Forensic Courts Unit

1
Forensic Courts Unit

• Center for Health Care Services

2
The Problem

• Forensic Cases are overwhelming the State
  Hospital System
• Bexar County now has a daily average of 164
  patients in DSHS hospitals where we are funded
  for 134 (-1,421,338 since Sept)
• 41 are Forensic
• Defendants wait in jail 1-4 months for a state
  hospital bed after a finding of incompetency (49
  Days average over the past 12 months)
• Misdemeanor cases take up a large proportion of
  those admitted to DSHS hospitals
• Jails have become the largest provider of mental
  health services in the country

3
How to Address the Problem

• DSHS funded 4 Pilot Outpatient Competency
  Programs after the legislature amended Article
  46B for restoration services (S.B.867)
• Pilots Travis, Tarrant, Dallas, and Bexar
• Our Pilot Program is integrated into the Forensic
  Courts Unit.
• The Forensic Courts Unit provides comprehensive
  outpatient services specifically to forensic
  clients as an alternative to incarceration or
  hospitalization

4
Why have specialized services?

• Courts require a responsible party in which to
  address any legal or public safety concerns
• Forensic clients require legal case management
  services directed at public safety
• Legal case management requires an understanding
  of the law pertaining to criminal commitments
• Frequent courtroom appearances
• Smaller caseloads to maintain adequate
  supervision 25 clients/caseworker

5
Forensic Court Programs
1. Outpatient Competency Restoration
2. Forensic Outpatient Commitments
3. Mental Health Court
4. Drug Court
6
Active Patient Population
OPCR
NGRI
Drug Court
MH Court
34 Clients
57 Clients
25 Clients
26 Clients
7
Recidivism

• MH Court 4 Rearrests
• OPCR 2 Rearrests
• NGRI 0 Rearrests
• 4 Recidivism
• 15 Clients were either rearrested or detained per
  our recommendation in the past 12 Months
• 10 Detention Rate
• Able now to directly admit to SASH Order of
  Detention

8
Forensic Outpatient Commitments

• Called the NGRI Program but is actually 2/3s
  NGRI Commitments and 1/3 Competency Commitments
• The Forensic Courts Unit actively works with the
  San Antonio State Hospital and the Kerrville
  State Hospital to develop outpatient alternatives
  to inpatient treatment.
• OPCR 7 New Clients NGRI 11 New Clients
• In the past 12 months

9
OPCR Program

• Individual and Group Competency Training
  following established criteria
• Weekly staffing and monthly court reporting
• Intensive case management
• Psychiatric Treatment
• Substance Abuse Treatment
• Residential Facility Available

10
OPCR Jail Diversion

• Jail Diversion We admit clients an average of 4
  days after their hearing compared to 49 days if
  waiting in Jail for a DSHS bed.
• We maintain clients on bond after they are found
  competent, usually DSHS cases spends months in
  jail awaiting trial after being found competent
  at DSHS.
• Order of Detention Now able to admit directly
  into SASH when possible

11
OPCR Costs

• Although our services are intensive, our costs
  for maintaining clients on OPCR is only a third
  of what DSHS treatment would be. 100 daily
  compared to 300 daily
• For a 60 day stay this is a cost savings of
  12,000 per client.

12
OPCR Benefits

• Mental Health Treatment rather than Incarceration
• Cost effective
• Clients able to utilize social supports
• Effective communication with the courts
• Staffings held with the courts and at the clinic
  (all programs)
• Accountability

13
OPCR Client Status

• 18 Active in Competency Restoration (37)
• 10 Extended Clients Competency Restoration
  Continues at less frequency (24)
• 6 Failed Rehosp DSHS (12)
• 6 Restored (12)
• 5 Dismissed (10)
• 1 AACOG (2)
• 2 Rearrest (4)
• 1 Deceased (2)
• 49 Total

14
OPCR Diagnosis

• Major Mental Disorder 63
• Mental Disorder BIF 20
• BIF or MR Only 17

15
Terms

• Initial 120 day restoration period (bail) which
  can be extended for 60 additional days once
• Committed annually thereafter
• Misdemeanors limited to 2 years OPCR
• Violent offenses to Vernon Maximum Security (a
  list of certain offenses)
• Other offenses to local hospitals

16
Competency Cycle
Arrest
Jail or Bond
Trial
Commitment
Informal Inquiry
Competency Evaluation
Initial Restoration
Hearing
Agreed Incompetency Hearing or Disposition
Competency Hearing
17
Forensic Court Services UnitCenter for Health
Care Services

• CHCS Director Aaron Diaz, Jail Diversion
• Clinical Administrator
• Michael Alkek
• 2711 Palo Alto Rd
• San Antonio, Tx 78211
• 210-533-2577 X303
• Cell 830-285-0127
• malkek_at_chcsbc.org
• Administrative Asst. Betty Salvatierra 371

18
Last 120 Days

• 72 Requests for Competency Evaluation
• 58 Competency Reports Competent
• 47 Competency Reports Incompetent
• 19 4603 Extensions
• 13 46C Extensions
• 35 46B Extensions
• 27 Restorations
• 16 OPCR Admissions
• 9 NGRI Releases DSHS
• 5 Competency Releases DSHS