State Hospital: Forensic Patients Receiving Timely Care

Ben Boulden

The Arkansas State Hospital in Little Rock

When an Arkansas court orders that a defendant undergo a forensic psychiatric evaluation or treatment before standing trial for a crime, it turns to the Arkansas State Hospital.

With almost all of its 12 psychiatrists and 13 psychologists employed by UAMS (many specializing in forensics), the State Hospital is a nine-unit, 226-bed psychiatric facility located just a few hundred yards west of the main UAMS campus.

The hospital administers all Arkansas court orders for forensic evaluation and treatment and completes about 20 percent of the evaluations performed in the state. Once a forensic evaluation is performed, patients found incompetent to stand trial receive treatment to restore them to a mental state in which they can understand the legal process and aid in their own defense.

Until 2012, all forensic treatment was performed on an inpatient basis at the State Hospital. An upward swing in court orders created longer waits for patients to get into the hospital for forensic treatment, until the medical staff developed a better way of honoring treatment orders.

We’re able to get people in more quickly and treat them more efficiently.Dr. Steve Domon

Partnering with community mental health centers, the hospital shifted from a system dependant on inpatient treatment to a mix of outpatient and inpatient treatment. The community mental health centers contracted with the hospital to provide the outpatient services, thus preventing unnecessary admissions.

Through this partnership, the hospital and its UAMS staff have all but eliminated the backlog, and most of those few patients who are waiting are receiving outpatient treatment.

“We’re able to get people in more quickly and treat them more efficiently,” said Steve Domon, M.D., the State Hospital’s medical director. “People are seeing now that this is a sustained change for the better.”

Domon said the new outpatient program has accomplished several things. People who need treatment are receiving it more quickly and effectively, and it is less likely that people will be incarcerated for weeks or months before receiving proper psychiatric care.

“We’re also avoiding unnecessary hospitalizations,” he said. “We were admitting people simply because we had a court order, regardless of whether they needed inpatient treatment. We’re now using our beds more efficiently because many people can be treated effectively, sometimes more so, as an outpatient.”

That means the State Hospital can do an even better job of honoring forensic orders and fulfilling its other major functions. In addition to administering and performing forensic evaluations and providing forensic treatment, it is responsible for monitoring patients who have been acquitted and conditionally released for a period of up to five years. The hospital also maintains units for the non-forensic general psychiatric care of adults as well as for the separate treatment of adolescents ages 13-17.

In keeping with the medical education mission of UAMS, the State Hospital supervises junior and senior medical student rotations, postgraduate first-year psychiatry residents and child and adolescent psychiatry residents. It is also the primary site for the UAMS forensic psychiatry fellowship and a forensic psychiatry postdoctoral program.

Domon said that the State Hospital is committed to improving the lives of Arkansans through education, and the UAMS faculty, fellows and residents are essential in fulfilling the core missions of the hospital.