Friday, December 29, 2006

Legislature should prioritize mental health spending that relieves local jails

Mental health advocates are asking Texas DAs to speak out to expand funding for "crisis care" for the mentally ill, and certainly better services are needed, but I can't tell that their proposals will specifically address the most pressing mental health woes of Texas' criminal justice system - particularly the growing need for "competency restoration."

Here's a portion of the letter to the DAs and CAs from the Texas Council of Community MHMR Centers:
It is estimated that there are approximately 54, 255 individuals requiring crisis services annually in Texas.

Our inability to serve these individuals adequately results in significant impacts upon hospital emergency rooms, county jails and law enforcement.

The Department of State Health Services earlier this year established a Crisis Services Redesign Committee to develop recommendations for mental health crisis services that are delivered through the local mental health authorities.

To see a full copy of the Crisis Services Redesign Report, go here.

The Committee recommended the following core services be available in communities to treat psychiatric emergencies:
  • Crisis hotline services
  • Psychiatric emergency services with extended observation services (23 to 48 hours)
  • Crisis outpatient services
  • Community crisis residential services
  • Mobile outreach services
  • Crisis intervention team (CIT) mental health deputy/peace officer program
The Department of State Health Services is requesting $82 million in their Appropriation Exceptional Item to begin implementation of a "mental health crisis system redesign."

If you wish to get involved, please contact:

Joe Lovelace
Associate Director - Behavioral Health
Texas Council of Community MHMR Centers
That $82 million figure represents a phase-in of a larger program that will ultimately cost $222 million per biennium, according to a September report (pdf) by the Department of State Health Services. That report identified several ways enhanced crisis care might help local jails, specifically:
  • mental health services often are not available or accessible so that the only placement, other than the street, is jail
  • long waiting times that law enforcement officers experience when escorting patients to health facilities result in jail placemet so that officers can return to their other duties
  • committee members and commenters statewide in agreement that jail for people whose need is for mental health services should not be an option
I'm glad the committee agrees jail is an inappropriate place for the mentally ill, but that's where we're warehousing an awful lot of them, nonetheless. Larry Hauser, Chief of Psychiatry at Brackenridge Hospital in Austin, told the Committee at a hearing that
Probably about 20 percent of the inmates in any given jail or prison are going to be mental health patients. That’s about the percentage here in Austin. We need a system to treat people in a humane environment where they are going to get proper care and it will keep them from rotating in and out of the system.
There's no question the effect of the shortage of mental health treatment facilities on the criminal justice system looms large. When a mentally ill defendant is in "crisis," to use the technocratic phrase, i.e., in the throes of mental illness and unable to engage in rational thought, a court will typically declare them "incompetent" to stand trial. That then requires "competency restoration" services from mental health crisis treatment centers. But the state hospitals are utterly full, and at any given time dozens or even hundreds of defendants may be waiting, often for many months, for treatment beds to open up.

Until then they're housed in the county jails. They've been found guilty of no crime yet. Indeed, the courts won't let them plead "guilty" until their competency is restored. That's a contributing reason why the report found that "people with mental illness who commit misdemeanors stay in jail longer and use more criminal justice resources than others [who are] not mentally ill."

In misdemeanor cases, it's not uncommon at all for a defendant to spend much longer waiting for a state hospital bed to open up to be treated and declared competent than the sentence would be for their alleged offense. (See a particularly unfortunate individual example of this from Injustice Anywhere.)

For all that, the DSHS report never specifically mentions competency restoration services, neither in the text nor in the proposed $222 million budget. But that remains a big concern for DAs, Sheriffs, judges and others in the criminal justice system. Maybe it's the case that expanded MH capacity allowed by the new spending would simply be enough to resolve the problem, but it's not specifically addressed either in the report or in Mr. Lovelace's letter.

I'll try to find out whether competency restoration funds would be addressed by this "Exceptional Item," or if the Lege would still need to pony up for those costs. Or if any reader knows more details, please let me know.

See prior related Grits coverage:


Anonymous said...

I have a great idea! Put some of the DA's ADA's in jail with the mentally ill for 4-6 months and listen to them scream and holler. See if that would make them want to change their minds. Half of them don't have hearts much less care.

Anonymous said...

Scott, your comments on mental health spending did an excellent job high-lighting the need for additional funding.

However, you wonder whether the new funds should be used to build a community based crisis system for persons with mental illness or address the need for competency restoration for those with mental illness in our jails.

In hearings held across Texas by the Department of State Health Services a clear mandate for the funding of community based crisis care was heard. Crisis care that will provide relief to the overcrowding of jails, emergency rooms and state mental hospitals. Funding that may have the flexibility to allow competency restoration at the community level.

To argue for increased funding for state mental hospitals is a short term solution to a much bigger problem.

In February, 2006 the LBB approved $13.4 million in additional dollars for state hospitals that increased by 96 forensic commitment beds. The waiting list for offenders needing competency restoration is greater now than in February.

As long as Texas doesn't have community based crisis services, jails will be used to house offenders with mental illness.

Joe Lovelace
Associate Director - Behavioral Health
Texas Council of Community MHMR Centers