Mental Health Systems March 2018 Patrick K. Fox, M.D., Chief Medical - - PowerPoint PPT Presentation

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Mental Health Systems March 2018 Patrick K. Fox, M.D., Chief Medical - - PowerPoint PPT Presentation

Sep 11, 2023 339 likes •487 views

Demands on State Forensic Mental Health Systems March 2018 Patrick K. Fox, M.D., Chief Medical Officer Colorado Department of Human Services Not an Issue Unique to Colorado Increase in competency to stand trial referrals from the courts

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Demands on State Forensic Mental Health Systems

March 2018

Patrick K. Fox, M.D., Chief Medical Officer Colorado Department of Human Services

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Not an Issue Unique to Colorado

  • Increase in competency to stand trial

referrals from the courts

  • Practices that contribute to the

criminalization of persons with a psychiatric disability

  • Downsizing or closure of hospital beds
  • Staff Shortages
  • Limited community resources for clients

with high needs

  • Defendants found permanently

incompetent to proceed

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Orders for CDHS Forensic Evaluations and Competency Restorations per Fiscal Year

Fiscal Year Exams Restorations (ITPs) % Change from FY 2000-01 In Pt Out Pt Total % Increase In Pt Out Pt Total % Increase Exams ITPs 2000-01 236 193 429 87 87 2001-02 169 271 440 2.6% 98 98 12.6% 2.6% 12.6% 2002-03 82 344 426

  • 3.2%

111 111 13.3%

  • 0.7%

27.6% 2003-04 90 415 505 18.5% 109 2 111 0.0% 17.7% 27.6% 2004-05 102 441 543 7.5% 135 1 136 22.5% 26.6% 56.3% 2005-06 190 630 820 51.0% 167 3 170 25.0% 91.1% 95.4% 2006-07 223 618 841 2.6% 224 23 247 45.3% 96.0% 183.9% 2007-08 264 650 914 8.7% 219 15 234

  • 5.3%

113.1% 169.0% 2008-09 329 626 955 4.5% 170 18 188

  • 19.7%

122.6% 116.1% 2009-10 356 646 1,002 4.9% 212 22 234 24.5% 133.6% 169.0% 2010-11 345 747 1,092 9.0% 213 18 231

  • 1.3%

154.5% 165.5% 2011-12 355 828 1,183 8.3% 268 45 313 35.5% 175.8% 259.8% 2012-13 445 797 1,242 5.0% 271 45 316 1.0% 189.5% 263.2% 2013-14 461 1,005 1,466 18.0% 282 107 389 23.1% 241.7% 347.1% 2014-15 490 1,194 1,684 14.9% 375 193 568 46.0% 292.5% 552.9% 2015-16 374 1,497 1,871 11.1% 450 221 671 18.1% 336.1% 671.3% 2016-17 378 1,902 2,280 21.9% 548 348 896 33.5% 431.5% 929.9% 2017-18 projected 378 2,258 2,636 15.6% 635 426 1060 18.3% 514.3% 1118.4% 2018-19 projected 383 2,640 3,022 14.7% 727 528 1255 18.3% 604.5% 1342.0% 2019-20 projected 387 3,022 3,409 12.8% 819 630 1449 15.5% 694.6% 1565.5% 2020-21 projected 392 3,404 3,796 11.3% 911 732 1644 13.4% 784.8% 1789.1% 2021-22 projected 396 3,787 4,183 10.2% 1004 835 1838 11.8% 874.9% 2012.6% 2022-23 projected 401 4,169 4,569 9.2% 1096 937 2033 10.6% 965.1% 2236.2%

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Number of Inpatients in Beds at Fiscal Year End vs Competency Evaluation and Restoration Orders - CMHIP

200 400 600 800 1000 1200 1400 1600 1800 20 40 60 80 100 120 140 160 180 200 220 FY05 FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 F(YTD)* Inpatient Comp Exam Bed Utilization Inpatient Restoration Bed Utilization RISE Restoration Bed Utilization Other Forensic Bed Utilization Inpatient Comp Exam Orders Outpatient Comp Exam Orders Restoration Orders, Patient at CMHIP Restoration Orders, Patient at RISE or in Community Total Evaluation and Restoration Orders per Fiscal Year Patients in Beds at Year End

*Projected orders for FY17, bed utilization as of 6/18/2017

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Precipitating Factors

  • Increase in competency to stand trial referrals from the courts
  • Practices that contribute to the criminalization of persons

with a psychiatric disability

  • Downsizing or closure of hospital beds
  • Staff Shortages
  • Limited community resources for clients with high needs
  • Defendants found permanently incompetent to proceed

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A Model for Understanding the Issue

Too Small (Bed Capacity)

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Increased flow (Referrals) Inadequate Drainage (Discharge Challenges)

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Strategies to Address Increased Flow

  • Jail Diversion Programs

– Pre-arrest jail diversion (CIT, LEAD) – Pre-arraignment jail diversion

  • Bond reform to increase jail release
  • Expand community behavioral health

treatment capacity

  • Change statute to limit the

circumstances for which an inpatient competency evaluation or restoration is ordered

  • Improved mental health services in

jails

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Strategies to Increase Capacity

  • Increase state hospital beds
  • Colorado added 20 additional restoration beds in 2007,

though the overall number of licensed beds decreased by 20% in ensuing years

  • Added 20 beds in March 2018, with an additional 24

beds by 2020

  • Capital construction plan to increase beds by 150 in

Denver area

  • Re-allocating bed space to incompetent to stand

trial

  • Increase capacity for outpatient programs
  • Jail-based competency evaluation and restoration
  • Purchase beds from private psychiatric facilities

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Strategies to Address Discharge Challenges

  • Enhance community behavioral health

resources

  • Facilitate discharges and the discharge

planning process

  • Subsidies and incentives to community

providers to accept patients who have been historically difficult to manage in the community

  • Impose no eject/no reject clauses with

contracts

  • Address the specific challenges posed by

defendants found permanently incompetent to proceed and limit the period of time permissible to restore the defendant

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Patrick K. Fox, M.D., Chief Medical Officer, CDHS patrick.fox@state.co.us 303-866-4669