Forensic Beds Estimation Model: A Practical Tool for Reducing Forensic Bed Wait Times

Program Description

In 2016, approximately 90,000 people were jailed but deemed incompetent to stand trial. Pretrial mental health services for this population are typically provided in state hospitals. However, due to nationwide bed shortages, the majority of state hospitals now maintain waiting lists for these beds. In some cases, the resulting delays can exceed one year. Consequently, thousands of mentally ill individuals sit in jail without ever having been found guilty of a crime. While jailed, their condition frequently deteriorates as their care poses a complicated burden for overwhelmed corrections systems. Far too frequently individuals die while in custody. This crisis has led to lawsuits, contempt of court hearings and devastating headlines across the country. Our Beds Capacity Model gives decision-makers the tools they need to solve this crisis. By utilizing queuing theory, real-world data from the system itself is used to mathematically model the pretrial forensic system. This interactive tool helps decision-makers determine how policy and systems changes, such as adding more beds or diverting individuals into treatment, can reshape the system. Often, the needed changes are surprisingly minor. In an era of limited budgets, decreased mental health spending and uncertain healthcare costs, our Beds Capacity Model is a lifesaving solution.

Creativity

In collaboration with the University of North Carolina, Gillings School of Global Public Health, we have developed an inventive solution to a problem plaguing communities across the nation. Previously applied to systems such as telecommunications, the Beds Capacity Model utilizes evidence-based approach that has never before been applied to the mental health pretrial system. Well-established queuing theory is used to project how changes to mental health policies and practices can dramatically reduce forensic bed waits. An interactive excel-based calculator allows users to model and assess the impact of changing various factors in their system to improve forensic bed waits. Policymakers finally have an evidence-based model they can rely on to examine their pretrial mental health system. With this tool, they can see how even relatively small and inexpensive changes in policy can dramatically reshape a state’s treatment system.

Leadership

The Beds Capacity Model is a pioneering approach to address a major challenge — one that stems from a systemic failure of national proportions. Our research team and advocates have disseminated the findings and innovations of the program throughout the country and generated interest from multiple stakeholders. In the process, we provide the prospect of hope and relief, both to overburdened budgets and the real people needlessly enduring dangerous jail confinement merely because elected officials do not know what else to do with them. The Innovation Award would allow the Treatment Advocacy Center to leverage its position as a national leader in eliminating barriers to treatment for people with the most severe psychiatric diseases and disseminate the Beds Capacity Model to a wider network of jurisdictions. The wider we can circulate these innovative solutions, the more individuals with serious mental illness we can help transition from behind bars into treatment.

Sustainability

Unfortunately, this is a nationwide crisis and so the opportunities for partnering to utilize the model are extensive. With multiple states currently being sued or held in contempt due to their forensic bed wait crisis, the vested interest of state and local policy makers continues to grow. Because this crisis impacts multiple sectors of government, including mental health, judicial, and corrections departments, all involved parties have vested interest. For example, the National Sherrifs’ Association has expressed concerns over the growing number of individuals with mental illnesses languishing in jails with nowhere to send them for treatment and continues to partner with the Treatment Advocacy Center to address this crisis. We have also partnered with Judge Leifman, Eleventh Judicial Circuit Judge in Miami-Dade and Director of the Criminal Mental Health Project, to implement the Beds Capacity Model in their system.

Replicability

The Beds Capacity Model is open source and can be used or downloaded from the web free of charge. Decision-makers and other organizations interested in addressing this crisis can use the model themselves to compute their own individualized outcomes. Our organization is available to provide technical assistance in using the model, ensuring data is correctly collected and aiding in how to use the model for decision-making. In states in which litigation around bed waits is underway or being considered, the model can assist the parties in determining outcomes that are mutually agreeable and help analyze the situation and potential solutions. Other organizations could also press their communities to use the model to address the bed-wait crisis in their community without engaging the Treatment Advocacy Center.

Results/Outcomes

We initially developed the model to address the impact of changing one of three variables: • Demand for beds, represented by inmates being added to a waitlist • Average length of stay for patients receiving competency services • Number of beds available We looked at data from 5 states – Texas, Wisconsin, New Jersey, Maine, and Florida. We found that very small changes to the system can have dramatic effects on the pretrial waiting lists. The following is an example of our findings: • Diverting just two offenders per month in Florida reduced average bed waits 75%; • Reducing length of stay in Texas by just 3 days (189 to 186) reduced bed waits from more than 2 months to just 2 weeks; • Increasing the supply of forensic beds in Wisconsin by just 8 beds reduced bed waits from almost 2 months to 2 weeks.