“The Back-of-Napkin Study”

Officer Patrick O’Bryan Reno, Nevada, Police Department [email protected]

(775) 745-0542

Officer O’Bryan’s Background

• Northern Nevada Crisis Intervention Team (CIT) Coordinator.

• 19 ½ years - Reno Police Department.

• 9 ½ years - Downtown Enforcement Team (Bicycle Team).

• 9 years - SWAT team.

• Defensive Tactics Instructor.

• Academy Instructor.

• Field Training Officer/Police Training Officer.

• DARE Instructor.

• Drug Recognition Expert (DRE).

Friday, November 14, 2003

“Fork in the Road”

First Cost Benefit Analysis

• Originally done out of curiosity. The cost of a bottle of vodka to the community.

• Also, originally done to get the attention of the university to ask for more formal study as a police department would immediately be suspect in the eyes of the media as a governmental entity. It is a police department, after all.

The Homeless Can be Costly One Example:

• A chronic inebriate needs to panhandle about $1.50 to $2.50 to obtain a cheap bottle of vodka from a downtown liquor store.

• If the chronic inebriate falls down, 911 is called and an ambulance (REMSA), fire and police are all dispatched, eight total personnel on average.

Chronic Inebriate Example Continued:

• REMSA to the hospital E.R. - $700.00

• E.R. Detox Process - $1200.00 $2000.00.

• Trauma criteria work-up if there is a pre existing diabetic or epileptic condition or if there is an obvious head injury - $6500.00.

Then, they go back out that same day…..

• The subject will most likely repeat the process many times a weeks, many weeks out of the year.

• Hard dollars vs. soft dollars? Does it matter?

• What is the quality of care – like prescribing sun screen for skin cancer.

• The acute symptoms are minimally treated while the chronic condition persists and is ignored.

Fiscal Outcomes

• Communities at a local, state and national level learn that ignoring mental illness and homelessness is expensive and just plain wrong.

• 50% increase in State of Nevada’s mental health budget for legislative session 2004.

• $1.5 million dollars made available for community triage centers for Las Vegas and Reno yearly since 2004 legislative session.

Frustration Factor:

• E.R.s • Jails • Courts • Non-profits…the Chronically Homeless • Business owners • Tourists • The concerned citizen • Police and Law Enforcement

First Homeless Memorial Service

• Assemblywoman Sheila Leslie asks for names of the homeless who have died on the streets for 2004 and any stories.

• Paddy O produces “Oh Captain” then leaves Reno leaving partner Steve Johns stuck with the sermon.

• Steve is not struck by lightning when speaking from the pulpit at church.

Critical Components of the Reno Cost Benefit Analysis

• Who did the study.

• The study objective.

• Simple direct outcomes.

• The anecdotal evidence combined with the statistical evidence….

• The story of Murray.

• My willingness to talk about it and take the risks. Margaret Wheatley’s idea about the importance of our “willingness to be disturbed.” “What I saw in the mirror.”

Malcolm Gladwell and The New Yorker

• Gladwell’s primary point: It may be more cost effective to solve homelessness and the issues associated with it (mental illness, substance abuse, co-occurring disorders) than it is to continue to manage it.

• “Power Curve” conversation.

• Treatment paradox, statistically driven to produce results, one result being catastrophic failure for those who don’t meet the treatment success criteria.

• Admission Criteria vs. Denial Criteria.

Slide 9

Range of Reno Cost Benefit Study:

• Reno, Sparks, Washoe County area…local area.

• State of Nevada Legislature.

• The New Yorker Magazine.

• Various United States Interagency Council on Homelessness (USICH) publications and venues. • National Homelessness Research Symposium 2007.

• University of Nevada Reno Cost Benefit Analysis (After almost four years).

Methodology

• Made simple phone calls and asked simple questions.

– How much does an ambulance run cost?

– How much does it cost to detox a drunk?

– How much does it cost to do a trauma work-up?

• Billing questions… non-medical: – I have three names, how much have they accumulated this year in hospital costs?

– Have those costs been reimbursed to the hospital in some fashion?

GAINS Center HIPAA Info.

• http://gainscenter.samhsa.gov/pdfs/integrating/Dispelling _Myths.pdf

• http://gainscenter.samhsa.gov/html/resources/presentati on_materials/audio/NetConf_Nov13_06.wma

• http://gainscenter.samhsa.gov/html/resources/presentati on_materials/ppt/Myths_11_13_06.pdf

• http://gainscenter.samhsa.gov/html/resources/presentati on_materials/pdfs/UniformPermission.pdf