Special Notice / Hearing: None__
Vote Required: 4/5ths
To: Honorable Board of Supervisors
From: Christina Corpus, Sheriff, Sheriff’s Office
Louise F. Rogers, Chief, County Health
Michael del Rosario, Director, Correctional Health Services, County Health
Subject: Agreement between County of San Mateo Sherriff’s Office, Correctional Health Services, and Liberty Healthcare Corporation for Early Access and Stabilization Services
RECOMMENDATION:
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Adopt a resolution:
A) Ratifying and approving an agreement between the County of San Mateo Sheriff’s Office, Correctional Health Services, and Liberty Healthcare for Early Access and Stabilization Services for the term of October 23, 2023, through October 22, 2026; and
B) Approving an Appropriation Transfer Request (ATR) increasing Unanticipated Revenue and Services and Supplies in the Correctional Health Budget Unit (6300B) in the amount of $120,000, and the increasing Unanticipated Revenue and Salaries and Benefits in the Sheriff’s Office Budget Unit (3000B) in the amount of $199,992.
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BACKGROUND:
The California Department of State Hospitals (DSH) is responsible for returning individuals to competency after such individuals have been charged with a felony and determined to be incompetent to stand trial (IST). DSH currently has a 2,000-bed waitlist for competency restoration. DSH founded the Early Access and Stabilization Services (EASS) program to facilitate treatment of seriously mentally ill incarcerated persons at the earliest possible point in their incarceration. Following a competitive procurement process, DSH contracted with Liberty Healthcare Corporation (Liberty Healthcare) to be the EASS program provider in this region. EASS treats individuals found IST on felony charges who are awaiting admission to a DSH facility. The goal of the EASS program is to restore to competency many of these individuals while incarcerated, as well as move them through the system and out of the jail more rapidly. Because EASS is a DSH program, once the incarcerated person has been declared IST, the EASS program has the ability to ‘fast track’ transfers the person to a more appropriate facility.
For the past three months, Correctional Health Services (CHS) and the Sheriff’s Office have been contracting with Liberty Healthcare to provide services to inmates under the EASS program on a pilot basis. This program has proven to be an invaluable resource and it is recommended to continue the contract for its entire three-year term. This Board’s approval of this contract is now sought because continuing the contract beyond this trial period will exceed $200,000.
The services provided under the EASS contract focus on beginning treatment on those incarcerated persons who are found to be IST and are awaiting a transfer to a state hospital. EASS will begin the treatment process in the County facility when an incarcerated person is identified by the courts as IST.
Prior to the inception of this program, IST incarcerated persons remained untreated as CHS had no mechanism for providing involuntary medication to that population. Under the EASS program, DSH’s contracted provider Liberty Healthcare is able to administer involuntary medications legally once an involuntary medication order is placed by the courts.
DISCUSSION:
The IST population at CHS is increasing currently there are approximately 25 incarcerated persons who fall under this category. CHS has only one psychologist on staff, and this population disproportionately consumes the psychologist’s resources, which exacerbates staffing challenges for CHS’ Forensic Mental Health team. The EASS program provides their own psychiatrist and clinicians to work with the IST population. If an incarcerated person is found permanently incompetent, DSH must find alternative placement for the incarcerated person where applicable. This saves many hours of work for the CHS clinicians, which allows CHS to allocate more resources to other incarcerated patient populations.
This item is coming to this Board late because the trial period began in October 2023 for three months.
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It is anticipated that EASS will decrease the incarcerated IST population by 25%, reduce the amount of time required to transfer an incarcerated IST person to a DSH facility by 75%-83%, and reduce the percentage of time spent by CHS Psychiatry on IST persons to 25%.
PERFORMANCE MEASURE:
|
Measure |
FY 2023-24 Estimated |
FY 2024-25 Projected |
|
Percentage decrease in incarcerated IST population in the jail |
25% |
40% |
|
Percentage reduction in amount of time required to transfer incarcerated persons to a DSH facility |
75% - 83% |
25% |
|
Percentage of time spent by CHS Psychiatry on ISTs |
25% |
0% |
FISCAL IMPACT:
The term of this agreement is October 23, 2023, through October 22, 2026. There is no Net County Cost impact. EASS pays the salaries of their psychiatrist and clinician and necessary equipment. EASS will also reimburse CHS for direct costs of the psychotropic medications associated with treatment while in the EASS program and will reimburse the Sheriff’s Office up to $16,666 per month for 2.0 FTE Correctional Officers needed to assist the EASS employees and provide IP transportation to treatment. The first Appropriation Transfer Request (ATR) increases CHS’ pharmaceutical budget to implement EASS, as well as increases revenue to accept the reimbursement. The second ATR increases the Sheriff’s Office salaries and benefits to provide the staffing needed and again, increases revenue to accept the reimbursement revenue. Revenue and expenses beyond June 30, 2024, will be included in future budget submissions.