Department of State Hospitals updates Senate subcommittee on proposed programs and facilities

Yesterday, the Senate Budget Subcommittee 3 on Health and Human Services received an update from the Department of State Hospitals (DSH) on a number of ongoing and proposed projects. The subcommittee, made up of Senators Richard Pan, William Monning and Jeff Stone, heard from Chief Deputy Director Stephanie Clendenin and Deputy Director of Administration Lupe Alonzo-Diaz.

DSH oversees five state hospitals which is the largest inpatient forensic mental health hospital system in the nation. Over 90 percent of patients are forensic patients, with the remaining population civil patients who are a danger to themselves of others and require 24-hour care.


Update on Los Angeles County Incompetent to Stand Trial Community Treatment

In the Governor’s January budget proposal, DSH requested $14.8 million to contract with Los Angeles County for 150 beds to treat IST patient in community settings. According to subcommittee materials:

“The contract, currently under negotiation to begin July 2018, would provide a coordinated continuum of mental health placements including five beds in a locked acute psychiatric hospital, 45 beds in a locked Institute for Mental Disease or mental health rehabilitation center, and 100 beds in residential facilities with clinical and supportive services. Los Angeles County has approximately 185 IST offenders awaiting state hospital placement. The contract would also include $2.5 million of funding for Los Angeles County staffing resources for 10-12 positions, including a clinical team of six to eight staff members, which would provide patient support by stabilizing patients on medications and preparing them for community placement, and a navigation team of two to three staff members to support connections to social services and other needs.”

DSH has updated its funding request to $13.1 million in 2018-2019 and $15.5 million ongoing to reflect changes to the total cost of beds and staffing levels.

Staff from the Legislative Analyst’s Office commented on the proposal.

“We think this is a potentially promising way of treating IST patients, as I mentioned earlier. We would note this is a new approach however and so we’d recommend approving it on a limited term basis and requiring that it be evaluated to make sure that this is an effective approach.”

Senator Pan agreed with the need for evaluation.

“I think it would be helpful to have at least some basic evaluation, including identifying some metrics because obviously success in LA County, although LA is a very large county, may also help us with other counties who may want to pursue something similar… So I hope the department will consider thinking about identifying some metrics in terms of being able to find the level of success of this intervention as we try to bring it to a larger scale.”


Update on New Facilities and Facility Repairs

DSH has a Conditional Release Program (CONREP) that provides outpatient treatment to stabilized patients. If a patient cannot live in the community without direct staff supervision, the patient is referred to a Statewide Transitional Resident Program (STRP).

However, the state only has one 17-bed STRP facility in Los Angles County. A 16-bed facility in Fresno County closed in November 2017.

DSH has found a new 26-bed facility in Northern California to potentially replace the closed STPR facility. DSH is requesting $1.6 million for the facility’s annual operating costs.

Another new facility, the Kern County Admission, Evaluation, and Stabilization Center is now up and running after delays in the negotiation and execution of the contact. An average of 5 patients per week are being admitted to get the facility up to its 60-bed capacity.

The AES Center, located at the Lerdo Pre-Trial Facility in Bakersfield, screens jail inmates who are found to be IST to determine where they should be treated. If a patient does not require state hospital treatment, they are treated at the AES Center.

The Napa State Hospital still requires repairs from damages received during the 2014 South Napa Earthquake. DSH provided an update on the building repair timeline and costs.

The estimated costs total $15.5 million with construction lasting until 2019.


Update on Program and Bed Expansions

DSH is working to expand bed capacity for Incompetent to State Trial (IST) patients at Metropolitan State Hospital. However, due to delayed inspections and additional modifications, DSH reduced its request of staff and funding for the expansion.

Now, DSH is requesting staff for approximately 96 forensic beds in 2018-2019 and 140 forensic beds in 2019-2020, a decrease from its original request for staff for approximately 236 forensic beds in 2018-2019.

To help alleviate waitlist issues, DSH is working on expanding Jail-Based Competency Treatment Program Expansions (JBCT). This program activates JBCT beds for the “treatment of IST patients in county jails, pursuant to approval of program expansions in previous budget requests. DSH contracts with county jail facilities to provide restoration of competency services in jails, treating IST patients with lower acuity and that are likely to be quickly restored to competency.”

In January, DSH requested funding for 104 new beds for JBCT programs.

JBCT programs in Mendocino and San Bernardino have experienced delayed activations, but Sonoma plans to add two beds in 2019-2020.