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Forensic Services Work Plan

 The Department of Human Services (DHS) Office of Mental Health and Substance Abuse

Services (OMHSAS) is analyzing service utilization, admission wait times, populationdemographics and other factors related to operations of the Regional Psychiatric ForensicCenters (RPFC) at Norristown and Torrance.

Competency evaluations and competency restoration treatments are part of the process to helpstabilize individuals from a psychiatric perspective so that they can return to their referring

 jurisdictions to participate in pending criminal proceedings. The centers also provide extendedcare for individuals who have not responded to treatment and are not able to participate in theirown defense. Other individuals are in extended care because of a judicial determination thatthey are not guilty for reason of insanity (NGRI). A review of available data detailing referralpatterns, waiting list statistics and utilization data was critical to identifying opportunities toadjust utilization patterns and improve access to service.

 At this point in the review OMHSAS has identified a significant service area that has a majorimpact on utilization of beds at the Norristown RPFC. Our data analysis identified 36 individualswho completed both evaluation and restoration services and were deemed competent to standtrial but remained in the Norristown Forensic Center for extended periods of time awaiting returnto the referring jurisdiction. These cases consumed over 12,000 bed days so far during thecurrent fiscal year. This is the equivalent of 30 forensic beds that could not be used to meet therestoration service needs of other individuals from the waiting list.

 Any efforts to move individuals who are determined competent to stand trial back to the referring jurisdiction on a timely basis will have an immediate effect in reducing the waiting period forother referrals.

Therefore, the following five focus areas will allow DHS to begin addressing the existing waitingtimes, including Philadelphia/Norristown specific initiatives:

1. Outpatient Competency EvaluationDHS will continue to work with counties to participate in the outpatient treatment processto reduce the number of requests for admissions to the forensic units for competencyevaluations. Recently Bucks County initiated the process and made six referrals tooutpatient treatment, thus removing requests for six admissions to Norristown.

 Approximately half of the competency evaluations in outpatient treatment havedetermined individuals to be competent, which for the vast majority of cases removesthe need for a forensic admission. We are approaching 150 cases which have avoided

forensic admission for the fiscal year and have a target of 200 for fiscal year 15/16.Specific next steps include:

1) Presenting the option for outpatient evaluation for every referral received for anadmission to one of the forensic units for a competency evaluation.

2) Reviewing the previous year’s data on the number of requested competencyevaluations done at the forensic units to target outreach to the counties that havemade the request so that we can meet with them to explain in detail the outpatientprocess and attempt to get them to utilize the process.

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2. Outpatient/Jail Based Competency Restoration A person is incompetent to stand trial if, due to a mental illness, he is substantiallyunable to understand the nature or object of the proceedings or to participate or assist inhis defense. Not everyone with mental illness is automatically considered incompetentto stand trial. Competency restoration is the provision of mental health treatment,including medication and therapy, to restore competence to stand trial. DHS staff were

approached by Allegheny County mental health staff about developing a model to do thisand a brief conversation occurred. A similar approach was made by the Philadelphiaprison mental health provider to Norristown staff; a meeting that covered this and manyof the Philadelphia specific items from above were discussed. Liberty HealthCareprovided information to DHS during the prior administration on the models they operatein California and Texas. Next steps are to official engage with interested parties andidentify which entity (state or county) pays for which services and obtain support fromthe judicial system. Successful implementation of this concept would make a significantimpact on the demand for state hospital forensic units.

3. Philadelphia Specific Initiatives for Immediate Action At this time, our hospital of focus is Norristown due to the larger number of individuals

awaiting admission in Philadelphia and Delaware Counties. DHS has been working areastakeholders on the following issues:

1) Ability to move up trial dates and for the mental health provider within the county jail,MHM Services, Inc. staff maintain the individuals until trial.

2) Alternative service/treatment options for those individuals not competent, nor likely toregain competency.

3) Conflicting evaluations on competency being received by the court’s consultingpsychiatrist for individuals Norristown identifies as competent. These reviews arecompleted by psychiatrists that are contracted with the Philadelphia courts with thelawyers present and reportedly are based on less than an hour of evaluation. (Theseare often cases where individuals with personality disorders feign MH issues to avoid

 jail.)4) Development of jail or community-based restoration treatment.5) Potential to use outpatient commitments to keep inmates on medications that are

working to maintain competency/stability. (Dauphin County is a leader in this area.)

4. Step Down Unit DevelopmentDHS would develop units in combination with Community Hospital Integration ProjectProgram (CHIPP) initiatives. The Department would work with stakeholders includingthe Public Defender ’s Office and county/city administrators on a step down unit thatcould help reduce wait times at Norristown State Hospital.

5. Process Changes - Internal

Due to the increasing complexity of the forensic issues and the need tomanage/coordinate the items above recommendations to changes in how DHS staffsand manages the services been developed. They include centralizing the referralprocess which would allow DHS to make priority decision on admissions; work with thecourts to divert admissions for lower level offenses to alternative service locations (oruse o/p services from above); reestablish a Forensic Section within OMHSAS under theOperations Bureau to coordinate forensic initiatives (this was present under the Rendell

 Administration); and generate regular statistical reports to be shared with the judicialpartners on utilization and other pertinent information. 

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