Bexar County Transfers Jail Mental Health Screenings to University Health

Bexar County has officially transferred responsibility for mental health and substance use screenings at its jail from the Center for Health Care Services (CHCS) to University Health. This transition, effective October 1, 2023, concludes a six-year contract with CHCS, marking the first time that medical and behavioral health assessments will be consolidated under a single provider since the Justice Intake and Assessment Annex (JIAA) opened in late 2018.

Previously, CHCS conducted mental health screenings while University Health managed medical intakes at the facility. Once detainees were admitted to the jail, University Health took over both medical and behavioral health treatment. In October 2023, Bexar County’s Office of Criminal Justice commissioned a study by the University of Texas Health Science Center at Houston to assess the efficiency of the annex in processing detainees and diverting individuals with behavioral health or substance use needs into appropriate treatment programs.

The study, led by Dr. Alexander Testa, revealed issues such as fragmented communication, inconsistent data sharing, and overlapping responsibilities among the various agencies operating within the annex. Following the study’s findings, Testa recommended consolidating screenings and treatments under a single provider. Alternatively, he suggested establishing a coordinated process integrating behavioral health assessments into the medical intake already performed by University Health.

Bexar County’s Department of Public Health began exploring solutions based on these recommendations. “We were considering what this means for the providers involved,” said Dr. Andrea Guerrero, Director of Bexar County Public Health. “University Health can provide both medical and mental health services, but CHCS cannot fulfill both roles effectively.”

The recommendation to change providers was made to the county in August 2023 and received approval for the fiscal 2026 budget on September 9, 2023. Following the transition, University Health President and CEO Edward Banos described the change as part of a broader initiative to enhance continuity of care. “This offers an opportunity for better continuity, as we will conduct assessments upon intake and ensure that individuals who need psychiatric services receive them either at the jail or at another appropriate facility,” Banos stated.

Discussions about this transition had begun months prior, with county officials approaching University Health to determine if they could assume intake services. This shift surprised CHCS, which had been managing mental health screenings at the annex for several years. Jelynne LeBlanc Jamison, President and CEO of CHCS, stated, “We were informed just a day before the county recommended the contract with University Health.”

Jamison noted that the findings from the study led to significant concerns about systemic processes within the JIAA. “Dr. Testa pointed out that there was no clear procedure in place, which complicates the processing of individuals,” she said. Following the announcement of the contract change, CHCS had to review the report independently after finding it online.

As CHCS ended its role on September 30, 2023, most of its staff were reassigned to other programs. University Health commenced screenings the following day, October 1, 2023, without a transitional period. Bexar Public Health played a vital role in staffing the annex during the initial training phase for 11 new positions. “CHCS did not assist in the transition; they left abruptly. However, Dr. Guerrero and her team were dedicated to ensuring we had adequate staff in place,” Banos commented.

Bexar Public Health anticipates that University Health will fully assume staffing responsibilities by November 10, 2023. Guerrero emphasized that the decision to consolidate mental health screenings was discussed with both agencies prior to budget approval. “We informed CHCS before the first court date in August,” she said, reiterating that CHCS remains a critical partner in the county’s behavioral health network.

“CHCS is still essential in providing care to the community,” Guerrero added. “The transition of mental health assessments at the JIAA to University Health aims to streamline processes and enhance diversion efforts.”

CHCS continues to manage other mental health programs for Bexar County, including jail-based competency restoration and assisted outpatient treatment. Jamison indicated that CHCS will maintain its focus on these initiatives while also advocating for more diversion options outside the jail. “We are continuing to provide all outpatient services and are optimistic about discussions surrounding the establishment of a diversion center,” she stated.

While the county aims to improve operational efficiency at the annex, Jamison expressed skepticism regarding whether changing providers will resolve the structural issues identified in the study. “We’ll have to wait to see if this truly streamlines the process,” she said. “Without addressing technology, staffing, and leadership issues, the change may not yield the desired results.”