Budgeting is important to any organization, if used correctly budgeting will set the financial framework for any organization. In doing an analysis for a budget the organization creates objectives for the acquisition and use of its resources. With a good analysis of a health budget administrators or financial planners can allot operating budgets to department heads and delegate responsibilities and decision making that will ultimately lead to the organization’s financial goals. Reviewing the 2015-2016 Health Budget for California, here is my health analysis for the Department of State Hospitals (DSH).
The Department of State Hospitals provides inpatient mental health services at five state hospitals in California. Patients in these hospitals are either civil commitments or forensic commitments. Civil commitments are referred by state hospitals where as forensic commitments are committed by courts and are classified as incompetent to stand trial (IST), not guilty by reason of insanity (NGI), mentally disordered offenders (MDOs), or sexually violent predators.
The Governor’s budget proposal is $1.7 billion which is about the same as the budget that was provided the previous year. This years’ proposal is proposed to operate 105 more IST beds than last year, modify an existing facility to operate an additional 232 more IST beds, and to involuntarily medicate certain NGI patients. As of January 2015, 550 patients are awaiting placement, 370 of those being IST patients
. In the previous years’ budget $28 million was allocated towards 105 IST beds and $4 million were allocated for an additional 50 beds for the Restoration of Competence program. In this years’ budget $65 million dollars would be used to operate nearly 2,150 new beds by 2019, with 371 patients on the waitlist and 1,300 patients already in facilities, this budget could potentially create more beds than is actually needed. During the previous budget year less than 20 percent of the budget for new capacity beds were actually utilized.
Therefore, this year’s budget is not aligned with last year’s budget, there is no proof the department will be able to operate at the budgeted capacity effectively and the proposed budgeted beds could possibly not ever all be accounted for with Proposition 47 which will likely reduce IST inpatient needs because the proposition changes the criteria that reduces the need for inpatient services. Future budget allocations can be could be used to activate the existing beds that are not currently being utilized to minimize the amount of IST patients that are waiting to be placed and hopefully in turn decreasing court costs and the chance of being held in contempt.
There is not enough information within this analysis to predict future trends of budget requirements. In light of the potential changes that could occur with Proposition 47 there is no way to estimate the forthcoming needs of inpatients in department state hospitals. The only way to prepare for the population in DSH is to first determine what will the long-term effects Proposition 47 will have on the IST patient population. If there are significant changes in patient population there should be a new budget submitted that is catered to the new modifications to reflect the increase or decrease of needs.
The most significant variance is the idea for more beds. It is uncanny the Governor would propose expanding more beds for the DSH when there are beds currently not being utilized to its maximum capacity and with the probability of a new proposition that could alter the need for inpatient services of IST patients. This variance is unfavorable due to the fact that these funds could possibly be misallocated if there is a reduction of inpatient services.
I agree with the LAO’s decision to recommends not to go forward with the Governor’s proposal to expand capacity of IST beds. LAO’s suggestion for there to be justification as to why the number of beds budgeted are greater than the number of beds being filled. Furthermore, LAO recommends DSH to access the potential impact seen in patient population since the implementation of Proposition 47. I agree with these recommendations solely for the reason of there being no solid evidence that there is a specific need for expansion on IST beds.
It would be more beneficial to the department of state hospitals and the patients if funds were used to help correct current glitches such as enclosing the fence that will allow the opening of 273 that are not considered functional because there is currently no fence securing those beds. In addition, there has been no assessment for the prospective need of additional staff that may be required with the opening of superfluous inpatient beds.