Outpatient Competency Restoration (OCR) Courtney Heard, Ph.D., LPC HB3793 Advisory Committee Meeting February 20, 2014

OCR: Program Description Outpatient Competency Restoration involves outpatient treatment to restore competency Services provided: Competency Education Training Medication Supportive Employment Housing Counseling Substance Use Treatment Intensive Case-Management Services Average length of stay (2008-2013): 128 days

OCR: Eligibility Eligibility Ineligibility Deemed incompetent to stand trial Misdemeanor or felony Offenses Ineligibility Deemed a danger to self or others Refusal of medication Brain damage or cognitive deficits that contribute to non-restorability Intellectual and Developmental Disabilities that contribute to non-restorability

Participant Characteristics

OCR Outcomes (2013) Other outcomes include: Absconded Reoffended Admitted to state hospital Other

OCR: Barriers to Higher Utilization Lack of clarity regarding Code of Criminal Procedure Ability to modify initial orders for 46B commitment from inpatient to outpatient Outpatient programming as an option for competency restoration treatment Timeframes for holding hearings post-competency restoration Lack of trust for outpatient mental health services Refusal of medications while in jail Lack of clinically appropriate justification for admission Extended lengths of stay Lack of resolution for participants deemed not restorable

OCR: Addressing Underutilization Providing education to defense and assistant district attorneys, judges, and law enforcement agencies: The competency restoration process Wraparound services provided by the LMHAs Encouraging the use of court-ordered medications while in jail Providing additional funding for outpatient step-down programs Utilization of peer supports Utilization of housing supports Statutory modifications