Community-Based Treatment Programs

The Department of State Hospitals (DSH), the state’s psychiatric hospital system, has experienced years of increasing numbers of referrals of individuals found incompetent to stand trial (IST) on felony charges. The increase is largely the result of individuals with serious mental illness - due to limited community-based treatment and early intervention treatment - decompensating to a point where engagement and treatment is difficult. As a result, individuals often become fixed in a cycle of untreated mental illness, homelessness, and incarceration – a de facto criminalization of mental illness. DSH has worked to expand capacity for IST treatment both within state hospitals, but more importantly within the community where individuals can be treated in the least restrictive environment that is clinically appropriate and safe.

With the significant investments in the current and proposed state budgets, DSH continues to expand the continuum of care for individuals found IST on felony charges. The expansive strategies implemented and planned are in response to the growing number of referrals and intended to partner with counties to increase opportunities for individuals with serious mental illnesses, who can be safely treated in community settings, to be diverted from the criminal justice system into community-based treatment rather than be institutionalized in a state hospital when that level of care is not clinically necessary.

In order to increase capacity in hospitals, DSH established an AES Center in Kern County jail where patients receive a full evaluation upon admission to determine the degree of competency restoration required before they are transferred to state hospitals or other programs. The center also treats short-term patients and discharges them back to the referring county directly.

DSH manages a statewide system of community-based services which treat patients with several different commitment types including IST. CONREP patients receive an intensive regimen of treatment and supervision that includes individual and group contact with clinical staff, random drug screening, home visits, substance abuse screening and psychological assessment. DSH has performance standards for these services which set minimum treatment and supervision levels for patients in the program. Each patient is evaluated and assessed while they are in the state hospital, upon entry into the community, and throughout their CONREP treatment.
FAQ on CONREP

Begun in 2011 as a pilot program, the Jail-Based Competency Treatment (JBCT) program treats IST patients inside of a special unit of the jail. This reduces the number of patients awaiting admission into state hospitals. In partnership with local Sheriff’s Departments, JBCT are found in more than 20 counties across California – some of them serving patients from neighboring counties. The dedicated bed capacity as of Fiscal Year 2021-22 was 443.

In 2018, DSH partnered with Los Angeles County’s Office of Diversion and Reentry to establish a Community-Based Restoration program to serve individuals deemed IST in the community. As of December 2021, the program has been expanded to 515 beds. The 2021 Budget Act includes funding to expand the program by an additional 252 beds in up to 17 additional counties activated over a 3-year period.

Since 2019, the DSH Diversion Program has partnered with counties in the development and expansion of programs to provide diversion opportunities to individuals deemed IST. These diversion programs provide treatment in the community for individuals with serious mental illnesses who meet specified criteria and are either currently determined by a court to be IST or likely to be found IST on felony charges. The goal is to divert these individuals from the criminal justice system and connect them to long-term treatment in the community. Individuals who complete their diversion program ultimately have their felony charges dropped. More than 20 counties have activated Diversion programs so far and the current 2021-22 budget has provided authority to expand this program in existing counties to serve more IST individuals, as well as to create new diversion programs in additional counties across the state.
Funding opportunities and technical resources for Diversion Program

In 2022, DSH has created a program, which allows DSH to re-evaluate individuals deemed IST on felony charges who are awaiting admission into a treatment program to determine if they remain incompetent or have restored to competency and no longer need to be committed.

In FY 2021-22, DSH established a 180-bed Forensic Assertive Community Treatment (FACT) program that will serve state hospital patients who are ready to transition to the community and will also serve IST individuals who have been court-approved for outpatient placement in lieu of state hospital placement.