
Population Served: Adults 18+ years of age deemed incompetent to stand trial Address: 110 S 12th St., Waco, TX 76703
Phone: 1-866-752-3451
Lakes Regional Community Center (LMHA) www.lrmhmrc.org
400 Airport Rd., Terrell, TX 75160 Main Phone: 972-524-4159 Crisis Hotline: 1-877-466-0660
Counties: Camp, Delta, Franklin, Hopkins, Lamar, Morris and Titus
This community does not have any facility-based crisis options. See the LMHA for other crisis options.
Spindletop Center (LMHA) www.stmhmr.org
655 S 8th St., Beaumont, TX 77701
Main Phone: 409-784-5400 Crisis Hotline: 409-838-1818
Counties: Chambers, Hardin, Jefferson and Orange
Crisis Respite: Population Served: Adolescents 13-17 years of age and adults 18+ years of age (separately)
Address: 2750 South 8th Street, Building C, Beaumont, TX 77701 Phone: 1-800-937-8097
Crisis Residential: Population Served: Adults 18+ years of age
Address: 2555 Jimmy Johnson Blvd., Port Arthur, TX 77640 Phone: 1-800-937-8097
Extended Observation Units:
Population Served: Adults 18+ years of age
Location 1 – Address: 3080 College St., Beaumont, TX 77701 Phone: 1-800-937-8097
Location 2 – Address: 2555 Jimmy Johnson Blvd., Port Arthur, TX 77640 Phone: 1-800-937-8097
Outpatient Competency Restoration (OCR) Program: Population Served: Adults 18+ years of age, deemed incompetent to stand trial
Address: 655 S. 8th St., Beaumont, TX 77701 Phone: 409-784-5400
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Texana Center (LMHA) www.texanacenter.com
5311 Ave. N., Rosenberg, TX 77471 Main Phone: 281-239-1300 Crisis Hotline: 1-800-633-5686
Counties: Austin, Colorado, Fort Bend, Matagorda, Waller and Wharton
Crisis Center: Access is available only via MCOT screenings (not a walk-in center). Population Served: Adults 18+ years of age
Crisis Hotline: 1-800-633-5686
Youth Empowerment Services (YES):
Population Served: Ages 3-18 years Counties: Fort Bend
Phone: 281-239-1485 Website: www.dshs.state.tx.us/mhsa/yes
Tri-County Services (LMHA) www.tricountyservices.org
1506 FM-2854, Conroe, TX 77304
Main Phone: 936-521-6100 Crisis Hotline: 1-800-659-6994
Counties: Liberty, Montgomery and Walker
Crisis Stabilization Unit (Psychiatric Emergency Treatment Center), and Extended Observation Unit:
Population Served: Adults 18+ years of age
Address: 706 FM 2854, Conroe TX 77301 Phone: 1-800-659-6994
Outpatient Competency Restoration (OCR) Program:
Population Served: Adults 18+ years of age deemed incompetent to stand trial Address: 1020 Riverwood Ct., Conroe, TX 77304
Phone: 936-521-6100
Guardian Angels – RTC Placement:
Population Served: Ages 9-17 Address: 9530 W. Montgomery Rd., Houston, TX 77088
Phone: 281-447-1812
Gulf Winds – RTC Placement:
Population Served: Ages 10-17 Address: 2904 1st St., Bay City, TX 77414
Phone: 979-254-2334
Have Haven – RTC Placement:
Population Served: Ages 10-17 Address: 14054 Ambrose St., Houston, TX 77045
Phone: 713-413-9490 Website: www.havehaven.org/
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Krause Children’s Residential – RTC Placement:
Population Served: Ages 12-17 Address: 25752 Kingsland Blvd., Katy, TX 77494
Phone: 281-392-7505 Website: www.krausechildrenscenter.org/
Renewed Strength, Inc. – RTC Placement: Population Served: Ages 5-18
Address: 110 Hambrick Rd., Houston, TX 77060 Phone: 281-448-7550
Website: www.renewedstrength.net/
Shamar Hope Haven- RTC Placement:
Population Served: Ages 10-17 Address: 2719 Truxillo St., Houston, TX 77004
Phone: 713-942-8822
Unity Children’s Home – RTC Placement:
Population Served: Ages 6-17 Address: 2111 River Valley Dr., Spring, TX 77373
Phone: 281-355-0716 Website: www.unityresidentialtreatmentcenter.org/
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Resources Available in the Southern Regions of Texas
Border Region Behavioral Health Center (LMHA) www.borderregion.org
1500 Pappas St., Laredo, TX 78041 Main Phone: 956-794-3000 Crisis Hotline: 1-800-643-1102
Counties: Jim Hogg, Starr, Webb and Zapata
This community does not have any facility-based crisis options. See the LMHA for other crisis options.
Camino Real Community Services (LMHA)
www.caminorealcs.org
19965 FM-3175 N., Lytle, TX 78052 Main Phone: 210-261-1000 Crisis Hotline: 1-800-543-5750
Counties: Atascosa, Dimmit, Frio, Karnes, La Salle, Maverick, McMullen, Wilson and Zavala
Crisis Respite: Population Served: Adults 18+ years of age
Address: 419 East San Marcos, Pearsall, TX 78061
Phone: 210-357-0300
The Center for Health Care Services (LMHA) www.chcsbc.org
3031 W I-10, San Antonio, TX 78201
Main Phone: 210-261-1000 Crisis Hotline: 210-223-7233
Counties: Bexar
Crisis Care Center and Extended Observation Unit: Population Served: Adults 18+ years of age
Address: 601 N. Frio, San Antonio, TX 78207 Phone: 210-223-7233 or 1-800-316-9241
Children’s Crisis Unit: The Children’s Crisis Unit provides crisis assessments to children if they are perceived to be a potential danger to themselves or others and they are physically within the boundaries
of Bexar County. Crisis assessors also conduct crisis assessments in the field, at schools, residences, and other locations.
Population Served: Ages 3-17 Address: 227 West Drexel, San Antonio, TX 78210
Phone: 210-223-7233 or 1-800-316-9241
Youth Empowerment Services (YES):
Population Served: Ages 3-18 years Phone: 210-261-1135
Website: www.dshs.state.tx.us/mhsa/yes
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Outpatient Competency Restoration (OCR) Program:
Population Served: Adults 18+ years of age deemed incompetent to stand trial Address: 3031 IH-10 West, San Antonio, TX 78201 Phone: 210-261-1000
Coastal Plains Community Center (LMHA)
www.coastalplainsctr.org
200 Marriott Dr., Portland, TX 78374
Main Phone: 361-777-3991 Crisis Hotline: 1-800-841-6467
Counties: Aransas, Bee, Brooks, Duval, Jim Wells, Kenedy, Kleberg, Live Oak and San Patricio
Rapid Crisis Stabilization Beds:
Population Served: Adults 18+ years of age Address: 200 Marriott Dr, Portland, TX 78374
Phone: 1-800-841-6467
Gulf Bend Center (LMHA) www.gulfbend.org
6502 Nursery Drive, Suite 100, Victoria, TX 77904-1178
Main Phone: 361-575-0611 Crisis Hotline: 1-877-723-3422
Counties: Calhoun, DeWitt, Goliad, Jackson, Lavaca, Refugio and Victoria
Extended Observation Unit: Population Served: Adults 18+ years of age
Address: 2701 Hospital Dr., Victoria, TX 77901 Phone: 1-877-723-3422
Hill Country Mental Health & Developmental Disabilities Centers (LMHA)
www.hillcountry.org
819 Water St, Suite 300, Kerrville, TX 78028 Main Phone: 830-792-3300 Crisis Hotline: 1-877-466-0660
Counties: Bandera, Comal, Edwards, Gillespie, Kendall, Kerr, Kinney, Medina, Real, Uvalde and Val
Verde
Crisis Stabilization Unit: Population Served: Adults ages 18+
Address: 643 Sheppard Rees Rd. Kerrville, TX 78028 Phone: 1-877-466-0660
Hector Garza Center – RTC Placement: Population Served: Ages 10-17
Address: 620 E. Afton Oaks Blvd., San Antonio, TX 78232 Phone: 210-568-8600
Website: www.abraxasyfs.com/facilities/hectorgarza/
Hill Country Youth Ranch – RTC Placement:
Population Served: Ages 5-17 Address: 522 Junction Hwy., Ingram, TX 78025 Phone: 830-367-2131
Website: www.youth-ranch.org/
22
New Life Children’s Treatment Center- RTC Placement:
Population Served: Ages 11-17 Address: 650 Scarbourough, Canyon Lake, TX 78133
Phone: 830-964-4390 Website: www.newlifechildrenscenter.org/
Behavioral Health Center of Nueces County (LMHA) www.bhcnc.org
1630 S. Brownlee Blvd., Corpus Christi, TX 78405
Main Phone: 361-886-6970 Crisis Hotline: 1-888-767-4493
Counties: Nueces
Crisis Respite:
Population Served: Adults 18+ years of age Address: 1546 S. Brownlee, Corpus Christi, TX 78404
Phone: 1-888-767-4493
Outpatient Competency Restoration (OCR) Program:
Population Served: Adults 18+ years of age, deemed incompetent to stand trial Address: 1630 S. Brownlee, Corpus Christi, TX 78404-3178
Tropical Texas Behavioral Health (LMHA) www.ttbh.org
1901 S. 24 St., Edinburg, TX 78539
Main Phone: 956-289-7000 Crisis Hotline: 1-877-289-7199
Counties: Cameron, Hidalgo and Willacy
Crisis Respite:
Population Served: Adults 18+ years of age Address: 715 North H St., Harlingen, TX 78550
Phone: 1-877-289-7199
Rapid Crisis Stabilization Beds:
Population Served: Adults 18+ years of age Address: 1901 South 24th Ave., Edinburg, TX 78540
Phone: 1-877-289-7199
Shoreline, Inc. – RTC Placement:
Population Served: Ages 13-17 Address: 1220 Gregory St., Taft, TX 78390
Phone: 361-528-3356
Website: www.shorelinetreatmentcenter.com/
Youth Empowerment Services (YES): Population Served: Ages 3-18 years
Address: 1901 S. 24 St., Edinburg, TX 78540 Phone: 956-289-7000
Website: www.dshs.state.tx.us/mhsa/yes
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Resources Available in the Western Regions of Texas
Emergence Health Network (LMHA) www.emergencehealthnetwork.org
1600 Montana Ave., El Paso, TX 79902 Main and Crisis Phone: 915-887-3410
Counties: El Paso
Crisis Residential and Rapid Crisis Stabilization Beds: Population Served: Adults 18+ years of age
Crisis Respite – Address: 8716 Independence, El Paso, TX 79907
Phone: 915-887-3410 Rapid Crisis Stabilization Beds
Phone: 915-887-3410
Extended Observation Unit: Population Served: Adults 18+ years of age
Phone: 915-887-3410
Outpatient Competency Restoration (OCR) Program:
Population Served: Adults 18+ years of age deemed incompetent to stand trial Phone: 915-887-3410
MHMR Services for the Concho Valley (LMHA) www.mhmrcv.org
1501 W Beauregard St., San Angelo, TX 76901
Main Phone: 325-658-7750 Crisis Hotline: 1-800-375-8965
Counties: Coke, Concho, Crockett, Irion, Reagan, Sterling and Tom Green
Crisis Respite:
Population Served: Adults 18+ years of age
Address: 244 N. Magdalen Bldg. #240, San Angelo, TX 76903 Phone: 1-800-375-8965
Rapid Crisis Stabilization Beds:
Population Served: Adults 18+ years of age Address: 1501 W Beauregard, San Angelo, TX 76901
Phone: 1-800-375-8965
24
Permian Basin Community Centers for MHMR (LMHA) www.pbmhmr.com
401 E Illinois Ave., Midland, TX 79701 Main Phone: 432-570-3300 Crisis Hotline (Alpine, Presidio, & Van Horn): 1-800-542-4005 Crisis
Hotline (Ft. Stockton): 1-877-475-7322 Crisis Hotline (Midland): 432-570-3300 Crisis Hotline (Odessa): 432-333-3265
Counties: Brewster, Culberson, Ector, Hudspeth, Jeff Davis, Midland, Pecos and Presidio
This community does not have any facility-based crisis options. See the LMHA for other crisis options.
West Texas Centers (LMHA)
www.wtcmhmr.org
319 Runnels St., Big Spring, TX 79720 Main Phone: 432-263-0007 Crisis Hotline: 1-800-375-4357
Counties: Andrews, Borden, Crane, Dawson, Fisher, Gaines, Garza, Glasscock, Howard, Kent, Loving,
Martin, Mitchell, Nolan, Reeves, Runnels, Scurry, Terrell, Terry, Upton, Ward, Winkler and Yoakum
Rapid Crisis Stabilization Beds:
Population Served: Adults 18+ years of age
Address: 319 Runnels St., Big Spring, TX 79720 Phone: 1-800-375-4357
Crisis Respite:
Population Served: Adults 18+ years of age
Address: 2607 Chanute, Big Spring, TX 79720 Phone: 432-263-0007
25
Appendix A Local Mental Health Authorities
ACCESS
www.accessmhmr.org 913 N. Jackson St.
Jacksonville, TX 75766 903-586-5507
Counties: Anderson and Cherokee
Andrews Center Behavioral Healthcare
System www.andrewscenter.com
2323 West Front St. Tyler, TX 75702
903-597-1351
Counties: Henderson, Rains, Smith, Van Zandt and Wood
Austin Travis County Integral Care
www.integralcare.org
1430 Collier St. Austin, TX 78704
512-447-4141 Counties: Travis
Behavioral Health Center of Nueces
County
www.bhcnc.org 1630 S Brownlee Blvd.
Corpus Christi, TX 78404 361-886-6900
Counties: Nueces
Betty Hardwick Center
www.bhcmhmr.org 2616 S Clack St.
Abilene, TX 79606
325-690-5100 Counties: Callahan, Jones, Shackelford,
Stephens and Taylor
Bluebonnet Trails Community Services
www.bbtrails.org 1009 N. Georgetown St.
Round Rock, TX 78664 512-255-1720
Counties: Bastrop, Burnet, Caldwell, Fayette,
Gonzales, Guadalupe, Lee and Williamson
Border Region Behavioral Health Center www.borderregion.org
1500 Pappas St. Laredo, TX 78041
956-794-3000
Counties: Jim Hogg, Starr, Webb, and Zapata
Burke www.myburke.org
2001 S Medford Dr.
Lufkin, TX 75901 936-639-1141
Counties: Angelina, Houston, Jasper, Nacogdoches, Newton, Polk, Sabine, San
Augustine, San Jacinto, Shelby, Trinity and Tyler
Camino Real Community Services
www.caminorealcs.org 19965 FM-3175 N.
Lytle, TX 78052 210-357-0300
Counties: Atascosa, Dimmit, Frio, Karnes, La
Salle, Maverick, McMullen, Wilson and Zavala
Center for Life Resources www.cflr.us
408 Mulberry St.
Brownwood, TX 76801 325-646-9574
Counties: Brown, Coleman. Comanche, Eastland, McCulloch, Mills and San Saba
26
Central Counties Services
www.cccmhmr.org 304 S 22nd St.
Temple, TX 76501 254-298-7000
Counties: Bell, Coryell, Hamilton, Lampasas
and Milam
Central Plains Center www.clplains.org
2700 Yonkers St. Plainview, TX 79072
806-293-2636
Counties: Bailey, Briscoe, Castro, Floyd, Hale, Lamb, Motley, Parmer and Swisher
Coastal Plains Community Center
www.coastalplainsctr.org
200 Marriott Dr. Portland, TX 78374
361-777-3991 Counties: Aransas, Bee, Brooks, Duval, Jim
Wells, Kenedy, Kleberg, Live Oak and San Patricio
Community Healthcore www.communityhealthcore.com
107 Woodbine Pl. Longview, TX 75601
903-758-2471
Counties: Bowie, Cass, Gregg, Harrison, Marion, Panola, Red River, Rusk and Upshur
Denton County MHMR Center
www.dentonmhmr.org
2519 Scripture St. Denton, TX 76201
940-381-5000 Counties: Denton
Emergence Health Network
www.emergencehealthnetwork.org
1600 Montana Ave. El Paso, TX 79902
915-887-3410 Counties: El Paso
Gulf Bend Center
www.gulfbend.org 6502 Nursery Drive, Suite 100
Victoria, TX 77904-1178 361-575-0611
Counties: Calhoun, DeWitt, Goliad, Jackson,
Lavaca, Refugio and Victoria
Gulf Coast Center www.gulfcoastcenter.org
123 Rosenberg, Ste. 6 Galveston, TX 77550
409-763-2373
Counties: Brazoria and Galveston
Heart of Texas Region MHMR Center www.hotrmhmr.org
110 S 12th St.
Waco, TX 76701 254-752-3451
Counties: Bosque, Falls, Freestone, Hill, Limestone and McLennan
Helen Farabee Centers
www.helenfarabee.org
1000 Brook Wichita Falls, TX 76301
800-669-4166 Counties: Archer, Baylor, Childress, Clay,
Cottle, Dickens, Foard, Hardeman, Haskell, Jack,
King, Knox, Montague, Stonewall, Throckmorton, Wichita, Wilbarger, Wise and
Young
Hill Country Mental Health and
Developmental Disabilities Centers www.hillcountry.org
819 Water St, Suite 300 Kerrville, TX 78028
830-792-3300 Counties: Bandera, Blanco, Comal, Edwards,
Gillespie, Hays, Kendall, Kerr, Kimble, Kinney,
Llano, Mason, Medina, Menard, Real, Schleicher, Sutton, Uvalde and Val Verde
27
Lakes Regional Community Center
www.lrmhmrc.org 400 Airport Rd.
Terrell, TX 75160 972-524-4159
Counties: Camp, Delta, Franklin, Hopkins,
Lamar, Morris and Titus
MHMR Authority of Brazos Valley www.mhmrabv.org
804 S. Texas Ave. Bryan, TX 77802
979-822-6467
Counties: Brazos, Burleson, Grimes, Leon, Madison, Robertson and Washington
MHMR Authority of Harris County
www.mhmraharris.org
7011 Southwest Fwy. Houston, TX 77074
713-970-7000 Counties: Harris
MHMR Services for the Concho Valley
www.mhmrcv.org
1501 W Beauregard St. San Angelo, TX 76901
325-658-7750 Counties: Coke, Concho, Crockett, Irion,
Reagan, Sterling and Tom Green
MHMR Tarrant
www.mhmrtarrant.org 3840 Hulen St.
Fort Worth, TX 76107
817-335-3022, 1-800-866-2465 Counties: Tarrant
Pecan Valley Centers for Behavioral &
Developmental HealthCare www.pvmhmr.org
2101 W. Pearl
Granbury, TX 76048 817-579-4400
Counties: Erath, Hood, Johnson, Palo Pinto, Parker and Somervell
Permian Basin Community Centers for
MHMR www.pbmhmr.com
401 E Illinois Ave. Midland, TX 79701
432-570-3300
Counties: Brewster, Culberson, Ector, Hudspeth, Jeff Davis, Midland, Pecos and
Presidio
Spindletop Center www.stmhmr.org
655 S 8th St.
Beaumont, TX 77701 409-784-5400
Counties: Chambers, Hardin, Jefferson and Orange
StarCare Specialty Health System www.StarCarelubbock.org
904 Avenue O St. Lubbock, TX 79401
806-766-0310 Counties: Cochran, Crosby, Hockley, Lubbock
and Lynn
Texana Center
www.texanacenter.com 4910 Airport Ave.
Rosenberg, TX 77471
281-239-1300 Counties: Austin, Colorado, Fort Bend,
Matagorda, Waller and Wharton
Texas Panhandle Centers
www.texaspanhandlecenters.org 901 Wallace Blvd.
Amarillo, TX 79106 806-358-1681
Counties: Armstrong, Carson, Collingsworth, Dallam, Deaf Smith, Donley, Hall, Hansford,
Hartley, Hemphill, Hutchinson, Lipscomb, Moore,
Ochiltree, Oldham, Potter, Randall, Roberts, Sherman and Wheeler
28
Texoma Community Center
www.mhmrst.org 315 W McLain Dr.
Sherman, TX 75092 903-957-4700
Counties: Cooke, Fannin and Grayson
The Center for Health Care Services
www.chcsbc.org 3031 W I-10
San Antonio, TX 78201 210-261-1000
Counties: Bexar
Tri-County Services
www.tricountyservices.org 1506 FM-2854
Conroe, TX 77304
936-521-6100 Counties: Liberty, Montgomery and Walker
Tropical Texas Behavioral Health
www.ttbh.org 1901 S. 24 St.
Edinburg, TX 78540 956-289-7000
Counties: Cameron, Hidalgo and Willacy
West Texas Centers
www.wtcmhmr.org 319 Runnels St.
Big Spring, TX 79720 432-263-0007
Counties: Andrews, Borden, Crane, Dawson,
Fisher, Gaines, Garza, Glasscock, Howard, Kent, Loving, Martin, Mitchell, Nolan, Reeves, Runnels,
Scurry, Terrell, Terry, Upton, Ward, Winkler and Yoakum
29
Appendix B Outreach, Screening, Assessment and
Referral Centers (OSARS)
Substance Abuse Intervention and Treatment
Abilene Regional Council on Alcohol/Drug Abuse
104 Pine St., Suite #210, Abilene, TX 79601
325-673-2242 or 1-800-588-8728
Bay Area Council on Drugs and Alcohol 1300-A Bay Area Blvd., #102, Houston, TX
77058 800-510-3111
Bluebonnet Trails Community Services 1009 N. Georgetown St., Round Rock, TX 78664
512-244-8444 or 1-800-841-1255
East Texas Council on Alcohol and Drug
Abuse 708 Glencrest Lane, Longview, TX 75601
903-753-7633 or 1-800-441-8639
El Paso Hospital District
5959 Gateway West, Suite 520, El Paso, TX 79925
915-521-7818 or 866-369-7199
Mid Coast Family Services 700 S. Zamora St., Suite LL5, San Antonio, TX
787207
210-271-9452 or 888-575-7842
120 S. Main St., Victoria, TX 77901 361-575-7842 or 888-575-7842
Permian Basin Regional Council on Alcohol and Drug Abuse
120 East 2nd St., Odessa, TX 79761
432-580-5100 or 1-800-332-2174
Recovery Resource Council 2700 Airport Fwy, Fort Worth, TX 76111
817-332-6329 or 877-332-6329
Rio Grande Valley Council 5510 N. Cage Blvd., Suite C, Pharr, TX 78577
956-787-7111 or 1-800-748-3577
400 Mann St. #903, Corpus Christi, TX 78401
361-884-9596 or 1-800-748-3577
Southwest Regional Planning Commission 4347 Phelan Blvd., Suite 104, Beaumont, TX
77707
409-833-7774 or 888-833-9077
StarCARE Specialty Health System 1950 Aspen Ave., Lubbock, TX 79404
806-767-1716 or 1-800-687-7581
The Council on Alcohol and Drugs Houston
303 Jackson Hill Street, Houston, TX 77007 713-942-4100 or 877-777-8829
ValueOptions – NorthSTAR
1199 South Beltline Rd., Ste. 100, Coppell, TX
75019 888-800-6799
30
Appendix C Helpful Links
2-1-1 Texas Mental Health Services
www.211texas.org/cms/search-mental-health-services-in-texas
Disability Rights Texas
www.disabilityrightstx.org/
Mental Health America of Texas
www.mhatexas.org
MentalHealthTX.org www.mentalhealthtx.org/
National Alliance on Mental Illness www.nami.org/
National Alliance on Mental Illness – Texas
www.namitexas.org/
Speak Your Mind Texas
www.speakyourmindtexas.org/
Substance Abuse and Mental Health Services Administration
www.samhsa.gov/
Texas Council of Community Centers
www.txcouncil.com/
Texas Department of State Health Services
www.dshs.state.tx.us/
Texas Department of State Health Services
– Mental Health and Substance Abuse Division
www.dshs.state.tx.us/mhsa/
Texas Health and Human Services
Commission www.hhsc.state.tx.us/
Texas Workforce Commission
www.twc.state.tx.us/
United Ways of Texas
www.uwtexas.org/
Crisis Services
1
Behavioral Health Issues and Crisis Services for Adults and Juveniles
Brettany Boozer, LCSW & Courtney Heard, Ph.D., LPC
Texas Department of State Health Services
Heard, C., & Boozer, B. (2015, February). Behavioral health issues and crisis services for adults and
juveniles. Educational session presented at the Mental Health Issues and Procedures in
Municipal Courts, Austin, TX.
Jail Diversion involves collaboration between Local Mental Health Authorities (LMHA),
NorthSTAR, and judicial officials such as judges and representatives from the District
Attorney’s Office, and law enforcement. Jail Diversion in the state of Texas parallels the
Sequential Intercept Model published by the Substance Abuse and Mental Health Services
Administration (SAMSHA), with jail diversion occurring across five intercepts: law
enforcement, initial detention/initial court hearings, jails/courts, re-entry, and community
corrections (i.e.
http://gainscenter.samhsa.gov/pdfs/integrating/GAINS_Sequential_Intercept.pdf).
In Texas, there are two overarching methods of jail diversion (i.e., Adults and Children):
1. Crisis Response Services: Mobile crisis response and crisis facilities
2. Access to Ongoing Care: Characterized by interagency collaboration to provide linkage to
on-going mental health treatment which may occur pre-booking, or post-booking of an inmate.
For some, additional supports may be provided through the Texas Correctional Office on
Offenders with Medical or Mental Impairments (TCOOMMI) to avoid future interaction with
law enforcement.
The ultimate goal of jail diversion practices is to intervene at the earliest point of the intercept
model; thus, there is a primary focus on pre-booking interventions.
Crisis Response Services
Pre-booking activities are designed to provide an intervention to individuals arrested for
committing a crime prior to being booked in jail for the arrest. Pre-booking is the most
frequently employed jail diversion strategy. Two overarching pre-booking diversion strategies
are crisis response services and Crisis Intervention Training (CIT) for law enforcement officials.
Crisis response services. The 80th
Texas Legislature appropriated $82 million for the Fiscal
Year 2008-2009 biennium. Guiding the appropriation of these funds was the expansion of crisis
services in the areas of mental health and substance abuse. Services that were implemented, or,
Please address correspondences electronically to the presenters at
[email protected], or, [email protected].
enhanced included crisis hotline, Mobile Crisis Outreach Teams (MCOT), and Psychiatric
Emergency Service Programs, all of which are currently utilized for jail diversion purposes.
Crisis Hotline – Crisis hotline services are available 24/7 and serve as the first point
of contact for mental health crises in the community. Qualified staff determines if
mobile emergency services are required to further assess the caller’s needs.
MCOT – These services are available 24/7 and are often the result of a referral that is
obtained through the crisis hotline. MCOTs deploy to various sites in the community
where a crisis situation has been reported. Generally, they are accompanied by law
enforcement.
PESC Programs – PESC programs encompass facilities that are staffed with mental
health and medical professionals that offer assessment and psychiatric stabilization to
individuals with behavioral health issues. These sites can be used for jail diversion
strategies, as law enforcement is encouraged to utilize these services, to achieve
detainee stabilization as an alternative to jail booking. A variety of PESC programs
are available:
o Extended Observation Units (EOU) - Extended observation units are designed
to provide emergency stabilization to individuals in behavioral health crisis
for up to 48 hours.
o Crisis Residential Services - Crisis residential services provide short-term,
community-based residential crisis treatment to persons who may pose some
risk of harm to self or others, and who may have fairly severe functional
impairment. The recommended length of stay ranges from 1-14 days.
o Crisis Respite Services - In contrast with crisis residential services, crisis
respite services provide short-term, community-based residential, crisis
treatment to persons who have low risk of harm to self or others and may have
some functional impairment who require direct supervision and care, but do
not require hospitalization.
o Inpatient Hospital Services - Hospital services staffed with medical and
nursing professionals who provide 24-hour professional monitoring,
supervision, and assistance in an environment designed to provide safety and
security during acute behavioral health crisis.
o Crisis Stabilization Units (CSU) - Short-term residential treatment designed to
reduce acute symptoms of mental illness provided in a secure and protected
clinically staffed, psychiatrically supervised, treatment environment that
complies with crisis stabilization unit licensing requirements.
Please address correspondences electronically to the presenters at
[email protected], or, [email protected].
Crisis intervention training (CIT)/mental health deputy/peace officer programs (i.e., Adults
and Children). In 2005, the Texas Commission on Law Enforcement Officer Standards and
Education mandated that all cadets receive 24 hours of crisis intervention training. This mandate
has since been changed to 16 hours. However, through the development of CIT, officers have
the opportunity to enhance their awareness of intervening with behavioral health populations
through taking a 40 hour course. CIT or, mental health deputy officers are generally called upon
when there is an individual with behavioral health issues in a crisis requiring law enforcement
intervention. These officers generally have strong collaboration with LMHAs and other agencies
that treat behavioral health issues. As an alternative to booking the individual into county jail,
many of these officers will transport the individual to a local treatment facility as a jail diversion
strategy.
Critical time intervention (CTI): Harris County Jail Diversion Program (i.e., Adults). S.B.
1185 of the 83rd
Legislative Session mandated the development of a jail diversion pilot program
in Harris County to reduce recidivism and the frequency of arrests and incarceration among
persons with mental illness. The 2014-2015 General Appropriations Act, S.B. 1, 83rd
Legislature, 2013 (Article II, Department of State Health Services, Rider 95) allocates $10
million to the establishment of the program, to which Harris County must match the dollar
amount. Services provided to participants will include integrated medical, mental, and physical
treatment. Additionally, the bill mandated that treatment encompass CTI principles, which
include psychiatric treatment and medication management, money management, substance abuse
treatment, housing, and life skills training.
Forensic Commitments
Outpatient Competency Restoration (i.e., Adults). S.B.867 of the 80th
Legislature amended
Chapter 46B of the Code of Criminal Procedure: Incompetency to Stand Trial. These
amendments explicitly permitted the outpatient treatment of individuals found incompetent to
stand trial, and determined not to be a danger to the community, for the purpose of competency
restoration treatment (see Article 46B.072. a-1). The Department of State Health Services
(DSHS) was provided funding to establish pilot sites for the implementation of OCR programs,
through local mental health authorities (LMHA), in collaboration with local judicial officials.
Since 2008 there have been twelve OCR sites established:
Center for Health Care Services - Bexar County
Austin Travis County Integral Care - Travis County
ValueOptions – NorthSTAR - Dallas County
MHMR of Tarrant County - Tarrant County
Emergence Health Network - El Paso
Gulf Coast Center & Tri-County Services - Galveston and East Texas areas
Spindletop Center - Beaumont area
StarCare Specialty Health System - Lubbock
Please address correspondences electronically to the presenters at
[email protected], or, [email protected].
Behavioral Health Center of Nueces County - Nueces County
Andrews Center Behavioral Healthcare Center - Tyler area
Community Healthcore - Longview area
Heart of Texas Region MHMR Center – Waco
Jail-based Competency Restoration Pilot Program (i.e., Adults). S.B. 1475 of the 83rd
Legislative Session directed DSHS to pilot a jail-based competency restoration program. The
2014-2015 General Appropriations Act, S.B. 1, 83rd
Legislative Session, 2013 (Article II, DSHS
Rider 74) appropriated $3.05 million for this purpose. S.B. 1475 requires that this pilot:
employ similar clinical treatment provided as part of a competency restoration
program at an inpatient mental health facility;
provide weekly treatment hours commensurate to the treatment hours provided as part
of a competency restoration program at an inpatient mental health facility; and
assign a staff to participant/defendant average ratio of not lower than 3.7 to 1.
Access to Ongoing Care
TCOOMMI (i.e., Adults and Children). In Texas, post-booking diversion strategies are
representative of interventions applied during Intercept 5of the Sequential Intercept Model.
TCOOMMI provides funding to some LMHAs for the development of treatment programs for
individuals on probation or parole. These individuals are generally identified by the courts to be
in need of mental health treatment. As a condition of their probation or parole, they must engage
in mental health treatment provided through the LMHA. Treatment generally entails linkage to
the LMHA where they meet with a case-worker weekly, receive psychotropic medication
treatment via a psychiatrist, and receive additional services consistent with the DSHS Texas
Resilience and Recovery Utilization Management Guidelines (i.e. visit
http://www.dshs.state.tx.us/mhsa/trr/um/ click on Texas Resilience and Recovery Utilization
Management Guidelines – Adult Services). If the individual complies with treatment, charges
may be dropped, severity of the offense may be reduced, or the sentence may be reduced.
Extended Jail Diversion Strategies
The below strategies may not be considered programs with the specific intent of diverting
individuals with mental illness out of the criminal justice system; however, they are strategies
implemented in Texas that have both direct and indirect influences on existing jail diversion
initiatives.
Texas Law Enforcement Telecommunications Systems (TLETS) (i.e., Adults and Children).
DSHS in conjunction with the Department of Public Safety (DPS) utilizes TLETS, which
permits the sharing of data between DPS and various agencies. Every individual booked into a
county jail receives a Continuity of Care Query (CCQ). The DPS TLETS permits that individual
(i.e. based on first and last name, date of birth, sex, social security number, and race) to be
Please address correspondences electronically to the presenters at
[email protected], or, [email protected].
searched across the DSHS Clinical Management for Behavioral Health Services system (i.e. a
data warehouse system including treatment information for all individuals who have received
services at institutions funded through DSHS such as LMHAs or state hospitals) to establish a
match of identity. Once a match is identified, the county jail receives a report with that
individual’s name and the location of the last LMHA in which a service was provided. County
jail staff contacts the LMHA to conduct a screening and provide linkage to mental health
services provided in the community via the LMHA, or, additional agencies (i.e. please see
http://www.dshs.state.tx.us/mhcontracts/ContractDocuments.shtm click on Information Item T).
Harris County Jail Diversion Pilot Program (i.e., Adults). S.B. 1185 of the 83rd
Legislative
Session mandated the establishment of a jail diversion pilot program that will operate for a
period of three years and treatment must incorporate principles of Critical Time Intervention.
Program staff will provide community-based jail diversion services to individuals with mental
illness with, or, without substance use issues. These individuals must have received treatment in
Harris County Sheriff’s Office (HCSO) Mental Health Unit, a history of recurring psychotropic
medication treatment in HCSO, and have one or more of the above criteria, as well as, three or
more bookings within the past two years. Program goals include reducing recidivism rates and
reducing the frequency of arrests for individuals with mental illness.
Health Community Collaboratives (i.e., Adults). S.B. 58 of the 83rd
Legislative Session directed
DSHS to enhance or expand existing services to persons experiencing homelessness and mental
illness in the 5 largest metropolitan cities in Texas. DSHS was allocated $6.9 million for Fiscal
Year (FY) 2014 and $16.5 million for FY 2015 for the implementation and expansion of these
projects. An example of such a project is Haven for Hope located in San Antonio. Haven for
Hope is a hub for individuals who are homeless. Law enforcement officers may drop off
individuals who are homeless at this site for assessment and linkage to treatment services. While
residing at Haven for Hope, individuals are provided with employment and job readiness
training, substance abuse treatment, education, spiritual, and additional services. Haven for
Hope services are rooted in a holistic and recovery-based treatment focus. There are over 80
organizations who partner towards maintaining Haven for Hope, 40 of which are located on the
premises.
Supportive housing and intensive community supports (i.e., Adults). The 83rd
Legislative
Session appropriated $24,840,940 towards the expansion of supportive housing for people with
mental illness who are homeless or at risk for homelessness. Eighteen LMHAs were awarded
funding towards the implementation of supportive housing to help stabilize a high need
population at potential risk of incarceration.
1
The Varieties of Traumatic Experience: Risk and Legality In
PTSD
Michelle Richter, Ph.D.
St. Edward’s University
Overview Legal Implications
Diagnosis Debate
PTSD Points
PTSD and Criminal Behavior Correlation between criminal behavior and a
PTSD diagnosis
Correlations can be misleading…
Little research examining role of specific PTSD symptoms and criminal behavior
2
The Law and Diagnosis Following the birth of the PTSD diagnosis,
PTSD began to instantly appear in many criminal trials
Battered-wife and Battered-child syndrome also began to appear as types of PTSD
How Often is PTSD a Court Issue? Recent review of case law resulted in almost
200 appellate cases in which PTSD was part of a criminal defense
Five types of PTSD defense…
Insanity
Mixed decisions from courts – some courts explicitly state a link from PTSD to violence –others explicitly deny it
Defense based many cases of dissociative episodes involving murder
3
Unconsciousness Defense Defendant not conscious during criminal act
PTSD and Self-Defense Primarily used as defense to support murder
by victim of domestic assault
Defendant feared imminent death or bodily harm
PTSD and Mens Rea Diminished capacity to form requisite state of
mind for a crime
4
PTSD As A Mitigating Circumstance
PTSD found by some courts to be a mitigating circumstance
Several cases, on appeal, found that PTSD should have been presented in court and reversed their original decisions
PTSD and Successful Defense Clear and direct connection between PTSD
symptoms and criminal behavior found by “expert”
Courts have found to be most relevant to criminal defenses :
Dissociations
Hyperarousal
Overestimation of danger
Legal Scholars Recommend… Assessing the veracity of the trauma -Examining confirmatory records
-Being alert to exaggerated/factitious trauma
- Begin with open-ended questions before asking about PTSD symptoms
- An accurate PTSD diagnosis
- Elucidate how PTSD symptoms contributed to crime
5
The Origin of the Debate
Expert testimony in court has its origin in a set of landmark rulings…
Daubert Trio Supreme Court landmark cases establishing
the admission of expert witness testimony in court
Reliability of diagnosis assumed
But should it be for PTSD?
Let’s Look Deeper… Before speaking of PTSD specifically, let’s
talk disorders generally…
Any Talk of Disorders Begins In One Place…
6
The Big ManualDSM = Diagnostic and Statistical Manual of Mental Disorders, now in it’s 5th Edition!
Let’s do a little pop quiz…
Which Disorder?
“I feel so sad almost every day, I’ve lost any desire to do anything fun anymore. I spend all my time being depressed all day long.”
7
And the diagnosis is… Major Depression
Generalized Anxiety Disorder
Posttraumatic Stress Disorder
Obsessive Compulsive Disorder
Bipolar Disorder
Which Disorder?
“I can’t get the past trauma out of my head. I keep reliving the same event over and over, all I can think about is how I could have done things differently.”
And the diagnosis is… Major Depression
Generalized Anxiety Disorder
Posttraumatic Stress Disorder
Obsessive Compulsive Disorder
Bipolar Disorder
8
Which Disorder?
“You can’t leave the house until you check the locks on every window and door over and over again. You go through the same rituals and are terrified that you will harm someone you care about. You just can’t get those thoughts out of your head.”
And the diagnosis is… Major Depression
Generalized Anxiety Disorder
Posttraumatic Stress Disorder
Obsessive Compulsive Disorder
Bipolar Disorder
And the correct diagnosis is…
Drum Roll Please…
9
And the correct diagnosis is… √Major Depression
√ Generalized Anxiety Disorder
√ Posttraumatic Stress Disorder
√ Obsessive Compulsive Disorder
√ Bipolar Disorder
DSM Dilemmas Comorbidity = Many of the disorders occur in
groups, it is uncommon to have just one disorder
Depression and Anxiety occur together in 80% of cases. What’s wrong with this picture?
DSM Dilemmas Categorical model dominates the
conceptualization of mental disorders
10
Let’s Talk Depression…
A page from the DSM…1) depressed mood most of the day2) markedly diminished interest in activities 3) significant weight loss when not dieting 4) insomnia or hypersomnia nearly every day 5) psychomotor agitation or retardation 6) fatigue or loss of energy nearly every day 7) feelings of worthlessness or guilt8) diminished ability to think or concentrate 9) recurrent thoughts of death
A page from the DSM… To be clinically depressed you must meet 5 of
9 possible symptoms…
But what if you meet 4? Will your health insurance still cover you?
11
Another page from the DSM…1) Feeling wound-up, tense, or restless2) Easily becoming fatigued3) Concentration Problems4) Irritability5) Significant tension in muscles6) Difficulty with sleep
Overall Conclusions for DSM Categorical System of the DSM fails to
adequately differentiate disorders…
A new diagnostic structure is needed…
New Classification System for Everything
A dimensional model (no strict cut-off points) vs. a categorical model
How would diagnosis look?
12
Dimensional Diagnosis
20
35
50
65
80
95
46 38 46 38 62 58 57 49 61 46 52 65
PAR SZD STP AS BDL HIS NAR AVD DPN OC DPR PA
T S
core
Scale
Diagnostic Scales
Now back to PTSD problems… Some Diagnostic Dilemmas…
Limitations of using the DSM for PTSD Diagnosis
High comorbidity rates of PTSD with:
depression
substance abuse
and other anxiety disorders
In court, someone diagnosed with PTSD is likely to have some of these other symptoms as well, whether diagnosed or not….
13
DSM Limitations Two potential limitations:
PTSD may include symptom overlap among many different disorders (i.e., PTSD and depression)
DSM cannot differentiate!
Major clinical problem!
And Now, Let’s Talk Trauma But we may be getting ahead of ourselves..
First, what is PTSD???
PTSD was born with DSM-III in 1980
Wait, why 1980???
Currently it is made up of several symptom groups…
14
Symptom Cluster #1 reexperiencing symptoms
Symptom Cluster #2 symptoms of avoidance and emotional
numbing
Symptom Cluster #3 hyperarousal symptoms
15
Newest Edition to the Family!
Cluster 4 – Negative Mood and Cognition
So What Else Is There? We’ve mentioned the symptoms, but what
qualifies as a stressor?
What Do You Think? Do you think the following scenarios might
cause PTSD???
16
To PTSD or not to PTSDExperiencing severe combat situations
To PTSD or not to PTSD
Witnessing a car accident
To PTSD or not to PTSDWatching a distressing news story on TV
17
Watching Reality TV?
Watching the final episode…
DSM-4 Stressor Criteria for PTSD Involves actual or threatened death or serious
injury to self or others, and intense fear, helplessness, or horror.
Why is this definition important? Because…
Why Is Diagnosis Important? The DSM-5 PTSD diagnosis will… Have enormous impact on who qualifies for a
PTSD diagnosis (military, domestic assault)
Affect the direction of PTSD research and funding
Significant legal implications
18
Studies Say… New revisions of the DSM should keep fear,
helplessness, horror, and dissociative symptoms as stressor criteria for PTSD
RESTRICT the diagnosis
Did the DSM authors listen to the research?
DSM‐5 Stressor Criteria for PTSD
Absolutely Not!
With DSM‐5, the stressor criterion has been expanded to include almost everything…
Fear, helplessness, horror is gone…
You can qualify by hearing a tragic story from a friend…
Legal Implications may be substantial
Who’s At Risk for these Symptoms?
Individual Risk/Resiliencey Factors Include:
Optimism
Self-Esteem
Social Support
Smaller Hippocampus
Genes! (short forms of 5HTTLPR gene)
Psychosocial Stressors
19
Copyright © Houghton Mifflin Company. All rights reserved.
9 - 55
James D. Laird and Nicholas S. Thompson, Psychology. Copyright © 1992 by Houghton Mifflin Company. Reprinted by permission.
The Diathesis Stress Model
Demographics PTSD in 6.8% of people. Women more likely
to be diagnosed with PTSD (9.7 % vs. 3.6 % men)
One study reported that 95 % of women who had been raped met criteria for PTSD 2 weeks later, but 45.9 % after three months
Why the Gender Difference? Reason for difference not fully understood:
Some biology: Women with PTSD have higher levels of cortisol (not same for men)
Sexual Assault more likely to lead to PTSD
So, type of stressor affects prevalence rates…
20
Treatment and Risk Exposure Exposure Exposure
Medications???
Risk in public
Thank You! Q and A
Understanding
PTSDHave you, or someone you love
Been through combat?
Lived through a disaster?
Been raped?
Experienced any other kind of traumatic event?
Have you ever thought that painful memories of that experience were still causing problems for you or a loved one?
You may have heard of PTSD—posttraumatic stress disorder—on the news or from friends and family, and wondered
what it is, or whether you or someone you know has it.
This booklet will help you understand what PTSD is. You’ll learn how to get help for yourself, a friend, or a family
member. It includes stories from people who have gotten help for their PTSD and have returned to their normal lives,
activities, and relationships.
The important thing to remember is that effective treatment is available.
You don’t have to live with your symptoms forever.
This guide covers:
What Is PTSD? .....................2
Getting Help ........................6
Resources .............................8
Produced by the National Center for PTSD | August 2013 U.S. Department of Veterans Affairs | www.ptsd.va.gov
2www.ptsd.va.gov
What Is PTSD?
PTSD
Posttraumatic stress disorder, or PTSD, can occur after someone goes through, sees, or learns about a traumatic event like:
• Combat exposure
• Child sexual or physical abuse
• Terrorist attack
• Sexual/physical assault
• Serious accident
• Natural disaster
Most people have some stress-related reactions after a traumatic event. If your reactions don’t go away over time and they disrupt your life, you may have PTSD.
See the next few pages for common reactions to trauma and PTSD symptoms.
How Common Is PTSD?
Many Americans have had a trauma. About 60% of men and 50% of women experience at least one traumatic event. Of those who do, about 8% of men and 20% of women will develop PTSD. For some events, like combat and sexual assault, more people develop PTSD.
Men
61% Experience
Trauma
8% Develop PTSD
Women
51% Experience
Trauma
20% Develop PTSD
3www.ptsd.va.gov
What Are Some Common Stress Reactions after a Trauma?
It is normal to have stress reactions after a traumatic event. Your emotions and behavior can change in ways that are troubling to you.
Fear or anxiety In moments of danger, our bodies prepare to fight our enemy, flee the situation, or freeze in the hope that the danger will move past us. But those feelings of alertness may stay even after the danger has passed. You may:
• feel tense or afraid• be agitated and jumpy• feel on alert
Sadness or depression Sadness after a trauma may come from a sense of loss---of a loved one, of trust in the world, faith, or a previous way of life. You may:
• have crying spells• lose interest in things you used to enjoy• want to be alone all the time• feel tired, empty, and numb
Guilt and shame You may feel guilty that you did not do more to prevent the trauma. You may feel ashamed because during the trauma you acted in ways that you would not otherwise have done. You may:
• feel responsible for what happened• feel guilty because others were injured or killed and you
survived
Anger and irritability Anger may result from feeling you have been unfairly treated. Anger can make you feel irritated and cause you to be easily set off. You may:
• lash out at your partner or spouse• have less patience with your children• overreact to small misunderstandings
Behavior changes You may act in unhealthy ways. You may:
• drink, use drugs, or smoke too much• drive aggressively• neglect your health• avoid certain people or situations
Most people will have some of these
reactions at first, but they will get better
at some time. If symptoms last longer
than three months, cause you great
distress, or disrupt your work or home life,
you should seek help.
4www.ptsd.va.gov
What Are the Symptoms of PTSD?
PTSD has four types of symptoms.
Reliving the event (also called reexperiencing) Memories of the trauma can come back at any time. You may feel the same fear and horror you did when the event took place. You may have nightmares or feel like you’re going through it again. This is called a flashback. Sometimes there is a trigger—a sound or sight that causes you to relive the event.
• Seeing someone who reminds you of the trauma may bring back memories of the event.
• You may think about the trauma at work or school when you need to concentrate on something else.
Avoiding situations that remind you of the event You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event.
• You may avoid crowds, because they feel dangerous.• If you were in a car accident or if your military convoy
was bombed, you may avoid driving.• Some people may keep very busy or avoid seeking
help. This keeps them from having to think or talk about the event.
Negative changes in beliefs and feelings The way you think about yourself and others changes because of the trauma. This symptom has many aspects, including the following:
• You may not have positive or loving feelings toward other people and may stay away from relationships.
• You may forget about parts of the traumatic event or not be able to talk about them.
• You may think the world is completely dangerous, and no one can be trusted.
Feeling keyed up (also called hyperarousal) You may be jittery, or always on the alert and on the lookout for danger. You might suddenly become angry or irritable. This is known as hyperarousal.
• You may want to have your back to a wall in a restaurant or waiting room.
• A loud noise can startle you easily.• If someone bumps into you, you might fly into a rage.
Real Stories: Teresa
On a military mission, the truck in front of Teresa’s
went over a roadside bomb, and there were no
survivors. She was badly injured in the explosion,
but the person in the seat where Teresa was
supposed to have been was injured much worse.
Teresa felt guilty about that.
After returning home, Teresa started having
nightmares and panic attacks. The awful images
of that day haunted her. The medicines she was
prescribed for her anxiety and sleep problems
didn’t seem to help. She didn’t want to leave
the house, go to work, or do anything. One day
she lost control and verbally abused her platoon
leader. Her first sergeant stepped in and insisted
that she see a psychiatrist.
Teresa was diagnosed with PTSD. She’s doing
better thanks to treatment at her local VA.
Although Teresa’s problems have not gone away,
she now has a great support team to help her.
“Now I’ve got a great support team. I owe a tremendous thanks to my counselor.”
5www.ptsd.va.gov
Real Stories: Frank
“It was nice to know there was a reason for what I was doing.”
Frank served our country in Vietnam. Before
the war, he had been a happy person, but
he rarely smiled once he came home.
For many years, Frank didn’t talk about
Vietnam, thinking he would spare people.
He started drinking more. He had a short
temper, and had to have his back to the
wall in restaurants because he kept thinking
someone was after him. He couldn’t hold a
job or have a successful relationship. He just
felt that something was wrong. Frank didn’t
realize it, but he was having many of the
symptoms of PTSD.
Frank went to the VA, where he was
diagnosed with PTSD and given treatment
and support. He’s doing much better now.
“I would definitely recommend any Veteran go and get help.”
What Other Problems Do People with PTSD Experience?
People with PTSD may feel hopelessness, shame, or despair. Employment and relationship problems are also common. Depression, anxiety, and alcohol or drug use often occur at the same time as PTSD. In many cases, the PTSD treatments described in the Getting Help section will also help these other disorders, because the problems are often related and the coping skills you learn work for all of them.
How Likely Is a Person to Develop PTSD after a Trauma?
How likely you are to get PTSD can depend on things like:
• How intense the trauma was or how long it lasted
• If you lost someone you were close to or if you were hurt
• How close you were to the event
• How strong your reaction was
• How much you felt in control of events
• How much help and support you got after the event
Some groups of people may be more likely than others to develop PTSD. You are more likely to develop PTSD if you:
• Are female or a minority
• Have little education
• Had an earlier life-threatening event or trauma
• Have another mental health problem
• Have family members who have had mental health problems
• Have little support from family and friends
• Have had recent, stressful life changes
6www.ptsd.va.gov
G etting Help
When Should a Person Get Evaluated for PTSD?
If you continue to be upset for more than three months, seek help. You can feel better!
Who Can Conduct an Evaluation, and What Does It Consist of?
PTSD is usually diagnosed in one or two sessions. Your doctor or a mental health professional will evaluate you. You will be asked about your trauma and symptoms. You may also be asked about other problems you have. Your spouse or partner may be asked to provide information.
The Department of Veterans Affairs has a PTSD questionnaire that you can take online. You can also take the screening test below.
If you find that you answered “yes” to many of the questions asked, you may have PTSD. It is best to talk to a mental health professional to find out for sure.
PTSD Screen
In your life, have you ever had any experience that was so frightening, horrible, or upsetting that, in the past month, you:
❑ Have had nightmares about the experience or thought about it when you did not want to?
❑ Tried hard not to think about the experience or avoided situations that reminded you of it?
❑ Were constantly on guard, watchful, or easily startled?
❑ Felt numb or detached from others, activities, or your surroundings?
Current research recommends that if you answered “yes” to any three items, you should seek more information from a mental health care provider. A positive screen does not mean that you have PTSD. Only a qualified mental health care practitioner, such as a clinician or psychologist, can diagnose you with PTSD.
7www.ptsd.va.gov
What Treatments Are Effective for PTSD?
There are good treatments available for PTSD. The two main types are psychotherapy, sometimes called “counseling,” and medication. Sometimes people combine psychotherapy and medication.
Psychotherapy Cognitive Behavioral Therapy (CBT) is the most effective treatment for PTSD. CBT usually involves meeting with your therapist once a week for 3-6 months. There are different types of CBT that are effective for PTSD.
Cognitive Processing Therapy (CPT) is a CBT in which you learn skills to better understand how a trauma changed your thoughts and feelings. It will help you see how you have gotten “stuck” in your thinking about the trauma. It helps you identify trauma-related thoughts and change them so they are more accurate and less distressing.
Prolonged Exposure (PE) therapy is a CBT in which you talk about your trauma repeatedly until the memories are no longer upsetting. You also go into situations that are safe but which you may have been avoiding because they are related to the trauma.
Eye Movement Desensitization and Reprocessing (EMDR) involves focusing on distractions like hand movements or sounds while you talk about the traumatic event. Over time, it can help change how you react to memories of your trauma.
Medication Selective Serotonin Reuptake Inhibitors (SSRIs) can raise the level of serotonin in your brain, which can make you feel better. The two SSRIs that are currently approved by the FDA for the treatment of PTSD are sertraline (Zoloft) and paroxetine (Paxil).
Sometimes, doctors prescribe medicines called benzodiazepines for people with PTSD. These medicines are often given to people who have problems with anxiety. While they may be of some help at first, they do not treat the core PTSD symptoms. They may lead to addiction and are not recommended for long-term PTSD treatment.
Real Stories: GinaGina had a great job, a loving husband, and a beautiful home. But
she was miserable. Some days, a kiss from her husband would
make her heart start pounding, and she would feel very afraid. She
did not realize that these panicky feelings were flashbacks—the
rexperiencing of the feelings that she had felt when she was a small
child and couldn’t protect herself.
Gina sought help. She went to a therapist, and finally revealed that
her uncle had repeatedly sexually abused her as a child. Her therapist
diagnosed PTSD, and started cognitive behavioral therapy with Gina.
Therapy taught her to challenge her thoughts and feel less distress.
She still has occasional flashbacks and panic attacks, but they’re now controllable, and she knows they will
pass. Before, she thought she’d always have to live with the flashbacks and bad feelings. Now, she can go
weeks without thinking about the abuse, and she feels certain that someday it will be years.
“You can be a normal thriving person and have mental health issues, get help for those, and still be okay.”
8www.ptsd.va.gov
R esources
How Can I Learn More About PTSD?
View the multimedia companion to this brochure and other resources at www.ptsd.va.gov/public/
In a Crisis?• Call 911
• Go to an emergency room
• Call 1-800-273-TALK (1-800-273-8255) (Español: 1-888-628-9454)
Veterans, go to www.suicidepreventionlifeline.org/Veterans to chat live with a crisis counselor
Where Can I Get Help for Myself or a Family Member?These links are accessible online at http://www.ptsd.va.gov/public/where-to-get-help.asp
• Where to Get Help for PTSD
• Mental Health Services Locator
• VA PTSD Program Locator
This guide was created by the National Center for PTSD, U.S. Department of Veterans Affairs. The Center conducts research and education on trauma and PTSD. Our website offers extensive information, educational materials, and multimedia presentations
for a variety of audiences, including Veterans and their families, providers, and researchers. Website: www.ptsd.va.gov
1
MENTAL HEALTHCOMMITMENT PROCESS
Texas Municipal Courts Education Center
Mental Health Clinic
February, 2015
Statutory Authority
• Health & Safety Code, Subchapter C
• Chapter 571 through Chapter 579
• Purpose of Subchapter C:
– Civil in nature – not a criminal sanction
– Define patient rights to notice and hearing
– Concept of “least restrictive means”
– Define criteria for detention and safeguards to “patient” rights
Distinctions
• Mental Health Services under Subchapter C are divided into voluntary and involuntary services
• Rights are retained under both voluntary and involuntary
• Mental Health is differentiated from Mental Retardation
• Mental Health is distinguished from Chemical Dependency
2
Jurisdiction
• Jurisdiction for placement beyond emergency detention lies with a County Probate Court, or the County Court with Probate jurisdiction.
• Ultimate case disposition is that of the Probate Court.
• Peace officers have the authority to make an emergency detention
• Magistrates’ have the ability to consider and order of protective custody
Emergency DetentionTx.H&SC ‐ Chapter 573
• A peace officer, without warrant may detain a person who the officer believes is (a) mentally ill, and (b) because of that mental illness there is a substantial risk of harm to self or others, if there is insufficient time to obtain a warrant.
• A “substantial risk of harm” may be shown by the person’s behavior or evidence of emotional distress and deterioration to the extent the person cannot remain at liberty.
Process for Emergency Detention
• A peace officer may form opinion based on personal observation or information of a credible person.
• Once in custody, the officer must immediately transport the person to an appropriate mental health facility (not a jail)
• Officer must inform the patient of reasons in non‐technical terms, and facility must provide patient with rights within 24 hours of detention.
• Officer may seize firearm from patient.
3
Application Other than Peace Officer
• An adult may file application for emergency detention with a Judge or Magistrate with the same standard regarding behavior.
• Application must be in person
• Magistrate must find mental illness, risk of harm, and that necessary restraint cannot be accomplished without detention.
• If basis found, magistrate shall issue warrant to peace officer.
Once Patient Detained
• Facility must accept patient detained by peace officer
• May detain NOT LONGER than 48 HOURS.
• During 48 Hours, patient must be examined by doctor within 12 hours
• Must be released at end of examination unless basis found
• If basis shown, application for Protective Custody (under Ch. 574) must be filed.
Court‐Ordered Mental Health ServicesChapter 574
• Any person may apply to a court with probate jurisdiction to find that a person is in need of mental health services.
• May be filed in county where person resides or is found
• If filed by a county/ district attorney, no CME is required at time of filing
• Person remains at liberty during application and until time of hearing
4
Hearing
• Hearing must be set w/in 14 days after filing• Application must be served on patient• State represented by county/ district attorney• Court must appoint an attorney• Attorney must discuss rights, hearing and appeal and must receive a copy of application.
• Two (2) CMEs made w/in last 30 days must be presented to the court. May order patient to submit to examination. If no CMEs, must release.
• Hearing must be before Judge of court with probate jurisdiction or associate judge.
Certificates of Medical Examination
• CMEs must be made by physician or psychiatrist within last 30 days.
• Must provide diagnosis and treatment• Must find that the person is:
– mentally ill; – “likely to cause serious harm to self or others;– Suffering severe, abnormal mental or emotional distress– Unable to provide for person basic needs or safety– Unable to make rational decision to submit to treatment; and
– If part of a request for protective custody, that restraint is necessary to prevent harm to self or others
PROTECTIVE CUSTODY
• Motion for Protective Custody (574.021) must be filed in a court in which an application for mental health services is pending.
• Filed at the request of the county/ district attorney or the court’s own motion
• The (probate) judge may designate a magistrate to issue protective orders
• Magistrate or judge may issue order for detention based upon opinion of a physician
5
Order for Protective Custody
• Order for apprehension and detention must be based on finding of mental illness and danger to self or others
• Must find risk based on behavior or action to the extent that the patient cannot remain at liberty.
• Order directed to officer to apprehend and detain patient and to transport them to an appropriate facility.
Hearing on Protective Custody(Probable Cause Hearing)
• Attorney must be appointed for patient
• Patient entitled to notice and pleadings
• Before Judge or assigned Magistrate
• Probable Cause as to patient is risk of harm to self or others
• Requires consideration of physician’s opinion
• MUST BE HELD within 72 HOURS of detention(with limited exception) TH&SC 574.025
• May consider all testimony and evidence
CONTINUED DETENTION
• A Protective Custody Order may order that the patient be:– detained in a mental health facility operated by the Texas Department of Health until the Hearing on application for Mental Health Services (w/in 14 days)
– Detained in another mental health facility the court finds appropriate;
– RELEASED if the judge finds no probable cause;
– Order the patient reappear at hearing for Court Ordered Mental Health Services (w/in 14 days of application)
6
TEMPORARY ORDERS (Hearing on Application)
• Must be heard by a Judge with probate jurisdiction (or associate judge)
• If by Associate judge, recommendations must be adopted by the Judge
• If basis shown, the Judge may order the detention of the patient for NOT LONGER than 90 days.
• Patient must submit to treatment during detention.
• Patient entitled to jury trial.
• Court may order “out‐patient” services
• Orders subject to “post‐commitment” modification
General Concepts
• All mental health services are intended to be “temporary” and should aim toward re‐integration into community
• Mental health issues are not “criminal”• Magistrate’s emergency orders are a “sub‐part” of the over‐all process under the probate court’s direction
• Proceedings are time sensitive.• Proceedings are confidential and not a matter of public record (i.e. Style of case – initials only)
Dependent on County Structure
• Familiarize yourself with your county processes.
• Often integrated with Justice of the Peace
• Contact your sheriff’s office to determine if special resources are available (mental health unit)
• Contact your County Court with probate jurisdiction.
HEALTH AND SAFETY CODE
TITLE 7. MENTAL HEALTH AND MENTAL RETARDATION
SUBTITLE C. TEXAS MENTAL HEALTH CODE
CHAPTER 573. EMERGENCY DETENTION
SUBCHAPTER A. APPREHENSION BY PEACE OFFICER OR TRANSPORTATION
FOR EMERGENCY DETENTION BY GUARDIAN
Sec. 573.001. APPREHENSION BY PEACE OFFICER WITHOUT
WARRANT. (a) A peace officer, without a warrant, may take a
person into custody if the officer:
(1) has reason to believe and does believe that:
(A) the person is mentally ill; and
(B) because of that mental illness there is a
substantial risk of serious harm to the person or to others
unless the person is immediately restrained; and
(2) believes that there is not sufficient time to
obtain a warrant before taking the person into custody.
(b) A substantial risk of serious harm to the person or
others under Subsection (a)(1)(B) may be demonstrated by:
(1) the person's behavior; or
(2) evidence of severe emotional distress and
deterioration in the person's mental condition to the extent
that the person cannot remain at liberty.
(c) The peace officer may form the belief that the person
meets the criteria for apprehension:
(1) from a representation of a credible person; or
(2) on the basis of the conduct of the apprehended
person or the circumstances under which the apprehended person
is found.
(d) A peace officer who takes a person into custody under
Subsection (a) shall immediately transport the apprehended
person to:
(1) the nearest appropriate inpatient mental health
facility; or
(2) a mental health facility deemed suitable by the
local mental health authority, if an appropriate inpatient
mental health facility is not available.
(e) A jail or similar detention facility may not be deemed
suitable except in an extreme emergency.
(f) A person detained in a jail or a nonmedical facility
shall be kept separate from any person who is charged with or
convicted of a crime.
Text of subsection as added by Acts 2013, 83rd Leg., R.S., Ch.
318 (H.B. 1738), Sec. 1
(g) A peace officer who takes a person into custody under
Subsection (a) shall immediately inform the person orally in
simple, nontechnical terms:
(1) of the reason for the detention; and
(2) that a staff member of the facility will inform
the person of the person's rights within 24 hours after the time
the person is admitted to a facility, as provided by Section
573.025(b).
Text of subsection as added by Acts 2013, 83rd Leg., R.S., Ch.
776 (S.B. 1189), Sec. 1
(g) A peace officer who takes a person into custody under
Subsection (a) may immediately seize any firearm found in
possession of the person. After seizing a firearm under this
subsection, the peace officer shall comply with the requirements
of Article 18.191, Code of Criminal Procedure.
Added by Acts 1991, 72nd Leg., ch. 76, Sec. 1, eff. Sept. 1,
1991. Amended by Acts 2001, 77th Leg., ch. 367, Sec. 5, eff.
Sept. 1, 2001.
Amended by:
Acts 2013, 83rd Leg., R.S., Ch. 318 (H.B. 1738), Sec. 1,
eff. September 1, 2013.
Acts 2013, 83rd Leg., R.S., Ch. 776 (S.B. 1189), Sec. 1,
eff. September 1, 2013.
Sec. 573.002. PEACE OFFICER'S NOTIFICATION OF DETENTION.
(a) A peace officer shall immediately file with a facility a
notification of detention after transporting a person to that
facility in accordance with Section 573.001.
(b) The notification of detention must contain:
(1) a statement that the officer has reason to
believe and does believe that the person evidences mental
illness;
(2) a statement that the officer has reason to
believe and does believe that the person evidences a substantial
risk of serious harm to the person or others;
(3) a specific description of the risk of harm;
(4) a statement that the officer has reason to
believe and does believe that the risk of harm is imminent
unless the person is immediately restrained;
(5) a statement that the officer's beliefs are
derived from specific recent behavior, overt acts, attempts, or
threats that were observed by or reliably reported to the
officer;
(6) a detailed description of the specific behavior,
acts, attempts, or threats; and
(7) the name and relationship to the apprehended
person of any person who reported or observed the behavior,
acts, attempts, or threats.
(c) The facility where the person is detained shall
include in the detained person's clinical file the notification
of detention described by this section.
(d) The peace officer shall give the notification of
detention on the following form:
Notification--Emergency Detention NO.
____________________ DATE:_______________ TIME:_______________
THE STATE OF TEXAS
FOR THE BEST INTEREST AND PROTECTION OF:
______________________________________
NOTIFICATION OF EMERGENCY DETENTION
Now comes _____________________________, a peace officer with
(name of agency) _____________________________, of the State of
Texas, and states as follows:
1. I have reason to believe and do believe that (name of person
to be detained) __________________________ evidences mental
illness.
2. I have reason to believe and do believe that the above-named
person evidences a substantial risk of serious harm to
himself/herself or others based upon the following:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
3. I have reason to believe and do believe that the above risk
of harm is imminent unless the above-named person is immediately
restrained.
4. My beliefs are based upon the following recent behavior,
overt acts, attempts, statements, or threats observed by me or
reliably reported to me:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
5. The names, addresses, and relationship to the above-named
person of those persons who reported or observed recent
behavior, acts, attempts, statements, or threats of the above-
named person are (if applicable):
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
For the above reasons, I present this notification to seek
temporary admission to the (name of facility)
_________________________ inpatient mental health facility or
hospital facility for the detention of (name of person to be
detained) __________________________ on an emergency basis.
6. Was the person restrained in any way? Yes □ No □
_________________________ BADGE NO.
_____________________
PEACE OFFICER'S SIGNATURE
Address: _________________________ Zip Code:
____________________
Telephone: ______________________
A mental health facility or hospital emergency department may
not require a peace officer to execute any form other than this
form as a predicate to accepting for temporary admission a
person detained under Section 573.001, Texas Health and Safety
Code.
(e) A mental health facility or hospital emergency
department may not require a peace officer to execute any form
other than the form provided by Subsection (d) as a predicate to
accepting for temporary admission a person detained under
Section 573.001.
Added by Acts 1991, 72nd Leg., ch. 76, Sec. 1, eff. Sept. 1,
1991.
Amended by:
Acts 2013, 83rd Leg., R.S., Ch. 318 (H.B. 1738), Sec. 2,
eff. September 1, 2013.
Sec. 573.003. TRANSPORTATION FOR EMERGENCY DETENTION BY
GUARDIAN. (a) A guardian of the person of a ward who is 18
years of age or older, without the assistance of a peace
officer, may transport the ward to an inpatient mental health
facility for a preliminary examination in accordance with
Section 573.021 if the guardian has reason to believe and does
believe that:
(1) the ward is mentally ill; and
(2) because of that mental illness there is a
substantial risk of serious harm to the ward or to others unless
the ward is immediately restrained.
(b) A substantial risk of serious harm to the ward or
others under Subsection (a)(2) may be demonstrated by:
(1) the ward's behavior; or
(2) evidence of severe emotional distress and
deterioration in the ward's mental condition to the extent that
the ward cannot remain at liberty.
Added by Acts 2003, 78th Leg., ch. 692, Sec. 6, eff. Sept. 1,
2003.
Sec. 573.004. GUARDIAN'S APPLICATION FOR EMERGENCY
DETENTION. (a) After transporting a ward to a facility under
Section 573.003, a guardian shall immediately file an
application for detention with the facility.
(b) The application for detention must contain:
(1) a statement that the guardian has reason to
believe and does believe that the ward evidences mental illness;
(2) a statement that the guardian has reason to
believe and does believe that the ward evidences a substantial
risk of serious harm to the ward or others;
(3) a specific description of the risk of harm;
(4) a statement that the guardian has reason to
believe and does believe that the risk of harm is imminent
unless the ward is immediately restrained;
(5) a statement that the guardian's beliefs are
derived from specific recent behavior, overt acts, attempts, or
threats that were observed by the guardian; and
(6) a detailed description of the specific behavior,
acts, attempts, or threats.
(c) The guardian shall immediately provide written notice
of the filing of an application under this section to the court
that granted the guardianship.
Added by Acts 2003, 78th Leg., ch. 692, Sec. 6, eff. Sept. 1,
2003.
SUBCHAPTER B. JUDGE'S OR MAGISTRATE'S ORDER FOR EMERGENCY
APPREHENSION AND DETENTION
Sec. 573.011. APPLICATION FOR EMERGENCY DETENTION. (a)
An adult may file a written application for the emergency
detention of another person.
(b) The application must state:
(1) that the applicant has reason to believe and does
believe that the person evidences mental illness;
(2) that the applicant has reason to believe and does
believe that the person evidences a substantial risk of serious
harm to himself or others;
(3) a specific description of the risk of harm;
(4) that the applicant has reason to believe and does
believe that the risk of harm is imminent unless the person is
immediately restrained;
(5) that the applicant's beliefs are derived from
specific recent behavior, overt acts, attempts, or threats;
(6) a detailed description of the specific behavior,
acts, attempts, or threats; and
(7) a detailed description of the applicant's
relationship to the person whose detention is sought.
(c) The application may be accompanied by any relevant
information.
Added by Acts 1991, 72nd Leg., ch. 76, Sec. 1, eff. Sept. 1,
1991.
Sec. 573.012. ISSUANCE OF WARRANT. (a) Except as
provided by Subsection (h), an applicant for emergency detention
must present the application personally to a judge or
magistrate. The judge or magistrate shall examine the
application and may interview the applicant. Except as provided
by Subsection (g), the judge of a court with probate
jurisdiction by administrative order may provide that the
application must be:
(1) presented personally to the court; or
(2) retained by court staff and presented to another
judge or magistrate as soon as is practicable if the judge of
the court is not available at the time the application is
presented.
(b) The magistrate shall deny the application unless the
magistrate finds that there is reasonable cause to believe that:
(1) the person evidences mental illness;
(2) the person evidences a substantial risk of
serious harm to himself or others;
(3) the risk of harm is imminent unless the person is
immediately restrained; and
(4) the necessary restraint cannot be accomplished
without emergency detention.
(c) A substantial risk of serious harm to the person or
others under Subsection (b)(2) may be demonstrated by:
(1) the person's behavior; or
(2) evidence of severe emotional distress and
deterioration in the person's mental condition to the extent
that the person cannot remain at liberty.
(d) The magistrate shall issue to an on-duty peace officer
a warrant for the person's immediate apprehension if the
magistrate finds that each criterion under Subsection (b) is
satisfied.
(e) A person apprehended under this section shall be
transported for a preliminary examination in accordance with
Section 573.021 to:
(1) the nearest appropriate inpatient mental health
facility; or
(2) a mental health facility deemed suitable by the
local mental health authority, if an appropriate inpatient
mental health facility is not available.
(f) The warrant serves as an application for detention in
the facility. The warrant and a copy of the application for the
warrant shall be immediately transmitted to the facility.
(g) If there is more than one court with probate
jurisdiction in a county, an administrative order regarding
presentation of an application must be jointly issued by all of
the judges of those courts.
(h) A judge or magistrate may permit an applicant who is a
physician to present an application by:
(1) e-mail with the application attached as a secure
document in a portable document format (PDF); or
(2) secure electronic means, including:
(A) satellite transmission;
(B) closed-circuit television transmission; or
(C) any other method of two-way electronic
communication that:
(i) is secure;
(ii) is available to the judge or
magistrate; and
(iii) provides for a simultaneous,
compressed full-motion video and interactive communication of
image and sound between the judge or magistrate and the
applicant.
(h-1) After the presentation of an application under
Subsection (h), the judge or magistrate may transmit a warrant
to the applicant:
(1) electronically, if a digital signature, as
defined by Article 2.26, Code of Criminal Procedure, is
transmitted with the document; or
(2) by e-mail with the warrant attached as a secure
document in a portable document format (PDF), if the
identifiable legal signature of the judge or magistrate is
transmitted with the document.
(i) The judge or magistrate shall provide for a recording
of the presentation of an application under Subsection (h) to be
made and preserved until the patient or proposed patient has
been released or discharged. The patient or proposed patient
may obtain a copy of the recording on payment of a reasonable
amount to cover the costs of reproduction or, if the patient or
proposed patient is indigent, the court shall provide a copy on
the request of the patient or proposed patient without charging
a cost for the copy.
Added by Acts 1991, 72nd Leg., ch. 76, Sec. 1, eff. Sept. 1,
1991. Amended by Acts 1991, 72nd Leg., 1st C.S., ch. 15, Sec.
5.19, eff. Sept. 1, 1991; Acts 1995, 74th Leg., ch. 243, Sec.
3, eff. Aug. 28, 1995; Acts 2001, 77th Leg., ch. 367, Sec. 6,
eff. Sept. 1, 2001.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 1145 (S.B. 778), Sec. 1,
eff. September 1, 2007.
Acts 2011, 82nd Leg., R.S., Ch. 510 (H.B. 1829), Sec. 1,
eff. September 1, 2011.
SUBCHAPTER C. EMERGENCY DETENTION, RELEASE, AND RIGHTS
Sec. 573.021. PRELIMINARY EXAMINATION. (a) A facility
shall temporarily accept a person for whom an application for
detention is filed or for whom a peace officer files a
notification of detention under Section 573.002(a).
(b) A person accepted for a preliminary examination may be
detained in custody for not longer than 48 hours after the time
the person is presented to the facility unless a written order
for protective custody is obtained. The 48-hour period allowed
by this section includes any time the patient spends waiting in
the facility for medical care before the person receives the
preliminary examination. If the 48-hour period ends on a
Saturday, Sunday, legal holiday, or before 4 p.m. on the first
succeeding business day, the person may be detained until 4 p.m.
on the first succeeding business day. If the 48-hour period ends
at a different time, the person may be detained only until 4
p.m. on the day the 48-hour period ends. If extremely hazardous
weather conditions exist or a disaster occurs, the presiding
judge or magistrate may, by written order made each day, extend
by an additional 24 hours the period during which the person may
be detained. The written order must declare that an emergency
exists because of the weather or the occurrence of a disaster.
(c) A physician shall examine the person as soon as
possible within 12 hours after the time the person is
apprehended by the peace officer or transported for emergency
detention by the person's guardian.
(d) A facility must comply with this section only to the
extent that the commissioner determines that a facility has
sufficient resources to perform the necessary services under
this section.
(e) A person may not be detained in a private mental
health facility without the consent of the facility
administrator.
Added by Acts 1991, 72nd Leg., ch. 76, Sec. 1, eff. Sept. 1,
1991. Amended by Acts 2001, 77th Leg., ch. 623, Sec. 1, eff.
June 11, 2001; Acts 2003, 78th Leg., ch. 692, Sec. 7, eff.
Sept. 1, 2003.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 202 (H.B. 518), Sec. 1,
eff. September 1, 2007.
Acts 2009, 81st Leg., R.S., Ch. 333 (H.B. 888), Sec. 1,
eff. June 19, 2009.
Acts 2013, 83rd Leg., R.S., Ch. 318 (H.B. 1738), Sec. 3,
eff. September 1, 2013.
Sec. 573.022. EMERGENCY ADMISSION AND DETENTION. (a) A
person may be admitted to a facility for emergency detention
only if the physician who conducted the preliminary examination
of the person makes a written statement that:
(1) is acceptable to the facility;
(2) states that after a preliminary examination it is
the physician's opinion that:
(A) the person is mentally ill;
(B) the person evidences a substantial risk of
serious harm to himself or others;
(C) the described risk of harm is imminent
unless the person is immediately restrained; and
(D) emergency detention is the least restrictive
means by which the necessary restraint may be accomplished; and
(3) includes:
(A) a description of the nature of the person's
mental illness;
(B) a specific description of the risk of harm
the person evidences that may be demonstrated either by the
person's behavior or by evidence of severe emotional distress
and deterioration in the person's mental condition to the extent
that the person cannot remain at liberty; and
(C) the specific detailed information from which
the physician formed the opinion in Subdivision (2).
(b) A mental health facility that has admitted a person
for emergency detention under this section may transport the
person to a mental health facility deemed suitable by the local
mental health authority for the area. On the request of the
local mental health authority, the judge may order that the
proposed patient be detained in a department mental health
facility.
(c) A facility that has admitted a person for emergency
detention under Subsection (a) or to which a person has been
transported under Subsection (b) may transfer the person to an
appropriate mental hospital with the written consent of the
hospital administrator.
Added by Acts 1991, 72nd Leg., ch. 76, Sec. 1, eff. Sept. 1,
1991. Amended by Acts 1999, 76th Leg., ch. 842, Sec. 1, eff.
June 18, 1999; Acts 2001, 77th Leg., ch. 367, Sec. 7, eff.
Sept. 1, 2001.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 510 (H.B. 1829), Sec. 2,
eff. September 1, 2011.
Sec. 573.023. RELEASE FROM EMERGENCY DETENTION. (a) A
person apprehended by a peace officer or transported for
emergency detention under Subchapter A or detained under
Subchapter B shall be released on completion of the preliminary
examination unless the person is admitted to a facility under
Section 573.022.
(b) A person admitted to a facility under Section 573.022
shall be released if the facility administrator determines at
any time during the emergency detention period that one of the
criteria prescribed by Section 573.022(2) no longer applies.
Added by Acts 1991, 72nd Leg., ch. 76, Sec. 1, eff. Sept. 1,
1991. Amended by Acts 2003, 78th Leg., ch. 692, Sec. 8, eff.
Sept. 1, 2003.
Sec. 573.024. TRANSPORTATION AFTER RELEASE. (a)
Arrangements shall be made to transport a person who is entitled
to release under Section 573.023 to:
(1) the location of the person's apprehension;
(2) the person's residence in this state; or
(3) another suitable location.
(b) Subsection (a) does not apply to a person who is
arrested or who objects to the transportation.
(c) If the person was apprehended by a peace officer under
Subchapter A, arrangements must be made to immediately transport
the person. If the person was transported for emergency
detention under Subchapter A or detained under Subchapter B,
the person is entitled to reasonably prompt transportation.
(d) The county in which the person was apprehended shall
pay the costs of transporting the person.
Added by Acts 1991, 72nd Leg., ch. 76, Sec. 1, eff. Sept. 1,
1991. Amended by Acts 2003, 78th Leg., ch. 692, Sec. 9, eff.
Sept. 1, 2003.
Sec. 573.025. RIGHTS OF PERSONS APPREHENDED, DETAINED, OR
TRANSPORTED FOR EMERGENCY DETENTION. (a) A person apprehended,
detained, or transported for emergency detention under this
chapter has the right:
(1) to be advised of the location of detention, the
reasons for the detention, and the fact that the detention could
result in a longer period of involuntary commitment;
(2) to a reasonable opportunity to communicate with
and retain an attorney;
(3) to be transported to a location as provided by
Section 573.024 if the person is not admitted for emergency
detention, unless the person is arrested or objects;
(4) to be released from a facility as provided by
Section 573.023;
(5) to be advised that communications with a mental
health professional may be used in proceedings for further
detention;
(6) to be transported in accordance with Sections
573.026 and 574.045, if the person is detained under Section
573.022 or transported under an order of protective custody
under Section 574.023; and
(7) to a reasonable opportunity to communicate with a
relative or other responsible person who has a proper interest
in the person's welfare.
(b) A person apprehended, detained, or transported for
emergency detention under this subtitle shall be informed of the
rights provided by this section and this subtitle:
(1) orally in simple, nontechnical terms, within 24
hours after the time the person is admitted to a facility, and
in writing in the person's primary language if possible; or
(2) through the use of a means reasonably calculated
to communicate with a hearing or visually impaired person, if
applicable.
(c) The executive commissioner of the Health and Human
Services Commission by rule shall prescribe the manner in which
the person is informed of the person's rights under this section
and this subtitle.
Added by Acts 1991, 72nd Leg., ch. 76, Sec. 1, eff. Sept. 1,
1991. Amended by Acts 1999, 76th Leg., ch. 1512, Sec. 2, eff.
Sept. 1, 1999; Acts 2003, 78th Leg., ch. 692, Sec. 10, eff.
Sept. 1, 2003.
Amended by:
Acts 2013, 83rd Leg., R.S., Ch. 318 (H.B. 1738), Sec. 4,
eff. September 1, 2013.
Sec. 573.026. TRANSPORTATION AFTER DETENTION. A person
being transported after detention under Section 573.022 shall be
transported in accordance with Section 574.045.
Added by Acts 1999, 76th Leg., ch. 1512, Sec. 3, eff. Sept. 1,
1999.
SUBCHAPTER B. PROTECTIVE CUSTODY
Sec. 574.021. MOTION FOR ORDER OF PROTECTIVE CUSTODY. (a)
A motion for an order of protective custody may be filed only in
the court in which an application for court-ordered mental
health services is pending.
(b) The motion may be filed by the county or district
attorney or on the court's own motion.
(c) The motion must state that:
(1) the judge or county or district attorney has
reason to believe and does believe that the proposed patient
meets the criteria authorizing the court to order protective
custody; and
(2) the belief is derived from:
(A) the representations of a credible person;
(B) the proposed patient's conduct; or
(C) the circumstances under which the proposed
patient is found.
(d) The motion must be accompanied by a certificate of
medical examination for mental illness prepared by a physician
who has examined the proposed patient not earlier than the third
day before the day the motion is filed.
(e) The judge of the court in which the application is
pending may designate a magistrate to issue protective custody
orders, including a magistrate appointed by the judge of another
court if the magistrate has at least the qualifications required
for a magistrate of the court in which the application is
pending. A magistrate's duty under this section is in addition
to the magistrate's duties prescribed by other law.
Added by Acts 1991, 72nd Leg., ch. 76, Sec. 1, eff. Sept. 1,
1991. Amended by Acts 2001, 77th Leg., ch. 1278, Sec. 1, eff.
June 15, 2001.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 202 (H.B. 518), Sec. 2,
eff. September 1, 2007.
Sec. 574.022. ISSUANCE OF ORDER. (a) The judge or
designated magistrate may issue a protective custody order if
the judge or magistrate determines:
(1) that a physician has stated his opinion and the
detailed reasons for his opinion that the proposed patient is
mentally ill; and
(2) the proposed patient presents a substantial risk
of serious harm to himself or others if not immediately
restrained pending the hearing.
(b) The determination that the proposed patient presents a
substantial risk of serious harm may be demonstrated by the
proposed patient's behavior or by evidence of severe emotional
distress and deterioration in the proposed patient's mental
condition to the extent that the proposed patient cannot remain
at liberty.
(c) The judge or magistrate may make a determination that
the proposed patient meets the criteria prescribed by Subsection
(a) from the application and certificate alone if the judge or
magistrate determines that the conclusions of the applicant and
certifying physician are adequately supported by the information
provided.
(d) The judge or magistrate may take additional evidence
if a fair determination of the matter cannot be made from
consideration of the application and certificate only.
(e) The judge or magistrate may issue a protective custody
order for a proposed patient who is charged with a criminal
offense if the proposed patient meets the requirements of this
section and the facility administrator designated to detain the
proposed patient agrees to the detention.
Added by Acts 1991, 72nd Leg., ch. 76, Sec. 1, eff. Sept. 1,
1991.
Sec. 574.023. APPREHENSION UNDER ORDER. (a) A protective
custody order shall direct a person authorized to transport
patients under Section 574.045 to take the proposed patient into
protective custody and transport the person immediately to a
mental health facility deemed suitable by the local mental
health authority for the area. On request of the local mental
health authority, the judge may order that the proposed patient
be detained in an inpatient mental health facility operated by
the department.
(b) The proposed patient shall be detained in the facility
until a hearing is held under Section 574.025.
(c) A facility must comply with this section only to the
extent that the commissioner determines that the facility has
sufficient resources to perform the necessary services.
(d) A person may not be detained in a private mental
health facility without the consent of the facility
administrator.
Added by Acts 1991, 72nd Leg., ch. 76, Sec. 1, eff. Sept. 1,
1991. Amended by Acts 1999, 76th Leg., ch. 1512, Sec. 4, eff.
Sept. 1, 1999; Acts 2001, 77th Leg., ch. 367, Sec. 9, eff.
Sept. 1, 2001.
Sec. 574.024. APPOINTMENT OF ATTORNEY. (a) When a
protective custody order is signed, the judge or designated
magistrate shall appoint an attorney to represent a proposed
patient who does not have an attorney.
(b) Within a reasonable time before a hearing is held
under Section 574.025, the court that ordered the protective
custody shall provide to the proposed patient and the proposed
patient's attorney a written notice that states:
(1) that the proposed patient has been placed under a
protective custody order;
(2) the grounds for the order; and
(3) the time and place of the hearing to determine
probable cause.
Added by Acts 1991, 72nd Leg., ch. 76, Sec. 1, eff. Sept. 1,
1991.
Sec. 574.025. PROBABLE CAUSE HEARING. (a) A hearing must
be held to determine if:
(1) there is probable cause to believe that a
proposed patient under a protective custody order presents a
substantial risk of serious harm to himself or others to the
extent that he cannot be at liberty pending the hearing on
court-ordered mental health services; and
(2) a physician has stated his opinion and the
detailed reasons for his opinion that the proposed patient is
mentally ill.
(b) The hearing must be held not later than 72 hours after
the time that the proposed patient was detained under a
protective custody order. If the period ends on a Saturday,
Sunday, or legal holiday, the hearing must be held on the next
day that is not a Saturday, Sunday, or legal holiday. The judge
or magistrate may postpone the hearing each day for an
additional 24 hours if the judge or magistrate declares that an
extreme emergency exists because of extremely hazardous weather
conditions or the occurrence of a disaster that threatens the
safety of the proposed patient or another essential party to the
hearing.
(c) The hearing shall be held before a magistrate or, at
the discretion of the presiding judge, before an associate judge
appointed by the presiding judge. Notwithstanding any other law
or requirement, an associate judge appointed to conduct a
hearing under this section may practice law in the court the
associate judge serves. The associate judge is entitled to
reasonable compensation.
(d) The proposed patient and the proposed patient's
attorney shall have an opportunity at the hearing to appear and
present evidence to challenge the allegation that the proposed
patient presents a substantial risk of serious harm to himself
or others.
(e) The magistrate or associate judge may consider
evidence, including letters, affidavits, and other material,
that may not be admissible or sufficient in a subsequent
commitment hearing.
(f) The state may prove its case on the physician's
certificate of medical examination filed in support of the
initial motion.
Added by Acts 1991, 72nd Leg., ch. 76, Sec. 1, eff. Sept. 1,
1991. Amended by Acts 1995, 74th Leg., ch. 101, Sec. 1, eff.
May 16, 1995.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 334 (H.B. 890), Sec. 4,
eff. September 1, 2009.
Sec. 574.026. ORDER FOR CONTINUED DETENTION. (a) The
magistrate or associate judge shall order that a proposed
patient remain in protective custody if the magistrate or
associate judge determines after the hearing that an adequate
factual basis exists for probable cause to believe that the
proposed patient presents a substantial risk of serious harm to
himself or others to the extent that he cannot remain at liberty
pending the hearing on court-ordered mental health services.
(b) The magistrate or associate judge shall arrange for
the proposed patient to be returned to the mental health
facility or other suitable place, along with copies of the
certificate of medical examination, any affidavits or other
material submitted as evidence in the hearing, and the
notification prepared as prescribed by Subsection (d).
(c) A copy of the notification of probable cause hearing
and the supporting evidence shall be filed with the court that
entered the original order of protective custody.
(d) The notification of probable cause hearing shall read
as follows:
(Style of Case)
NOTIFICATION OF PROBABLE CAUSE HEARING
On this the __________ day of __________, 19___, the
undersigned hearing officer heard evidence concerning the need
for protective custody of __________ (hereinafter referred to as
proposed patient). The proposed patient was given the
opportunity to challenge the allegations that (s)he presents a
substantial risk of serious harm to self or others.
The proposed patient and his attorney _____________ have
been
(attorney)
given written notice that the proposed patient was placed under
an order of protective custody and the reasons for such order on
___________________.
(date of notice)
I have examined the certificate of medical examination for
mental illness and _________________________________________.
Based on
(other evidence considered)
this evidence, I find that there is probable cause to believe
that the proposed patient presents a substantial risk of serious
harm to himself (yes ___ or no ___) or others (yes ___ or no
___) such that (s)he cannot be at liberty pending
final hearing because
________________________________________________________________
_______________________________________________________________.
(reasons for finding; type of risk found)
Added by Acts 1991, 72nd Leg., ch. 76, Sec. 1, eff. Sept. 1,
1991.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 334 (H.B. 890), Sec. 5,
eff. September 1, 2009.
Sec. 574.027. DETENTION IN PROTECTIVE CUSTODY. (a) A
person under a protective custody order shall be detained in a
mental health facility deemed suitable by the local mental
health authority for the area. On request of the local mental
health authority, the judge may order that the proposed patient
be detained in an inpatient mental health facility operated by
the department.
(b) The facility administrator or the administrator's
designee shall detain a person under a protective custody order
in the facility until a final order for court-ordered mental
health services is entered or the person is released or
discharged under Section 574.028.
(c) A person under a protective custody order may not be
detained in a nonmedical facility used to detain persons who are
charged with or convicted of a crime except because of and
during an extreme emergency and in no case for longer than 72
hours, excluding Saturdays, Sundays, legal holidays, and the
period prescribed by Section 574.025(b) for an extreme
emergency. The person must be isolated from any person who is
charged with or convicted of a crime.
(d) The county health authority shall ensure that proper
care and medical attention are made available to a person who is
detained in a nonmedical facility under Subsection (c).
(e) Repealed by Acts 2001, 77th Leg., ch. 367, Sec. 19,
eff. Sept. 1, 2001.
Added by Acts 1991, 72nd Leg., ch. 76, Sec. 1, eff. Sept. 1,
1991. Amended by Acts 2001, 77th Leg., ch. 367, Sec. 10, 19,
eff. Sept. 1, 2001.
Sec. 574.028. RELEASE FROM DETENTION. (a) The magistrate
or associate judge shall order the release of a person under a
protective custody order if the magistrate or associate judge
determines after the hearing under Section 574.025 that no
probable cause exists to believe that the proposed patient
presents a substantial risk of serious harm to himself or
others.
(b) Arrangements shall be made to return a person released
under Subsection (a) to:
(1) the location of the person's apprehension;
(2) the person's residence in this state; or
(3) another suitable location.
(c) A facility administrator shall discharge a person held
under a protective custody order if:
(1) the facility administrator does not receive
notice that the person's continued detention is authorized after
a probable cause hearing held within 72 hours after the
detention began, excluding Saturdays, Sundays, legal holidays,
and the period prescribed by Section 574.025(b) for extreme
emergencies;
(2) a final order for court-ordered mental health
services has not been entered within the time prescribed by
Section 574.005; or
(3) the facility administrator or the administrator's
designee determines that the person no longer meets the criteria
for protective custody prescribed by Section 574.022.
Added by Acts 1991, 72nd Leg., ch. 76, Sec. 1, eff. Sept. 1,
1991.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 334 (H.B. 890), Sec. 6,
eff. September 1, 2009.
SUBCHAPTER C. PROCEEDINGS FOR COURT-ORDERED MENTAL HEALTH
SERVICES
Sec. 574.031. GENERAL PROVISIONS RELATING TO HEARING. (a)
Except as provided by Subsection (b), the judge may hold a
hearing on an application for court-ordered mental health
services at any suitable location in the county. The hearing
should be held in a physical setting that is not likely to have
a harmful effect on the proposed patient.
(b) On the request of the proposed patient or the proposed
patient's attorney the hearing on the application shall be held
in the county courthouse.
(c) The proposed patient is entitled to be present at the
hearing. The proposed patient or the proposed patient's
attorney may waive this right.
(d) The hearing must be open to the public unless the
proposed patient or the proposed patient's attorney requests
that the hearing be closed and the judge determines that there
is good cause to close the hearing.
(e) The Texas Rules of Evidence apply to the hearing
unless the rules are inconsistent with this subtitle.
(f) The court may consider the testimony of a nonphysician
mental health professional in addition to medical or psychiatric
testimony.
(g) The hearing is on the record, and the state must prove
each element of the applicable criteria by clear and convincing
evidence.
(h) A judge who holds a hearing under this section in
hospitals or locations other than the county courthouse is
entitled to be reimbursed for the judge's reasonable and
necessary expenses related to holding a hearing at that
location. The judge shall furnish the presiding judge of the
statutory probate courts or the presiding judge of the
administrative region, as appropriate, an accounting of the
expenses for certification. The presiding judge shall provide a
certification of expenses approved to the county judge
responsible for payment of costs under Section 571.018.
(i) A judge who holds hearings at locations other than the
county courthouse also may receive a reasonable salary
supplement in an amount set by the commissioners court.
(j) Notwithstanding other law, a judge who holds a hearing
under this section may assess for the judge's services a fee in
an amount not to exceed $50 as a court cost against the county
responsible for the payment of the costs of the hearing under
Section 571.018.
(k) Notwithstanding other law, a judge who holds a hearing
under this section may assess for the services of a prosecuting
attorney a fee in an amount not to exceed $50 as a court cost
against the county responsible for the payment of the costs of
the hearing under Section 571.018. For a mental health
proceeding, the fee assessed under this subsection includes
costs incurred for the preparation of documents related to the
proceeding. The court may award as court costs fees for other
costs of a mental health proceeding against the county
responsible for the payment of the costs of the hearing under
Section 571.018.
Added by Acts 1991, 72nd Leg., ch. 76, Sec. 1, eff. Sept. 1,
1991. Amended by Acts 1997, 75th Leg., ch. 1354, Sec. 1, eff.
Sept. 1, 1997; Acts 2001, 77th Leg., ch. 1252, Sec. 1, eff.
Sept. 1, 2001; Acts 2001, 77th Leg., ch. 1420, Sec. 10.006,
eff. Sept. 1, 2001.
Sec. 574.032. RIGHT TO JURY. (a) A hearing for temporary
mental health services must be before the court unless the
proposed patient or the proposed patient's attorney requests a
jury.
(b) A hearing for extended mental health services must be
before a jury unless the proposed patient or the proposed
patient's attorney waives the right to a jury.
(c) A waiver of the right to a jury must be in writing,
under oath, and signed and sworn to by the proposed patient and
the proposed patient's attorney unless the proposed patient or
the attorney orally waives the right to a jury in the court's
presence.
(d) The court may permit an oral or written waiver of the
right to a jury to be withdrawn for good cause shown. The
withdrawal must be made not later than the eighth day before the
date on which the hearing is scheduled.
(e) A court may not require a jury fee.
(f) In a hearing before a jury, the jury shall determine
if the proposed patient is mentally ill and meets the criteria
for court-ordered mental health services. The jury may not make
a finding about the type of services to be provided to the
proposed patient.
Added by Acts 1991, 72nd Leg., ch. 76, Sec. 1, eff. Sept. 1,
1991.
Sec. 574.033. RELEASE AFTER HEARING. (a) The court shall
enter an order denying an application for court-ordered
temporary or extended mental health services if after a hearing
the court or jury fails to find, from clear and convincing
evidence, that the proposed patient is mentally ill and meets
the applicable criteria for court-ordered mental health
services.
(b) If the court denies the application, the court shall
order the immediate release of a proposed patient who is not at
liberty.
Added by Acts 1991, 72nd Leg., ch. 76, Sec. 1, eff. Sept. 1,
1991.