1. Managing Bed Capacity in Florida’s Forensic System of Care
National Association of State Mental Health Program Directors
October 3, 2016
Wendy Scott, Director, Mental Health Treatment Facilities
Bob Quam, Chief Hospital Administrator, Mental Health Treatment Facilities

2. Objectives Program Overview Forensic Trends Priority of Effort-to Date
Priority of Effort-Next Steps

3. Program Overview

4. Department of Children and Families Mental Health Facilities
Northeast Florida State Hospital
Legend
Secure Forensic Facilities
Florida State Hospital-Forensic
North Evaluation and Treatment Center
Civil Facilities
Florida State Hospital-Civil
West Florida Community Care Center (Lakeview Center)
Florida Civil Commitment Center at DeSoto CI (CorrectCare RS)
Treasure Coast Forensic Treatment Center At Martin CI (Correct Care RS)
Department of Children and Families Mental Health Facilities
South Florida State Hospital (Correct Care RS)
South Florida Evaluation and Treatment Center (Correct Care RS)

5. Statewide Forensic Capacity
TYPE OF BEDS
TOTALS
Secure Forensic
1160
(1013-Male, 167 Female)
Forensic Step-Downs
455
Total Forensic Beds
1615

6. Forensic Commitment Process
1) Charged with Felony
3) Court Determines Criteria Met for Involuntary Placement
4) Court Commits to Department of Children and Families
2) Court Deems ITP or NGI Based on Evaluation
6) Services Provided in Mental Health Treatment Facility Until No Longer Meets Commitment Criteria
5) Admission Scheduled to Mental Health Treatment Facility
7) Facility Recommends Release
8) Court Approves/Disapproves Release from Commitment

7. Criteria for Forensic Commitment (Chapter 916, F.S.)
Charged with a Felony Offense.
Incompetent to Proceed (ITP) or Not Guilty by Reason of Insanity (NGI).
Danger to Self or Others due to Mental Illness.
Less Restrictive Alternatives Inappropriate.
At Least 18 Years of Age (or a juvenile adjudicated
as an adult).
Criteria for Forensic Commitment (Chapter 916, F.S.)

8. Forensic Admissions to State Mental Health Treatment Facility
Court Ordered for Placement
Referral Packet to Mental Health Program Office.
Admission Scheduled (statutory requirement to admit within 15 days)
Recovery Needs Assessed and Services Provided.
Recommended for Release when No Longer Meet Commitment Criteria.

9. Services Provided at SMHTFs
Basic Support Services
Healthcare Services
Psychiatric Treatment and Rehabilitation
Enrichment Services
Dialectical Behavioral Therapy
Continuity of Care Services
Competency Restoration Training and Evaluation

10. ITPs NGIs Forensic Discharges
Majority Discharged Back to Jail as Competent to Proceed
Stepped-down to a Civil Facility pursuant to Chapter 394, F.S. 
Rubio: Adjudicated competent to proceed & court-ordered to remain at a mental health treatment facility to maintain competency. 
If Non-Restorable, charges dropped or conditionally release to the community.
NGIs
Returned to the Community on a Conditional Release.
Stepped-down to a Civil Facility pursuant to Chapter 394, F.S.

11. Managing Entities
Divert individuals who do not need to reside in the most restrictive settings.
Assist facilities with discharges and/or conditional release planning.
Monitor and serve individuals in the community and ensure adherence to conditional release plans.

12. Managing Entities by Region
Lutheran Services Florida
Big Bend Community Base Care
Central Florida Cares Health System
Southeast Florida Behavioral Health Network
Broward Behavioral Health Coalition
Central Florida Behavioral Health Network, Inc.
South Florida Behavioral Health Network Inc.

13. Forensic Trends

14. Forensic Commitment Appropriations
*Budget amounts for FYS , and have been revised to exclude a program appropriation discrepancy that belonged to the Sexual Predator Program.

15. Forensic Commitments and Designated Bed Capacity

16. Forensic-ITP Admissions & Discharges

17. Forensic-NGI Admissions & Discharges

18. *Forensic-Rubio Admissions & Discharges
Rubio Definition: Individuals adjudicated competent to proceed who are court-ordered to remain at a mental health treatment facility to maintain competency pending trial. 
*Rubios—Individuals adjudicated competent to proceed who are court-ordered to remain at a mental health treatment facility to maintain competency pending trial. 

19. Forensic Challenges Independent Community Evaluators Court Delays
Rubio Commitments
Lack of Community Resources
Decreased Funding

20. Priority of Effort to Date

21. Priority of Effort-Process
Develop Action Plans to Achieve Priority Goals
Implement Action Steps & Update Action Plans
Review Progress Toward Priority Goals (Monthly)
Identify Additional Actions Needed to Achieve Priority Goals Do
Plan
Act
Check

22. Forensic Waiting List Grows

23. Priority of Effort to Reduce the Forensic Wait List
The Department, Managing Entities and Network Service Providers have coordinated efforts to achieve the following objectives:
Goal 1: Increasing forensic community discharges and diversions.
Goal 2: Reducing days to trial competency.
Goal 3: Reducing days to pick up for individuals restored to trial competency.

24. Goal 1: Increase Forensic Community Discharges & Diversions
Regions developed action plans to decrease commitments, increase diversions and increase discharges
Revised Seeking Placement List/Process
Established Monthly Continuity of Care Calls
Expanded Community Capacity

25. *Conditional Releases (CRs) from MHTFs for FY 15/16
*Trend data not available for Conditional Release due to changes in data reporting/collection process.

26. Goal 2: Reduce Days to Trial Competency
Established New Internal Performance Targets
Modified Training Curriculum for Evaluators
Implemented “Hotlist” Process
Legislation Requiring Continuation of Medications
Legislation Authorizing Decreased Timeframe for Dismissal of Charges.

27. *Average Days to Restore Competency
*Average Days to Restore is calculated using a trimmed mean, with the top & bottom 5% excluded.

28. Goal 3: Reduce Days to Pickup
Conduct Semi-Weekly Return to Court Calls with Regional Counsel.
Legislation Requiring 30 Days to Pickup.
Provided Assistance to Regions with Average Pickup Days Exceeding 30 Days.

29. Average Pick Up Days

30. Additional Efforts to Reduce Forensic Waitlist
$2.6 million including 43 FTEs for forensic bed expansion of 25 secure beds at Florida State Hospital.
$1.2 million for forensic bed expansion of 11 secure beds at South Florida Evaluation and Treatment Center.

31. Priority of Effort to Reduce the Forensic Wait List

32. Priority of Effort Next Steps

33. Priority of Effort to Improve the Quality and Performance of State Mental Health Treatment Facilities
A strategic plan has been developed and will be deployed over the next four years, with primary objectives to:
Goal 1: Improving Clinical Oversight
Goal 2: Expanding Active Treatment
Goal 3: Reforming Forensic Services
Goal 4: Improve and Align Infrastructure to Serve Special Populations

34. Reform Forensic Services
Establish New Internal Days to Restore Competency Target
Introduce New Staffing Models
Expand Treatment:
Increasing Court Education Services
Implement a Relapse Prevention Program
Implement Illness Management and Recovery Program
Treat Individuals with Non-Violent Offenses in the Community

35. Legislative Budget Requests
Funding has been requested for the following in State Fiscal Year 2017/2018 to accomplish identified priority goals: 
Additional Facility Positions
Improve and Expand Programming
Community Forensic Multidisciplinary Teams

36. Discussion: Questions/Suggestions

37. Bob.Quam@myflfamilies.com Wendy.Scott@myflfamilies.com