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Steve Griffin, Deseret News
Kristen Cox, executive director of the Governor's Office of Management and Budget, and Dallas Earnshaw, Utah State Hospital superintendent, lead a tour of the Inpatient Forensic Restoration Unit at the Provo hospital on Thursday, July 19, 2018.

PROVO — Efforts to cut down wait times and increase the number of patients treated at the Utah State Hospital for mental health issues before standing trial are working.

What once was a more than six month wait has become a 40-day turnaround for patients accused of crimes and deemed incompetent to stand trial until receiving services.

The waitlist for beds, which was approaching 100 potential patients, has been reduced to 15.

" For every $1 we receive in revenue, there are $4 in requests. The need … is endless. "
Kristen Cox, executive director of the Governor's Office of Management and Budget

"It's a big system we have to work with. There's a lot to do on a day-to-day basis and things can fall through the cracks," Utah State Hospital Superintendent Dallas Earnshaw said during a Thursday update about an ongoing pilot program to find operational efficiencies at the hospital.

Steve Griffin, Deseret News
Kristen Cox, executive director of the Governor's Office of Management and Budget, and Dallas Earnshaw, Utah State Hospital superintendent, get a look at a single room as they lead a tour of the Inpatient Forensic Restoration Unit at the Provo hospital on Thursday, July 19, 2018.

"There are problems in government, we know that," said Kristen Cox, executive director of the Governor's Office of Management and Budget, which is partnering with the hospital to implement improvements that will allow it to serve more people with greater efficiency and effectiveness. "For every $1 we receive in revenue, there are $4 in requests. The need … is endless."

She said hospital officials have "turned around a tough system" in the last six months, but "the process of improvement never ends."

In the years he's been at the hospital's helm, Earnshaw has seen a 500 percent increase in demand for forensic services — the processing of accused criminals who also have substance abuse or mental health issues.

"It's not just Utah," he said. "It's a challenge people are dealing with in every state."

The Utah State Hospital, however, is working on settlement agreements resulting from 2015 litigation, where the Utah nonprofit Disability Law Center cited unconstitutional detainment of prisoners who were sitting in jail cells too long before receiving treatment prior to being proven innocent or guilty.

"People were suffering on a systemwide basis," said the center's legal director, Aaron Kinikini.

Steve Griffin, Deseret News
Kristen Cox, executive director of the Governor's Office of Management and Budget, and Dallas Earnshaw, Utah State Hospital superintendent, center, lead a tour of the Inpatient Forensic Restoration Unit at the Provo hospital on Thursday, July 19, 2018.

A special report by the Deseret News highlighted the lengthy wait times and the toll it was taking on mentally ill Utahns and their families. Kinikini said the News' investigation was the "catalyst in bringing about much-needed change."

He said he's pleased with the work the hospital has done.

"Now, less people are suffering," Kinikini said.

Under the settlement agreement, Utah's Department of Human Services must admit patients requiring court-ordered treatment at the state hospital within just 14 days, and then must maintain that reduced wait time.

The program is focusing on improving inpatient numbers, but also works with the hospital's outreach and jail-based treatment units to reduce unnecessary hospitalizations.

Steve Griffin, Deseret News
Dallas Earnshaw, Utah State Hospital superintendent, opens a locked door as he leads a tour of the Inpatient Forensic Restoration Unit at the Provo hospital on Thursday, July 19, 2018.

In the six months of implementing changes, officials have diverted 250 people who would've been treated at the hospital — taking up critical space — and have either helped them through minor issues at the jail unit or sent them to civil commitments.

"We are documenting the cases every day and making those decisions early on," said Don Rosenbaum, director of forensic services at the Utah State Hospital. "The goal is to streamline those capable of restoration and not have them languish here."

He said about 70 percent of patients treated at the comprehensive facility have their competency restored enough to face their charges and communicate with an attorney. Thirty percent are generally committed and moved out of the 100-bed forensic unit for further treatment.

"The hardest part is often helping them understand and accept that they actually have a mental illness," said hospital psychiatrist Dr. Richard Spencer. "That's a hard bar to reach."

Steve Griffin, Deseret News
Kristen Cox, executive director of the Governor's Office of Management and Budget, and Dallas Earnshaw, Utah State Hospital superintendent, center, lead a tour of the Inpatient Forensic Restoration Unit at the Provo hospital on Thursday, July 19, 2018.

He said mental illness can't be cured, but treatment, along with a combination of various types of therapy and medications, can help them to manage symptoms and "make their lives manageable."

Patients living at the forensic unit often share a room, which Earnshaw said is a safety concern. They are able to have their own clothing, papers and books, and occasionally are allowed to listen to music, depending on their treatment plan. Their rooms are built to avoid any type of self-harm.

"We are very cautious," Earnshaw said. "On any given day, we have 30 patients on watch for a high risk of suicide."

Patients are able to move about the units they're assigned to, as well as go outside where there is a track and basketball court. Food made on-site is delivered to a dining room at each unit.

Steve Griffin, Deseret News
Blake Harris, unit nursing director at the Utah State Hospital, inspects a double room in a wing of the Inpatient Forensic Restoration Unit at the Provo hospital on Thursday, July 19, 2018.

Staci Ghneim, operational excellence consultant with the governor's Office of Management and Budget, said the goal is "to provide quality, safe, timely and affordable mental health care" to patients assigned to the hospital by the court system. And, with the efficiencies they've come up with in the pilot program, the hospital has turned out "better for employees and for stakeholders, taxpayers included," Ghneim said.

Patients are assessed and given a treatment plan beginning the day they arrive at the hospital. They are also given a planned discharge date at that time. The top reason for delayed discharges is waiting for a court hearing to be assigned, which Earnshaw said the hospital is addressing by contacting the court immediately after determining a person's competency has been restored rather than waiting until their next scheduled hearing.

" We've made wonderful progress. "
Dallas Earnshaw, Utah State Hospital superintendent

The hospital has increased capacity by 78 percent, allowing 66 admissions compared to 37 during the same time last year, according to the Utah Department of Human Services and the Governor's Office of Management and Budget, which is overseeing the lawsuit settlement.

The average length of stay has been reduced by 183 days, down to 798 days from of the previous average of 981 days. And the hospital is discharging more people from the forensic units than it did last year.

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"We've made wonderful progress," Earnshaw said, adding that he's grateful for the opportunity to do things better. He said the public pressure, the lawsuit and the pilot program have given the hospital "a voice."

"This program gave us the opportunity to tell our story more openly," he said.

Earnshaw said that while the changes have been positive, there is still much more to do. He's looking forward to serving people better and in a smarter way in the near future.

The next settlement agreement deadline is Sept. 30, by which the Utah State Hospital must further reduce wait time to 30 days for patients to receive competency restoration treatment.

Steve Griffin, Deseret News
A double room in a wing of the Inpatient Forensic Restoration Unit at the Utah State Hospital in Provo is pictured on Thursday, July 19, 2018.