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Managing Bed Capacity inFlorida’s Forensic System ofCareNational Association of State Mental HealthProgram DirectorsOctober 3, 2016Wendy Scott, Director, Mental Health Treatment FacilitiesBob Quam, Chief Hospital Administrator, Mental Health Treatment Facilities1
Objectives Program Overview Forensic Trends Priority of Effort-to Date Priority of Effort-Next Steps2
Program Overview3
NortheastFlorida StateHospitalLegendSecureForensicFacilitiesFlorida StateHospital-ForensicWest FloridaCommunityCare Center(LakeviewCenter)NorthEvaluation andTreatmentCenterFlorida StateHospital-CivilFlorida CivilCommitment Centerat DeSoto CI(CorrectCare RS)CivilFacilitiesTreasure CoastForensic TreatmentCenter At Martin CI(Correct Care RS)Department ofChildren and FamiliesMental HealthFacilitiesSouth FloridaState Hospital(Correct CareRS)4South Florida Evaluationand Treatment Center(Correct Care RS)
Statewide Forensic CapacityTYPE OF BEDSTOTALS1160Secure Forensic(1013-Male, 167 Female)Forensic Step-Downs455Total Forensic Beds16155
Forensic Commitment Process1) Charged with Felony5) Admission Scheduledto Mental HealthTreatment Facility2) Court Deems ITP orNGI Based onEvaluation6) Services Provided inMental HealthTreatment Facility UntilNo Longer MeetsCommitment Criteria3) Court DeterminesCriteria Met forInvoluntary Placement4) Court Commits toDepartment ofChildren and Families7) FacilityRecommends Release8) CourtApproves/DisapprovesRelease fromCommitment6
Criteria for Forensic Commitment(Chapter 916, F.S.) Charged with a Felony Offense. Incompetent to Proceed (ITP) or Not Guilty by Reason ofInsanity (NGI). Danger to Self or Others due to Mental Illness. Less Restrictive Alternatives Inappropriate. At Least 18 Years of Age (or a juvenile adjudicatedas an adult).7
Forensic Admissions to State Mental Health Treatment Facility Court Ordered for Placement Referral Packet to Mental Health Program Office. Admission Scheduled (statutory requirement to admitwithin 15 days) Recovery Needs Assessed and Services Provided. Recommended for Release when No Longer MeetCommitment Criteria.13
Services Provided at SMHTFs Basic Support Services Healthcare Services Psychiatric Treatment and Rehabilitation Enrichment Services Dialectical Behavioral Therapy Continuity of Care Services Competency Restoration Training and Evaluation9
Forensic DischargesITPsMajority Discharged Back to Jail asCompetent to ProceedNGIsStepped-down to a Civil Facilitypursuant to Chapter 394, F.S.Returned to the Community on aConditional Release.Rubio: Adjudicated competent toproceed & court-ordered to remain ata mental health treatment facility tomaintain competency.Stepped-down to a Civil Facilitypursuant to Chapter 394, F.S.If Non-Restorable, charges dropped orconditionally release to thecommunity.10
Managing Entities Divert individuals who do not need to reside in the mostrestrictive settings. Assist facilities with discharges and/or conditional releaseplanning. Monitor and serve individuals in the community andensure adherence to conditional release plans.11
Managing Entities by RegionLutheran Services FloridaBig Bend Community Base CareCentral Florida CaresHealth SystemSoutheast FloridaBehavioral HealthNetworkCentral Florida Behavioral HealthNetwork, Inc.South Florida Behavioral HealthNetwork Inc.12BrowardBehavioralHealth Coalition
Forensic Trends13
Forensic Commitment Appropriations180.0M APPROPRIATED (IN MILLIONS)160.0M159.6M151.6M 152.7M 152.5M144.5M139.3M140.0M130.2M 129.6M134.8M 134.7M120.0M100.0M80.0M60.0M40.0M20.0M.0MFY 07/08 FY 08/09 FY 09/10 FY 10/11 FY 11/12 FY 12/13 FY 13/14* FY 14/15* FY 15/16* FY 16/17STATE FISCAL YEAR*Budget amounts for FYS 2013-14, 2014-15 and 2015-16 have beenrevised to exclude a program appropriation discrepancy that belongedto the Sexual Predator Program.14
Forensic Commitments and Designated Bed Capacity180017491729# of Bed/Commitments1750170016771677165016091600 43154315591518148714501400FY 06/07 FY 07/08 FY 08/09 FY 09/10 FY 10/11 FY 11/12 FY 12/13 FY 13/14 FY 14/15 FY 15/16State Fiscal Year# Designated Forensic Beds# Forensic Commitments15
Forensic-ITP Admissions & Discharges1900# ITP 3137314551446132714891336120011001000FY 06/07 FY 07/08 FY 08/09 FY 09/10 FY 10/11 FY 11/12 FY 12/13 FY 13/14 FY 14/15 FY 15/16State Fiscal YearITP AdmissionsITP Discharges16
Forensic-NGI Admissions & Discharges300# NGI 421216615010597100105971247866686665500FY 06/07 FY 07/08 FY 08/09 FY 09/10 FY 10/11 FY 11/12 FY 12/13 FY 13/14 FY 14/15 FY 15/16State Fiscal YearNGI AdmissionsNGI Discharges17
*Forensic-Rubio Admissions & Discharges403834# Y 11/12FY 12/13FY 13/14FY 14/15State Fiscal YearRubio AdmissionsRubio Discharges*Rubios—Individuals adjudicated competent to proceed whoare court-ordered to remain at a mental health treatmentfacility to maintain competency pending trial.18FY 15/16
Forensic Challenges Independent Community Evaluators Court Delays Rubio Commitments Lack of Community Resources Decreased Funding19
Priority of Effortto Date20
Priority of Effort-ProcessDevelopAction Plansto AchievePriority GoalsIdentifyAdditionalActions Neededto AchievePriority GoalsImplementAction Steps& UpdateAction PlansReview ProgressToward PriorityGoals (Monthly)21
Forensic Waiting List 150115141525FY 2012/2013FY 2013/2014FY 2014/20151485State Fiscal Year# of AdmissionsAvg. Days to Admit220# Days to Admit1520# Admitted14
Priority of Effort to Reduce the Forensic Wait ListThe Department, Managing Entities and Network ServiceProviders have coordinated efforts to achieve thefollowing objectives: Goal 1: Increasing forensic community dischargesand diversions. Goal 2: Reducing days to trial competency. Goal 3: Reducing days to pick up for individualsrestored to trial competency.23
Goal 1: Increase Forensic CommunityDischarges & Diversions Regions developed action plans to decreasecommitments, increase diversions and increasedischarges Revised Seeking Placement List/Process Established Monthly Continuity of Care Calls Expanded Community Capacity24
*Conditional Releases (CRs) from MHTFs for FY 15/16140122120100# CRs8380604039200ITPsNGIsTotal CRsCommitment Type*Trend data not available for Conditional Release due to changes indata reporting/collection process.25
Goal 2: Reduce Days to Trial Competency Established New Internal Performance Targets Modified Training Curriculum for Evaluators Implemented “Hotlist” Process Legislation Requiring Continuation of Medications Legislation Authorizing Decreased Timeframe forDismissal of Charges.26
*Average Days to Restore Competency1401400120120121115120010810698# Days100981029410008080060600404002020000FY 0607 FY 0708 FY 0809 FY 0910 FY 1011 FY 1112 FY 1213 FY 1314 FY 1415 FY 1516State Fiscal Year# Days# Restored*Average Days to Restore is calculated using a trimmed mean, withthe top & bottom 5% excluded.27# Restored126
Goal 3: Reduce Days to Pickup Conduct Semi-Weekly Return to Court Callswith Regional Counsel. Legislation Requiring 30 Days to Pickup. Provided Assistance to Regions with AveragePickup Days Exceeding 30 Days.28
Average Pick Up 11681269113812151287FY 1011FY 1112FY 1213FY 1314FY 1415FY 1516State Fiscal YearDischargesAverage Pick up Days291050Competent DischargesAverage Days to PIckup25
Additional Efforts to Reduce Forensic Waitlist 2.6 million including 43 FTEs for forensic bed expansion of25 secure beds at Florida State Hospital. 1.2 million for forensic bed expansion of 11 secure beds atSouth Florida Evaluation and Treatment Center.30
Priority of Effort to Reduce the Forensic Wait List16001314Priority of Effort1215801210109# FY 2012/2013FY 2013/2014FY 2014/2015FY 2015/2016State Fiscal Year# of AdmissionsAvg. Days to Admit310# Days to Admit1560
Priority of EffortNext Steps32
Priority of Effort to Improve the Quality and Performanceof State Mental Health Treatment FacilitiesA strategic plan has been developed and will be deployed over thenext four years, with primary objectives to: Goal 1: Improving Clinical Oversight Goal 2: Expanding Active Treatment Goal 3: Reforming Forensic Services Goal 4: Improve and Align Infrastructure to Serve SpecialPopulations33
Reform Forensic Services Establish New Internal Days to Restore Competency Target Introduce New Staffing Models Expand Treatment:– Increasing Court Education Services– Implement a Relapse Prevention Program– Implement Illness Management and Recovery Program Treat Individuals with Non-Violent Offenses in the Community34
Legislative Budget RequestsFunding has been requested for the following in State Fiscal Year2017/2018 to accomplish identified priority goals: Additional Facility Positions Improve and Expand Programming Community Forensic Multidisciplinary Teams35
Discussion: Questions/Suggestions36
Bob QuamWendy lies.com37
Center) South Florida Evaluation and Treatment Center (Correct Care RS) South Florida State Hospital (Correct Care RS) Florida Civil Commitment Center . South Florida Evaluation and Treatment Center. 30. Priority of Effort to Reduce the Forensic Wait List 1501 1514 1525 1590 9 10 13 12 0 2 4 6 8 10 12 14 1440 1460 1480 1500 1520 1540 1560 1580
