Law enforcement officers’ increasing burden of handling behavioral health crisis transports for homeless people sparks renewed call for shelter

Data to be shared with community foundations during upcoming talks involving representatives of Tallahassee’s homeless facility, County Commission learns

Lynette Herbert. News Leader photo
Lynette Herbert. News Leader photo

From Oct. 1, 2015 through March 31 of this year, the majority of individuals transported multiple times — by law enforcement officers and a firm under contract with Sarasota County — to hospitals or other facilities because of specific types of behavioral health crises were identified as homeless, a Sarasota County study has found.

The survey of data regarding all transports related to Baker Act and Marchman Act situations showed 298 of the 2,360 individuals “were identified as having ‘high need’ and ‘high utilization’ (HNHU), because they accessed crisis facilities three or more times” during that six-month period, says the Behavioral Health Acute Care System Data Review released by Sarasota County’s Health and Human Services Department.

Of those 298, the report notes, 41 additionally were identified as Super High Need High Utilization because they had been taken to facilities six or more times during the study period, the report continues. Based on the facilities’ data and Homeless Management Information System (HMIS) reports, 65% of the HNHU clients were identified as homeless; of the 41 Super High Use High Need clients, the report adds, 86% were homeless.

The Baker Act involves individuals who are committed to facilities on an involuntary basis because of mental health issues. Marchman Act cases involve substance abuse or impairment that leads to a person posing a danger to himself or herself, or to other people.

“I think it’s important to show how we’ve turned our police officers into expensive social workers,” Commissioner Charles Hines said on Oct. 26, after hearing a presentation on the study.

A come-as-you-are shelter is what the county needs, Hines told his colleagues. “I’m going to keep banging this gong until [one has been established].”

The county’s director of services for the homeless did offer hope to the board this week: Representatives of Tallahassee’s homeless shelter are scheduled to meet next month with the boards of the foundations in Sarasota County.

Lynette Herbert, public health services manager for the county, shared data from the transports report with the County Commission on Oct. 26. The study was undertaken by members of the county’s Acute Care System Task Force, which comprises representatives of local behavioral healthcare providers, the Florida Department of Children and Families, the Central Florida Behavioral Health Network, law enforcement agencies, hospital emergency departments and Ambitrans, a medical transportation firm. County Health and Human Services Department staff assisted with the initiative, a memo to the commission explains.

A closer look at the data

A slide shows details regarding the Baker Act transports. Image courtesy Sarasota County
A slide shows details regarding the Baker Act transports. Image courtesy Sarasota County

Regarding Baker Act situations, Herbert noted, data showed that the Sarasota County Sheriff’s Office handled 57% of the transports during the study period, which correlated to the 250,000 population figure for the unincorporated parts of the county. The Sarasota Police Department was involved in 31% of the calls. The Venice and North Port police departments handled 12% of them, with Ambitrans covering the remainder.

Conversely, Herbert continued, the Sarasota Police Department handled 58% of the Marchman Act cases during the study period, while the Sheriff’s Office was involved in 34% of them. “That appeared kind of high,” Herbert said of the Police Department statistic.

When Commissioner Christine Robinson asked for clarification about when the Marchman Act can be used, Herbert explained, “Law enforcement must believe that the person [poses a threat] to himself or others,” and substance abuse must be a contributing factor.

Robinson pointed out that when she was a prosecutor in the county, she used to preside over the mandatory hearings within 72 hours of a person’s commitment under the Baker Act. In Marchman Act cases, she continued, “you’re released as soon as the impairment is over. ‘You’re dried out,’ is what we used to say. … It’s much easier to use the [Marchman Act than the Baker Act],” she added, seeking corroboration from Herbert.

Hearings also can be conducted in Marchman Act cases, Herbert replied.

“They’re very rare,” Robinson told her.

A slide shows details of Marchman Act transports. Image courtesy Sarasota County
A slide shows details of Marchman Act transports. Image courtesy Sarasota County

The conservative estimated cost of crisis services for the people in the study identified as High Need High Use, Herbert continued, was $1,465,540 over the six months, or 42% of the approximately $3.5 million in total transportation expenses. The Super High Need High Use people accounted for 24% of the High Need High Cost total during the study period, or $357,574.

The survey also verified anecdotal information the task force members had, Herbert noted: Misdemeanors accounted for 73% of all the criminal charges among the High Need High Utilization group and 85% of the charges involving Super HNHU individuals. Most of those misdemeanors related to incidents such as public consumption of alcohol, open containers in public and trespassing, she said.

A review of the HMIS data also showed that 29% of the HNHU and Super HNHU individuals did not access any services provided specifically for homeless people, Herbert continued. Additionally, their engagement in case management and employment services was very low, she said.

“Basic life-sustaining services such as shelter, food, and showers were the majority of services accessed [96%],” as shown by the data for the HNHU population, the report points out.

Voicing frustrations

“You said a lot of things in a very professional way and laid it out,” Hines told Herbert at the conclusion of her presentation. “I’m going to not be so professional.” Over the past two years, Hines continued, “this community has lacked leadership to have the courage to do a come-as-you-are shelter.”

Hines added, “We’ve put law enforcement in a horrible way to try to find a way to deal with, [for example] the drunk guy that’s in front of a business or in a neighborhood,” to try to help residents and business owners complaining about their quality of life.

A graphic shows details about access of services among those individuals identified as High Need High Utilization. Image courtesy Sarasota County
A graphic shows details about access of services among those individuals identified as High Need High Utilization. Image courtesy Sarasota County

While undertaking the study, Herbert replied, “We came to have compassion for all of our law enforcement agencies across the county.”

People who have to sleep outside “are in danger,” he stressed. “We forget a man died after being stung by yellow jackets because he had no place to go. We can’t have any more of those.”
Furthermore, Hines said, “Law enforcement is using probably the most expensive way to deal with what I just described,” by taking the homeless people to a hospital emergency room, crisis center provided by the nonprofit First Step of Sarasota or Bayside Center for Behavioral Health, which is a program of Sarasota Memorial Hospital.

Robinson earlier had talked about the standards for utilizing the Marchman and Baker acts, Hines continued, “versus just [a situation in which] somebody’s in the wrong place at the wrong time in the wrong neighborhood, who’s homeless.” He told his colleagues, “We’ve got to fix this!”

“I am going to stand shoulder-to-shoulder with Commissioner Hines,” Chair Al Maio said. “This commission unanimously took a giant step forward and offered millions and millions of dollars to buy a facility [for a shelter], [plus] more millions per year for an unspecified number of years to staff it with professionals [who would serve as case managers for homeless individuals].”

Maio added, “A large majority of [EMS and law enforcement transports of homeless individuals to health care facilities] are happening in the city, and we got extensive pushback [from the City Commission on the shelter proposal].”

A slide offers details about clients identified as High Need High Utilization. Image courtesy Sarasota County
A slide offers details about clients identified as High Need High Utilization. Image courtesy Sarasota County

In 2013, the City and County commissions hired a nationally known consultant on homelessness issues — Robert Marbut — to assess the situation in the community and make recommendations. A come-as-you-are shelter was Marbut’s top priority, and he suggested it be established within the city because of the proximity to healthcare service providers the residents would need to access. However, the City Commission has remained adamantly opposed to a facility within the city limits.

Over the past 18 months, the City Commission has focused on a Housing First approach to homelessness.

The last time the two boards met on the issue was in November 2015.

Vice Chair Paul Caragiulo noted his “tremendous amount of personal frustration” over the lack of a shelter. “Sometimes it can’t help but feel like [the need is] just not serious enough yet, which is really alarming, considering where we are right now.”

A way forward?

Commissioner Carolyn Mason reminded her colleagues about the presentation they heard in September regarding the Kearney Center in Tallahassee, which serves Leon County’s homeless population.

“They said government needs to be a partner in this but not drive the bus,” she added.

Rick Kearney, CEO of Mainline Information Services, was the benefactor of the center, which serves between 600 and 700 people a day, he reported to the County Commission on Sept. 20. He said community leadership is the key to establishing a shelter, adding that the private sector should take on that role.

“I think this commission needs to stay on top of the private sector,” Mason pointed out on Oct. 26. “Otherwise, you’re not going to know how to partner with them.”

Wayne Applebee. File photo
Wayne Applebee. File photo

Then Wayne Applebee, the county’s director of services for the homeless, told the board about the upcoming meetings between Kearney Center representatives and foundation boards of directors in Sarasota County, “to facilitate that private-side leadership for us.”

The information Herbert had presented, Applebee continued, will be an important facet of those discussions.

He reminded the board that after Marbut provided his recommendations, nonprofit organizations — led by the Gulf Coast Community Foundation — established two emergency shelters for homeless families and children “in a rapid fashion.”

“It is painful for us to go for a walk for lunch and see the problem not solved,” Maio said of the homeless people in downtown Sarasota. However, he added that Applebee’s optimism about the upcoming foundation discussions “makes me feel a little better.”

Robinson then made a motion to ask the county administrator to send to each municipality in the county a copy of the full report on which Herbert had based her presentation. Hines seconded her motion.

After it passed unanimously, Robinson asked Herbert whether it would be possible for the board to get quarterly reports in the future on the same types of statistics provided in the study.

The Acute Care System Task Force already had considered preparing an update covering the period from April through September, Herbert said. However, the group does meet quarterly, she added.

When Maio asked if she thought it might be possible to provide a report to the board within 30 days after each of those quarterly sessions, Herbert told him, “Yes.”

Robinson then made a second motion, calling for the county administrator to provide the data and other relative information to the County Commission on a quarterly basis. That motion, seconded by Mason, also passed unanimously.