Location: SCR 352
Status Update on Task Force Subcommittees
COMMITTEE ON TREATMENT OF PERSONS WITH MENTAL HEALTH DISORDERS IN THE CRIMINAL JUSTICE SYSTEM
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10:36 AM -- Status Update on Task Force Subcommittees
Ms. Harding gave an update on the restoration competency subcommittee. She was joined by Dr. Patrick Fox, representing the Colorado Department of Human Services (DHS). Dr. Fox explained that DHS is focused on the implementation of SB 17-012, including the curriculum to establish adult competency. DHS has a curriculum in use both at the Mental Health Center in Pueblo and the Jail Restoration Program in Arapahoe County. DHS is considering competency restoration for juveniles and persons with intellectual and developmental disabilities. The department is also examining potential changes to statute that would make best use of outpatient competency restoration, especially for individuals who may remain in jail custody, but who would be appropriate to receive competency restoration services in the jail in which they reside.
Senator Martinez Humenik remarked that DHS will need to request additional funding in its supplemental budget request to meet the requirements of SB 17-012. She also noted that SB 17-012 responded to the use of competency guidelines that are outdated and urged DHS to update those guidelines.
Senator Fields asked Dr. Fox to explain competency restoration. Dr. Fox explained that when an individual is charged with a criminal act, if any party including attorneys or judge, or has any reason to believe that the defendant does not understand the charges, the way the court works, or the defendant's ability to assist in their own defense, then the issue of competency is raised. A judge then has discretion to make a finding of whether competency is legitimately in question, based on a basic assessment by a judge. More often, a judge will order a competency evaluation by a psychiatrist or psychologist on whether the defendant is competent to proceed. Once a defendant is deemed incompetent, the case may not proceed until restoration services are delivered to restore the defendant to competency. In Colorado, competency restoration programs exist at the Mental Health Institute at Pueblo and the Jail Based Restoration Program, but the General Assembly has historically not required the Office of Behavioral Health (OBH) within DHS to provide community-based competency restoration. SB 17-012 clarified that OBH is responsible for providing competency restoration services, and for establishing a curriculum for competency restoration.
Representative Benavidez asked about the development and implementation of the competency curriculum. Dr. Fox explained that DHS will be reaching out to stakeholders and developing best practices. Dr. Fox also explained that DHS will receive more than 800 restoration orders this year. The cost of competency restoration services is approximately $30-$40 per hour and generally requires 1-2 hours per week. Committee members asked follow up questions and Dr. Fox clarified that most individuals facing this situation suffer from a mental health disorder that impedes them from understanding the judicial process, and that competency restoration addresses both an individual's ability to rationally and factually understand the proceeding.
Senator Martinez Humenik commented that outpatient services may not be successful for everyone, and that she looks forward to an update about how this new process works in the future.
Ms. Harding provided the data subcommittee update, explaining that the subcommittee is in the process of examining the data-sharing involved in the medication consistency requirements of SB17-019. Ms. Harding has met regularly with the Health IT Work Group and has presented at the E-Health Commission meeting, and gave an overview of SB17-019 and its potential to leverage data-sharing opportunities. In her role at OBH, Ms. Harding is in the process of soliciting information on hiring someone to do research that would include polling all Colorado county jails to find out what their process is for identifying and screening individuals for behavioral health needs, and whether any part of the process is documented in electronic health records. She explained that many metro-area jails have existing electronic health records and may be able to connect those records, but many of the rural county jails do not necessarily use e-health records.
Representative Benavidez asked about storage locations for e-health data. Ms. Harding responded that county jails are storing data within their electronic health records and the data is not shared without a paper consent form and fax machine. CORHIO is a system by which all of the hospitals in the state are connected and share e-health records. Representative Benavidez and Ms. Harding continued to discuss possible ways to assist jails in developing electronic health records. Ms. Harding explained that there is no state-level data collected about the number of individuals with behavioral health issues who are booked into jail, but that she hopes the research she is doing will help to address that information gap.
Senator Martinez Humenik expressed concern about situations in which an individual who is receiving a prescription medication to treat a behavioral health condition is moved from one facility to another, and where the medication available to the person is different based on the location change. She commented that this diminishes the effectiveness of these types of medications, and that consistency in vendors could help to eliminate this problem. Ms. Harding explained that in her role at OBH she is learning about state procurement rules in order to optimize the process by which small county jails purchase prescription medications. Representative Benavidez also suggested identifying private or non-profit pharmacies in the area who could help rural jails order and inventory medications.
Representative Singer asked about options for complying with SB 17-019 in jails that can not participate in electronic health record sharing. Ms. Harding explained that in that situation inmates must complete a paper release form which identifies that they have a behavioral health diagnosis, are receiving medications, and want their information shared. Representative Singer and Ms. Harding continued to discuss current practices and potential future changes under SB 17-019.
Senator Martinez Humenik asked Ms. Harding why DHS is hiring an outside contractor to perform the research she mentioned previously. Ms. Harding explained that DHS chose to hire a contractor because the department is under time pressure to implement several bills that passed in the 2017 legislative session and because of the complexity involved in the research.
Jennifer Longtin, co-chair of the housing work group, explained that the work group's legislative priorities are to set a limit on the application fee that can be charged by a landlord as part of a rental application, and to change the point during a rental application when a landlord can ask a potential tenant for their criminal history. She explained that one problem with a limitation on application fees is that there is a wide variety of fee amounts currently charged by landlords.
Representative Singer asked whether the housing work group had met with the Department of Local Affairs (DOLA) regarding the implementation of SB 17-021. Ms. Longtin explained that DOLA will be providing vouchers to groups that already provide application fee support. Representative Benavidez asked about how a person would obtain a voucher under SB 17-021. Ms. Longtin explained that the vouchers will be available from organizations that already have a relationship with DOC. Ms. Longtin and committee members continued to discuss the implementation of SB 17-021.
Senator Fields urged the Task Force to examine situations in which landlords accept applications from and charge fees to many applicants, knowing they have only a single apartment to rent. Ms. Longtin explained that one long-term solution is creating permanent affordable and mixed-income housing. She also emphasized the importance of a universal background check that can be re-used on multiple rental applications, and of implementing notice requirements that would require a landlord to tell prospective tenants prior to application that they will be prevented from renting if they have certain criminal convictions.
The chair of the prevention subcommittee, Ashley Tunstall, representing the DHS Division of Youth Services, and Dr. Jaden Web, representing the DHS Office of Children, Youth and Families, explained the subcommittee's recent activities. They distributed a handout (Attachment A) and discussed decisional capacity. Dr. Web explained that decisional capacity describes whether a client is able to make a rational, informed decision and are therefore able to give legal consent. Current statute contemplates decisional capacity for persons age 18 and older, but because minors ages 15 and over are able to consent to receive mental health services, there is a gap where the law does not specify who may make a capacity assessment. Current law is unclear as to who may perform capacity determinations and when they are required. Dr. Web argued that any licensed clinician should be able to perform a capacity assessment for the services that they are providing.
Representative Singer asked whether Dr. Fox had received any feedback from licensed mental health care providers or from the Department of Regulatory Agencies (DORA). Dr. Web explained that he had not received feedback from DORA, and that licensed providers are unaware of the lack of clarity in the law. Ms. Tunstall explained that they were presenting this information at this point in an attempt to highlight the issue in time for the interim bill request process. Senator Martinez Humenik suggested that the prevention subcommittee continue to examine this issue, speak with stakeholders, fully understand the context, and to come up with suggestions for solutions.
Representative Benavidez asked if the prevention subcommittee was doing anything to address the school to prison pipeline or opioid addiction. Ms. Tunstall explained that the prevention subcommittee is only one month old so they were still defining the scope of the subcommittee. Representative Benavidez suggested the prevention subcommittee look at mental health courts diversion programs. Ms. Tunstall explained that the prevention subcommittee has been tasked with examining pre-k and K disciplinary actions and the prevention of suspension and expulsion in school.