In a nutshell
Bluebonnet Trails Community Services is a group of mental health professionals that aid the county in a variety of capacities, including behavioral health crisis, substance use and intellectual development disability services.
The organization presented an update to county commissioners highlighting how the partnership has been able to save the county money through more efficient and effective response to behavioral health issues in the area.
The largest area of saving comes from a public and private partnership between the county mental health authorities and private psychiatric hospitals. BTCS has negotiated for over $3 million in state funding for this program, with the county funding $750,000 for fiscal year 2023-24.
What they’re saying
Precinct 4 County Commissioner Russ Boles compared the mental health issues experienced throughout the county to the many complaints his office received for potholes.
“We've all hit a pothole. ... We all know how to react. ‘First of all is my car okay? Is the alignment okay?’” Boles said. “But if you have not been in the throes of a mental health crisis, it's not something that you can control. ... God forbid, but when you hit your mental health pothole, know that there have been professionals—including [Precinct 3 County] Commissioner [Valerie] Covey—that have thought it out thoroughly. And that's comforting to me.”
The breakdown
A variety of BTCS teams and programs have helped save the county money.
1. BTCS staff aiding in 911 response
Supported by federal grant funding, BTCS staffs five mental health professionals to aid the county’s 911 dispatchers receiving calls pertaining to mental illness or distress. BTCS staff members are also able to provide crisis intervention, de-escalation and treatment coordination. Estimated cost savings per deployment are:
- Emergency medical services savings: $613
- Law enforcement savings: $114
- Fire department savings: $640
2. Mobile Crisis Outreach Team
One of the most used services, according to BTCS Executive Director Andrea Richardson, is the Mobile Crisis Outreach Team, which helps render intermediate support for those experiencing a mental health crisis. The team often utilizes their mobile space to provide assessments, determining the appropriate level of care needed.
This service is mostly funded by Texas Health and Human Services, with the remaining costs being covered by the BTCS reserve fund. Estimated cost savings include:
- Local emergency room bed day usage: $1,917
3. Youth Therapeutic Respite Program
The youth respite program aims to reduce youth interaction with the juvenile correctional system with a 16-bed, short-term residential facility that provides wraparound services for children and adolescents ages 5 to 17. These services include therapy, care coordination, family services, psychiatric evaluation, medication management and case management.
The program is funded by both CARES Act and American Rescue Plan Act funding as well as by the Texas Department of Family and Protective Services. Estimated cost savings per day are:
- Residential treatment center beds diverted: $618
- Private psychiatric hospital beds diverted: $625
- Juvenile Justice Center beds diverted: $204 (preadjudication) $309 (post-adjudication)
4. Crisis respite unit
The crisis respite unit provides short-term residential care for adults throughout personal recovery and mental wellness. The program has 16 beds for those individuals at risk of mental crisis.
Funding for this program comes from Texas Health and Human Services, Medicaid and BTCS reserve funds. Estimated cost savings per day are:
- Private psychiatric hospital bed diverted: $625
- WilCo jail bed diverted: $396
- State hospital bed diverted: $791
5. Diversion center
A partnership involving BTCS, Williamson County, Williamson County Sheriff’s Office and Crisis Intervention Team, the diversion center provides a drop-off center for law enforcement who have responded to an individual dealing with a mental crisis.
The center provides a safe space for mental health professionals to determine the appropriate level of care, as well as a safe transfer and transportation to the next step in care.
Operations are funded by federal and state programs, as well as, the BTCS reserve fund. Renovations for the building were funded by CARES Act dollars, totaling nearly $4 million. Estimated cost savings are:
- Jail bed days diverted: $396 for a person with severe mental illness
- Average cost to incarcerate pretrial defendants with misdemeanor charges: $4,425
- Average cost to incarcerate pretrial defendants with state jail charges: $7,021
- Average cost to incarcerate pretrial defendants with felony charges: $19,293
- State hospital beds diverted per day: $791
- Local emergency room usage per day: $1,917
The diversion center has been utilized by law enforcement for 280 individuals since September. There is at least one person a day referred to the diversion center, according to the presentation to county commissioners.
6. Private psychiatric beds for hospitalization
As of November, BTCS pays for 23 beds per day in response to limited access for intensive levels of care.
Funding for this program comes from both Williamson County and Texas Health and Human Services. Close to $700,000 has been spent for the hospitalization of those individuals without insurance experiencing a behavioral health crisis since September. Estimated cost savings per day are:
- State hospital beds diverted: $791
- Local emergency room usage: $1,917
7. Jail-based competency restoration
This program helps individuals charged with a crime that may not be fit for trial to receive inpatient or outpatient treatment in order to restore competency, thus allowing for the justice system to continue in a timely manner.
It was noted that before this pilot program was implemented, some individuals being held in the Williamson County Jail may have been waiting years before reaching a court. Now, led by a BTCS forensic practitioner, the individuals helped were restored to competency within an average of 45 days. Estimated cost savings are:
- $736,198 from a combination of reduced days incarcerated, reduced travel costs to and from state hospitals, and reduced cost in forensic competency re-evaluations
8. Residential withdrawal management
Traditionally known as the detox program, the withdrawal management program provides a safe environment for individuals to begin recovery.
Implemented in September, the program has provided services to 15 individuals for an average stay of seven days. Estimated cost savings per day include:
- Private psychiatric hospital bed diverted: $625
- Local emergency room bed diverted: $1,917
The Williamson County Jail system currently staffs a jail-based care coordinator as well as a court-based care coordinator. These positions ultimately reduce time between booking and court hearings, increase appropriate jail diversions and reduce a return to the justice system, according to BTCS.
The staff positions are currently funded by the BTCS reserve fund.
