Continuity of Care Task Force February 5, 2010

BACKGROUND The Texas State Psychiatric Hospital system is nearing capacity While total admissions and civil commitments have decreased, the number of forensic commitments has increased Forensic commitments generally involve longer lengths of stay The increased number of forensic commitments and longer term patients has overcome the impact of decreased admissions

TASK FORCE GOALS Examine the overall continuum of care for individuals with severe mental illness who move through multiple systems Make and prioritize recommendations to improve efficiencies, access and quality Examine barriers to discharge for individuals in State Hospitals with extended lengths of stay Make and prioritize recommendations to resolve barriers to discharge

TIMELINE Four Task Force Meetings ◦ February 5, 2010 ◦ February 19, 2010 ◦ March 26, 2010 ◦ April 16, 2010 Four Public Forums ◦ March 3, 2010, Czech Heritage Hall, LaGrange, TX Individual Interviews Meetings with Key Professional Groups Final Report—September 30, 2010

SYSTEM MAPPING State Hospital capacity issues are multi- factorial How do individuals move through systems? What are the similarities and differences of this movement across the state? What are some potential points of intervention? What additional data do we need?

POINTS OF POTENTIAL INTERVENTION Community Prevention Law Enforcement Jails Courts Re-Entry/Re-Integration

LAW ENFORCEMENT ◦ Community Based Alternatives to Arrest/Incarceration  Wide utilization of MCOT? ◦ Specialized Law Enforcement Teams/Models  Implemented in most urban areas?  Rural alternatives? ◦ Law Enforcement Training ◦ Discretion about Charges ◦ Data Needs?

JAIL BASED STRATEGIES Screening/Assessment Jail Based Treatment ◦ Formularies ◦ Forced Medications Utilization of 16.22/ Release on Personal Bond Data Needs?

COURT BASED STRATEGIES Identification of behavioral health issues Court coordinators Raising competency Specialized dockets/courts/attorneys Restoration ◦ Outpatient restoration of competency ◦ Not likely to regain Data needs?

RE-ENTRY/RE-INTEGRATION Discharge Planning ◦ Jails ◦ Prisons ◦ Hospitals Appointments Medications Housing

COMMUNITY PREVENTION Expansion of community based (not just crisis) care Target population Guardianship Integrated Behavioral Health ACT/FACT/FICM Data Needs?

NEXT STEPS System Mapping Follow Up Examination of Extended Stay Population Other Stakeholders? Future Planning