Friday, January 27, 2012

Judge: State mental hospitals must take incompetent inmates within 21 days

Big news for mentally ill defendants in Texas declared incompetent to stand trial, not to mention the state agency that is supposed to provide "competency restoration" services, which presently has a months-long waiting list. After a court ruling this week, such long delays have been deemed unconstitutional and state mental hospitals have been ordered to begin taking inmates within 21 days after they've been declared incompetent. Reports Andrea Ball at the Austin Statesman ("Judge: Mentally incompetent inmates being kept in jail too long," Jan. 26):
Texas routinely violates the constitutional rights of mentally incompetent prisoners by forcing them to stay in jail for up to six months before moving them to psychiatric hospitals, a Travis County judge ruled this week.

State District Judge Orlinda Naranjo ruled that the Department of State Health Services must start moving "forensic commitments" — people accused of crimes who have been ruled incompetent to stand trial because of mental illness — to state psychiatric hospitals within 21 days of receiving a judge's order. Over the past two years , the average prisoner spent six months in jail waiting for a hospital bed, the ruling states.

"Keeping incompetent pretrial criminal defendants confined in county jail for unreasonable periods of time violates the incompetent detainees' due process rights as guaranteed by the Texas Constitution," Naranjo wrote.

A final order that would specifically lay out how the health department should proceed has not been issued, said Tom Kelley , spokesman for the attorney general's office. That agency has not decided whether it will appeal the case. Right now, there is no timetable for when the changes might be instituted.
 I contacted the attorney in the case from the group Disability Rights Texas, Beth Mitchell, who forwarded a copy of Judge Naranjo's ruling (uploaded here on Google Documents).

The lawsuit is aimed at the Commissioner of the Department of State Health Services, and while everyone thinks it'd be a good idea to reduce waiting times, the decision raises as many questions as it answers. The state cut state hospital funding and other mental health services this year, so seeking more resources in the near term will be like squeezing blood from a stone. Meanwhile, the average waiting list for beds in 2011 was about 300 people, wrote Judge Naranjo, with about 800 beds designated for "forensic" use.

How will DSHS comply with this ruling or will they balk and appeal? If they comply, will they contract for beds, and if so where, and with what money? Will they shift more beds to forensic purposes, and if so what impact will that have on other severely mentally ill folks with civil commitments (69% of state hospital patients, says the ruling)? Will the Legislative Budget Board authorize extra interim expenditures - as they did for the $5 million per month extra being spent on TDCJ healthcare - or will they let the system limp along, noncompliant, until the 2013 session? And what remedy might Judge Naranjo be able to muster to compel them to act sooner? ¿Quien sabe?

This is a welcome ruling, but it doesn't manufacture extra hospital beds out of thin air. Perhaps, though, it will set in motion a process that forces the Legislature to focus on the question much more seriously, and immediately, than they have in the past.


ckikerintulia said...

Thanks, Scott. No place for the mentally incompetent. A brother of some of the Tulia 39 or 46, depending on which way you read the counts, was borderline incompetent. He got pulled over, swallowed some substance rather than giving it up, was convicted for concealing evidence and received a long sentence. This was after McEachern was no longer DA. His successor DA acknowledged that the defendant did not belong in prison, "but I don't have any other place to put him." One of his brothers said, "He can't survive in prison." He was dead within 3 years.

Don said...

So basically, he would have lived 15 years longer if he gotten the death penalty. Wow!

Anonymous said...

mental health dept nneds to do like other state agencies... find a way or be replaced with someone who will.

for too long our state mental health has been rewarded for failing to perform while at the same being given more and more money. State Auditor's Office needs to start asking why everytime another "Mental Health" sub agency is created why all the money is going to create more administrative structure. Eliminate the all the excessive admin. and send the money down to services.

Abolishing subagencies like TACOM, TACOOMI, or whatever the hell its called would be a great start.

rodsmith said...

finding the money is easy. Just walk thought the state offices in the capital and just FIRE every 3rd aid!

Gritsforbreakfast said...

Christ, Charles, what an awful story. Really sorry to hear that.

Anonymous said...

I tried for about 5 years to get decent mental health services from the state for a family member who eventually ended up in prison. Ths system is so blatantly incompentent, its just amazing. I talked with social workers and doctors who were clueless on what recent research had shown to be the most effective treatments. One of the doctors working at the state hospital was a convicted sex offender. He seemingly was unaware that there had been any research since the 70s on what a recent Johns Hopkins white paper on depression considered to be the most effective treatment for depression with psychosis. This treatment is only offered at one state hospital, as far as I know, and a Master's level social worker at the facility I was dealing with was unaware it was offered anywherei in the state hospital system. Calling them incompetent is being too generous. On another occasion the patient was experiencing significant side effects from a medication. The medication was being pushed by the local community MHMR (I just recently saw where the manufacturer lost a large lawsuit in Pennsylvania. They were paying state agencies and officials to make sure this drug was given preference). The liason person who worked for the MHMR agency and was supposed to coordinate services with the state hospital wanted the patient kept on the drug, despite the fact that it made her look like someone with advanced Parkinsons. The ageny's policy(which was likely influenced by money from the drug company)was more important than the best interest of the patient. The best interest of the patient meant nothing to this bureaucrat. Fortunately, I was able to get the doctor to listen to me instead. The treatment provided is just to try one medication for a while, ignore serious, life threatening side effects. Discharge them and hope for the best. Then when they return, they just try another pill. If the patient is lucky they might throw in some occasional therapy.

I think it is tragic that mental health services in Texas are so bad. But, honestly, if they shut down the entire state hospital system, I don't know that things would be that much worse.

Prison Doc said...

Wasn't it Andrew Jackson who said "John Marshall has made his decision, now let him enforce it"?

As Grits points out you can't conjure beds out of thin air, so I wouldn't hold my breath that this decision will make a difference unless it just puts larger numbers out on the street.

Folks I know who work in the state facilities claim that a lot of the forensic evaluations are on people just trying to "work the system" to avoid criminal convictions--but even if that's true, I don't know how you crack that nut either.

aball said...

Anonymous - The Statesman has been doing a series of stories on the state hospitals. If you've like to talk about your experience, please feel free to drop me a line at

Thanks, Scott, for posting my article!

Andrea B

Gritsforbreakfast said...

Thanks for writing it, Andrea, and for getting the facts straight. It's a lot easier for me to just point and say "what she said."

If you're continuing to look at this topic, one angle you might look at: Harris County has a great system of vetting jail inmates up front and getting them on their prescriptions as early in the process as possible - well before any competency hearing - and as a result their forensic commitments have much lower lengths of stay in state hospitals, I'm told, than most other jurisdictions. The folks in the mental health division in the Harris County public defender office can talk to you about it.

A Texas PO said...

In the probation field, many of these folks that make it to our caseloads are just tossed into the mix by administrators who sheeply wish us the best of luck. CJAD offers absolutely no training whatsoever on how to effectively manage special needs offenders. Much of my knowledge from working in probation was gained through trial and error, unfortunately. My biggest headaches have been dealing with TCOOMMI and local MHMR facilities. I was told in conferences, phone calls, and certification trainings that TCOOMMI will follow the offender through programs like SAFPF to ensure that the necessary medical care follows them through each phase until they return home and are provided services by the local MHMR. Then the offender gets released, and no one knows anything. My SAFPF clients had a difficult time getting set up with MHMRs while in the transitional treatment centers because their stay was only temporary. Then, once they returned home, suddenly there's a 6-month wait at the local MHMR, even though these folks had been receiving services there before. The Lege keeps cutting the funding, which only puts more pressure on the state hospitals which is why their waits are so long. Study after study shows that community-based services do wonders for these folks, yet, if you don't live in one of the big cities, you're pretty much screwed and the Sheriff is the only real mental health provider around. I was lucky enough to be a part of the early discussions that led to Bexar County's Center for Health Care Services, which, though not perfect, was a huge improvement in San Antonio to streamline services. But when I suggested something similar in my home county, I couldn't even get the local MHMR to agree to meet and discuss. The failure, IMO, starts with the local MHMRs.

Anonymous said...

Texas MHMR is what you get when you let an agency Audit themselves rather than being submitted to an outside audit. While at the same time removing all accountability for the work they are supposed to be doing. The whole venture of creating yet more MHMR agencies to work in juvenile probation, adult probation, and prison has been nothing but a total jack-off of tax dollars. Just more people being hired to lament how they don't have any money to provide services.

Here is one example of how MHMR jacks off our tax dollars. Not many people are aware that MHMR goes out and bids on rest area maintenance along highways and interstates. Each contract is worth a couple of million. They don't even have to bid competitively. Using taxpayer dollars and MHMR clients they go out and make boo koo $$ and don't have to answer for where or how the money is spent. This is the kind of bullshit that goes on leading agencies to drift so far off course from their primary purposes they become useless, bottomless pits of money.

From top to bottom, MHMR is an agency filled full of gold-bricking lazy asses. Ironically there are plenty of MHMR people available for any and every other agency meeting across the country, out of state conference,retreats... so they can't be too overworked.


DEWEY said...

"And what remedy might Judge Naranjo be able to muster to compel them to act sooner? ¿Quien sabe?"
Confine "our" state congress critters to a state mental hospital (they are incompetent anyway) and let them hold sessions there.

Anonymous said...

They will make room by pushing those in the state hospitals already out sooner than their commitment allows to make room for the ones waiting. And, they will use up all the civil beds. They will change their inpatient commitment to an outpatient commitment.

Anonymous said...

Anonymous 5:43,
The MHMR consumers working at those roadside parks are the ones receiving the funds for that, not the MHMR. These consumers are not likely to find jobs in traditional places so the MHMR employs them for these purposes, not to get rich. MHMR's are non-profit agencies, so they can't profit by law.

Anonymous said...

I would also like to way in...hat about the adolescents? The literature is clear that there is a disproportionate number of youth with severe mental illness in the youth prison system. However, no one has looked at those in the correctional setting that are incompetent. My hunch is that the juveniles that qualify for the "mental health" discharges from state corrections, were incompetent at the time of their adjudication. However, the state's juvenile competency laws are vague to say the least. We need standardized assessments and a true "forensic" unit for that population. I have seen the forensic units for adults, and they have come a long way in the last couple years. Now its time to look across the life span.

Anonymous said...

@ 9:58am

Total B.S. I used to have a number of such contracts and lost them due to MHMR saying they wanted those rest areas.

Maybe you aren't aware but even the MHMR contract amount is listed on the sheet of winning bids for all rest areas. To make this short and sweet, when I secured the winning bid for the same rest areas that MHMR assumed, MHMR receive 2 to 3 time the amount my company did. AND, come to find out MHMR paid its employees far less than I was paying mine. Now you go do the Math and tell me where all the missing money went.

It is a total lie to insinuate that all of the money goes to MHMR clients/employees and none of the "administrative costs" are paid as part of the ED and management salaries of that particular MHMR office.

Anonymous said...

What about sanction for judges who take up the valuable state hospital beds for competency restoration with clients for misdemeanor offense such as criminal trespass. I have seen homeless persons who are mentally ill sent to state hospitals because the local county judge does not like them sleeping at or around the courthouse.

Anonymous said...

Anon 1:51
If this were Facebook, I would hit the like button.