Review the Joint Committee on Access and Forensic Services (JCAFS) data dashboard. Bill Manlove presented the updated dashboard.
Under the Supply header, renovation beds will be available next time. Reduction from the total supply reflects that the number of beds provided are more closely tied to budgeted amounts for bed day costs. This is a more accurate representation of what we are budgeted to provide. Only four beds offline due to staffing – these are in San Antonio.
In Big Spring, the Pine unit had to be closed due to staffing. This is the ICU unit. Their overall census was lowered due to recalculations attributable to maximum capacity, which is a new funding methodology. This will be addressed in potential additional beds and will be reported further in the presentation.
We could bring on an additional 170 beds if all we had to do was add staffing and furniture. Total beds are 2,700, including 500 potential beds. Each new bed that’s built costs half a million dollars. Members ask for each state hospital to be listed along with their potential beds and those currently in use.
In 2002, 18% was forensic and today we see (under the utilization data section) this proportion is 65%. The MSU wait list is growing by about five per month. We are trying to keep patients out of jail and out of inpatient settings – unless they need them – in order to restore them in a less expensive and restrictive setting. There will be an increase in forensics as we move forward because people are paying attention to mental health now. Defense attorneys are asking for mental health evaluations to protect their licenses. Felonies are driving the increase in forensics. Same with cases of “not guilty by reason of insanity” (NGRI). These will continue to go up.
Data on misdemeanants was requested. There were 105 in hospitals in April.
As the forensic population goes up, the civil capacity is restricted. Length of time spent looking and waiting for beds has increased. They are having to go wait in private facilities or jail. Members who are in the trenches need to be listened to. We are the ones looking for beds at 2 in the morning.
Sheriff on the Committee asked if we are at the point where we need to ask for supplemental appropriations to address the growth in forensic patients. Local taxpayers pay for forensics waiting for a bed. There is no reimbursement for these people who are in county jail for months. Supplemental funding is needed. This is an emergency.
Another Member stated that we are talking about people that are on forensic commitment and there’s a court order in place for them to receive treatment. However, there are a number of people in the jails who are mentally ill, do not have a court order, and have been waiting there for a long time. If a supplemental request is to be made, I think there is a real opportunity to focus on the population that has mental illness but would not necessarily need a forensic commitment if they could just get the treatment they need. In the time that these people are waiting, we are missing opportunities for intervention.
Sheriff member describes the financial strains on county jails due to the Sandra Bland Act and other elements.
The waiting list is approaching 800. Most are there because they have been found incompetent to stand trial or NGRI. A person in jail is not necessarily a forensic patient. These people are waiting longer than the 21-day period.
350 beds have been bought, paid for, and are coming. One third of hospital patients have been there for over a year. We are housing them. They don’t need the hospital level of care. If we were to go ask for more money, what is it for? Step-down capacity so we can move them? Inpatient care? Let’s start thinking about the back door. More beds are just going to fill up and stay full.
Two or three recommendations should be made to HHSC regarding some of these issues before the end of the session. The agency’s ability to testify and bring issues forward in the session has passed. The bed issue is not new and has been brought forward on multiple occasions. Agency staff can take information forward. Exceptional Items related to these issues are being considered. Pay increases are key as are construction issues. These will enable beds to stay online if they are passed.
Jail beds can’t be taken offline. Jails are struggling to recruit and retain staff. Each jail is really struggling with this. Compliance issues are a burden as well. Everyone who shows up has to be taken care of. Pay raises really help, according to one member. Let’s shine a light on the Exceptional Items. Can we do a supplemental report? The purpose would be to support the request already submitted and outline the crisis. We need to talk about the forensic crisis. We could take this on as a subcommittee. Realizing state agency staff can’t lobby, other members can take this on.
MSU is not equaling 100%. Q: Why is this? A: Staffing is a constraint. Though we have new beds coming, they are not here yet. Q: How can we free up existing capacity? A: If we can move forensic patients out more quickly, civil capacity is freed up. There are some ways to move forensics out more quickly statutorily. Right now, we don’t have the data to make these identifications.
Daily reports on max security occupancy is usually 95%. More investigation is needed to pinpoint the reasons why this is below 100%.
The adolescent forensic program is down a little. Adult forensic population is back up.
For the full report, follow this link.
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