1
The Back-of-Napkin Study

• Officer Patrick OBryan
• Reno, Nevada, Police Department
• obryan_at_ci.reno.nv.us
• [phone]

2
Officer OBryans 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).

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Friday, November 14, 2003

• Fork in the Road

4
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.

5
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.

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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.

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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.

8
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 Nevadas 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.

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Frustration Factor

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

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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.

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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 Wheatleys idea about the
  importance of our willingness to be disturbed.
  What I saw in the mirror.

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Malcolm GladwellandThe New Yorker

• Gladwells 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 dont meet the treatment
  success criteria.
• Admission Criteria vs. Denial Criteria.

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Slide 9
14
Range of Reno Cost Benefit Study

• Reno, Sparks, Washoe County arealocal 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).

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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?

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GAINS Center HIPAA Info.

• http//gainscenter.samhsa.gov/pdfs/integrating/Dis
  pelling_Myths.pdf
• http//gainscenter.samhsa.gov/html/resources/pres
  entation_materials/audio/NetConf_Nov13_06.wma
• http//gainscenter.samhsa.gov/html/resources/prese
  ntation_materials/ppt/Myths_11_13_06.pdf
• http//gainscenter.samhsa.gov/html/resources/prese
  ntation_materials/pdfs/UniformPermission.pdf