Saturday, February 04, 2006

More counties grumbling at backlog of incompetent defendants in Texas jails

Following up on a story first covered on Grits a couple of weeks ago, there are more complaints in the press about defendants who've been declared mentally incompetent languishing in Texas jails waiting for state hospital beds to open up. Every time this gets covered we learn a little more about the problem. Reports the Waco Herald Tribune ("New state policy limiting criminal psychiatric beds has local officials upset," Feb. 3):
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.

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.”

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.
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 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.

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:

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.

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.

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.

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.

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.

UPDATE: More from the McAllen Monitor

See prior Grits coverage of this topic:


Anonymous said...

Actually, Petda, I don't have a blog...although it seemed that to post over at your site, I had to register as a blogger.

Thanks for what you are doing.

Anonymous said...

Patients Bill of rights and Mental Healthcare in Texas

Have you noticed in the past fifteen years how the homeless populations in cities across Texas and the nation have skyrocketed? Officials estimated that in the year 2000 homelessness increased 12 percent in one year. At that time an average of 22 percent of homeless were considered mentally ill. Today census takers are scrambling in Dallas and across the state in cities trying to get a grasp on the latest figures which some estimate may be near 30-40 percent mentally ill. Why is this so? Political spin doctors are quick to blame the increase on a bad economics, while others blame the good economy and the lack of affordable housing. However, according to mayors across the U.S., the strength of America's economy has had little or no impact on the homelessness in their cities. Regardless of who is right it does not answer our question of why there is such an increase in the mentally ill homeless in Texas.
In the 1970s, control of the Texas mental health commitment process was taken over by the courts. During that time two physicians (including a psychiatrist) who had no financial interest in the patient's treatment, or the medical examiner, had authority, for all practical purposes, to admit the mentally retarded to an institution. Today we have no idea who to call except local emergency services or the police.
In 1991 State legislators under Gov. Ann Richards and help from the A.C.L.U. and trial lawyers across our state passed the initial Patients Rights legislation. To the public this seemed to be legitimate law aimed at protecting the rights of all patients. It included the confidentiality of records and humane treatment in safe facilities. It included certain rights to protect patients from commitment to asylums by scrupulous spouses and family members. However, the less advertised acts issued in this legislation will continue to haunt Texans for many years to come. Today the mentally ill are now afforded the followings rights
(1) the right to register and vote at an election;
(2) the right to acquire, use, and dispose of property, including contractual rights;
(3) the right to sue and be sued;
(4) all rights relating to the grant, use, and
revocation of a license, permit, privilege, or benefit under law;
(5) the right to religious freedom; and
(6) all rights relating to domestic relations.

This has created a completely new area of law and opened up a gold mine for attorneys of the mentally challenged in our state. Under these laws it is now considered to be in violation of the persons fundamental and civil rights to be locked up in a psychiatric facility if they are not found to be at eminent risk for causing harm to themselves or others. Sounds reasonable, unfortunately, it also means that an individual can choose to remain psychotic, delusional or actively engaged in the use and abuse of substances, and the only way that law enforcement, the court system and the state public mental health system can become involved is if the individual is threatening to hurt himself or is at risk for hurting others.
When law enforcement travels to the individual's home, or the site of a disturbance, the individual has to engage in threatening behaviors secondary to an obvious mental health condition at the time he or she is assessed by law enforcement. Law enforcement is then required to transport the individual to the appropriate and designated crisis mental health screening facility in the community. The role of the screener at the crisis facility is to determine if the individual meets the criteria necessary for hospitalization and make to ensure that if the individual is allowed to leave the crisis facility, he or she is no longer in crisis. Is this screener qualified by law? Again, what this individual will be looking for is eminent indications of dangerousness towards self or others. This does not mean that the individual is not assessed to be in need of treatment. In fact, the center will often offer an individual mental health follow up appointment or a referral for substance abuse treatment if it is obvious, based on behavior and mental status, which the individual is in need of, and could benefit from treatment. What this means is that the individual, according to the law in this state, cannot be forced to accept treatment simply because he or she suffers from a mental illness or a substance abuse problem or disorder. It means that the individual, by law, is considered competent to make decisions about whether he or she wants to accept help and participate in treatment. In the words of bipolar Dr. Collelle Okeef, “We may be crazy, but not stupid”.
Also, if this person is deemed a threat to themselves or society they are then entitled to full legal representation. Will the attorneys be compensated from state coffers or the na├»ve patient’s disability check?
Both the state system and the private sector are in a period of major turmoil. With the Texas Department of Mental Health and Mental Retardation placed by House Bill 7 under the auspices of the Commission on Health and Human Services, the umbrella agency established by Richards and the legislature has yet to deliver. Major issues such as the rise in homelessness, and the rapid increase of individuals with mental illness complicated by drug and alcohol abuse will further complicate the system.
And after all the census counting is done I believe we will find that tens of thousands of the homeless on Texas streets are mentally ill, unstable patients who refuse voluntary treatment or medication. What are we going to do then?
I believe that folks in our country who have been diagnozed mentally ill are entitled to rights afforded all citizens under the U.S. constitution, only after they have been medically stabilized and are not a threat to themselves or society. Only then are they able to lead meaningful and effective lives in our society.

Gritsforbreakfast said...

Not to dispute your history, anonymous, because you're talking about stuff I'm not aware of , but this item is talking about people who HAVE been declared mentally incompetent by the courts and ARE being forced onto their meds, at least once they get into the hospital. What's more, the number of mentally ill homeless far outstrips the number of institutional beds that have ever been available, so I have to wonder if it's really true that an historic system could have "locked [them] up in a psychiatric facility if they are not found to be at eminent risk for causing harm to themselves or others." At the macro level the numbers don't seem to add up.

I also wonder if some of the new rights you're talking about like voting, etc., stemmed from a) the Americans with Disabilities Act passed in the early 90s, or b) the Reagan-era federal decision to de-institutionalize the mentally ill. Finally, for the record, people are forced into substance abuse treatment all the time -- that's what the whole drug court movement is premised on. So while I don't know enough history to dispute what you say at all, and it may be exactly right, other facts I am aware of make me think there's more to the story. In any event, nobody, Dem, Republican or otherwise, is proposing to expand the state psych hospital system enough to lock everybody up the way you advocate, so I'm not sure the critique points to a solution.

Other states have tried using mental health courts to force patients/offenders onto their meds on an outpatient basis, and though I'd prefer if folks could get treatment before a crisis, I think in the current environment that probably makes a lot of sense. I'd be curious as to your opinion what should be done. Best,