Transcript Joint Hearing of Senate Health and Human Services and Senate State Affairs Joint Interim Charge #3 August 23, 2006

Joint Hearing of
Senate Health and Human Services
and
Senate State Affairs
Joint Interim Charge #3
August 23, 2006
DSHS State Mental Health Hospitals
Austin State Hospital
•283 civil/ 24 adult forensic
+
+
North Texas State Hospital
Big Spring State Hospital
(Vernon/Wichita Falls)
•74 civil/118 adult forensic
El Paso Psychiatric Center
El Paso Psychiatric Center
+ Terrell State Hospital
+
•58 civil/16 adult forensic
+
Big Spring State Hospital
Kerrville State Hospital
+ Rusk State Hospital
•18 civil/184 adult forensic
+
Waco Center for Youth
North Texas State Hospital:
•Vernon: 0 civil/234 adult forensic
+ Austin State Hospital
+
•Wichita Falls: 241 civil/24 adult forensic
Kerrville State Hospital
Rusk State Hospital
+
San Antonio State Hospital
•245 civil/90 adult forensic
Rio Grande State Center
•55 civil/0 adult forensic
San Antonio State Hospital
•278 civil/24 adult forensic
Terrell State Hospital
•292 civil/24 adult forensic
Waco Center for Youth
+
Rio Grande State Center
•78-bed residential treatment facility for youth
Senate Health and Human Services and Senate State Affairs  DSHS Presentation  August 23, 2006
2
How do People Enter the System?
Civil Commitments
•
Criteria
Presence of Symptoms of Mental
Illness which result in Patient’s:
– Danger to themselves
– Danger to others
•
•
Magistrates/Peace Officers
Adult Relatives and Guardians
Admissions Physician
Treatment Team
Types
– Emergency Detention (24 hour)
– Orders of Protective Custody (30
day maximum)
– Court Ordered MH Services (90
day Temp/ 12 month Extended)
Criteria
– Charged with or Convicted of
Criminal Act
– Mental Illness or Instability
•
Who Gets Involved
– Courts/Judges/Juries
– Admissions Physician
– Treatment Team
Who Gets Involved
–
–
–
–
•
Forensic Commitments
•
Types
– Awaiting Adjudication
• Competency Restoration
– Post-Adjudicated
• Not Guilty by Reason of
Insanity (NGRI)
Senate Health and Human Services and Senate State Affairs  DSHS Presentation  August 23, 2006
3
When do People Exit the System?
Civil Commitments
• Treatment team determines the
person is no longer an imminent
risk to self or others and can
safely be treated in a less
restrictive setting
• An appropriate community
placement exists
Forensic Commitments
• Treatment team recommends
when the person is competent to
stand trial, or (for NGRI) the
person is no longer an imminent
risk to self or others and can
safely be treated in a less
restrictive setting
• Courts/Judges must approve
discharges or changes in
commitment status.
• State Hospitals and Local
Mental Health Authorities have
little control over the actual
discharge of patients.
Senate Health and Human Services and Senate State Affairs  DSHS Presentation  August 23, 2006
4
Growth in Number of Forensic Patients
During 2005 and early 2006, the state hospital system in Texas operated at levels
exceeding capacity. One driver of demand was an increasing number of criminal
code (forensic) commitments. The forensic population now represents 30% of the
patients in state mental health hospitals.
35%
30%
25%
20%
15%
10%
5%
0%
Percent Capacity
July 26, 1998 July 26, 1999 July 26, 2000 July 26, 2001 July 26, 2002 July 26, 2003 July 26, 2004 July 26, 2005 June 26, 2006
13%
13%
15%
16%
21%
21%
Senate Health and Human Services and Senate State Affairs  DSHS Presentation  August 23, 2006
27%
31%
30%
5
Average Lengths of Stay
The average amount of time forensic patients stay at facilities
is considerably longer than that of patients who are at facilities
on civil commitments.
Average Length of Stay (ALOS)
80
ALOS in
Days
60
40
20
2001
2002
2003
2004
2005
ALOS
Forensic
79
80
80
85
79
ALOS Civil
30
27
25
26
26
Senate Health and Human Services and Senate State Affairs  DSHS Presentation  August 23, 2006
6
Population Growth Compared
to Funded State Hospital Beds
Funding for State Mental Hospital Beds has declined while the Texas
population has grown
30
25
20
15
10
5
0
State Hospital Beds
Est. Pop. In Millions
.
40
35
25.0
20.0
15.0
10.0
5.0
FY '92
FY ' 98
FY '06
3,560
17.7
2,774
19.8
2,237
22.5
Senate Health and Human Services and Senate State Affairs  DSHS Presentation  August 23, 2006
0.0
7
State Mental Health Hospital Capacity
• In February 2006, the LBB approved $13.4 million in
additional expenditures for state mental health hospital
capacity. These funds were transferred from DSHS’ FY07
appropriations to FY06.
• As a result, statewide hospital system capacity was
increased by 96 forensic commitment beds and 144 civil
commitment beds, for a total of 240 beds.
• Currently, 194 of those beds are available for use. All 96
of the forensic beds are being fully utilized.
• 334 additional positions were required to fully staff the
additional beds. As of July 28th, 239 positions have been
filled and the remainder should be filled by the end of
August.
Senate Health and Human Services and Senate State Affairs  DSHS Presentation  August 23, 2006
8
State Mental Health Hospital Capacity
• Considerations:
– Examine the commitment process to minimize state hospital
stays for forensic patients
• Shorten the timeframe between patient restoration to
competency and their return to court
• Ensure patient is returned to court as soon as clinically
indicated
– Implement options for community-based competency
restoration
• Requires community-wide engagement
• Provision of clinical services and supports are critical to
success
• These models can significantly reduce total public costs
and improve outcomes
Senate Health and Human Services and Senate State Affairs  DSHS Presentation  August 23, 2006
9
Crisis Services Redesign
• February 2006, DSHS established the Crisis Services Redesign
Committee to develop recommendations for a comprehensive
array of crisis services.
• Members of the committee include medical experts, citizen
stakeholder groups, law enforcement representatives, county
probate court judge representation, and county representatives,
as well as individuals from professional organizations and
provider groups.
• A redesign of crisis services will build on, and is a part of, the
service improvements made by the evidence-based Resiliency
and Disease Management program.
• A thorough review of the current crisis system was conducted,
including holding public hearings around the state, reviewing
current research and consultation with experts.
Senate Health and Human Services and Senate State Affairs  DSHS Presentation  August 23, 2006
10
Crisis Services Redesign
The committee is considering a range of effective
community-based interventions designed to intervene in
and avoid crisis and the need for hospitalization, including:
• 24-hour hotline
• Mobile outreach
• 23 to 48-hour hold capacity
• On-call psychiatric services
• Crisis residential services
• Respite
• In-home crisis resolution services
Senate Health and Human Services and Senate State Affairs  DSHS Presentation  August 23, 2006
11
Effective Treatment Models
• Prevention and early intervention services—
research shows that adverse experiences in
childhood have long-term consequences (ACE
study)
• Jail diversion
• Mental Health courts
• Drug courts
• Access to Recovery project
Senate Health and Human Services and Senate State Affairs  DSHS Presentation  August 23, 2006
12
Texas Access to Recovery Client
Outcomes as of 8/1/06
•
•
•
•
•
92.99%
66.47%
93.90%
99.00%
88.71%
Abstinent
Employed
Not arrested
Not homeless
Socially connected
Senate Health and Human Services and Senate State Affairs  DSHS Presentation  August 23, 2006
13
Return on Investment for Alternatives
to Incarceration
Substance Abuse and Crime Prevention Act (SACPA-California)
Total cost savings after 30-month follow-up period = $173.3 million
SOURCE: SACPA Cost Analysis Report (First and Second Years); prepared by UCLA Integrated Substance
Abuse Program; March 13, 2006.
Senate Health and Human Services and Senate State Affairs  DSHS Presentation  August 23, 2006
14
Youth in Texas at Risk for
Juvenile Justice Involvement
Parental Involvement with
Criminal Justice System
Becomes
Parent
Youth
Behavioral Problem
Juvenile
Justice
CPS Youth
Youth Substance
Abuse Problem
Senate Health and Human Services and Senate State Affairs  DSHS Presentation  August 23, 2006
15
The Challenge
DSHS mental health services are only part
of the public mental health system in Texas.
Law enforcement, education, Medicaid,
CHIP, the criminal justice system, hospitals
and other entities all play major roles in
treating Texans with mental illnesses.
Senate Health and Human Services and Senate State Affairs  DSHS Presentation  August 23, 2006
16
Considerations
• Better coordination of efforts, resources and
funding
• Consistent application of evidence-based
approaches
• Incentives to create diversion options
• Improved data sharing to demonstrate
outcomes and savings
Senate Health and Human Services and Senate State Affairs  DSHS Presentation  August 23, 2006
17