Managing Bed Capacity in Floridas Forensic System of

Managing Bed Capacity in Florida’s Forensic System of Care National Association of State Mental Health Program Directors October 3, 2016 Wendy Scott, Director, Mental Health Treatment Facilities Bob Quam, Chief Hospital Administrator, Mental Health Treatment Facilities 1

Objectives • Program Overview • Forensic Trends • Priority of Effort-to Date • Priority of Effort-Next Steps 2

Program Overview 3

Northeast Florida State Hospital Legend Secure Forensic Facilities Florida State Hospital-Forensic West Florida Community Care Center (Lakeview Center) North Evaluation and Treatment Center Civil Facilities Florida State Hospital-Civil Florida Civil Commitment Center at De. Soto CI (Correct. Care RS) Treasure Coast Forensic Treatment Center At Martin CI (Correct Care RS) Department of Children and Families Mental Health Facilities South Florida State Hospital (Correct Care RS) 4 South Florida Evaluation and Treatment Center (Correct Care RS)

Statewide Forensic Capacity TYPE OF BEDS TOTALS 1160 Secure Forensic (1013 -Male, 167 Female) Forensic Step-Downs 455 Total Forensic Beds 1615 5

Forensic Commitment Process 1) Charged with Felony 2) Court Deems ITP or NGI Based on Evaluation 6) Services Provided in 5) Admission Scheduled to Mental Health Treatment Facility Until No Longer Facility Meets Commitment Criteria 3) Court Determines Criteria Met for Involuntary Placement 7) Facility Recommends Release 6 4) Court Commits to Department of Children and Families 8) Court Approves/Disapproves Release from Commitment

Criteria for Forensic Commitment (Chapter 916, F. S. ) • Charged with a Felony Offense. • Incompetent to Proceed (ITP) or Not Guilty by Reason of Insanity (NGI). • Danger to Self or Others due to Mental Illness. • Less Restrictive Alternatives Inappropriate. • At Least 18 Years of Age (or a juvenile adjudicated as 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 admit within 15 days) • Recovery Needs Assessed and Services Provided. • Recommended for Release when No Longer Meet Commitment 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 Evaluation 9

Forensic Discharges ITPs Majority Discharged Back to Jail as Competent to Proceed NGIs Stepped-down to a Civil Facility pursuant to Chapter 394, F. S. Returned to the Community on a Conditional Release. Rubio: Adjudicated competent to proceed & court-ordered to remain at a mental health treatment facility to maintain competency. Stepped-down to a Civil Facility pursuant to Chapter 394, F. S. If Non-Restorable, charges dropped or conditionally release to the community. 10

Managing Entities • Divert individuals who do not need to reside in the most restrictive settings. • Assist facilities with discharges and/or conditional release planning. • Monitor and serve individuals in the community and ensure adherence to conditional release plans. 11

Managing Entities by Region Lutheran Services Florida Big Bend Community Base Care Central Florida Cares Health System Southeast Florida Behavioral Health Network Central Florida Behavioral Health Network, Inc. South Florida Behavioral Health Network Inc. 12 Broward Behavioral Health Coalition

Forensic Trends 13

Forensic Commitment Appropriations 180, 0 M $ Appropriated (in Millions) 160, 0 M 159, 6 M 151, 6 M 152, 7 M 152, 5 M 144, 5 M 139, 3 M 140, 0 M 130, 2 M 129, 6 M 134, 8 M 134, 7 M 120, 0 M 100, 0 M 80, 0 M 60, 0 M 40, 0 M 20, 0 M 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 15/16* FY 16/17 State Fiscal Year *Budget amounts for FYS 2013 -14, 2014 -15 and 2015 -16 have been revised to exclude a program appropriation discrepancy that belonged to the Sexual Predator Program. 14

Forensic Commitments and Designated Bed Capacity 1800 # of Bed/Commitments 1750 1749 1729 1700 1677 1650 1600 1546 1550 1500 1609 1600 1608 1573 1561 1595 1543 1530 1478 1518 1532 1543 1559 1487 1450 1400 FY 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 15/16 State Fiscal Year # Designated Forensic Beds # Forensic Commitments 15

Forensic-ITP Admissions & Discharges 1900 # ITP Admissions/Discharges 1800 1845 1654 1700 1600 1588 1572 1595 1506 1570 1528 1500 1616 1476 1400 1300 1623 1313 1373 1429 1455 1446 1327 1677 1489 1336 1200 1100 1000 FY 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 15/16 State Fiscal Year ITP Admissions ITP Discharges 16

Forensic-NGI Admissions & Discharges 300 # NGI Admissions/Discharges 258 250 230 209 241 257 225 210 200 174 212 166 150 105 100 97 105 97 124 78 66 65 50 0 FY 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 15/16 State Fiscal Year NGI Admissions NGI Discharges 17

*Forensic-Rubio Admissions & Discharges 40 38 # Admissions/Discharges 35 34 31 34 30 25 22 20 21 15 10 5 9 15 14 5 0 FY 11/12 Rubio Admissions FY 12/13 FY 13/14 State Fiscal Year Rubio Discharges *Rubios—Individuals adjudicated competent to proceed who are court-ordered to remain at a mental health treatment facility to maintain competency pending trial. 18 FY 14/15 FY 15/16

Forensic Challenges • Independent Community Evaluators • Court Delays • Rubio Commitments • Lack of Community Resources • Decreased Funding 19

Priority of Effort to Date 20

Priority of Effort-Process Develop Action Plans to Achieve Priority Goals Identify Additional Actions Needed to Achieve Priority Goals Implement Action Steps & Update Action Plans Review Progress Toward Priority Goals (Monthly) 21

Forensic Waiting List Grows 1530 13 1525 12 1520 10 10 9 1515 # Days to Admit # Admitted 14 8 1510 1505 6 1500 4 1495 2 1490 1501 1514 1525 FY 2012/2013 FY 2013/2014 FY 2014/2015 1485 # of Admissions State Fiscal Year Avg. Days to Admit 22 0

Priority of Effort to Reduce the Forensic Wait List The Department, Managing Entities and Network Service Providers have coordinated efforts to achieve the following objectives: • Goal 1: Increasing forensic community discharges and diversions. • Goal 2: Reducing days to trial competency. • Goal 3: Reducing days to pick up for individuals restored to trial competency. 23

Goal 1: Increase Forensic Community Discharges & Diversions • Regions developed action plans to decrease commitments, increase diversions and increase discharges • Revised Seeking Placement List/Process • Established Monthly Continuity of Care Calls • Expanded Community Capacity 24

*Conditional Releases (CRs) from MHTFs for FY 15/16 140 122 120 100 # CRs 83 80 60 40 39 20 0 ITPs NGIs Total CRs Commitment Type *Trend data not available for Conditional Release due to changes in data 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 for Dismissal of Charges. 26

*Average Days to Restore Competency 120 126 120 121 115 108 106 98 100 # Days 1400 98 1200 102 94 1000 80 800 60 600 40 400 20 200 0 0 FY 0607 FY 0708 FY 0809 FY 0910 FY 1011 FY 1112 FY 1213 FY 1314 FY 1415 FY 1516 State Fiscal Year # Days # Restored *Average Days to Restore is calculated using a trimmed mean, with the top & bottom 5% excluded. 27 # Restored 140

Goal 3: Reduce Days to Pickup • Conduct Semi-Weekly Return to Court Calls with Regional Counsel. • Legislation Requiring 30 Days to Pickup. • Provided Assistance to Regions with Average Pickup Days Exceeding 30 Days. 28

Average Pick Up Days 30 1310 25 24 22 1260 21 20 20 20 1210 15 1160 10 1110 5 0 1215 1168 1269 1138 1215 1287 FY 1011 FY 1112 FY 1213 FY 1314 FY 1415 FY 1516 State Fiscal Year Discharges Average Pick up Days 29 1060 Competent Discharges Average Days to PIckup 25

Additional Efforts to Reduce Forensic Waitlist • $2. 6 million including 43 FTEs forensic bed expansion of 25 secure beds at Florida State Hospital. • $1. 2 million forensic bed expansion of 11 secure beds at South Florida Evaluation and Treatment Center. 30

Priority of Effort to Reduce the Forensic Wait List 1600 13 14 Priority of Effort 12 1580 12 1540 10 10 9 8 1520 6 1500 4 1480 2 1460 1440 1501 1514 1525 1590 FY 2012/2013 FY 2013/2014 FY 2014/2015 FY 2015/2016 # of Admissions State Fiscal Year Avg. Days to Admit 31 0 # Days to Admit # Admits 1560

Priority of Effort Next Steps 32

Priority of Effort to Improve the Quality and Performance of State Mental Health Treatment Facilities A strategic plan has been developed and will be deployed over the next 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 Special Populations 33

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 Community 34

Legislative Budget Requests Funding has been requested for the following in State Fiscal Year 2017/2018 to accomplish identified priority goals: • Additional Facility Positions • Improve and Expand Programming • Community Forensic Multidisciplinary Teams 35

Discussion: Questions/Suggestions 36

Bob Quam Wendy Scott Bob. Quam@myflfamilies. com Wendy. Scott@myflfamilies. com 37