Arkansas officials are hoping a new means of evaluating mental patients who are criminal defendants will result in fewer waiting in limbo, either in jail or out in the community, because their mental conditions prevent them from assisting in their own defense.

The Arkansas Department of Human Services is nearly eight months into an initiative contracting with community mental-health centers around the state to help move the defendants through the criminal-justice system and, as well, to help the State Hospital reduce its waiting list of forensic patients.

There has been a drastic increase in demand in the past decade on Arkansas’ forensic system to provide court-ordered evaluations, said agency spokesman Amy Webb.

The State Hospital regularly deals with two types of pretrial forensic orders: a “305” order in which a defendant must be evaluated to determine mental state at the time of the crime, and the lesser-known “310” order in which the evaluation determines whether the patient is fit to help defense attorneys.

A 310 order gives the state 10 months to “restore fitness” - provide treatment to stabilize and improve - so the patient can understand the criminal charges and assist in the defense efforts, according to Department of Human Services documents.

Thus the program the state began in April to expedite such orders was dubbed Forensic Outpatient Restoration.

The chief of one of the centers helping the state with its backlog said the benefits for the patient are twofold.

“If they qualify for restoration, then they can get services in their own community,” said Tom Petrizzo, chief executive officer of Ozark Guidance Center in Springdale.

“And they would be moving toward resolution of whatever the charges were against them, rather than just waiting - I don’t know how to say it, but just languishing in jail or out on bond,” he said.

Until the patient’s criminal case can move towarda trial, a plea bargain or dismissal of the charges, Petrizzo said, “They’re on hold.”

In one year alone, between January 2010 and January 2011, the state’s 310 waiting list grew from 44 to 64 patients, a spike of more than 45 percent. The number of those who sat in jail while on the waiting list grew from 25 to 32, a 28 percent increase.

Webb said the strain on the state system led Gov. Mike Beebe to give the State Hospital a $2.5 million allocation in July 2011 to add more than a dozen new staff members.

But the department’s Behavioral Health Services Division also recognized the need for people to get services close to home so that they wouldn’t have to make expensive, long trips to Little Rock and end up having to stay in the State Hospital for evaluation and treatment, she said. So the state decided to turn to community healthproviders to help out.

By January of this year, the 310 waiting list continued upward, with 74 patients total - 37 of them in jail.

“Take-home message: We have been losing ground on our 310 waiting list despite increasing overall numbers of admissions,” wrote the State Hospital’s medical director, Dr. Steven Domon, in a report titled “Forensics 101 and the Outpatient Restoration Process.”

Around the time of the Forensic Outpatient Restoration program’s start in April, the number of defendants waiting for 310 evaluations had again climbed to 90, half of whom were in jail.

TEXAS RESULTS

In Texas, where state lawmakers funded pilot Outpatient Competency Restoration clinics in four counties in 2008, 80 percent of defendants are successfully restored to competency during treatment plans that average about three months, the Austin American-Statesman reported in May.

At that time, officials told the newspaper the programs had successfully helped about 600 mostly misdemeanor defendants achieve competency at less than half the cost of the state’s typical inpatient restorations, but that the outpatient method often took longer.

In a January 2011 report, the Hogg Foundation for Mental Health in Austin found that the four pilot projects in Travis, Bexar, Dallas and Tarrant counties had served about 415 patients at that point.

And while the community outpatient treatments took on average 13 days longer than the state’s treatments, the average daily cost per person was $140 compared with $401 when the patient is committed to one of the state-run hospitals, for an average perperson cost of $14,280 compared with $35,689.

Texas officials estimated then that investing in more outpatient centers would result in savings of nearly $20 million in the state’s two-year budget biennium, when the costs of the program’s averting lengthy jail stays for the defendants also was taken into account.

Perhaps more importantly, a prosecutor told the American-Statesman this year, the number of detainees whose fragile mental states can’t take a long jail stay without deteriorating further could be reduced.

Petrizzo recalled that around the time of Beebe’s interest in the issue, a consultant from Texas made a presentation to Arkansas officials on how private providers can help a state move the process for defendants more quickly and how it can cut costs.

According to Department of Human Services documents, Arkansas officials believe that the providers’ outpatient treatment in the communities can sometimes help the defendants before they would have gotten off the State Hospital’s waiting list for inpatient evaluation - meaning the new program shows promise to divert some patients from the state facility entirely.

STATE PARTICIPANTS

Between the program’s inception and early October, Petrizzo said, Ozark Guidance Center assessed 24 patients. Of those, roughly a half dozenreceived or are receiving restoration treatment.

About 10 patients out of the total were referred back to the State Hospital, Petrizzo said: “They were too complicated for outpatient.”

The nonprofit Springdale center’s contract with the state is not for a flat amount, he said, but rather is based on fees for service.

Six other providers around the state have contracted with the Department of Human Services for Forensic Outpatient Restoration and an eighth, Delta Counseling Associates, has an agreement pending its training by the State Hospital, Webb said.

The other six are: Professional Counseling Associates, South Arkansas Regional Health Center, Little Rock Community Mental Health Center, Health Resources of Arkansas, Southwest Arkansas Counseling and Mental Health Center and Mid-South Health Systems.

Since the program began in April, the State Hospital has referred 74 clients on its inpatient waiting list to the community providers for outpatient restoration, according to a report that Webb provided.

More than half the defendants - 38, or 52 percent - were able to achieve competency and were either re-evaluated or scheduled to be re-evaluated, either by the community provider or by the State Hospital, the report said.

Northwest Arkansas, Pages 13 on 11/25/2012