Tag: mental health

Bonus! 3 pm workshops, 3/4/25

by The San Marxist, posted in 3 pm Workshops

There are two workshops: one very short and one very long.

  1. Evoke Wellness.

Back in December, Council had a lot of questions for these guys.  They offer mental health and addiction treatment for people referred over by the police.  We’ve allocated 150K of Covid money for this. This is a follow up discussion with the director at Evoke.

Amanda: What’s it look like if you’re receiving services?

The director gives an extremely detailed answer!

  • Prescreen for eligibility. Detox? Residential? Intensive Outpatient?
  • Say we’re starting with detox. Then there’s an evaluation and intake process.
  • Then you’re seen by nursing staff to get orders from the medical director on the detox protocol, medication regimen
  • Detox lasts 5-7 days. Completely voluntary. You’re free to leave at any point.
  • Residential: 21-28 days. Could be detox and then residential.
  • In the residential part: first there’s a biopsych-social assessment: trauma history, drug use history, family relationships, everything. You need a full picture to treat the whole person.
  • Clinical team and medical team working together to monitor the patient 24/7.
  • During the day: like school, 6 hours a day. Learn about substance abuse and mental health conditions, tools, coping skills to hopefully achieve longterm sobriety.
  • Breakfast, meds, 9:30-5:30 programming, community involvement with 12-step panels holding meetings with clients.
  • You also get a therapist and case manager. The case manager will help with the discharge process.
  • Therapist meets weekly and as needed.
  • 6 hours/day of group therapy.
  • Longer lengths of stay produce better outcomes. Typically 28-35 days.
  • Discharge plans: typically clients take the clinical recommendation for a sit down placement in a PHP (partial hospital hospitalization) – lower level of care, higher level of freedom, and so own down the levels of care.

Amanda: How often is the intake the first time the person’s ever run through their trauma?
Answer: Depends if they’ve ever had treatment before. Could be first time, could have relapsed.

Amanda: Typical client to staff ratio?
Answer: 8:1 ratio, plus nursing staff and on-call medical director and leadership team.

Amanda: On the discharge plan: If you don’t want to go through everything, can you still get a discharge plan?
Answer: Yes. And if they won’t accept the discharge plan, our case managers will help connect them with resources that work for them.

Amanda: What about people that are indigent? How does medication work upon discharge?
Answer: For all clients, detox meds are covered for free, for 5-7 days. They are responsible for their medications, but if they have no resources, we will keep providing it. The discharge coordinator will work with them to find the community resources to stay on their medications.

Alyssa: Last year, I asked for info about Evoke. They were in the process of getting a mental health license – did that happen?
Answer: We are licensed for co-occuring disorders. There must be substance disorder with a mental health disorder. Actually pretty rare to have a substance issue without a mental health issue, so this is pretty much all our patients. We do not currently serve clients that only have a mental health issue and no substance abuse.

Alyssa: This helps San Marcos?
Chief Standridge: The goal is jail diversion. We’re using funds from both San Marcos and Hays money. If they have insurance, we use that first. If they’re indigent, we try to use our funds. But only if they’re residents of San Marcos.

Everyone is really pleased by the high quality of the answers given by the director.

Alyssa: I’m very hopeful? There’s a lot of structural root causes and obstacles that have to be overcome, and we have to think about those when it’s time to budget. And the public defenders office has been really helpful in locating resources. But I am anxious about the rise in need for support services. We’re setting people up for failure if we don’t supply resources.

Shane: I’m tickled to death! How it all came together, as a team.

(This is Covid money, so we’ll have to figure out how to fund it going forward.)

…

Workshop 2:  SMPD. This is a 2 hour presentation!

This is SMPD’s opportunity to put their best foot forward.  This is a description of all the trainings and guard rails in place at SMPD.  Everything is couched in really positive terms – “Do we make mistakes? Sure! But we then unpack it and learn from it.”  

This isn’t bad! It’s totally fine. It’s what any other department would do. However, a police department requires an extra level of skepticism, because of the sordid history leading up to this moment in time.  

Usually I’d use Council questions to look for cracks in the presentation. But they ran out of time, because the council meeting starts at 6 pm.

So this is a very glowing presentation, without any opportunity to give a counter-narrative. Anyway, I’m just the messenger. Don’t shoot me.

…

Chief Standridge came here four years ago. We’re kind of summarizing the internal protocols that he’s implemented over this time.

There are five different speakers.

Speaker #1: Internal changes

“ABLE” stands for Active Bystander for Law Enforcement. This is basically like “Friends Don’t Let Friends Drive Drunk.” How do you create an environment where cops will tattle on each other?

The goal is for the consequences of not intervening to be bigger than the consequences of intervening. They do some training around interventions as well.

Here’s how many internal cases they’ve dealt with:

I mean, it’s absolutely impossible to interpret this. Is this a lot, or a little? How often are incidents going unreported? Would I agree with the outcomes if I knew all the details of the incidents?

There’s no way that PD could answer these questions! But it also means that we can’t really makes sense of this data.

It’s like if five people go to the doctor for measles, and the doctor treats three of them, and diagnoses one with allergies and one with mumps.

  • That doesn’t tell you much about the number of measles cases in the rest of the town
  • It also doesn’t tell you if the doctor is making correct diagnoses

Both those things would be much harder to figure out.

Here are the investigations that were found to be substantiated:

In 2021, we had one IA investigator. Now we have four. So that definitely helps have more eyes looking out for bad behavior.

…

The Event Review Board

The Event Review Board reviews every incident, use of force, pursuit, and preventable accident. They try to see what the department could change to reduce these events.

It’s a broad group of people and they’re supposed to look at any potential event, no matter how minor.

Some data:

Again, I just don’t have enough context to make sense of these numbers.

The speaker might have said given good context! But this was a three hour presentation, and if she did, I didn’t jot it down in my notes.

Also:

None of these were available last April, when Malachi Williams was killed. Alyssa brings this up.

Amanda asks about the costs of these?

Taser 10: $343K for 123 officers, or about $2789 per officer, per year. (Includes the Taser 10, body cameras, unlimited video storage, training, and software licensing.)
BolaWrap: $1,299.99 each, and $38.99 each for cartridgets
40 mm foam bullet launcher thing: $1,273.50 each

I don’t know if each officer gets each thing, but that would come to $5362 per officer. With 123 officers, it’s about $660K.

Look, I want the officers to use less lethal force. I’m just pointing out that SMPD spends bigger sums of money, and they do it much more quickly and easily than any other department.

…

This next thing is actually really great.

Suppose you stop someone and they don’t speak English. You open up this Voyce app, and there’s a live translator. You pay by the minute.

Notice they can provide sign language as well. (But it only works if officers remember that people can be deaf. This would not have helped John Kelley, the deaf man that was tased in 2019 for not responding when SMPD told him to stop.)

The speaker says that there was one time that they needed a Mandarin translater at 3 am. This is pretty invaluable for that. (It was originally designed for the medical community. Seems invaluable there, too.)

This app doesn’t help you figure out what language the other person is speaking though. You have to use google or something.

That was all the first speaker!

…

Next speaker: Accreditation

So I guess not all the PDs are accredited, but now we are?

We’re not there yet, but we’re working towards it.

Basically you have to come up with policies that satisfy the agency in these areas:

You have to show compliance with 173 best practices.

(This meeting was the day when it was super windy and there was all the spooky smoke and dust hanging over the city. Everyone’s alarms kept going off for the evacuations up in Kyle.)

Anyway, it sounds like it’s a ton of work:

And then you have to stay accredited:

…

Onto the next speaker!

This one is super interesting – it’s on our 911 call center.

Basically, there’s a nationwide shortage of 911 dispatchers. We used to have 9 vacancies. We filled over half of them, and we’ve got a current batch of highers to fill the rest.

What happened is that we started paying a reasonable salary, and got a reputation as a good place to work. So we’re in a much healthier spot now.

911 callers also have language barriers. Instead of the VOYCE app, they use something called CyraCom:

Alyssa points out that this happened in the original 911 call involving Malachi Williams. The caller only spoke Spanish. While they were connecting with CyraCom, there was just this awful dead silence, where the caller had no idea whether or not they were going to get any help.

Alyssa suggests having a few pre-scripted lines like, “One moment while we connect with a translator” or something. This is a great idea.

We’re also trying a new program:

This is a program where they transfer mental health calls out to trained mental health providers, who will connect the person with local resources, or stay on the line and talk the person through whatever’s going on.

They can also transfer the call back to 911, if they think we need to send out an emergency response, after all. The responder then goes right out, because the call is already in the system.

They’ve been doing it since November. It turns out that most of the calls do come back to us, after all? And we end up sending someone out. It’s a work in progress!

…

Next speaker! The SMPD Mental Health Unit.

I don’t know what the training to be a Mental Health Officer really means. Is it a course? Is it multiple courses? Is it like a Master’s degree? Are you supervised by a mental health professional?

(I’m sure I could look it up, but I’m just trying to first get this whole entry out on time.)

It sounds like they do good things: they sit with people who are scared and nervous before testifying or going to court. They get food boxes from Hays County Food Bank if someone needs it. They’re generally problem-solving and checking in on people’s well-being. They will sometimes stay with someone for months, making regular follow ups to help manage someone’s care.

Here, have some data:

An “emergency detainment” is if someone is an immediate danger to themselves of others. They try to avoid doing that, though. It may mean taking them to an ER or a substance abuse facility. (But not jail.)

…

Next speaker! What comes next with Mental Health Officers?

Here’s what the state is doing:

It used to be that officers had two options:

  • Take someone to an emergency room
  • Take someone to jail and go through courts.

Now we’ve got more options. The state created a big Mental Health Officer framework in 2015.

Here’s what we’ve got so far:

Here’s what we’re aiming for:

…

Next speaker! Context of Crime.

We report crime in two ways:

We are transitioned in 2018/2019 from UCR to NIBRS, which is better data. But any longterm comparison requires UCR data.

Longterm violent crime:

Short term crime rates:

Note from me: On the motor vehicle theft, this is happening everywhere:

But it’s always worth remembering that crime is way down, overall:

…

Back to the presentation.

More crime trends:

and specifically violent crimes:

Saul asks a great question – does this include Texas State data?
Answer: No. They have their own police and their data is not included.

Again, this is mostly just following national trend lines, as the nation returns to baseline after Covid:

It’s still a good thing!

And it’s still way, way lower than 30 years ago:

This recent data also corresponds time-wise with Chief Standridge arriving in 2021. So we are simultaneously implementing new strategies:

There’s a special victims unit:

They partner with Hays-Caldwell Women’s Shelter.

…

Next up is Chief Standridge! He is very apologetic.

There is a specific Chief’s Advisory Panel. In order to get community feedback, they drew up some questions about the public’s crime-related fears.

The plan was for everyone on the panel to chat up their neighbor and get some informal feedback. Max Baker offered to digitize the survey and share it with the San Marcos Civics Club.

When staff got the responses, they threw out anything that didn’t seem relevant to the question at hand. Chief Standridge is extremely apologetic to this. He apologizes profusely and specifically to Max and the public.

Here are the remaining answers:

He promises to get the full data, including the extra answers, out as quickly as possible.

(My personal answer is car crashes on I-35. That terrifies me.)

…

By this point, it is 5:30, and the looming 6 pm meeting starts to take over the presentation.

Councilmembers have lots of questions, but there’s not really time for them.

…

Next presentation! School Resource Officers.

SROs are supposed to be three things: Counselor, educator, and law enforcement:

But not these things:

We have five total:

We’ve been doing this since Columbine, and most of the community is pretty happy with it:

…

Back to Chief Standridge:

He sums up with this program for the next year:

At this point, they are almost out of time. There are slides on the Marijuana Decriminalization Dashboard, but he doesn’t get to them. But it’s all publicly available here.

The full slide show is also available here.

…

There’s a very quick Q&A, but it’s rushed and haphazard. Hopefully there will be a real Q&A scheduled in the future.

Holy moly, that was long.

Hours 0:00 – 1:56, 12/17/24

by The San Marxist, posted in Hour summaries

Citizen Comment

These were very interesting! 

Topic 1: Two speakers (Noah Brock and Annie Donovan) unpack part of Item #16 for us. 

Item #16 is about the Texas State Legislature. San Marcos lobbies the state government on various municipal issues. So we have a list of guiding principles.  

Here’s one of those items on the list:

I’m going to start with quoting Noah, because this is gold. First he reads that bullet point above. Then he says:

“This is a very specific location that’s called out in this guiding document.  The wording sounded familiar.  So I looked up what the last principles document said, in November 2022:

link

“They just replaced the words “SMART Terminal” with the location. So I went a little bit further, back to 2020. The document said the following:

link

“Then I went even further, to 2018, where I found the origin statement:

link

“Is it the city’s goal to develop an intermodal freight facility at this location? It appears that the original idea was to support light industrial manufacturing with a connection to the airport. Now we have a heavy industrial park that can stack containers 80 ft high, with no connection to the airport. 

Why does the wording keep changing to fit a developer’s current project? Isn’t a guiding principle supposed to come from the city, and not a developer?  

Do you remember when the city council voted unanimously to approach the developer of this project and change the development agreement, because the people did not support it, on May 2, 2023?   I would like to see a motion to remove this item from the document in its entirety. Thank you.”

So yes! In our packet of “what’s best for the city” we have a line item which is carved out specifically to be “what’s best for SMART/Axis Logistics”.  Verrrrrrry interesting. Stay tuned.

Topic 2: HSAB is the Human Services Advisory Board. The city allocates $550K in grants to nonprofits, and the HSAB awards the amounts.  There are a few comments here:
– The chair of the HSAB pleading that this amount of money is nowhere close to the need in the community
– A speaker on behalf of the Salvation Army, about how they weren’t funded as they’ve been in the past.

This will be unpacked in Item 15.

Topic 3: This place:

It’s on LBJ, at the train tracks, across from Toma Taco.

The city leases the property to Ruben Becerra, the Hays County Judge (which is not a “judge” so much as being like the mayor of Hays County.)  This speaker is super angry about this! 

We’ll get to the backstory on this property – Item 10 – but I still have questions.

…

Item 5:  Return of Evoke Wellness, for the final $50K of Covid Money.

This last bit of Covid money is going to the mental health program partnership between SMPD and Evoke Wellness, for people needing substance abuse treatment. (The county also works with Evoke Wellness.  This is part of a larger, semi-coordinated program to keep people with mental health crises and/or substance abuse out of jail.) We discussed this last time, too.

Amanda: How does this program work? Walk me through it. 

She basically wants to know all three parts:
1. how do people in crisis end up at Evoke Wellness?
2. What happens when you’re there?
3. What happens after discharge?

Part 1: how do people in crisis end up at Evoke Wellness?

First, SMPD responds to a call for someone in crisis. First, if they need medical help, SMPD will take them to the hospital. (Probably Christa Rosa).

If the person is stabilized but having a mental health crisis, SMPD tries to try to find out if the person has insurance or not. If so, then we try to find a facility that accepts their insurance. They’ll take the person to the treatment facility.  It might not be in San Marcos – could be Austin or San Antonio.

If they have no insurance or financial means, then once they’re stabilized, we give a mental health evaluation, and figure out what they need. Then we take the person to Evoke Wellness (for substance abuse) or Hill Country Mental Health.

Part 2: They’re at Evoke Wellness

No one from Evoke Wellness was on the line at the meeting, to talk about the services they offer there.  Amanda asked if we could have a workshop from them to hear about what their services are.  Everyone is on board with this.

Part 3: Discharge after Evoke Wellness

When they get to the treatment center, they start meeting with a case manager. They’re working on a discharge plan from day 1.

There are a few options for after they’re discharged:

  • Reconnect with safe support system, if that exists. Either the center, family, or mental health officer will give them a ride there.
  • Longterm treatment: may discharge to Sober Living, they may go to partial in-patient, several different places to go.

Amanda asks: What if someone has zero support services and zero resources? 

Answer: Then the case manager has to get to work.  Find shelters available. For example, Hill Country has an in-patient crisis stabilization unit in Kerrville. They’re in-house and have a big list of resources.  We make sure there’s a bed available at a destination shelter. The case manager is going to put together a plan to try to make sure the person does not end up homeless.

…

How many people are we helping?

Total, San Marcos is putting $150K towards Evoke Wellness, and Evoke Wellness is also providing 5 scholarships this year.

Chief Standridge says that costs vary wildly, depending if the person needs in-patient or out-patient treatment. But on average, $17K/person is a reasonable estimate.

So we can ballpark this: $150K plus the 5 scholarships helps about 10-15 people per year.

Alyssa asks: What kind of metrics do we have to assess how this is working?

Answer: We’ve got tons of internal statistics, but we’re not yet coordinating well on the county level, in order to get stats on the full scope of the issue. This is one of our big goals, though.

….

Just a quick soapbox: It is a moral obligation to help the most vulnerable people in society.  It does not matter if they made bad choices. Someone living on the streets with mental illness and/or substance abuse problems is being failed by society. And big problems cost a lot. 

But big problems can also be prevented! If we invested more heavily in prevention – early childhood support, family support, increase the living wage, increase housing, effective addiction prevention programs – it would be cheaper than working to solve big problems once they take root, on an individual basis. (And that’s not even counting the value added to people’s lives, for not being derailed by catastrophe.)

Can San Marcos afford to do all this properly on our own? Of course not.  But the state could! Texas had a $33 billion dollar surplus in 2023, and we’re projected to have a $20 billion surplus this coming year.  

Will Texas spend it on making a fair and just society??? (no.) Stay tuned!

…

Item 10:  We’re back to this cutie little place:

I think right now it’s called Las Dos Fridas.

Before that, it was Katz’s On the Go Cafe:

Before that, it was Santi’s Tacos:

And before that, Dixie Cream Donuts:

Ok.  Back in 2013, Union Pacific railroad offered to sell San Marcos four properties:

We agreed. (We hoped this property might someday be a good train station on the Lonestar Light Rail connecting San Antonio to Austin.  That’s what I dream about at night, at least.)

Now, Union Pacific sold the land to San Marcos in 2013, but not the physical little building.  The building was owned by Dixie Cream Donuts.  

Furthermore, look at that red border – the border runs right through the building!  So weird. They carved the Dixie Cream Donuts building, half on Union Pacific land, and half on San Marcos land.   (We even asked them about it at the time: “why not run the border around the building? It can be all UP, or all SM. We don’t care.”  

Union Pacific said, “nope.  We do this all the time.”  Okay then!)

At some point, Dixie Cream Donuts sold the building to Ruben Becerra.  So Becerra now owns the building, and leases the land underneath it from both Union Pacific and San Marcos.  He then sublets it to Las Dos Fridas.

…

No one is very excited about extending this lease to Becerra. This would just be a mini-extension, to match the sublease to Las Dos Fridas. It would expire in January 2026.

Council decides this is very thorny, what with Becerra being the Hays County Judge and all.  Council says cryptic things like, “I need to be able to give an answer when my constituents ask me what on earth is going on.” 

They decide to postpone until January. 

What happens if we don’t renew this lease? It’s not clear! Becerra still owns the building, he could in theory move it, although it’s probably not structurally sound.

The vote:

Yes, postpone until January: Everyone except Matthew Mendoza.

No! Let’s settle this now! Matthew.

I have no idea why Matthew wanted to settle it now. I don’t even know which way he wants it to go!

…

Item 14: New flood maps.

Ok, FEMA has been working on our flood maps since the 2015 floods. The old flood maps were based on 1990 data, so this is very much needed. The new maps are called Atlas 14.

Here’s how much city land is now in a flood plain:

So about 800 new acres of San Marcos are now in the floodplain. We don’t know how many homes and businesses that is, though.

So if you’re now in the floodplain, what changes? There are two main things:

  1. Building codes: the city has stricter ordinances if you’re building in a flood plain.

Old buildings don’t have to be retrofitted, but any new buildings or additions have to meet flood plain standards. (Like being raised off the ground.)

This isn’t actually a new change – the city has been using the Atlas-14 data since 2017 in our ordinances.

2. Flood insurance rates for home owners.

This is part of a much bigger, larger problem. “Flooding is the most frequent severe weather threat and the costliest natural disaster facing the nation.” Even when insurance providers pull out of high risk places like Florida and California, everyone can get insurance because there’s a federal program called the National Flood Insurance Program.

The problem is that floods are really, really expensive. So flood insurance rates for people in a flood plain are very expensive. Many people can’t afford it, and go without. This causes two more problems:

  • Rates go up even more for everyone else
  • NFIP still doesn’t have enough money to give out in case of flooding.

It’s a giant mess. It’s even worse when you think of the historical context in a place like San Marcos: wealthy people built their homes uphill, and left the downhill places for poorer neighborhoods. So it’s the people in Blanco Gardens and Victor Gardens and Dunbar that live in floodplains and have to debate flood insurance, not the University or the Historic District.

So how much are rates going up?

Amanda Rodriguez cites a study from Rice University about flood rates rising.  (I think it’s this one.)

So rates in Hays County are projected to go up 137% increase. (Legally, the increase is capped at 18% per year. So over the next 5-10 years, your premiums would step up to cover the increased risk.)

Mark Gleason weighs in.  He has a lot of lived experience with floods, particularly because he got hit hard in Blanco Gardens in 2015.  

His main points:

  1. The National Flood Insurance Program is broken.
    • San Marcos is a member. This gets us a 15% discount, but subjects us to FEMA rules about rebuilding.
    • Premiums are unaffordable so people go without. Then disaster hits and they can’t afford to rebuild, and sell at low prices, and fancier housing gets built. (Yes.)
  2. If you’re in the floodplain now, you don’t have to retrofit your current home or business. But anything new, or an addition, has to conform to floodplain development standards
  3. If you own your home outright, you’re not required to purchase flood insurance. 
  4. But everybody SHOULD get flood insurance. It’s very cheap if you’re not in the flood zone

Mark’s solution: Feds need to come in and fix the Blanco River. It needs some sort of flood control. It’s cheaper to fix the Blanco than it is to raise homes. 

Jane: What about the San Marcos river and Purgatory Creek? Historically, those flood, too. It’s not just the Blanco.

Basically, no one could possibly have any good answers. Mark certainly doesn’t know what it might take to fix the Blanco. None of us know what it would take to fix the flooding. None of us know the extent to which climate change will make things worse. We are all just kind of holding our breath and hoping.