CSAC 119th Annual MeetingHealthy Counties - Healthy California

Restoration of Competency Jail Based Program

Saves Time and Money!

Presented By

Terry Fillman, MBA, RN, CCHPHealth Services Administrator

San Bernardino County Sheriff’s Depart

Jail Bed Day Management

• Incompetent to Stand Trial (IST)

• Average Length of Stay (ALS)

• 2009/2010 the ALS for pre-sentenced IST inmates average was 765 days each

• 2009/2010 the ALS for pre-sentenced non-IST inmates average was 42 days each

Incompetent to Stand Trial Issues

• Pre-sentenced time for IST – Arrest court process to determine IST– State mental hospital admission wait time– State mental hospital admission treatment time– Return to jail determined competent– Return to court process – Possible decompensation– Repeat process– Adjudication

Jail-Based Program• CA Department of State Hospital Pilot– 20-bed jail-based treatment program– Incompetent-to-stand trial felony cases– Open-ended option to transfer to State Hospital– Open new collaboration partners

• The objectives of Liberty Health ROC Program– Restore to competency- Fast Track– Provide less costly housing and program alternative to

state hospital– Help reduce State Hospital waitlist and bed supply– Enable patients to receive more timely treatment

Fast Track Model

• The “Fast Lane”– IST defendants are

diverse & vary in terms of speed of restorability.

– Identify & separate the rapid responders from the defendants requiring long-term treatment.

– Eases congestion heading to the state hospital & reduce the waitlists.

Team Approach• Coordinating with the courts, judges, and DA• Addressing public defender’s concerns• Collaborating with State Hospital• Coordinating jail services– Classification and security issues– Housing and Programming space– Custody staff training– Health Services

• Primary healthcare, medications, labs, etc– Jail mental health services

• Pre and Post ROC program• Suicide Watch

General Statistics to October 2013

• Total admissions: 229• Total discharges: 215• Restored to competency:

– Average length of treatment (LOT) for restored patients: 56 days– LOT range for restored defendants: 14 to 150 days– Restored in < 90 days: 89%

• Competency Findings upheld: 98%• Transferred to State Hospital: 45%

– Average time between admission and transfer request: 60 days – Average length of stay (LOS) for transfers: 90 days

Medication Data to October 2013

• Number of patients prescribed psychotropic medication(s): 90%

• Choose not to force medications• Medication compliance incentive program– Fully compliant 87%– Intermittent compliance 3%– Refusing medication: 10%*Compliance not affecting outcome

Fiscal Outcomes• California Legislative Analyst Office Report:– Recommended expanded use of ROC programs

because of ability to significantly decrease costs to public sector

– After first nine-months of operation, LAO estimated: • $1.2 million savings for the State• $200,000 savings for San Bernardino County • ROC provided treatment at a cost of about $70,000 less per

patient.

– Information and statistics from LAO report, January 3, 2012 at www.lao.ca.gov

Evidence Based Outcomes

• 2012 - 2013 ALS for pre-sentenced IST inmates average 296 days each

• 2012 – 2013 Reduction in jail bed days for IST 469 days each

> 93,000 Jail Bed Days Saved since inception of Jail Based Restoration of Competency Program at San Bernardino County Sheriff’s Department!

Contact Information

• Deputy Chief Greg Garland ggarland@sbcsd.org

• Health Services Administrator Terry Fillman tfillman@sbcsd.org

• ROC Executive Director Kevin Rice karice@sbcsd.org