1. CSAC 119th Annual Meeting Healthy Counties - Healthy California
Restoration of Competency
Jail Based Program
Saves Time and Money!
Presented By
Terry Fillman, MBA, RN, CCHP
Health Services Administrator
San Bernardino County Sheriff’s Depart
Terry: Intro to topic

2. Jail Bed Day Management
Incompetent to Stand Trial (IST)
Average Length of Stay (ALS)
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
Terry: Review of jail bed days and specific types of incarcerations found a glaring issue with IST

3. Incompetent to Stand Trial Issues
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
Terry: Review details

4. Jail-Based Program CA Department of State Hospital Pilot
20-bed jail-based treatment program
Incompetent-to-stand trial felony cases
Open-ended option to transfer to State Hospital
Open new collaboration partners
The objectives of Liberty Health ROC Program
Restore to competency- Fast Track
Provide less costly housing and program alternative to state hospital
Help reduce State Hospital waitlist and bed supply
Enable patients to receive more timely treatment
Kevin

5. Fast Track Model The “Fast Lane”
IST defendants are diverse & vary in terms of speed of restorability.
Identify & separate the rapid responders from the defendants requiring long-term treatment.
Eases congestion heading to the state hospital & reduce the waitlists.
Kevin

6. Team Approach Coordinating with the courts, judges, and DA
Addressing public defender’s concerns
Collaborating with State Hospital
Coordinating jail services
Classification and security issues
Housing and Programming space
Custody staff training
Health Services
Primary healthcare, medications, labs, etc
Jail mental health services
Pre and Post ROC program
Suicide Watch
Kevin

7. General Statistics to October 2013
Total admissions: 229
Total discharges: 215
Restored to competency:
Average length of treatment (LOT) for restored patients: 56 days
LOT range for restored defendants: 14 to 150 days
Restored in < 90 days: 89%
Competency Findings upheld: 98%
Transferred to State Hospital: 45%
Average time between admission and transfer request: 60 days
Average length of stay (LOS) for transfers: 90 days
Kevin

8. Medication Data to October 2013
Number of patients prescribed psychotropic medication(s): 90%
Choose not to force medications
Medication compliance incentive program
Fully compliant 87%
Intermittent compliance 3%
Refusing medication: 10%
*Compliance not affecting outcome
Kevin

9. 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
Terry explain

10. Evidence Based Outcomes
ALS for pre-sentenced IST inmates average 296 days each
2012 – 2013 Reduction in jail bed days for IST 469 days each
> 93,000 Jail Bed Days Saved since inception of Jail Based Restoration of Competency Program at San Bernardino County Sheriff’s Department!
Terry explain

11. Contact Information
Deputy Chief Greg Garland
Health Services Administrator Terry Fillman
ROC Executive Director Kevin Rice