Saturday, November 01, 2008

Outpatient centers better solution than jails for competency restoration

Four new pilot programs providing outpatient competency restoration services have significantly reduced the number of mentally ill inmates languishing in county jails waiting for state hospital beds to open up, according to a handout from the Department of State Health Services (pdf) distributed last week to a conference sponsored by the Texas Task Force on Indigent Defense.

This is a great idea because there's no real public safety benefit and a lot of extra expense to insisting competency restoration services be delivered in a carceral setting. For some defendants, sure, but not indiscriminately for everyone. Here's how the DSHS flyer described the new pilots:
The Outpatient Competency Restoration (OCR) pilots were launched by Department of State Health Services (DSHS) earlier this year in response to Senate Bill 867, 80th Legislature which amended Article 46B, Code of Criminal Procedure, in many respects to explicitly allow for outpatient competency restoration of defendants who have been determined by the court not to be a danger to others (see CCP, Art. 46B.072(a) ). Funding was awarded for pilot sites for OCR in selected areas where the Mental Health Authority and local judiciary have partriered together for this unique concept in competency restoration. OCR programming and curricula were modeled after successful OCR programs in other states.
Harris County was the first to do outpatient competency restoration, and now these pilots cover the other major metropolitan areas. The four sites are:
  • Austin Travis County MHMR (Travis)
  • Center for Health Care Services, San Antonio (Bexar)
  • North'Texas Behavioral Health Authority, Dallas (Dallas)
  • Tarrant County MHMR, Fort Worth (Tarrant)
These outpatient programs are not in secure settings and are suitable when the court believes the defendant won't be a danger. Jeannette Kinard, head of Travis County's Mental Health Public Defender unit, said the Travis County outpatient is available to both felons (except violent, "3g" offienders) and misdemeanants.

The need for these new programs arises because once a defendant is declared incompetent to stand trial, their case cannot be resolved, even if it's a petty misdemeanor, until their mental state improves. Defendants could sit in jail for months waiting for a state hospital bed, legally unable even to plead guilty to minor charges that would otherwise get them out immediately for time served.

The bulk of volume of court commitments to state hospitals comes from these larger jurisdictions, so they're a great place to start, but really there needs to be outpatient competency restoration provided through MHMR Centers statewide. Managing a mentally ill inmate whose case cannot be disposed can be an even greater problem in smaller, rural jurisdictions whose jail and staff are likely not trained or equipped to handle them. For that matter, defendants frequently "de-compensate" in jail after they've been in the state hospital, which requires even more time before a court can dispose of the case. That's a lot less likely in a supervised outpatient program because they don't have the dramatic shift from the hospital to the jail cell and can schedule the court date when the defendant is stable.

Before the 80th Legislature allowed the outpatient option, the only way to get the needed mental health treatment for competency restoration was to send defendants to one of Texas' state mental hospitals. But Texas quit building new hospitals and since 2003 has underinvested in the ones we have as well as in indigent mental health care generally.

By 2006, the waiting list was many months long and defendants had to wait in jail the whole time, even for petty misdemeanors. There was literally no legal option for them, so Advocacy Inc.'s Beth Mitchell sued on behalf of a man who was beaten by other inmates while waiting in jail for a state hospital bed to open up. It was that litigation more than anything that spurred DSHS' new strategy.

The Lege authorized outpatient competency restoration in 2007, but did not agree to pay for new state hospital beds, making outpatient competency restoration the only remaining option to what was clearly an untenable situation. No funding was designated for the task, however, and counties were slow to step up. Only Harris County MHMR - to their great credit - took it upon themselves to immediately begin providing competency restoration services. Mitchell told the indigent defense conference they're already seeing great results, with recidivism declining for those receiving outpatient competency restoration compared to those treated in jail or a state hospital.

Given that history, DSHS deserves kudos for creating these new programs to fill the gap, helping solve their own problem (state hospital waiting lists) and the jails' at the same time. According to their handout, the pilots will divert 427 people from state hospital beds in 2009 now that they're all up and running at full capacity. That's a good start, but I'll bet if they were funded for it they could handle more volume - certainly some people need full-blown hospitalization, but probably the majority do not.

The waiting list to get incompetent defendants into Austin State Hospital was not long ago many months long, but thanks to the outpatient diversion, the wait is down to 7-10 days, according to a Sergeant from the Travis County Sheriff's Crisis Intervention Team. Violent offenders who require competency restoration must go to the state facility in Vernon, he said, for which the waiting list is currently 20-23 days - still too long, perhaps, but a far cry from the months-long waits that were routine just a couple of years ago. (For those offenders, I still think in the long run the state will still have to pay for more beds.)

In the meantime, I'd like to see the 81st Legislature take the "pilot" label off these competency restoration programs and fund their expansion in other jurisdictions. DSHS, with a little added motivation from Advocacy Inc.'s lawsuit, has latched onto what I think is exactly the right solution to a lingering problem that's still creating headaches for a lot of jails around the state.

See the DSHS flyer (pdf) and prior, related Grits posts:


Anonymous said...

The citizens of Galveston are suffering under a brutal and corrupt police force. The Galveston Police Department makes approximately 8000 arrests a year, for a population of 57,000 (plus some tourists).

Harmful officers are retained and continue their patterns of abuse.

Cops shoot
at unarmed man, jail him for felony evadin arrest

Anonymous said...

I implore anyone involved in civil rights advocacy, et cetera who is reading this excellent blog to help stop these terrible civil rights abuses.

The situation is really dire. Although only 50 miles from Houston Galveston is in a time warp and procedures there seem to have come from the pre-Civil Rights era.

officer arrest black sheriff dept employee for interference in the duties
of a police officer

deputy acquitted at trial for interfering in the duties of a white police

Here are a few more examples. The officer from the previous post had another questionable arrest:

Anonymous said...

On October 11, 2008 police beat up and arrested 11 people including Brandon Backe and the FEMA director of operations for Galveston. The instigator was an off duty police officer who wanted someone to throw away their plastic drink cup. (I can't help but think he was jealous of Brandon Backe and that had something to do with it). This event occured at the San Luis Hotel pool bar, H20. The hotel did not call the poice - everything was instigated by an Officer Sanderson.

The FEMA official was arrested after he made a phone call asking for help in a police brutality incident.

reporting police brutality, FEMA executive arrested

observed excessive force

Cops shoot
at unarmed man, say he had gun, no gun found, he is jailed for evading arrest

Nothing seems to be done about. I believe it's an emergency situation, and implore anyone who can to help.

Many thanks,

A scared Galvestonian

Anonymous said...

The Galveston arrest rate is nearly three times the national average for urban areas. Acording to national statistics, in 2003 the nationawide arrest rate for urban areas was 5.109.

Galveston PD data shows between 7000 and 8000 arrests per year.

Galveston population if 57,000 (pre-Ike)

To get the percentage rate take 7500 for number of arrests (between 7000 and 8000) and divide by population of 57000.

Galveston's arrest rate is thus:

Please help us, anybody

Anonymous said...

Good morning!

You wanted info about UTMB and prison healthcare. The TDCJ hospital should be open for a few beds, soon. UTMB lacks catering facilities, so that's the major block right now. TDCJ patients requiring inpatient care are getting it, and UTMB is also transferring employees (who want to) from the campus hospital to positions in correctional health.

As to the comments about the Galveston PD? They scare the crap out of me, too.

Anonymous said...

Warped stats: The Galveston population swells to thousands more than 57,000; These folks are called tourists. The Galveston PD and the Galveston County SO could make many more arrests but that might turn off those foolish enough to want to visit the island.
Second comment: Another blog contributor noted that TDCJ Hospital, Galveston, would be re-opening the 17th of November. I couldn't confirm that opening.

Retired 2004

Anonymous said...

I'd have to check on November 17th. Hospital Galveston certainly won't be fully open due to the food situation. I don't know how many inpatients the mess tent is capable of handling.

Anonymous said...

I was comparing the stats of Galveston arrests per capita to arrests per capita in the U.S. urban population. That's places like Detroit, New York City, Los Angeles, Chicago .... I'm sure all of these cities have their population "swell" at a greater percentage than Galveston. For example

Additionally, they have sometimes millions of commuters swelling their population on a daily basis - but this is not included in the national arrests per capita data.

I am confident that with accurate statistical analysis (rather than "population swells" statements) the arrest rate would not change much.

I implore you, please help the citizens of Galveston who are suffering under a corrupt and brutal police force.

The truth is tourists are rarely arrested. Even the wedding reception beat down was perpetrated mostly on islanders.

Anonymous said...

Incidentally the rape conviction rate in Galveston County is only 1.25 percent (yes, you read that correctly). 400 arrests, 5 convictions
So even though there's a frenzy of brutal arrests, women are not adequately protected.

Anonymous said...

Let's compare Galveston stats to New York City's stats
In NYC in 2007 the total number of arrests (felony and misdemeanor) was 314,484 source:

Last year in Galveston the total number of arrests was approximately 8,000

The population of New York City in 2006, according to the Census Bureau, was 8,214,426.
Galveston's population is 57,000.

To get the arrests per capita divide the total number of arrests by the population:

For Galveston: 8000 divided by 57,000 equals .140, a 14% per capita arrest rate

For NYC: 314,484 divided by 8,214,426 equals .038, a 3.8% percent per capita arrest rate

NYC is the safest big city in the world, so we can't say that it's dangerous because they don't arrest enough people

Also, NYC has a huge tourist population, as well as commuter population

Anonymous said...

Accounting for tourism stats

Let's take Galveston's average number of tourists of 4.1 million (generally acknowledged by islanders to be a significant overestimate) and divide it by 365 - to get how much greater the population is due to tourists on a daily basis

4,100,000 divided by 365 equals 11,232 - so taking into account the tourist population we have an extra 11,232 people on the island daily

Now let's add that number 11,232 to number of Galveston residents, for a total of 68,233

Now we'll divide the number of arrests annually, 8000, by our new population & tourists number of 68,233 to get the arrest rate per capita

We get .12 so even factoring in the tourist numbers, Galveston has an arrest rate of 12%

Compared to a national urban average arrest rate of 5%

Anonymous said...


Forgive me, I meant 400 reports of rape, not arrests. So the rape conviction rate is 1.25% of reported rapes

Anonymous said...

Now what happens to NYC stats (to compare with Galveston) if we factor in tourists and commuters?

NYC has approximately 46,000,000 visitors staying in hotel rooms each year. (source NYC tourism)

Divide by 365 and we get an extra population of 127,000 per day. Additionally, 3.8 million people per day commute to the borough of Manhattan.

Sum these and we get 3,927,000 more people daily than are included in the census population numbers

We'll add this number to our NYC U.S. census population number of 8,214,426 to get the total daily population of
12,141,497 people

Now we'll divide the total number of arrests in NYC annually by the total daily population

314,424 divided by 12,141,497 equals .025 or an arrest rate of 2.5 percent per capita of daily population

Anonymous said...

So the Galveston arrest taking into account tourist numbers is nearly 5 times that of NYC when taking into account tourists and commuters

Galveston: 11.2% arrest rate
NYC: 2.5% arrest rate

the tourist number I got for Galveston counts cars, so it includes any commuters

Anonymous said...

"Outpatient centers better solution than jails for competency restoration" is the topic.

I just realized I was attempting to make a point with one of them. My bad!

Retired 2004

Anonymous said...

FYI- Although Harris County has been given credit as the first OCR facility, the local mental health authority in Smith, Wood, Rains, Henderson, and Van Zandt Counties (Andrews Center) has been offering outpatient competency restoration for quite a while (without additional funding). Although the additional funding would be nice, it comes with a heavy portion going towards administration and away from direct services. We have saved the taxpayers approx. $450,000 in hospital bed days through our competency programs in the last fiscal year, again, with no additional funding. The standardization of treatment across the state with the RDM and TRAG has diverted dollars from treatment to oversight. Standardization is optimal, but DSHS is going a little overboard. Most caseworkers in the local centers are being turned into utilization managers and not service coordinators.
In our area, another option that has saved taxpayers is our pre-competency services. With this we offer competency restoration programs to begin at the initial suspician of competency issues, even prior to their competency exam. It is a voluntary program and can occur on an outpatient basis and in the jail setting. Jail is not the best setting for therapeutic treatment. But, for many reasons, mental health pr bonds are not being utilized. Advocacy Inc. litigation has caused a paradoxical fear in some clinicians in treating the mentally ill in the jail. Just because a person is incarcerated, does not mean we should stop serving their mh needs, especially if our goal is to keep them competent! Yes, outpatient centers are better than jails for competency restoration, but that title implies that those unlucky enough not to get released should not be treated while in jail.

Anonymous said...

The people of Galveston are suffering under a brutal and corrupt police force and desperately need the help of anyone involved in civil rights advocacy.

Please do something, anyone.

Anonymous said...

I find it a little strange that Mr. Anonymous Retired 2004 is admonishing me for seeking help with the Galveston Police Brutality and Corruption problem.

I'm writing on this forum because I know most of the readers here actually care.

I'm writing anonymously because I'm afraid of the Galveston Police Department as they have beaten up and falsely arrested those who speak out, including newspaper photographers who photograph their violence.

I believe the situation in Galveston can be related to any post on this blog in a meaningful way.