Topic:
MENTAL HEALTH; HEALTH FACILITIES; PSYCHIATRY AND PSYCHIATRISTS;
Location:
MENTAL HEALTH FACILITIES;
Scope:
Connecticut laws/regulations;

OLR Research Report


August 2, 2000

 

2000-R-0704

WHITING FORENSIC DIVISION

By: Helga Niesz, Principal Analyst

You asked what Whiting Forensic Institute is, who gets sent there and what the standards for admission are, how many beds the place has, how many staff, what the average stay is, whether there are enough beds or whether more are needed, and what the need is and the cost involved in a potential expansion.

SUMMARY

The Whiting Forensic Institute is now known as the Whiting Maximum Security Service (WMSS), part of a broader Whiting Forensic Division of Connecticut Valley Hospital, a state mental hospital. It is under the administration of the Department of Mental Health and Addiction Services (DMHAS). The division now also includes the Dutcher Enhanced Security Service and the Restoration Treatment Program in Battell Hall.

The division's patients are people who have a psychiatric disability and are a serious danger to themselves or others, including people who are found not guilty of a crime by reason of insanity, are not competent to stand trial, are convicted of a crime but whom the court sends to the division for pre-sentence evaluation, are in the custody of the Department of Corrections (DOC), but cannot be managed at DOC facilities, and people from the general psychiatric population at other mental health facilities who are dangerous to themselves or others.

The division engages in treatment, security, evaluation, testimony, risk management, public safety, education and research.

The Whiting Forensic Division has a total of 268 beds, of which 103 are in the WMSS, 117 are in Dutcher, and 48 are in the Restoration Service.

The whole division has 552 authorized staff positions, of which 225 are in the WMSS, 174 in Dutcher, and 78 in the Restoration Treatment Program. The rest are division-wide staff.

Average stay information was only available for insanity acquittees supervised by the Psychiatric Security Review Board (PSRB). Their average term of commitment to PSRB is 42.6 years, but the average stay for these people who start their commitment in WMSS is 6.1 years, after which they are transferred to Dutcher for, on average, another 2.6 years.

We obtained most of this information from a memo (enclosed) sent to us in response to our questions by Doreen DelBianco, DMHAS' legislative liaison, which also discussed admissions, discharges, waiting lists, and related issues.

We were able to obtain no specific information on the need for more beds, the level of need, or expansion costs. Neither DMHAS nor the Office of Fiscal Analysis could currently answer this question. DMHAS is now studying this issue as part of its planning, according to a second (enclosed) memo from DelBianco, but the department will apparently not have specifics available until January. One of the expert panel recommendations of the Governor's Blue Ribbon Commission on Mental Health (p. 123) is an expansion of beds at the Whiting Forensic Division, but the recommendation contains no details. The full Blue Ribbon report is available at: http://www.dmhas.state.ct.us/PDF/fullreport.pdf

WHITING FORENSIC DIVISION

The former Whiting Forensic Institute was statutorily renamed in 1995 and expanded as the Whiting Forensic Division of Connecticut Valley Hospital (PA 95-257, CGS 17a-560 to 576). It is under the control of the DMHAS. The division consists of three parts:

1. The Whiting Maximum Security Service (WMSS) is the highest security level. It consists of three acute admission units and three intermediate/extended treatment units.

2. The Dutcher Enhanced Security Service has a lesser security level than WMSS. It consists of three community preparation units working primarily with insanity acquittees, and two special assessment and treatment units. The three units that form the Community Preparation Program are for individuals under the jurisdiction of PSRB who are in some stage of community reintegration. One of the special assessment and treatment units is for insanity acquittees who no longer need maximum security, but still need intensive treatment and rehabilitation prior to community reintegration, and another unit is for civil patients designated as high risk, that is, individuals with extensive histories of physical and/or sexual violence. For the Dutcher Service, 80% of the patients are PSRB patients who no longer require maximum security.

3. The Restoration Treatment Program in Battell Hall was administratively moved to the Whiting Forensic Division in October 1999. This program provides inpatient services for patients committed after being found not competent to stand trial (CGS 54-56d). A defendant in a criminal case cannot be tried, convicted, or sentenced while he is not competent, i.e., unable to understand the proceedings against him or assist in his own defense. The program evaluates and treats patients at least age 18 who have been found to be in need of inpatient competency restoration. The treatment team must find that the patient is either competent to stand trial, not yet competent to stand trial but restorable, or non-restorable. Currently, patients with a bond lower than $100,000 are sent to this program. Occasionally, the court considers the offense's seriousness and specifically requests that higher risk patients be sent to the WMSS.

ADMISSION STANDARDS

The division's statutory purpose (CGS 17a-561) is to care for and treat:

1. patients with psychiatric disabilities, confined in facilities under DMHAS control, who require care and treatment under maximum security conditions;

2. people convicted of serious offenses specified in CGS 17a-566 (see below), who, after examination by the staff of the division's diagnostic unit, are found to have psychiatric disabilities and be dangerous to themselves or others and to require custody, care, and treatment at the division; and

3. inmates in the custody of the Commissioner of Correction transferred under CGS 17a-512 to 17a-517 and who require custody care and treatment at the division.

Basically, patients who go to the Whiting Maximum Security Service include individuals in the following categories:

PSRB Insanity Acquittees. A court can acquit a defendant of a crime by reason of insanity and place him under the jurisdiction of the Psychiatric Security Review Board, which can decide to place the patient at Whiting if he is a danger to himself and others (CGS 17a-582). About 65% of the patients are in this category.

Restoration to competency patients. Patients whose crimes have resulted in bail or bonds greater than $100,000 and/or pose a significant risk of assault or escape, if there is a question of their competence to stand trial, can be sent to WMSS for evaluation and, if there is a probability that they can be restored to competence, can be treated there for up to 18 months until they are competent to stand trial (CGS 54-56d).

Pre-sentence evaluation. A court, before sentencing someone convicted of an offense for which the penalty may be imprisonment in the Connecticut Correctional Institution at Somers or of a sexual offense involving physical force or violence, age disparity between an adult and a minor, or a sexual act of a compulsive or repetitive nature, (and if it appears to the court that the person has psychiatric disabilities and is dangerous to himself and to others) can order the defendant examined by qualified division personnel. This initial examination must be done and a report made to the court within 15 days after the court orders it. If the report recommends additional examination at the division's diagnostic unit, the court may, after a hearing, order the defendant committed to the diagnostic unit for up to 60 days. (CGS 17a-566).

Post-sentence evaluation and recommendations. Depending on the recommendations resulting from the pre-sentence evaluation, if the court finds the individual has a psychiatric disability and is a danger to himself or others and requires custody, care, and treatment at the division, the court can sentence him and order him to be committed to the division (CGS 17a-567).

Patients admitted from the Department of Correction. These could be admitted for short-term evaluation or stabilization and then sent back to a DOC facility or committed for a longer period. If they are considered to have a psychiatric disability and to be desperate or dangerous, they must be hospitalized in the Whiting Forensic Division (CGS 17a-502, 17a-512 to 517).

Voluntary civil and civilly probated patients. An individual who has not committed a crime may be admitted voluntarily or committed by a probate court if he is found to have a psychiatric disability and be dangerous to himself or others (CGS 17a-498, 17a-506).

NUMBER OF BEDS

The WMSS officially has 103 beds, but when the need arises they convert other space to beds, so that the census typically runs between 105 and 110. The Dutcher Enhanced Security Service has 117 beds. The Restoration Service in Battell Hall has 48 beds, but the census typically runs at 50.

STAFF

The whole Whiting Forensic Division has 552 authorized staff positions.

The Whiting Maximum Security Service staff consists of about 225 authorized positions, working three shifts for 24-hour coverage. There are a total of 176 authorized positions for direct care workers (forensic team specialists) and nursing staff. Authorized staff includes one medical director, 6.5 psychiatrists, six psychologists, seven social workers, and nine rehabilitation therapists. There are also 26 police officers.

The Dutcher Service has 174 authorized positions; 141 of them nursing and direct care positions. The rest are unit directors (5), psychiatrists (5), psychologists (4), social workers (4), rehabilitation therapists (10), and PSRB monitors (5).

The Restoration program has about 78 authorized staff positions, of which 56 are nursing and direct care staff. The others are a program manager, unit directors (2), psychiatrists (3.8), psychologists (2), social workers (4), rehabilitation workers (4), patient education workers (1), and restoration monitors (4).

In addition, 74 managerial, administrative, medical, and other staff are authorized for the division.

AVERAGE STAY

The average term of commitment to the PSRB is 42.6 years, consistent with the types of serious crimes these insanity acquittees have committed. But the average stay for a PSRB patient starting his commitment in the WMSS is 6.1 years before transfer to the DESS, with a lesser security level. These patients are seldom discharged directly from the WMSS.

The average length of stay for a PSRB patient from admission to Dutcher through conditional release is 2.6 years.

The DMHAS memo did not provide an average length of stay for the Restoration Treatment Program. But the expected length of stay is 60 days and may vary depending on the time needed to obtain a competency finding, according to the memo. The finding can take up to 18 months.

WMSS ADMISSIONS, DISCHARGES, AND WAITING LISTS

In 1998, the number of admissions to WMSS reached 50; in 1999, it was 61; and from January 1st to April 30th of this year, it was 23 patients, according to the memo provided to us by DelBianco. WMSS discharged 37 patients in 1998, 43 patients in 1999, and 17 patients between January 1st and April 30th of this year. Since 1996, WMSS has transferred 56 patients to the Dutcher Service.

The number of patients coming into WMSS from the DOC has increased, according to the DMHAS memo. Traditionally, these patients had been inmate transfers for diagnostic work-ups with the mission being stabilization, transfer and return to DOC to complete their sentence. But over the past 2 1/3 years, more inmates have come to WMSS at the end of their sentence. Of the four DOC inmates admitted in 1998, one came at the end of sentence. In 1999 of the 13 admitted, six came at the end of sentence. Of the six admitted so far this year, three came at the end of their sentence.

Waiting lists can only apply to three groups of patients: (1) those sent to Whiting for pre-sentence evaluation, (2) DOC inmate transfers, and (3) civil patients. There were two people from each of the first two categories on a waiting list, as of the writing of the DMHAS memo, but one from each group was expected to be admitted soon.

There was no one on a waiting list from the third category. The other types of admissions are by court order and not discretionary.

NEED FOR MORE BEDS AND COST

The attached follow-up memo on your question of the need for more beds from DelBianco informs us that DMHAS has recently embarked on a full study of the needs of the department's hospital and community system, with particular attention to the Whiting Forensic Division, both as part of the work of the Governor's Blue Ribbon Commission on Mental Health and the department's own strategic planning. The department will work closely with other agencies to develop recommendations for Whiting. The memo cautions that, though projections show Whiting as at or above capacity, the entire system must be examined to look at ways to address the problem. DelBianco informed us that specific information on whether there is an actual need for more beds, the level of need, and its cost will likely be available in January.

The memo provides no further details on the need for beds or the cost involved, but it offers to share the information with us once it is available.

OLR report 99-R-1059, “Medication for Involuntarily Committed Mentally Ill People”, October 21, 1999, states that the last time a daily treatment cost at Whiting was computed was in FY 1994-95. It was $738; adjusting for inflation would raise that cost to $834.

The state comptroller's 2000 per capita per diem figures for the support of people in humane institutions set the overall rate for people in Connecticut Valley Hospital (of which Whiting is now a part) at $714. It does not show a separate rate for Whiting.

HN:ts