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Special CMHDA Forensics/ AB 109 Meeting May 11, 2012 Sacramento

Special CMHDA Forensics/ AB 109 Meeting May 11, 2012 Sacramento. Incompetent to Stand Trial (IST) Process County of San Bernardino (Developed from the CONREP P&P Manual 2007) Presenters: Department of Behavioral Health (DBH) and Liberty Healthcare Corporation. Introduction.

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Special CMHDA Forensics/ AB 109 Meeting May 11, 2012 Sacramento

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  1. Special CMHDA Forensics/AB 109 Meeting May 11, 2012 Sacramento Incompetent to Stand Trial (IST) Process County of San Bernardino (Developed from the CONREP P&P Manual 2007) Presenters: Department of Behavioral Health (DBH) and Liberty Healthcare Corporation

  2. Introduction • County of San Bernardino, DBH • Conditional Release Program (CONREP)-San Bernardino and Riverside County • Incompetent to Stand Trial (IST) Process • Restoration of Competency (ROC) Program

  3. Definition • PC 1370 (a)(2): • When a person is found mentally incompetent, the court orders an evaluation for placement to be conducted by the Conditional Release Program (CONREP) within 15 days • Referral Packet sent to Community Program Director (CPD): • Documents provided: • Court order to evaluate • Copy of the arrest report and formal complaint/information regarding the offense(s) charged • Psychiatric/psychological reports • State summary of criminal history information ("Rap Sheet") [PC 11105.1 authorizes reception of this information]

  4. Placement Evaluation • Individual evaluated to determine the most appropriate treatment facility or site • Must consider the following at minimum: • Review of legal/medical documents; and then consider the following: • Direct Outpatient Placement • Inpatient Placement Requirement

  5. Placement Evaluation Types • Direct Outpatient Placement, then shall also encompass: • Personal interview • Collateral contact(s) with family, alleged victims and/or significant others • Inpatient Placement Requirement:[PC 1601 (a)]: • Penal Code section 1601 (a) requires a 180 day inpatient stay prior to outpatient treatment for those charged with particular crimes • Examples: Murder, Mayhem; Kidnapping with inflicted great bodily injury or ransom, Assault to commit rape, Rape by force or threat, Arson

  6. IST Statistics • San Bernardino County • Fiscal Year – 2010/2011 • Total: 105 • Number of PC 1601 cases – 42 • Fiscal Year – 2011/current (3/2012) • Total: 74 • Number of PC 1601 cases – 32 • Riverside County • Fiscal Year – 2010/2011 • Total: 105 • Number of PC 1601 cases – 39 • Fiscal Year – 2011/current (3/2012) • Total: 97 • Number of PC 1601 cases – 33

  7. Placement Recommendations • Justifications: • The recommendation for placement in a specific treatment facility or site must be accompanied by a justification for the placement that considers: • Applicability of PC 1601(a) • Need for a secure environment • Estimated length of treatment • Location of facility • Availability of resources • State hospital admission policiesand • Plan for payment of services if other than state hospital

  8. Placement Recommendations • Placement Alternatives: • State hospital • Local public/private inpatient treatment facility • Community outpatient treatment, unless precluded by PC 1601(a) • Referral to Regional Center if person is develop-mentally disabled (PC 1370.1) • Incompetent as a result of a developmental disability • Incompetent as a result of a mental disorder, but is also developmentally disabled. • Referred back to court per PC 1367 if found to be developmentally disabled

  9. Court Order for Commitment • Court reviews CONREP placement recommendation, the court then determines the most appropriate treatment site as follows: • State Hospital • Local public/private inpatient treatment facility • Outpatient Treatment • Regional Center • Restoration of Competency (ROC) Program

  10. Court Order for Commitment (cont…) • State Hospital: • An underlying criminal charge requires a minimum of 180 days in a locked setting [PC 1601(a)]or • Person needs intensive, long-term treatment in a secure environment, not available in the community • Local public/private inpatient treatment facility: • A person may be committed to a local public or private inpatient treatment facility approved by the Community Program Director • The means of funding local inpatient treatment should be assessed prior to making such a recommendation • Local inpatient treatment facilities must possess a current valid license that permits the locked treatment of persons with mental disorders. These facilities include: • Locked acute psychiatric facility • Locked skilled nursing facility or • Locked intermediate-care facility

  11. Court Order for Commitment (cont…) • Outpatient Treatment: • Placed directly into an outpatient treatment program under these circumstances: • The required treatment is available in such a program • Not a danger to the health and safety of him/herself or others and • Does not require placement in a secure setting or is not prohibited from outpatient placement [PC 1601(a)] • Statistics (SB/RIV): 2010: 1 case; 2011: 1 case; 2012: None • Regional Center: • Person with a developmental disability referred to a Regional Center for an evaluation

  12. Court Order for Commitment (cont…) • Restoration of Competency (ROC) Program: • Jail based program – located at West Valley Detention Center (WVDC) • Criteria: • Individual must be incarcerated at one of the four detention centers in San Bernardino County • Individual must be at least 18 years of age • Court order for Restoration of Competency Treatment by County Superior Court • Must be in stable medical (physical) condition as assessed by physician • Potential individuals screened for likelihood to respond to treatment in a short-term period (less than 90 days)

  13. ROC Program Background • CA DMH (Dept. State Hospitals) issued RFP in 2008 • Seeking providers to deliver locally-based (jail) Restoration of Competency Services • To individuals charged with felonies and found IST • Forty (40) beds available (maximum) • One (1) year pilot program • Goals: • Help alleviate the backlog of inmates in the county jails waiting for admission to the state psychiatric hospital system • Help alleviate the bed shortage of CA DMH

  14. ROC Program Goals • Restore the individual to competency as quickly as possible • Address: Malingering, Communication Barriers • Provide treatment to stabilize psychotic symptoms • Individuals may be admitted with acute reactive mental health states and/or psychotic symptoms • Primary focus will be to remediate functional deficits (i.e. understand their current legal status, assess ability to communicate with attorney) • Following Competency Restoration: • Return back to their previous housing status • DBH Jail Mental Health Services (JMHS) are resumed • Projected length of stay for ROC treatment is less than 90 days

  15. ROC Program Contract with SBCSD • Contract was awarded to Liberty Healthcare Corporation (Liberty) • Liberty enters a contract with San Bernardino County, Sheriff Department (SBCSD) • Budget • Approximately $500k = $68.49 per participant/day (does not include medication costs-separate reimbursement) • Contract Period: 7/1/2010 – 6/30/2013 • Implemented in 1/2011 – Twenty (20) beds only out of the available forty (40) • Beds located in Unit 15, the Sheltered Housing Unit at WVDC

  16. ROC Program Overview • Forensic Staffing: • Psychologist, LCSW, RN, Psychiatrist, Recreational Therapist • Statistics • 84 ISTs admitted • 56 Days: Average length of treatment for restoration • 84% Voluntary medication compliant • 13% Malingering

  17. Challenges and Considerations Consideration Utilize Current IST Process No change to the IST referral process between the Superior Courts and the County of San Bernardino, DBH (CONREP Program)

  18. Challenges and Considerations Challenge San Bernardino County Detention Centers do not have LPS designation Impact Medication compliance based on voluntary basis

  19. Challenges and Considerations Consideration Developing and Enhancing Existing Relationship with Partners Partners County DBH & Sheriff Department, Liberty & Department of State Hospitals (formally known as CA DMH), Superior Courts, and State Hospitals Challenge Contracted General MH Services

  20. Challenges and Considerations Challenge Providing Services specific to Female Population Impact Housing Conflicts Shortage of Female Housing at WVDC especially in Unit 15: Sheltered Housing Unit (one tank) Currently only have two units for females at WVDC

  21. Challenges and Considerations Consideration Medication Costs No medication costs are included in the daily rate ($68.49/individual/day) Liberty will reimburse for medications based on actual costs separately

  22. Challenges and Considerations Challenge Meeting Bed Capacity Impact Have to pay salary for Deputy based on contracted bed allowance regardless if bed capacity is met (SBCSD: estimated $125,000/Deputy/year)

  23. Challenges and Considerations Challenge Increased Incarcerations due to AB 109 Population Impact Long term housing now required for AB 109 Population – Creating housing dilemmas in the detention centers

  24. Challenges and Considerations Consideration Sharing Knowledge about the ROC Program Prior to Implementation provide information to all the surrounding Superior Courts and related criminal justice partners (i.e. DA, PD, Private Attorneys)

  25. Thank You Questions And Comments

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