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:

• Lawsuit moves forward to require quicker competency restoration
  
• Competency restoration legislation moving, funding for new forensic beds in jeopardy
  
• Priorities: Mentally incompetent inmates languishing in Texas 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
• 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
• When I was sick, did you imprison me?
  
• MH funding not enough, but better than a sharp stick in the eye