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DATE: |
December 5, 2023 |
02 |
SUBJECT
Title
SHERIFF - REQUEST TO APPROVE AMENDMENT TO THE REVENUE CONTRACT WITH DEPARTMENT OF STATE HOSPITALS FOR THE FELONY INCOMPETENT TO STAND TRIAL (IST) PROGRAM (DISTRICTS: ALL)
Body
OVERVIEW
The Department of State Hospitals (DSH) is responsible for restoring competency to individuals with serious mental illnesses who are found mentally incompetent to stand trial (IST) on felony charges, pursuant to California Penal Code 1370. A person cannot be tried or sentenced while mentally incompetent, therefore IST defendants are to be committed to a state hospital for care and treatment to restore competency in order to stand trial. There is a high demand in California for state hospital beds for substantive services to restore competency, which has created delays to IST treatment. DSH has made efforts to mitigate restorative service delays by introducing programs to facilitate expediency in the competency restoration process as well as alternatives to incarceration through diversion programs.
The San Diego County Sheriff’s Department (SDSD) and DSH agreed to implement the Re-Evaluation Services IST program at Sheriff’s detention facilities and entered into a revenue agreement executed in October 2022 with estimated expenditures of $100,000 per year for Fiscal Years 2021-22, 2022-23, and 2023-24. The SDSD agreed to facilitate access and provide security to IST individuals who DSH identified as being selected for re-evaluation services. IST individuals are escorted from their respective housing locations to the telehealth interview areas within the facilities. SDSD further agreed to provide DSH with relevant incarcerated persons' medical records, including mental health and behavioral health records, and coordinate interviews with defendants who have been determined to be IST on a felony charge, and are awaiting placement into a DSH restoration program.
Due to the high demand for competency restorative services, DSH has increased the re-evaluation services provided by the program, which has resulted in an increase of additional $300,000 in the estimated expenditures of the revenue agreement between now through June 30, 2024. This is a request to approve a revenue agreement addendum increasing the estimated expenditures and revenue for services provided to the DSH Re-Evaluation Services for IST program.
RECOMMENDATIONS
SHERIFF
1. Waive Board Policy B-29, Fees, Grants, Revenue Contracts - Department Responsibility for Cost Recovery that requires docketing Revenue Contracts with the Board at least 60 days prior to effective date of the contract.
2. Approve and authorize the Clerk of the Board to execute, upon receipt, an amendment to the Agreement for Incompetent to Stand Trial (IST) services between the County of San Diego, through the Sheriff’s Department, and Department of State Hospitals (DSH), to increase funding by $300,000.
3. Establish appropriations of $300,000 in the Sheriff's Department, Salaries & Benefits, based on revenue from DSH for the IST program. (4 VOTES)
EQUITY IMPACT STATEMENT
The Department of State Hospitals and San Diego County Sheriff's Department recognize the systemic impact the Statewide waitlist for incompetent to stand trial treatment services has had on incarcerated persons with serious mental illness who are awaiting trial. This agreement continues the focus on equity by decreasing the disparity from the State justice system and benefits the incarcerated person by supporting the access to restoration services.
SUSTAINABILITY IMPACT STATEMENT
The proposed actions support the County of San Diego’s Sustainability Initiative of resiliency by ensuring the County’s ability to respond more efficiently to the immediate needs of incarcerated persons with serious mental illness requiring incompetent to stand trial treatment services. The proposed action to expedite access to restoration and forensic services for incarcerated persons contributes to the County of San Diego's Sustainability Goal to provide just and equitable access because it lessens the time that incarcerated persons need to be housed in a Jail Based Competency Treatment Program or in a state hospital.
FISCAL IMPACT
Funds for this request are not included in the Fiscal Year 2023-24 Operational Plan for the Sheriff's Department. If approved, this request will result in current year costs and revenue up to $300,000. The funding source is revenue from Department of State Hospitals. There will no change in net General Fund cost and no increase in staff years.
BUSINESS IMPACT STATEMENT
N/A
Details
ADVISORY BOARD STATEMENT
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BACKGROUND
Pursuant to California Penal Code Section 1370, when defendants on felony charges cannot understand the criminal proceedings against them or assist counsel in their defense because of a mental disorder, they are found incompetent to stand trial (IST), and the trial or judgement is suspended. They are then ordered to be committed to a state hospital by the courts for substantive services to restore competency so they may continue judicial proceedings.
In August 2022, the Department of State Hospitals (DSH) estimated a majority of individuals deemed IST are unhoused at the time of their arrest and have failed to access any Medi-Cal reimbursable mental health services in the six months prior to their arrest. Moreover, nearly half of IST incarcerated persons within the state of California are cycling in and out of the criminal justice system. This increases IST referrals to state hospitals from the courts.
DSH has made efforts to proactively attempt to remediate delays in statewide IST treatment services. On November 15, 2016 (2), the Board approved the Jail Based Competency Treatment (JBCT) program at San Diego Central Jail. The program has two components: a 30-bed inhouse restoration program, and an agreement between the DSH and the County for partial reimbursement of the program cost on a fixed per diem basis. On August 6, 2019 (3), the Board approved the request to renew the DSH revenue contract for JBCT program services. The Board's approval allowed the competitive procurement for these services for an initial term of one-year, and four one-year option periods for the period of January 1, 2020 to December 31, 2024.
DSH also implemented an Early Access and Stabilization Services (EASS) program to address the IST crisis. On September 12, 2023 (3), the Board approved the County Revenue Agreement for Security for the EASS program, which assists the state in meeting treatment timeliness. DSH contracted with a provider, with the goal of providing early access to enhanced treatment services while the IST individual is in jail, awaiting placement into a state hospital or JBCT program. These services include medications, increased clinical engagement, and competency education for felony IST defendants. DSH provides reimbursement for medications and deputy coverage supporting the EASS program.
This continued high demand for restorative treatment resulted in a waitlist for IST treatment services across the state. California is currently in an IST crisis, in terms of timeliness of restoring competency to individuals the courts have determined to be IST.
The DSH established the Re-Evaluation Services for Felony IST programs as authorized under Assembly Bill (AB) 133 and Welfare and Institutions Code (WIC) Section 4335.2. These services performed by DSH are for the purposes of re-evaluating competency status, medication status, and to assess individuals for placement in an alternative community-based programs such as a mental health diversion or community-based restoration programs. The Re-Evaluation Services for the Felony IST program establishes a process and resources for DSH to perform re-evaluations, primarily through telehealth appointments, for IST defendants pending placement to a state hospital or JBCT program. The re-evaluations performed under this program includes assessing whether the individual has been restored while in jail, determining if the individual is non-restorable or not requiring restoration, filing a report to the court on the status of the patient, and if restored, filing a PC 1372 report, and assessing whether the individual may be a good candidate for diversion and inform the District Attorney, Public Defender, and the Diversion or Community-Based Restoration program, if one is available in the county.
This is a request to approve the revenue agreement addendum for services provided to the DSH Re-Evaluation Services for an additional $300,000 between now through June 30, 2024.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today's proposed actions support the County’s 2023-2028 Strategic Plan Initiatives of Equity and Justice. In terms of Equity, specific to health, this action shall reduce disparity and disproportionality of healthcare among those individuals deemed IST by providing better access to these services as some incarcerated persons wait longer than others for treatment by the State. This action will promote the access and security of the services in hopes of expediting the return to the adjudicative system for those incarcerated persons deemed IST and requiring IST treatment services, which furthers the Justice Initiative of reducing disparities and disproportionality across the justice system.
Respectfully submitted,
kelly a. martinez
Sheriff
Attachment(s)
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