Monday, February 04, 2008

Legislature's underinvestment in competency restoration beds creates havoc for mentally ill jail inmates, county jails

The 80th Texas Legislature failed to fix the crisis, so mentally ill defendants who're declared incompetent to stand trial are still locked up in county jails in record numbers.

Por ejemplo, the Austin Statesman's Andrea Ball has a fine piece profiling the case of Daniel Whitehead, a schizophrenic/bipolar defendant arrested for allegedly forging a check. He was declared incompetent because of his mental state and spent 106 days in the already-full Travis County Jail waiting for a bed at the Austin State Hospital to open up. Reported Ball ("Mentally ill people's care falling to jails, emergency rooms in Austin," Feb. 6):

Since November, at least 125 depressed, suicidal or violent people have been sent to emergency rooms.

Previously, most of those people would have gone to the state hospital, said Dr. Jim Van Norman, medical director for the Austin Travis County Mental Health Mental Retardation Center.

Now, some spend up to 14 days in emergency rooms waiting for a bed in a psychiatric facility. Others are treated and released from emergency rooms without any mental health care.

Then there are people who, like Whitehead, spend months in jail waiting to be sent to a psychiatric hospital.

Incompetent defendants must undergo "competency restoration" services before they can go to trial or plea bargain; those services are performed only at state hospitals except in Houston, which has limited competency restoration services at the county jail.

I've not been as focused on this subject since the Legislature decided to short change funding for forensic beds at state hospitals last year and Advocacy Inc. announced it would move forward with litigation.

The state's community MHMR centers lobbied against funding additional forensic beds, claiming it would be better to manage competency restoration in the community. So they convinced the Lege to give money that otherwise would have gone to treat mentally ill people in jails for community based programming.

Problem is, the Lege gave MHMR centers the money without mandating that they handle competency restoration cases. So mentally ill folks like Daniel Whitehead basically got screwed to the wall. This guy spent longer in jail waiting to be declared competent than he likely would have received as a sentence if convicted and punished!

So what's it like to be a mentally deranged jail inmate?

Last fall, according to jail documents provided by Whitehead, he was beaten by other inmates and suffered multiple injuries. On Oct. 25, Whitehead filed a request for medical care and wrote that he was allergic to the antipsychotic drug Thorazine. On Oct. 26, he filed another request for aid and again noted his allergy to Thorazine.

When he received treatment five days later, a nurse told him that she planned to inject him with Thorazine. According to the medical records, the nurse returned to the clinic, rechecked Whitehead's chart for drug allergies, found none, and injected him with the antipsychotic.

"I begged them not to do it," Whitehead said. "Immediately I started having trouble breathing."

Whitehead's medical records indicate he also broke out in hives on his legs, stomach and buttocks and developed sores in his nose.

Shelly Eaton, senior paralegal for the Travis County sheriff's office, declined to comment on Whitehead's medical case.

After Whitehead had spent 82 days in jail, officials still had no idea when he would be sent to a psychiatric hospital, said Bode, Whitehead's lawyer.

So on Dec. 21, Advocacy Inc. — a federally funded agency that works to protect people with disabilities — filed a court motion asking officials to either hospitalize Whitehead or release him.

"He needed to be getting competency restoration treatment, and the only place he should be getting it is the state hospital," said Beth Mitchell of Advocacy, who teamed up with Whitehead's lawyer to file the motion. "There was no legal reason for him to be (in jail), so they had to let him go."

On Jan. 14, one week before Whitehead's court hearing, the state moved him to the state hospital.

Whitehead's case typifies the plight of dozens, perhaps hundreds of inmates around the state at any one time waiting in jail for competency restoration services. Not only is it inhumane and unsafe to lock up mentally ill people in dangerous jail settings, it serves no justice interest. The wait is caused solely by a lack of capacity, a failure by state government to provide services it mandates defendants receive before they're declared competent.

Ball's article effectively illuminates how most mental health care inevitably falls on local emergency rooms as well as prisons and jails. In economists terms, an underinvestment in human capital has resulted in expensive externalities that cost more to mediate than would providing indigent mental health care in the first place.

Society benefits a lot more if Daniel Whitehead's mental illness is brought under control than if he's punished for a $231 forged check written while he was off his meds. There has to be some way to divert such folks to receive services and help instead of prosecuting them like their behavior was rational.

In terms of the number of people affected, the lack of competency restoration beds is hardly the biggest problem faced by the justice system. But for those affected - both the defendants and the ill-equipped jailers who must care for them, for that matter their fellow jail inmates - the situation alternates on a grave continuum between sad and dangerous.

The community MHMR centers who received extra funding last year should immediately develop competency restoration programs aimed at county jail inmates, otherwise their claim that community based funding is "better" than sending inmates to state hospitals looks like disingenuous money grabbing. If they don't step up - and I seriously doubt they will - the 81st Texas Lege should either require them to do so, or take that money back and spend it on eliminating backlogs for forensic beds at state hospitals.

See prior, related Grits posts:


Anonymous said...

Not only did the 80th Lege not do MHMR right, they did not do anything about the conduct of the BPP. They still do not follow the rules, they made and nothing is done about the mistakes and none caring attitudes of members on boards. There are three in each Region, one is appointed and two are hired. The "appoointed" one makes decisions and he has never interviewed anyone. Thank goodness there are a few who truly care about there fellow mankind.

Either make the BPP follow rules, or dismantle the whole system. There used to not be a BPP,sentences were lighter and when that was served, that person was allowed to go home to their families. No more does a parole really count. If you are paroled, you should be released at the earliest possible time and not have to wait while someone makes a decision out of pure meaness to make someone stay longer than even the Judge stated in the Court Transcript.

Ok, Lege it is time you put you hand and mouth in the correct position and stop dilly dally around and get it right. Either make the BPP follow the rules, are dismanteld the entire system, they cause more full prisons than some Judges and some of them just stink and are mean. There needs to a lot of changes in the Judgeship positions also. Also, consider the money spent to pay for Inmates and those who have to stay in County jails due to the full prisons in Texas, that costs even more per day for the County jails to keep Inmates that TDCJ is paid to care for Inmats in their units and the food they are fed, is uneatable!

Vote time is coming up and people in Texas are tired of most of the money paid in taxes go toward a system that mistreats people and gives no medical care, pays employees very little for a very hard job. No wonder the turn over rate is so difficult. We certainly could have a more efficient sytem if the people who have been paroled are released and made to stay for x number of months more when the Judge, did not even say this. Lege do something, this may be your last chance!!

If the State had not taken away so much money from State Hospitals and closed so many, those with mental illness could get help and not be mistreated further. Stop the insanity of this government of Texas and follow your heart, from what I have heard that is Jesus talking to you. Think about it!!

Anonymous said...

Great example! It would have cost far less to care for this man properly in the first place.

Let's see......106 days in jail at say $60 per day would be $6,360. Then of course there is the cost of diagnosis and medical care, albiet bad care, the Court staff and of course the Lawyers for the Defendent and County. Next the mental health restoration services will not be cheap and the poor guy will still have a trial or plea deal. There will be jail time and/or probation.

These things are not without their cost. I'm guessing well over $50,000 all said and done. All for a $231 bad check. His bank account probably had $200 ($31 short) so the entire check was bounced.

At the end of all this, neither society nor this guy are really better off.

What a system!

Anonymous said...

We have a just and merciful God. We had better count on that mercy for the injust ways we treat people. This in a state where politicians list their church affiliation as a qualification for office!

Anonymous said...

The county jails are not set up to manage the mentally ill.The guards working for the county jails are not trained to handle and deal with the mentally ill. The medical-aid staff are not trained to know how to handle the mentally ill.If MHMR is not going to step-up to the plate to provide proper care for the mental that are in need then the funding needs to be returned enabling the counties to build a section and/or building to manage and take care of the mentally ill. Completely separated from the county jails.To hire the properly trained staff to provide care for them.In a local jail housing a mentally ill person I received reports that about ever 2 nights about 2 or 3am in the morning one of the guru mugging guards would go into this mentally ill persons jail cell and beat him up.This person did not do anything accept sit on the floor of his cell all day watching his 7" Black and White TV.He was not administered his medications. He was never heard asking for guards or anything like that. It just seem like whoever was doing the beating up was just doing it because they could.Now that is not right.That is not what America is supposed to be about.I say,REFORM or OUT THE DOOR.Flo,PAPA

Anonymous said...

Gritsforbreakfast said...

So what's the point of that clip, rage? Do you see no distinction between a murderer and somebody who passes a $231 bad check?

Anonymous said...

Hey Grits....Why is it the states problem? What is preventing the county to step up and serve thier own community? Nothing. Everybody wants to pass the buck. Let's examine.... Person commits a crime in a city/county crime is a local community so should not locals provide alternatives to reduce crime? Create economic conditions - jobs, school to better its people. They are a tax base just like the state is and the taxes stay local. Why should someone is East Texas pay for MHMR access in Harris County. Just a thought.

Anonymous said...

@10.56 ~ it doesnt matter whether it's the state or the county's problem, the fact is, those with mental illness will not get the care and support they need in a jail or prison. It is unfair on the individual and unfair on those given the task of 'looking after' the individual.

Gritsforbreakfast said...

@10:56 - when the state requires the county to do stuff without giving funding, it's typically called an "unfunded mandate." The state requires competency restoration, and historically has provided it through the state hospitals. Cuts to mental health services in 2003 are the main reason for the current shortage. I think this is pretty much a state problem.

In any event, as a taxpayer I don't really care which govt entity has their hand in my pocket. I'm more worried that the system work than who pays for it, though I know that's where the devil arises in the details.

Anonymous said...

Actually Grits, I was trying to help your point that prison care for mentally ill inmates is insufficient, since the one in the article killed himself--the second suicide in two days in Houston jails.

Easy there killer.

Anonymous said...

come on don't care what govt entity is in your pocket. Lets be real. You sound like the President. Why don't you take his advice...the IRS accepts checks and money orders. I agree service should be provided. But it has to be done locally in my mind. Again I'm in the country...things are reasonable and cheap here. Why should I pay for crap in big cities. The state set guidlines such that there is a equal standard. They should provide SOME money. But in essesence its a local issue. Just my two bits. I'm off to the fields.

Gritsforbreakfast said...

Ah, I see your point.

Go ask your local sheriff what he thinks. I'll bet you'll find that if the state didn't deal with it, your county wouldn't be remotely capable of meeting the statutory requirements for competency restoration.

Small counties don't have the infrastructure to deal with this. For that matter, MHMR centers are regional, multi-county entities - each county doesn't have their own.

Applying that philosophy across the board on every issue, you might not like the results. E.g., smaller counties for a while essentially couldn't apply the death penalty because of indigent defense costs, so they recently created a regional capital defender for most of West Texas.

One or two high cost inmates with serious mental illness can run up expenses really quickly when you have to pay for services from 100 miles away.

BTW, what are you planting this early, 11:59? best,