Local jails housing incompetent inmates won't get immediate relief in 80th Lege budget

Proposed new spending at community health centers for "competency restoration," while necessary, won't help in the short term, won't be enough to cover projected needs, and pending litigation could force the state to spend more to correct the problem by 2009 - that is, if the Texas Legislature's budget conferees don't agree to more funding with a different spending mix than either chamber has suggested.

As I write this, nearly 200 mentally ill or retarded defendants in Texas are stranded in local county jails, some of them for many months on misdemeanor charges, waiting for courts to declare them competent to stand trial. For the sheriffs and mental health professionals who must handle the situation and the courts who are charged with protecting their rights, it's a pressing problem that only the Legislature can solve.

Columnist Bob Ray Sanders in the Fort Worth Star Telegram has the first topline numbers I've seen regarding new funding for forensic mental health beds in state hospitals ("Right thinking on Tarrant County mental healthcare," May 6):

The new state budget calls for restoration of the 10 percent of funds cut during the last session. And for the first time in a long time, bills that have passed both chambers call for new funding for mental health crisis services.

Although mental health advocates were hoping for around $80 million in additional revenue, the Senate legislation calls for $52 million in new money for crisis situations, and the House approved $35.6 million. That means the final amount will have to be worked out in conference.

Those who've followed the issue closely may recall that I and others wondered at the beginning of the session whether even the projected $80 million would be enough because the proposal didn't include more inpatient state hospital beds.

The Legislative Budget Board's comparison of the House and Senate budgets says new money in both budgets would go to improving community mental health crisis centers. That's fine, and needed, but right now only the one in Houston performs "competency restoration" services. That will do NOTHING to address the immediate backlog of incompetent, mentally ill or retarded defendants awaiting assessment and treatment.

Mental health advocates oppose new beds across the board, not just forensic beds in particular. But testimony to the House Criminal Jurisprudence Committee last week said demand for forensic beds for competncy restoration increased 100% since 2001. Forensic patients, said the Department of State Health Services' Chris Lopez, typically require 75-80 days to restore competency, compared to an average length of stay of less than half that for civil commitments and other types of patients.

As I mentioned last week, pending legislation should alleviate some of the pressure, but only more bed capacity for competency restoration in state hospitals will solve the short-term crisis. I guess, the Sheriffs, like me, don't follow the health-related committees as closely, but the failure to address this crisis will cause a real problem for local county jails unles local community centers get on the stick and start offering those new services, on the cheap no less, awfully darn quickly - that seems unlikely. Let's hope SB 867 is REALLY effective, and look for litigation to compel additional spending before the 81st session if this is all they do.

If Texas really wanted to prevent crime instead of merely show its animosity and disdain for criminals, we'd invest significantly more in mental health treatment, both in the community centers and to improve competency restoration.

Three out of ten Texas prison inmates are former clients of the state's indigent mental health system. Between 38-50% of youth inmates in TYC suffer from serious mental illnesses, it was reported recently. Our failure to treat the mentally ill results in terrible human and financial consequences. It's one of those pay me now or pay me later kind of deals, but when you pay later you pay a lot more and get a worse result.

Want More? See Bernard Harcourt's recent writing on the subject of incarceration and mental illness at the Volokh Conspiracy, all linked here, and also prior, related Grits posts:

• Priorities: Mentally incompetent inmates languishing in county jails
  
• 75-year old mentally incompetent grandmother stranded in Lufkin jail most of 2006
  
• Lawsuit could force Texas to treat mentally incompetent defendants
  
• Legislature should prioritize mental health funding that relieves local jails
• When I was sick, did you imprison me?
  
• Chincy state hospital funding leaves mentally incompetent defendants stranded
• Unfunded mandate: Counties struggle to pay for mentally incompetent defendants' care
• More counties grumbling at backlog of incompetent defendants in county jails
• MH funding not enough, but better than a sharp stick in the eye