Mentally ill languish in Bexar jail awaiting assessment, competency restoration

Several notable stories out of San Antonio this week related to mental illness in county jails deserve Grits readers attention:

• Bexar breaks law on menally ill inmates, Aug. 1
• County cannot decide not to comply with the law, Aug. 5
• Jail is not answer for mentally ill, Aug. 6
• Nelson Wolff: Political will in Austin needed to help mentally ill, Aug. 7
• Texas is 49th in mental health funding, Aug. 7

Last Sunday's story identified a problem that is likely also an issue at most other Texas county jails. It opened:

Bexar County is breaking a state law requiring the swift examination of every mentally ill prisoner in jail, leaving an untold number of inmates languishing without proper psychiatric care.

Local courts are supposed to order psychiatric exams and use the results to route many of the mentally ill offenders toward treatment and away from the jail, where only one part-time and two full-time psychiatrists are employed to treat about 900 inmates a day suffering from some form of mental illness.

The jail is screening inmates when they are booked and providing a daily list of the mentally ill to magistrates.

But the courts at that point drop the ball, saying they are overwhelmed and lack the resources to order the examinations or distribute reports to attorneys. And mental health providers inside the jail say they lack the staff to adequately examine every prisoner who might be mentally ill.

As a result, the jail continues to warehouse mentally ill offenders accused of minor crimes who would be better served in psychiatric hospitals. The courts’ failure to follow the law contributes to crowding at the jail, where an estimated 21 percent of the 4,500 prisoners have a mental illness.

Ironically, Bexar has been widely recognized for its jail diversion program for the mentally ill, where police take some offenders to a "Crisis Care Center" instead of jail. Judge Wolff points out that "Since its inception in 2002, the Jail Diversion Program has prevented 5,600 people from even seeing the inside of a jail cell by law enforcement instead bringing those individuals to the Crisis Care Center." But for those actually taken to the jail, apparently the systems remain an under-resourced mess and magistrates have openly refused to comply with a law requiring mental health evaluations on the front-end of the process.

The latest story focuses particularly on the issue of competency restoration and the declining number of forensic beds available at state hospitals, a subject which this blog has been tracking for several years.

Forensic beds in hospitals are used to treat mentally ill inmates who are deemed not competent because of their illness to proceed to trial.

In Texas, the current wait for a forensic bed is three to six months, and the waiting list numbers about 350 for nonviolent inmates, state officials said.

“I've got 103 in jail right now waiting to go to the state hospital,” said Ron Stretcher, criminal justice director of Dallas County. “About a year ago they started squeezing down on the number of beds, but the state Legislature controls that. The state is pushing costs down to the county.” ...

Associate Probate Judge Oscar Kazen, who presides over hearings to commit those in mental health crises, said further slashing of state hospital beds would only worsen the inequity in how the mentally ill are punished.

“People just disappear into that (competency restoration) hole and sometimes don't come back for months and months and months,” Kazen said.

The competency restoration issue is big sleeper issue that's reaching critical mass, headed quickly once again toward crisis stage. The state began pilot programs to do competency restoration locally in four counties, including Bexar, but their outpatient program only has 50 slots. The story mistakenly quotes a local official saying the Bexar program was unique, but it's one of four legislatively authorized pilots. In general, those pilots have worked well but not operated at a volume sufficient to take pressure off state hospitals. Cuts to state hospital's forensic beds constitute a direct shift of costs to local jails, which are generally ill-equipped for such tasks.

FWIW, this is some of the best original reporting on criminal justice issues out of San Antonio since their paper began sharing content with the Houston Chronicle. And I'd bet the farm that similar stories could be told throughout the state wherever reporters poke their noses into this obscure but critical aspect of the justice system.