Moments that Matter: Meaningful progress in reducing wait times for competency restoration

During the first year of the pandemic, I was embedded at the Department of Health. This experience was both the most difficult and rewarding of my entire career. I saw firsthand what can be accomplished when leaders collaborate. Never before in state history have more agencies come together with the single motivation of “What can we do to help?”

I also saw the value of data. This was evident both in how we managed the massive weekly flow of information and scientific evidence and in how we measured outcomes. An example is in how we built COVID-19 dashboards that could tell us where resources were needed and where efforts were going well. I also saw the value of simplicity, such as by having one place individuals could go to register for tests or vaccines online and coupling that with Indiana 211 for those who had challenges navigating the internet. We created the simplest system in the country for individuals to get a vaccine during that first year.  
I took these lessons into my role as Secretary by asking all of us in FSSA to focus on not just what we are working on but how we do that work. I asked you to be collaborative, use data, and simplify processes. And I asked you to do this work in a culture of inclusion and trust. This week I was again reminded of how this approach can impact those we serve.

What does it mean to be found incompetent to stand trial? Competency here is a legal term. It means that individuals who are arrested can participate in their trial. It requires them to understand the charges against them and to be able to work with their legal team. For many Hoosiers, untreated mental illness is what led to their arrest and what prevents them from being competent to stand trial. The solution is easy, right? Get them treatment.

As with all things in healthcare, the answer is not that simple. Indiana law requires that anyone found incompetent to stand trial be committed to the Division of Mental Health and Addiction for treatment. That treatment traditionally has been at one of five state hospitals that serve adults. These hospitals, like all parts of the healthcare system, have faced enormous challenges in the last 3 years. The pandemic has increased the number of individuals needing mental health treatment. It has also resulted in a healthcare staffing crisis. Our hospitals, like all hospitals, have seen a massive staff turnover. These and other challenges created an ever-growing waitlist for our state hospitals, which at one point was more than 4 months long. What this means is that if an individual with untreated mental illness was arrested and found incompetent to stand trial, they might have to wait for up to four months before getting treatment. Most of these individuals waited in jails for treatment. This is a less-than-ideal location to await treatment and has the potential to worsen their underlying mental illness. This is also a problem that nearly every state is struggling to solve.

Shortly after starting as Secretary, DMHA Director Jay Chaudhary brought me this problem. What could we do? Falling back to the lessons of the pandemic, we could collaborate. We could use data. We could simplify.
Under the leadership of Jay, Executive Director of the State Hospital Network Katrina Norris, and General Counsel Leslie Huckleberry, we brought together staff from across FSSA and challenged the new ICST team to come up with a plan that would take us from a wait time of 4 months to 4 weeks in 2 years. This is no small feat.

This week I got an update on the progress this group has made. It is nothing short of amazing what has been accomplished in such a short time. Shortening the waitlist time from 4 months to 4 weeks would require us to treat incompetent to stand trial individuals outside of the state hospital, increase our hospital capacity, and decrease how long it takes to treat and discharge individuals, among other changes. The team working on this is comprised of more than 18 individuals from across our agency and state hospital system and involves 7 working groups. They collaborate weekly. They have embraced data by creating data dashboards to monitor their progress. And they have found ways to simplify the work they do across the state hospital system.

So, how are we doing? Since beginning this work at the end of 2021, we have cut the wait time of ~120 days in half. This means that only 44 individuals are waiting for treatment in jail today, instead of 88. If these trends continue, we will not only likely hit our goal of going from 4 months to 4 weeks in 2 years but may very well exceed it. This matters not just because everyone likes to meet their goals, but because these goals matter to the individuals we serve. The faster we can treat individuals in crisis the faster we can get them back where they want to be—home.

Thank you again to the ICST team working on this. They are proof that not only does what we do matter but how we do it also matters. Imagine what we can accomplish if we collaborate a little more; If we learn to use data better; If we find ways to simplify how we administer our programs and make it easier for individuals to get the services they need; And if we do all of this in an inclusive environment built on trust.

Note: If you have any examples or stories of work you and your colleagues do that matters, please send them my way. You can send them to me at SecOffice@FSSA.in.gov with the heading Moments that Matter. These stories will be archived on The Hub here.

Dan