II. Optimize the Use of Community Psychiatric Beds in the Region

Gap Addressed

Even with the hospital replacement proposed in Section I, state hospitals, including ASH, are not well designed for short-term acute illness stabilization (i.e., admissions often needing less than a week). This type of care is better provided within a private acute care facility.

Solutions

1. Expand the Community Psychiatric Bed-purchasing program (CPB).

As described previously, although purchasing community psychiatric beds sometimes (but not always) may have a higher per diem expense than ASH, the alternative workflow design leads to significantly shorter lengths of stay, so that total episode costs are decreased. Additionally, the private workflow design optimizes outcomes. Moreover, although there is an admissions backlog into ASH, there are a number of community facilities with current capacity for short-term admissions, as described in the “ASH Service Area: Inpatient Facility Utilization” section of this report. The LMHAs use this resource now, but there are additional opportunities to expand this capability. Expanding community psychiatric bed purchasing could quickly meet some of the mental health needs within the ASH Service Area even while the new facility is being built. Currently, within the ASH Service Area, LMHAs purchase $17M in CPB beds; a 10% increase could provide another 200 to 250 admissions/year, further allowing ASH to focus on the longer-term subacute and complex care it is best at providing, and thereby increasing its capacity. This relatively modest investment will take pressure off state hospital expansions, ultimately providing a less expensive solution that also provides better care.

2. Expand CPB program to provide short-term competency restorations.

As part of the expansion of the CPB program, we propose expanding inpatient competency restoration in community-based inpatient facilities to allow more rapid evaluation of individuals with mental health disorders facing legal charges who clinically require a short hospitalization. LMHAs have the statutory authority to use facilities other than the state hospital for competency restoration. However, in order for this approach to work, statutory changes are required, in which the facility has the ability to discharge the individuals receiving care at the time doing so is clinically indicated, not as dictated by the court. Private facilities are not likely to agree to accept patients in which they cannot manage clinical care and hospital discharge decisions. The court would then determine at discharge whether the individual can be released on his/her own recognizance or instead must return to jail for legal processing. We recommend HHSC funding a pilot program with a provider in Travis County (where the majority of the forensic waitlist is located) to establish processes and costs for this program; this program might be able to be funded through SB292 appropriations. Additional changes to the competency restoration programs to accommodate this suggestion are discussed in the next section of this report.