Tuesday, April 02, 2013

Band-aid bills no substitute for competency restoration funding

Bills up in committee today and tomorrow aim to treat some mentally ill defendants deemed incompetent to stand trial in county jails instead of state mental hospitals. But without significantly more funding for mental health services, Grits remains skeptical they'll have much effect.

In today's Texas Senate Criminal Justice Committee meeting, legislators will consider a privatization scheme for competency restoration services (i.e., helping the mentally ill stabilize so they're competent to stand trial). Sen. Robert Duncan's SB 1475 would establish two pilot programs that would hire contractors to perform competency restoration in county jails instead of sending incompetent inmates to a state mental hospital. Harris County already does something similar, but in-house in conjunction with the local mental health authority instead of using a private contractor. Duncan is from Lubbock, which has also experimented with competency restoration in-house. The programs would cost about $1.7 million per year.

No doubt something must be done to reduce the long wait times for state hospital beds. The state has said it cannot comply with a court order mandating that prisoners be accepted in competency restoration programs within 21 days. My own preference would be for counties to utilize a mix of outpatient and in-jail competency restoration, particularly for nonviolent and misdemeanor offenders, only sending folks to the state hospital in the most severe cases or when in-county services have failed. The state authorized a pilot programs a few years back to perform "outpatient" restoration, which in Harris County ended up meaning performing competency restoration in the jail. That's still an improvement over waiting for months in jail for a hospital bed to open up, then months more for treatments to kick in. But it's still not quite "outpatient" in my book.

Just as or arguably even more critical than the shortage of hospital beds is the systemic underfunding of community-based crisis services for people with mental illness. Ideally, the state should spend more resources to help mentally ill folks in crisis before they end up committing crimes. But without some game changing increase in funds - perhaps through Medicaid expansion under Obamacare - it's hard to see that happening given the state leadership's priorities.

In any event, we're long past the point where small-ish "pilot" programs will solve anything. The real problem, as has been the case for years, is that the state simply doesn't adequately fund mental health services in the criminal justice system, or for that matter, apart from it. The problem isn't inefficiency of government vs. the private sector, it's that the state doesn't spend enough for either government or the private sector to handle the massive volume of mentally ill people cycling through the justice system. The bill mandates that the pilots use private contractors (GEO Group says "thank you"), but this is very much a core government function and it makes little long-term sense to do it through a vendor instead of with state or county employees.

Duncan's pilot programs do not particularly bother me; I'd prefer to see more of this work done in-county, though I see little wisdom in the privatization aspect. But neither do they inspire me to think they offer any real solution.

Tomorrow, the Texas House Corrections Committee will consider legislation (HB 2349 by Zerwas) authorizing the Department of State Health Services to commission jail-based competency restoration programs using the local mental health authority or a provider they approve to provide services. That makes a lot more sense to me than handing the job off to the GEO Group or some other private contractor. Zerwas' bill would also establish a "conditional release pilot program" which would create a process for identifying jailed, incompetent defendants who have been incarcerated for more than a year, are not yet competent to stand trial, but are taking their meds and have been judged by mental health professionals to be capable of independently functioning and not a danger to the public. Perhaps that pilot should be extended to the state mental hospitals as well. Even better, perhaps the bill could be amended so that some competency restoration work could be performed on an outpatient basis from the get-go, particularly for nonviolent and misdemeanor offenses.

Personally, I prefer Zerwas' approach to Duncan's but both fail to address the core dilemma, which is that Texas has failed to adequately fund mental health and uses county jails as a substitute for community-based crisis intervention services. Grits is far from sanguine the Lege will do much of anything this session that seriously addresses the underlying lack of funding that's spurred this crisis. Certainly these two bills are merely band aids.

See prior, related Grits posts:


quanah_xochitl said...

I'm curious as to why you are against private businesses performing the "stabilizing" programs? From my experience, private mental health professionals are more effective overall.

The GEO Group is a good example of why legislators should not incentivize incarceration - bad economics; however, there are also ways to incentivize de-incarceration (is that a word?) and better mental health treatment.

Gritsforbreakfast said...

qx - I don't generally think privatization is best for core government functions, particularly in the criminal justice system. For one offs or things government does that overlap with the private sector, it's fine to use private services. For example, I'm fine using private providers for outpatient services, but in the jail there's really no good reason for it except an excuse to give out a contract.

Relatedly, you say the GEO Group is why the Lege should not incentivize incarceration, but they're the only ones doing private sector competency restoration right now in Texas and IMO are the most likely candidate to soak up these pilot contracts.

As for whether "de-incarceration" is a word: It is around here! best,