1. Restoration of Competency in Jail: A Proven Program That Saves Time and Money 
John McMahon, Sheriff
San Bernardino County Sheriff’s Dept
Presented by:
Terry Fillman, Health Services Administrator
Jon Pacewiczh, Captain
Corrections Standards and Operations Division

2. Jail Bed Day Management
Abbreviations:
(IST) Incompetent to Stand Trial
(ALS) Average Length of Stay
2009/2010 the ALS for pre-sentenced IST inmates average was 765 days each
2009/2010 the ALS for pre-sentenced non-IST inmates average was 42 days each
Review of jail bed days and specific types of incarcerations found a glaring issue with Incompetent to Stand Trial inmates and their length of stay! Jail bed days cost the Sheriff’s Dept

3. Incompetent to Stand Trial Issues Not Just Programming Time
Pre-sentenced time for IST
Arrest court process to determine IST
State mental hospital admission wait time
State mental hospital admission treatment time
Return to jail determined competent
Return to court process
Possible decompensation
Repeat process
Adjudication
The problem with the IST process is not just with the length of programming time! Prior to the ROC program, NO ONE was taking responsibility for the court process time, getting the correct paperwork, wait time for admission to the State Hosp, when someone returned from State Hosp there was no adequate mental health follow up or ensure medication compliance…which would often lead to decompensation and starting the process all over again….hence the 765 days!

4. Jail-Based Program The program design The objectives of Liberty ROC
20-bed jail-based treatment program
Incompetent-to-stand trial felony cases
Open-ended option to transfer to State Hospital
The objectives of Liberty ROC
Restore to competency in under 70 days
Provide less costly alternative to state hospital
Contribute to resolution of State’s waitlist dilemma
Enable patients to receive more timely treatment
(Read slide: describes details of program)

5. Fast Track Model The “Fast Lane”
IST defendants are diverse & vary in terms of speed of restorability.
ROC aims to identify & separate the rapid responders from the defendants requiring long-term treatment.
Eases congestion heading to the state hospital & reduces the waitlists.
(Read slide: describes details of program)

6. Program Requirements Coordinating with the courts and judges
Addressing public defender and prosecuting attorney’s concerns
Collaborating with the Department of State Hospitals
Coordinating with:
Custody staff for security and patient access
Health Services staff for shared patient care
(Read slide: describes details of program) These details were the biggest hurdles in establishing the program since it had never been done and generally these diverse stake holders were not accustomed to be working together!

7. General Statistics to August 2014
Total admissions: 310
Restored to competency: 99% of those accepted
Average length of treatment (LOT) for restored patients: 56 days
LOT range for restored defendants: 14 to 150 days
Restored in < 90 days: 89%
Transferred to State Hospital: 40% of total IST
Transfer due to high acuity with long term needs
Average time between admission and transfer request: 60 days
Average length of stay (LOS) for transfers: 90 days
(Read slide: describes details of program)

8. Medication Data to August 2014
Number of patients prescribed psychotropic medication(s): 90%
How compliant are they?
Fully compliant : 87%
Intermittent compliance : 6%
Refusing medication: 7%
(Read slide: describes details of program)

9. Malingering Tested Malingering
Some IST defendants grossly exaggerate or fabricate symptoms of a mental illness and/or cognitive impairment.
Motivated by a desire to:
Delay their criminal proceedings
“Do time” in a better environment (jail vs. hospital)
Obtain medications that are highly abused in corrections
Lay the foundation for a Not Guilty by Insanity defense
ROC defendants suspected of malingering undergo comprehensive psychological testing and extensive observation prior to rendering a final opinion.
(Read slide: describes details of program)

10. Beneficiaries/Benefits
Beneficiary
Benefit
The State of California
Reduction in patient referrals to State Hospital
Efficient utilization of resources
Timely treatment for lowest and highest acuity mental health patients
Cost savings and containment
(Read slide: describes details of CA State Benefit)

11. Beneficiaries/Benefits
Beneficiary
Benefit
The Courts
Reduction in court time for IST cases
Thorough and comprehensive reports
Improved communication with all parties
(Read slide: describes details of courts Benefit)

12. Beneficiaries/Benefits
Beneficiary
Benefit
Mental Health Patient
Improved and timely mental healthcare
Continuity with housing, staff and care providers
Reduction in court and incarceration time
(Read slide: describes details of Mental Health Patient Benefit)

13. Fiscal Outcomes California Legislative Analyst Office Report:
Recommended expanded use of ROC programs because of ability to significantly decrease costs to public sector
After first nine-months of operation, LAO estimated:
$1.2 million savings for the State
$200,000 savings for San Bernardino County
ROC provided treatment at a cost of about $70,000 less per patient.
Information and statistics from LAO report, January 3, 2012 at
Evaluation of the program from the CA Legislative Analyst Office with cost savings identified after nine months of operations

14. Evidence Based Outcomes
Before ROC
2009 – 2010 average length of stay for pre-sentenced IST inmates: 765 jail bed days
After ROC
average length of stay for pre-sentenced IST inmates: 279 jail bed days
2012 – 2014 Reduction in jail bed days for IST 486 days
310 IST inmates with ROC x 486 jail bed days saved =
150, 660 jail bed days saved since the inception of Jail Based Restoration of Competency Program at San Bernardino County Sheriff’s Department
(Read slide describes fiscal benefit to SBCSD)

15. Contact Information
Greg Garland, Deputy Chief of Corrections
Terry Fillman, Health Services Administrator
Jon Pacewiczh, Captain C.S.O.D
Kevin Rice, ROC Executive Director
Contact info: Done! Enjoy the rest of the day!!!!!!!!!!!!!