The majority of criminal commitments are for people who have been found incompetent to stand trial. That means they don't understand the charges against them and cannot aid in their defense.If the Sheriff is scared, imagine how the inmates must feel. Local officials are also increasingly fearful of growing costs. According to the San Antonio Express News ("New state rule adds to Bexar jail burden," Feb. 2), in addition to treatment costs in the jail, when space finally opens up counties must now fork over travel expenses to transfer incompetent inmates to faraway locales because hospitals near the big cities are full up.
On average, such competency patients are hospitalized for 85 days, officials say. But some stay longer.
The rest of the forensic population is even slower to treat. They are people who have been found not guilty by reason of insanity, and their treatment often lasts for years, if not their lifetime.
[Barbara] Tate, the head of the local MHMR, estimated that it will now take several months to move someone from a local jail to a state hospital. In the past, the process usually only took a few days, she said. ...
“We should not be holding these people because this is not a place (designed) to do that,” [McLennan County Sheriff Larry] Lynch said. “It's kind of scary. We are not trained to do this ... but they keep forcing it on us.”
The county will have to take such inmates to Kerrville if beds are available. If not, they'll have to go as far as El Paso, Vernon, Rusk or Big Spring.That's in addition to treatment costs for those waiting in the jail to be transferred. What's more, even when they are transferred, reported the Express News, the new arrangement will mean they get less appropriate care than health professionals prefer, because new doctors must get up to speed on each case. Some mental health professionals say it was better for public safety when more of the severely mentally ill were permanently institutionalized:
That means shelling out up to $1,000 per overnight trip with two deputies, said Deputy Chief Dennis McKnight.
Bexar County deputies took forensic patients to San Antonio State Hospital 190 times last year, McKnight said.
"If we do 190 next year" to the four more distant hospitals, "that's $190,000 that's getting dumped on the taxpayers all of a sudden," he said.
I'm not sure I support permanent institutionalization of the mentally ill -- with new generation medications and proper support, in theory most should be able to function outside hospitals or prisons. But since Texas' de-institutionalized these folks many years ago, dumping them in the streets, basically, with no means to support themselves or maintain their treatment regimens, now the only means for getting them help is through the criminal justice system. That's an unmitigated tragedy.
If the patients caught in the current revolving-door system of state mental health care go to a new hospital each time, they'll be strangers, making treatment harder, said Dr. John Sparks, medical director of detention health care services
And their commitment begins on the day of the judge's ruling — so if it does take longer to get them to treatment, it's that much less time they have to get better before their next hearing before Carruthers. New hearings mean more costly trips, McKnight noted, although he hopes the county can buy video conferencing to cut that cost.
To Garcia, it's just part of a decades-long erosion of state care for the mentally ill that leaves them no home but jail.
"A lot of these chronic schizophrenics, they were living at the state hospital with room and board, smoking cigarettes. They never got into trouble," he said.
The Waco paper offered up a fine editorial on the topic ("Fiscal Psychosis," Feb. 3), demanding that Texas' Legislative Budget Board step up and find emergency funds needed to fix the problem. Their commentary, I thought, hit the nail on the head:
This is not just an issue about the handling of one segment of our mentally ill population. It's about Texas' general unwillingness to meet the needs of the mentally ill.Damn straight. This issue seems to be picking up steam, doesn't it? I don't know that the Legislative Budget Board has the authority or more importantly the ready cash to fix the problem, but if Texas makes it through another special session without ponying up more money, the state probably risks civil rights litigation on behalf of these inmates, whose rights have already been stripped from them by a judge.
Mental health advocates say the problem goes beyond psychiatric hospitals per se to community mental health services in general, where Texas ranks 47th in per capita spending.
“When individuals with mental illnesses get mental health treatment in their communities, they are less likely to deteriorate and end up involved with the criminal justice system,” said Lynn Lasky Clark of the Mental Health Association in Texas.
Clark said law enforcement officers sometimes drive mental health patients across the state for hospitalization because of a lack of local mental health services.
Texas should put more of its faith and its resources into mental health services that can treat people and keep them out of jail.
But when they land in jail and a judge says that's not the place for them, they shouldn't be there.
UPDATE: More from the McAllen Monitor
See prior Grits coverage of this topic:
- Chincy state hospital funding leaves mentally incompetent defendants stranded
- Unfunded mandate: Counties struggle to pay for mentally incompetent inmates' care
- Blog Activism: How it's supposed to work
- Meth use may be boosting criminal commitments to psych hospitals