“The Back-of-Napkin Study”

“The Back-of-Napkin Study” Officer Patrick O’Bryan Reno, Nevada, Police Department obryan@ci.reno.nv.us (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 GladwellandThe 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.

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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/presentation_materials/audio/NetConf_Nov13_06.wma • http://gainscenter.samhsa.gov/html/resources/presentation_materials/ppt/Myths_11_13_06.pdf • http://gainscenter.samhsa.gov/html/resources/presentation_materials/pdfs/UniformPermission.pdf

“The Back-of-Napkin Study”