A Beds Capacity Model to Reduce Mental Illness Behind Bars

National Association of Pretrial Services Agencies, Fort Worth, TX.

Transcript

1. National Association of Pretrial Services Agencies August 20, 2018 Elizabeth Sinclair, MPH Director of Research
2. Treatment Advocacy Center The Treatment Advocacy Center is the only national nonprofit dedicated exclusively to eliminating legal and other barriers to the timely and effective treatment of severe mental illness We do not accept funding from hospitals, companies or entities involved in the sale, marketing or distribution of pharmaceutical products. ESTABLISHED 1998 by E. Fuller Torrey, M.D.
3. Keeping the Issues in the Spotlight
4. Outline } Why are we here? } What are some practical solutions to the problem of forensic bed waits? } How can we utilize simulation modelling as a decision support tool? } Example of how this can be applied? } Q&A
5. Severe Mental Illness in the United States An estimated 8.3 millionadults in America have severe mental illness That is a 3.3% prevalence rate of schizophrenia and severe bipolar disorder in the general population Approximately 50% receive no treatment in a given year
6. SMI in the Criminal Justice System in 2018 People with SMI are at higher risk than the general public to become law enforcement incident calls, typically because of untreated symptoms. } At least 1 of 10 incident calls to law enforcement are associated with a mental health crisis In Rhode Island, it has been reported that 40% of police calls involve people who were mentally ill
7. The “New Asylums” An estimated 1.8 million of individuals with serious mental illness are booked into US jails every year Nearly 400,000 are incarcerated on any given day; 40% of individuals with severe mental illness spend time behind bars during their lifetimes
8. Why are jails and prisons the ‘New Asylums’?
9. De-institutionalization
10. The Ideal The idea behind deinstitutionalization was fundamentally sound. Most patients could live safely outside a hospital while being treated in community facilities, provided that such treatment facilities existed.
11. The Execution
12. Why “New Asylums”? In 1955, we had almost 560,000 beds in state hospitals By early 2016, we had 37,679
13. Lionel Penrose’s Hypothesis in 1939 Based on a cross-sectional study in 18 countries, Dr. Penrose found that prison and mental hospital populations are inversely related. If one form of confinement is reduced, the other will increase. Where prison populations are extensive, psychiatric hospital populations will be small. And vice versa. Lionel Penrose 1898-1972 Psychiatrist Medical geneticist Mathematician Chess theorist
14. Trans-institutionalization
15. An estimated 536,000 US jail inmates are awaiting trial any given day At least 139,360 have a mental illness the majority are legally “incompetent to stand trial” (IST) Despite other options, state hospitals remain the default treatment setting for IST services Roughly 8,800 state psychiatric beds exist to serve this purpose Why State Hospital Beds Matter
18. Impact on Inmates Pretrial forensic bed waitlists are maintained in 78% of states. Most waits around a month long, some as long as a year ONLY 17% OF THESE DEFENDANTS RECEIVE TREATMENT WHILE THEY WAIT Suicide is the leading cause of death in US jails
19. Inside the New Asylums Risk of segregation/solitary confinement is high At least 84,000 US prisoners live in isolation at least 16 hours a day That is about 1 in every 6-7 adult inmates. At least 3% of females and nearly 10% of males are reported to have SMI Some have been there for years 70% of jails report segregating inmates with mental illness
20. Impact on Corrections
21. Impact on Taxpayers County governments spend $9 billion to jail pretrial defendants Jails spend 2-3x more per inmate on detainees with mental illness than on other inmates
22. Impact on States
23. Stuck in the Competency Restoration Revolving Door
24. We Asked ’WHAT IF?’ } Fewer people with mental illness were being arrested and added to bed waitlists? } Average state hospital stays were not extended for non-clinical reasons? } There were more psychiatric beds?
25. Solution: Beds Capacity Modelling Relatively small changes in common policy and practice could dramatically reduce pretrial bed waits and the mass incarceration of individuals with serious mental illness
26. Sample Finding In FLORIDA … diverting 2 SMI detainees from the 120 reaching jail per month reduced average bed waits from 12 days to 3 days
27. Sample Finding In TEXAS … reducing average hospital stay from 189 days to 186 days (2%) reducedbed waits from 2 MONTHS to 3 days
28. Sample Finding In WISCONSIN ... adding 8 psychiatric beds to the state’s 70 reduced average bed waits from nearly 2 months to 2 weeks
29. Simulation Modeling • “Process of creating and analyzing a digital prototype of a physical model to predict its performance in the real world.” What is a simulation model? • It is most useful when changes to a real system are difficult to implement, involve high costs, or are impractical. Why do we need to use a digital prototype? • Writing code in a programming language, statements simulation modeling software, formulas in an Excel spreadsheet etc. How do we create and analyze a simulation model?
30. Arrival Exit Pre-arrest and pre- trial diversion, such as CIT and AOT Step-down units, supported housing, community treatment options Psychiatric bed capacity, staffing
33. Example Two server queueing system Objective: To test out two different customer routing policies at a fast food restaurant. • Policy 1: Single waiting line - two servers – customer joins whichever server is free • Policy 2: Two distinct waiting lines (one for each server) – incoming customer joins the shorter line
34. Example Two server queueing system } 1 customer arrives every 15 minutes. } A server takes approximately 20 seconds to service a customer. Policy 1 Policy 2
35. Result Average wait time Policy 1: 20 minutes Policy 2: 24 minutes
36. Solution: Forensic Bed Wait Calculator
37. Miami-Dade Jail Diversion Program
38. Acknowledgements } Doris Fuller, Chief of Research and Public Affairs (ret.), Treatment Advocacy Center } Dr. Kristen Hassmiller-Lich, Associate Professor, Health Police and Management, University of North Carolina Gillings School of Public Health } Sidd Nambiar, PhD Candidate, Health Systems Engineering, North Carolina State University } Judge Steve Leifman and the Criminal Mental Health Project staff
39. Questions? Comments? Elizabeth Sinclair Director of Research Office of Research and Public Affairs sinclaire@treatmentadvocacycenter.org @TreatmentAdvCtr #TACResearch