Sep 21, 2020
INTERCEPT 0COMMUNITY SERVICES
Intercept 0: Community Services
• Helpline
• Lutheran Social Services
• Southeastern Behavioral Health
• Carroll Institute
• Falls Community Health
• Avera and Sanford ERs
Helpline Calls
National Suicide Prevention Lifeline: 1,538 calls
2016 Identified Needs for Mental Health & Addictions (Summary)
Triage Services 756
Substance Abuse 1,128
Mental Health 537
Other (counseling, support groups, etc.) 1,666
Suicide Prevention 2,056
Talklines/Warmlines 3,005
Grand Total 9,148
Lutheran Social Services (Counseling)
Total clients served: 667
21 2853
13 17 24 40
451434
0
50
100
150
200
250
300
350
400
450
500
Clients by Service
Southeastern Behavioral Health
Total clients served annually: about 5,000
Top referral sources:
– Department of Social Services
– Schools
– Family / self / friends
– Hospital / medical facilities
– Court / criminal justice
– Human Services Center
Carroll Institute
Clients served annually: 2,000
Carroll Institute: The Arch
3%
0%
83%
4%
5%
0% 0%
5%
0%
Referral Sources, FY2017
Alcohol/Drug Provider
Community Hospital
Court/Criminal Justice
Department of Social Services
Family/Self/Friend
Human Services Center
Indian Health Services
Other
Other Social Services
Carroll Institute: The Arch
41.72%
27.51% 26.34%
0.47% 0.47% 1.63%0.23% 0.00% 0.70% 0.47% 0.23% 0.23%
31.76%
7.62%
26.32%
5.08%
10.89%9.26%
0.00%
4.36%1.27% 2.54%
0.54% 0.36%0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
Discharges, FY16 and FY17
FY16 FY17
New Horizons
2015 2016
Total Admissions 145 63
Average Length of Stay 11.3 9.8
Average Daily Census 6.9 2.4
New Horizons
2015 2016
To Inpatient 51 13
To Slip Slot 27 16
To Outpatient 45 16
IVC Dropped 6 1
Terminated 20 20
Total Discharges 149 66
Falls Community Health
1,998
231
871
543446
86
292 231
0
500
1,000
1,500
2,000
2,500
Behavioral health Chemical dependence Substance abuse:Alcohol
Substance abuse:Drugs
Encounters and Patients
Encounters Patients
Medical encounters 27,096
Medical patients 8,852
Hospital ERs
6364 6081
25422024
5560
1000
2000
3000
4000
5000
6000
7000
Encounters(total)
Mental health Substance abuse Substance abuse:Alcohol
Substance abuse:Drugs
ER Encounters (2016)
Total
Arrival to ER
3929
2341
73 240
500
1000
1500
2000
2500
3000
3500
4000
4500
Walk In EMS Law enforcement Unlisted/Other
Means of Arrival (2016)
Total
Length of ER Stay
Average stay: 190 minutes (3.2 hours)
Total ER time: 1,197,973 minutes
832 days
2.28 beds per day
Disposition after ER
4722
593 556218 199 161 1120
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Disposition (2016)
Total
Intercept 0: SummaryOrganization Behavioral Health Clients Served (2016)
Helpline > 9,000 calls statewide
Falls Community Health 500 to 1,000 behavioral health patients
Lutheran Social Services 667 counseling clients
Carroll Institute 2,000 clients
Southeastern Behavioral Health 5,000 clients
Hospital ERs 6,589 behavioral health encounters
Adults with SMI (est. 5% MSA) 9,156
Adults with SUD (est. 15% MSA) 27,468
INTERCEPT 1LAW ENFORCEMENT
Intercept 1: Law Enforcement
• Calls for Service
• Mobile Crisis Team
• Arrests and Charges
• Detox and Sobering Center
Calls for Service
Total calls in 2016: 127,547
Incident Type Calls % of All Calls
Disorderly Subjects 12,462 9.77
Accident 8,988 7.05
Larceny 4,594 3.60
Family Dispute 4,416 3.46
24/7 Violation 4,048 3.17
Check Wellbeing 3,946 3.09
Narcotics Violation 3,738 2.93
Intoxicated Subject 2,769 2.17
Prisoner Transport 2,611 2.05
Vandalism 2,537 1.99
Abandoned Vehicles 2,466 1.93
Assault 2,419 1.90
Calls for Service
Most calls are resolved on scene.
127,547
79,114
15,145 9,734
1,326 98 -
20,000
40,000
60,000
80,000
100,000
120,000
140,000
Total calls NecessaryAction Taken
Arrest / Lodgedat Jail
Citation Lodged at Detox Lodged atMcKennan
Selected Call Outcomes, 2016
Mobile Crisis Team
In 2016, MCT’s diversion rate was 94.7%.
Calls Received 572
Calls Declined 85
Calls Taken 487
Remained Home 417 85.6%
Voluntary Admission to
Avera Behavioral Health 30 6.2%
Detox / Other Placement 14 2.9%
Involuntary Hold 26 5.3%
Which calls result in arrest?
Incident Type
Calls
Resulting
in Arrest
% of Incident
Type Resulting
in Arrest
% of All Calls
Resulting in
Arrest
24/7 Violation 2,272 56.13% 15.00%
Narcotics Violation 2,014 53.88% 13.30%
Disorderly Subjects 1,545 12.40% 10.20%
Warrant Service 1,352 59.09% 8.93%
Assault 922 38.11% 6.09%
Shoplifting 848 44.40% 5.60%
DWI 842 61.59% 5.56%
Runaway 517 31.51% 3.41%
Family Dispute 472 10.69% 3.12%
Non Hazardous Moving Violations 371 36.92% 2.45%
Traffic 337 47.13% 2.23%
Intoxicated Subject 293 10.58% 1.93%
Which calls result in arrest?
12,462
8,988
4,594 4,4164,048 3,946 3,738
2,769 2,611 2,537
1,545
260 116472
2,272
62
2,014
29328 69
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
DisorderlySubjects
Accident Larceny FamilyDispute
24/7Violation
CheckWellbeing
NarcoticsViolation
IntoxicatedSubject
PrisonerTransport
Vandalism
Calls and Arrests by Call Type, 2016
Calls Arrests
Arrests and Charges
Total arrests in 2016: 11,993
2314
986
474859
160341
608
886
799 108
492 77
0
500
1000
1500
2000
2500
3000
3500
Drug/Narcotic DisorderlyConduct
DUI Shoplifting Liquor LawViolations
Trespassing
SFPD and Sheriff's Office Arrests, 2016(Selected Charges)
Alone Plus Other Charges
Detox
Clients: 241 (165 IVCs)
Bed days: 1,552
Average daily census: 4.25
Sobering Center
Total bookings: 2,621
Bookings per day: 7.18
Average length of stay: 9.7 hours
Intercept 1: SummaryOrganization Instances (2016)
Calls for service 127,547 calls
Necessary action taken 79,114 calls
Arrests 15,145 calls
MCT calls 572 calls
Detox 241 clients
Sobering Center 2,621 bookings
INTERCEPTS 2 AND 3INITIAL DETENTION AND JAIL
Intercepts 2 and 3: Jail
• Bookings
• Mental health and substance abuse
Bookings
24%
76%
All Bookings (2016)
MH or SUD
Neither MH nor SUD
Bookings
Bookings % of all bookings
MH or SUD 4,201 24.1%
SUD alone 1,942 11.1%
MH alone 1,465 8.4%
Co-occurring 794 4.5%
Neither MH nor SUD 13,256 75.9%
All bookings 17,454
Bookings
10,308
1,039 1,428478
3,139
240468
3540
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
Unsentenced (MinnehahaCounty)
Sentenced (MinnehahaCounty)
Contract / Other County All others
Bookings by Legal Status
Neither MH nor SUD MH or SUD
Bookings
10,455
2,798
1,556 419
2,811
1,390
560
2740
2,000
4,000
6,000
8,000
10,000
12,000
14,000
Misdemeanor Felony Violent Probation violation
Selected Characteristics
Neither MH nor SUD MH or SUD
Length of Stay
331
353
247
434
180
216
0
50
100
150
200
250
300
350
400
450
500
MH or SUD SUD MH Co-occurring Neither MH norSUD
All bookings
Average Length of Stay (hours)
Length of Stay
119
757
177
263279
1,147
264
342
0
200
400
600
800
1000
1200
1400
Unsentenced (MinnehahaCounty)
Sentenced (MinnehahaCounty)
Contract / Other County All others
Average Length of Stay by Legal Status
Neither MH nor SUD MH or SUD
Length of Stay and Self-Reported MH/SUD
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
< 12 hours 12 to 24 hours 24 to 48 hours > 48 hours
Positive Report by Length of Stay
SUD MH COOC None
Intercepts 2 and 3: Jail
• Next steps:
– Improve data quality with universal mental health screening at intake
– Data matching to identify at booking people known to community-based behavioral health providers
– Criminogenic risk assessment tool
SUPER UTILIZERS
Super Utilizers
62.1%
17.9%
8.2%
4.2%2.6% 1.4% 1.1% 0.7% 0.5% 0.2% 0.2% 1.1%
29.4%
16.9%
11.6%
7.9%6.0%
4.0% 3.5% 2.5% 2.2% 1.1% 1.0%
14.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
1 2 3 4 5 6 7 8 9 10 11 12+
Number of Bookings in 2016
Super Utilizers (All Bookings)
People (%) Bookings (%)
n=9,533 n=20,169
Top 5%490 people
28.3% of bookings
Top 1%102 people
14.0% of bookings
Super Utilizers
66.9%
12.7%
5.5%1.7% 2.6% 1.3% 0.6% 0.9% 1.2% 0.3% 0.4% 0.3% 0.1% 0.3% 0.4%
5.1%
19.3%
7.3%4.8%
1.9%3.7% 2.2% 1.3% 2.1% 3.0%
0.7% 1.2% 0.9% 0.5% 1.0% 1.7%
48.4%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Number of Bookings in 2016
Super Utilizers (Detox and Sobering Center)
People (%) Bookings (%)
Top 5%20 people
48.4% of bookings
n=782 n=2,708
Super Utilizers
62.6%
17.9%
8.3%
4.2%2.5% 1.4% 1.0% 0.7% 1.3%
33.0%
18.8%
13.1%
8.9%6.7%
4.5% 3.6% 2.8%
8.0%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
1 2 3 4 5 6 7 8 9+
Number of Bookings in 2016
Super Utilizers (Jail Bookings)
People (%) Bookings (%)
n=9,203 n=17,461
Top 5%638 people
25.6% of bookings
Top 1%123 people
8.0% of bookings
Super Utilizers
18.32%
34.95%
46.93%
54.87%
69.91%
6.52%
13.80%
21.70%19.49%
29.31%
8.88%13.01% 12.16%
15.38%10.66%
2.91%
8.15%
13.07%
20.00%
29.94%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
1 2 3 4 5+
Number of Bookings in 2016
Self-reported SUD and MH Disorders by Number of Bookings
SUD or MH SUD alone MH alone Co-occurring
Super Utilizers
Compared to those who don’t report problems, people who self-report behavioral health problems are:
• 2.14 times as likely to have multiple bookings
• 5.74 times as likely to have 5+ bookingsMultiple (2+)
bookings RR
RR 95% conf.
interval
SUD or MH 2.14 2.03 to 2.25
SUD 1.87 1.77 to 1.97
MH 1.26 1.17 to 1.36
COOC 2.18 2.07 to 2.30
5+ bookings
RR
RR 95% conf. interval
SUD or MH 5.74 4.88 to 6.76
SUD 3.28 2.80 to 3.84
MH 1.04 0.82 to 1.33
COOC 5.43 4.68 to 6.31
n=9,203
Takeaway
• Behavioral health problems contribute to cycling through the criminal justice system.
COSTS AND CAPACITY
Super Utilizers: Jail
Top 1% and self-reported behavioral health problems
• 106 people with 5+ bookings in 2016
• 71 total days in jail per person, on average
• 7,510 bed days annually
• 21 beds per day
• $713,427 annually
Super Utilizers: Jail
Top 5% and self-reported behavioral health problems
• 446 people with 5+ bookings in 2016
• 62 total days in jail per person, on average
• 27,710 bed days annually
• 76 beds per day
• $2,632,518 annually
Cost of Care: Avera and Sanford ERs
• Total charges: $40,037,269
• Average charges per encounter: $6,076
Insurance: Avera and Sanford ERs
4348
2020
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Insured Uninsured
Insurance Rate for ER Encounters, 2016
Total
Insurance: Falls Community Health
4,2994,839
0
1,000
2,000
3,000
4,000
5,000
6,000
Insured Uninsured
Payer
Estimated Cost Summary
Organization Behavioral Health Cost Estimate (2016)
Jail (super users) $700,000 to $2.6 million
Hospital ER (total) $40 million
Uninsured (est.) $9.7 million
Medicaid (est.) $6.1 million
Estimated Potential Demand
Source
Annual
Admissions
Daily
Admissions
Length of
Stay (hours)
Daily Beds
Occupied
Detox 241 0.66 155 4.3
Sobering Center 2,621 7.2 9.7 3
Pre-arrest triage 2,656 7.3 279 84.6
Redirected from hospital 636 1.7 3 0.2
Total 6,154 16.86 92.1
Observed length of stay
Estimated Potential Demand
Source
Annual
Admissions
Daily
Admissions
Length of
Stay (hours)
Daily Beds
Occupied
Detox 241 0.66 72 2
Sobering Center 2,621 7.2 9.7 3
Pre-arrest triage 2,656 7.3 72 21.8
Redirected from hospital 636 1.7 3 0.2
Total 6,154 16.86 27
72 hour maximum
Estimated Potential Demand
Source
Annual
Admissions
Daily
Admissions
Length of
Stay (hours)
Daily Beds
Occupied
Detox 241 0.66 155 4.3
Sobering Center 2,621 7.2 9.7 3
Pre-arrest triage 266 0.73 12 0.37
Redirected from hospital 636 1.7 3 0.2
Total 3,764 10.29 7.87
Conservative Pilot
DEMOGRAPHICS
Gender
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Arrests(SFPD &
SO)
CarrollInstitute
MCT Falls CH LSS Avera ER Sanford ER
Male Female Unknown/Other
Race
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Arrests Carroll MCT Falls CH LSS Population
White Native American Black Asian Multiracial Hispanic Other Unknown
Language
Falls Community Health clients best served in another language:
23%
Arrests by Age
0
100
200
300
400
500
600
700
0 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75 80
Arrests by Age, 2016 (SFPD & SO)
30 years
40 years
POLICY QUESTIONS
Policy Questions
• Goal
– Shift burden from CJ / ED, or
– Engage underserved groups?
• Target population
– Super utilizers, or
– Unreached, new clients?
• Point of intervention
• Services