Download San Bernardino County -- Incompetent to Stand Trial

CSAC 119th Annual Meeting
Healthy Counties - Healthy California
Restoration of Competency
Jail Based Program
Saves Time and Money!
Presented By
Terry Fillman, MBA, RN, CCHP
Health 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
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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
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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
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Coordinating with the courts, judges, and DA
Addressing public defender’s concerns
Collaborating with State Hospital
Coordinating jail services
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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
[email protected]
• Health Services Administrator Terry Fillman
[email protected]
• ROC Executive Director Kevin Rice
[email protected]