SPRINGDALE — Mental-health advocates have made progress on increasing bed space for acutely ill patients in Northwest Arkansas in the past decade, but gains in areas relating to criminal justice such as greater access to outpatient forensic evaluations and better treatment services for jailed patients are desperately needed, they say.
In fact, when a task force last week looked at a long list of goals established in 2002 and saw how many remained unfulfilled, all they could talk about was where they should start.
Some of the achieved goals took several legislative sessions to accomplish, participants in the Task Force on Mental Health in the Judicial System noted. So the group’s strategy for the coming legislative session is to focus solely on three areas.
Two are supporting and furthering a state Forensic Outpatient Restoration program begun earlier this year and communicating closely with the state Department of Human Services about the top mental-health needs in its coming budget request.
The third is establishing a pilot program of jail-based services to recognize and treat mental illness in those incarcerated in county and city jails.
The group’s chief organizer, Nancy Kahanak, said the task force’s next steps will include drafting logistics of how it will organize and move forward.
Wednesday’s meeting in Springdale was a follow-upto a mental-health forum Oct. 10 in Rogers moderated by Benton County Circuit Judge Jon Comstock.
ADDING BED SPACE
Sgt. Steve Whitmill, an administrator with the Washington County sheriff’s office who was sheriff from 2001-2004, remembers when Northwest Arkansas had a desperate shortage of inpatient beds for the most acutely ill mental patients.
In April 2002, Northwest Medical Center in Springdale closed Highland Hall, its 20-bed unit, leaving the area without Medicaid-covered beds for adults in need of acute mental-health care. Adults having a mental-health crisis often ended up in jails.
In April 2005, the Arkansas Legislature fully funded an $11.5 million annual budget request by mental-health centers statewide in both years of the biennium, for patients both in and out of the criminal justice system. It was the first time lawmakers had funded their request 100 percent.
The previous session, the statewide center had received only $5.8 million in the first year of the biennium and roughly $9.3 million in the second year.
By 2009, two hospitals stepped in to restore the acute inpatient beds lost. Northwest Medical Center-Springdale opened its 29-bed Behavioral Health Unit in partnership with Ozark Guidance Center and University of Arkansas for Medical Sciences. In addition, Springwoods Behavioral Health opened in Fayetteville, devoting 20 of its 80 beds to acutely ill adult patients.
With the new state initiative earlier this year, the Forensic Outpatient Restoration program, Northwest Arkansas’ focus seems to have shifted from the importance of inpatient beds, Whitmill said.
In one sense, that’s good, although several task force participants said far too few patients are gaining access to such forensic evaluations.
“Right now we’re using the Outpatient Restoration program to try to avoid having to use acute inpatient beds,” Whitmill said. “That seems to be working, but what we’ve got to do is get them into that program.”
REDUCING WAITS
This new means of evaluating mental patients who are criminal defendants involves eight mental-health providers around the state contracting with the Arkansas Department of Human Services to assist the State Hospital in meeting a type of court order knownas a 310.
The new program shows promise to reduce the number of defendants waiting, sometimes in jail, because their mental condition prevents them from assisting in their own defense.
A 310 order is entered when a judge finds a defendant mentally “unfit” to proceed with trial or adjudication. To be considered fit, the patients must be able to understand thecharges against them and help their defense attorneys with their criminal proceedings.
The 310 forensic-treatment order gives the state 10 months to restore fitness so the defendant’s legal case can proceed.
Cheri Pieper Carden, a community liaison with Ozark Guidance Center’s Fayetteville office, believes the 30 patients the center has seen this year are a fraction of those who need such evaluations.
“It’s the tip of the iceberg,” she said.
Carden said she gets calls from jail staff members saying someone needs her help, but until she hears this from a judge she’s powerless to help them.
“That’s the law. We have to have a court order,” she said.
Statewide, only 163 such evaluations were ordered in 2011, according to Department of Human Services documents.
Some on the task force said defense attorneys and judges should be educated on the availability of the 310 order when the defendant can’t help with the case.
On Friday, Whitmill said he’s noticed there’s more of a lag time for patients with public defenders than for those with private attorneys, because it can take time before the public defender is appointed.
“In a perfect world, everybody would have a representative who could sign them up for the restoration program,” he said, because an unfit person is unable to do so. In many case he’s seen, “Once they got back on their meds, they were completely compatible with society.”
SETTING PRIORITIES
When the task force established priorities for its goals, it may have been taking advice from those familiar with past lobbying efforts.
Rob Gershon with Ozark Guidance said failing to focus and prioritize the goals tends to lead nowhere.
Without a manageable list of achievable targets, “You’re going to have a lot of activity and no results,” he said.
David Williams, who headed Ozark Guidance when the region lost its inpatient beds, suggested that some goals center on not losing ground already gained, including sustaining increased mentalhealth funding.
It’s paramount to ensure that the Forensic Outpatient Restoration program is not cut from the Department of Human Services budget, he said.
“That was a major breakthrough,” Williams said.
Northwest Arkansas, Pages 17 on 12/02/2012