Correctional Mental Health Program

Michigan Office of the
Auditor General
Thomas H. McTavish, C.P.A.
Auditor General

EXECUTIVE DIGEST #3965097
Correctional Mental Health Program

INTRODUCTION
This report, issued in April 1998, contains the results of our performance audit of the Correctional Mental Health Program, Bureau of Forensic Mental Health Services, Department of Community Health (DCH).

AUDIT PURPOSE
This financial audit was conducted as part of the constitutional responsibility of the Office of the Auditor General. Performance audits are conducted on a priority basis related to the potential for improving effectiveness and efficiency.

BACKGROUND
In July 1992, as the result of a contract between the Department of Corrections (DOC) and DCH, DCH established the Correctional Mental Health Program, which is administered by the Bureau of Forensic Mental Health Services. The Bureau's mission is to promote, maintain, or restore patients' mental health and/or legal competence, prevent mental illness, and effect rehabilitation in Michigan's correctional and forensic patient populations.

The Bureau's Correctional Mental Health Program provides four levels of treatment: outpatient, residential, rehabilitative, and acute. The outpatient and residential programs provide treatment at various correctional facilities in the State to prisoners who are less severely mentally ill. The rehabilitative and acute programs provide treatment in an inpatient hospital setting to prisoner patients who demonstrate severe mental illnesses.

During fiscal year 1995-96, the Bureau's Correctional Mental Health Program expenditures were approximately $54.9 million. As of June 1997, the Program had 791 employees.

AUDIT OBJECTIVES, CONCLUSIONS, AND NOTEWORTHY ACCOMPLISHMENTS

Audit Objective: To assess the effectiveness of the Bureau's management information system in monitoring the Correctional Mental Health Program.

Conclusion: We concluded that the Bureau's management information system was generally effective in monitoring the Correctional Mental Health Program. However, we identified a reportable condition related to the accuracy of data in the mental health record system (Finding 1).

Noteworthy Accomplishments: During fiscal years 1995-96 and 1996-97, the Bureau, in conjunction with DOC, implemented a project to improve two components of the mental health record system. These efforts included redesigning database elements, data collection forms, and output reports used by field and central office staff for tracking mental health referrals and services provided to prisoners. To comply with amendments to selected provisions of the Mental Health Code, the Bureau implemented new procedures for involuntary treatment of prisoners with mental illness. These new procedures are designed to facilitate prompt access to treatment and reduce the need for longer hospitalization.

Audit Objective: To assess whether the Bureau's rehabilitative and acute care programs were effective and efficient in returning prisoner patients to less intensive treatment programs based on successful treatment outcomes.

Conclusion: We concluded that the Bureau's rehabilitative and acute care programs were generally effective and efficient in returning prisoner patients to less intensive treatment programs based on successful treatment outcomes. However, we identified reportable conditions related to admission and discharge criteria and record maintenance (Findings 2 and 3).

Noteworthy Accomplishments: During 1994, the Bureau opened Huron Valley Center (HVC), a new prisoner inpatient psychiatric hospital in Ypsilanti, to replace the inpatient programs located at Riverside Correctional Facility. In May 1997, HVC received accreditation from the Joint Commission on Accreditation of Health Care Organizations. The accreditation was one of the compliance requirements in the USA consent decree.

The Bureau, in cooperation with DOC, developed referral and transfer procedures for severely mentally ill prisoners from administrative segregation settings in State correctional facilities to Bureau treatment programs. These procedures were necessary to help assure federal court officials involved with the consent decree that prisoners are receiving appropriate treatment.

Audit Objective: To assess the Bureau's effectiveness in identifying prisoners who need mental health services and in providing mental health treatment to prisoners who live in the general prison population.

Conclusion: We concluded that the Bureau was generally effective in identifying prisoners who need mental health services and in providing mental health treatment to prisoners who live in the general prison population. However, we identified a reportable condition related to treatment consent documentation (Finding 4).

Noteworthy Accomplishments: Since becoming responsible for the Correctional Mental Health Program in 1992, the Bureau has upgraded the residential level of care by implementing the Residential Treatment Program model. This treatment model includes enhanced clinical staffing and new treatment programs, such as psychosocial rehabilitation modules, cognitive behavioral intervention, and dual diagnosis programs for prisoners with mental disorders and substance abuse problems. The Bureau anticipates that the treatment model will result in earlier detection and preventive intervention of mentally ill prisoners to avoid serious deterioration in their conditions.

Audit Objective: To assess the effectiveness and efficiency of the Bureau's administration of mental health service contracts.

Conclusion: We concluded that the Bureau's administration of its mental health service contracts was generally effective and efficient. However, we identified a reportable condition related to the Bureau's internal control structure over personal service contracts (Finding 5).
AUDIT SCOPE AND METHODOLOGY
Our audit scope was to examine the program and other records of the Correctional Mental Health Program. Our audit was conducted in accordance with Government Auditing Standards issued by the Comptroller General of the United States and, accordingly, included such tests of the records and such other auditing procedures as we considered necessary in the circumstances.

Our methodology included examination of the Bureau's records and activities for the period October 1, 1994 through July 15, 1997.

To accomplish our objectives, we obtained an understanding of the Bureau's operations by conducting a preliminary survey. We assessed the adequacy and reliability of the Bureau's management information system in monitoring program activity and evaluated management's use of data collected. We also evaluated treatment plans for selected prisoner patients to determine if plans were prepared in accordance with Bureau standards, and we reviewed plan goals and objectives to determine if planned outcomes included movement to less intensive treatment programs. In addition, we reviewed methods used to identify and serve prisoners entering the corrections system who require mental health services to determine if methods were applied in accordance with established standards. We also reviewed the Bureau's use of contractual service employees in lieu of classified State employees and evaluated the Bureau's methods for determining the need for and use of contractual services.
AGENCY RESPONSES
Our audit report contains 5 findings and 6 recommendations. The preliminary response prepared by the Bureau indicated that it concurred with 3 of our recommendations and has taken steps to comply with each of them. The Bureau indicated that it did not concur with the remaining 3 recommendations.
Full Audit Report - #3965097 - Correctional Mental Health Program

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