Sunday, November 07, 2010

Lubbock considers in-house competency restoration for mentally ill defendants

Defendants deemed incompetent to stand trial because of mental illness typically must wait for beds in state hospitals to open up before they can be declared competent to enter a plea, even for petty misdemeanors. Now Lubbock County may join the ranks of jurisdictions performing competency restoration in the jail instead of sending them all to state hospitals, where waiting lists are typically months long. Reports the Lubbock Avalanche Journal ("Lubbock County to consider funding mental health services in jail," Nov. 7):
The services for severely mentally ill inmates would include intervention, rehabilitation, competency restoration and education and are meant to reduce mentally ill inmates’ length of stay behind bars and reduce the probability they will return.

Officials hope the $260,000-per-year program will reduce the amount of time mentally ill defendants spend in jail by providing services — namely competency restoration — the county isn’t currently equipped to provide.

“The whole thing is to shorten the length of stay they have and reduce recidivism,” said Cathy Pope, chief executive officer of Lubbock MHMR.
She said the program that would be implemented is based on existing best practices programs around the country.

A psychiatrist would spend three or four hours per week at the jail and the contract would fund three mental health workers in the Special Needs Unit, which is scheduled to open as soon as mental health positions are funded.

Although the workers perform other functions, such as cognitive rehabilitation, the primary focus is on competency restoration, Pope said. That means psychiatrically stabilizing the individuals and then getting them to a point where they can assist in their own legal defense.

Restoration is currently done locally at MHMR’s Sunrise Canyon and also in Vernon at North Texas State Hospital. But limited beds at the local and regional level have forced Lubbock County inmates to sit in jail, oftentimes for years, with no conviction and no treatment.
One county inmate allegedly spent seven years in Lubbock's jail awaiting trial because of a lack of competency restoration services, which is far and away the longest I've ever heard of anybody waiting for a forensic bed at Texas state mental hospitals.

Cuts to state hospitals - where half of all beds are allocated for competency restoration - will inevitably shift costs to county jails which must incarcerate defendants while they wait for these services. So Lubbock is getting ahead of the curve by installing these services now, along with their new Special Needs Defender office which is also focused on mentally ill defendants. Other counties will end up following Lubbock's lead whether they like it or not: It's too expensive to keep pretrial defendants incarcerated for months or years on end - sometimes for petty misdemeanors - waiting on the state to provide mandatory services.

Assuming they pull the trigger on the new arrangement, the Sheriff and commissioners court in Lubbock deserve tremendous credit for going this route. Other counties would do well to follow suit now before budget cuts at the Legislature next year strand even greater numbers of mentally ill inmates in local jails.

See prior, related Grits posts:


Anonymous said...

"A psychiatrist will spend three to four hours a week" ? Who do they think they are kidding? And a yearly budget of $260,000.00 is an absolute joke! MHMR will be no more effective than it is now. Pathetic and very sad.

Gritsforbreakfast said...

Basically competency restoration in practice amounts to little more than getting psychotic and bipolar inmates back on their meds. For that narrow task - depending on the number of incompetent inmates - it's at least a good start. Most jail psychiatrists these days are little more than scrip writers.

The greater expense are extra supervision costs in the jail for mentally ill defendants, which in practice Lubbock is already paying while they wait for state hospital beds to open up.

It might be too little, but it's a good idea in concept and better than a sharp stick in the eye. :)

Unknown said...

Does anyone know how the mentally ill are interrogated in the first place to determine their guilt? Just wondering if there are special techniques police use since the Reid technique does not specify any difference in questioning styles.

Anonymous said...

Sorry Grits!
This is like a sharp stick in the eye calling itself a cure for blindness. The state has to get serious about treatment for mental illness. As it has been stated many times, prisons have become warehouses for the mentally ill.
The cost to the public for that kind of solution is huge, not only in the cost to house the mentally ill but in the recidivism rate. If we know anything about mental illness it is that the mentally ill are rarely compliant with medications when they are on their own. It is a revolving door.
There are no short cuts to help for the mentally ill because there is no cure (in most cases) that does not require long term medical AND psychological supervision.
If we really helped the mentally ill, crime would be reduced. Towns like Lubbock would not be building bigger jails and hiring more cops or more prosecutors.
To say that "it might be too little" is just a poor excuse to let the good old boys continue being negligent. Where is the compassion of the religious right toward their fellow man who is insane? I say that it is not there! While open to helping a poor and struggling family or doing volunteer work for various causes seems to be "socially" acceptable in Texas, people are still uncomfortable and unwilling to face up to the reality about mental illness in their own surroundings.
Sometimes advocates have to push their agenda, get right up "in your face" with the facts before the need for real change will be recognized. I believe that will be the only way Texas will ever face mental illness. Until then we will have this half-baked solutions and hopes that it will sweep some of the truth about mental illness in the correctional system under the rug for a time.

Gritsforbreakfast said...

9:33, this program is focused narrowly on the issue of competency restoration, it's not a substitute for mental health spending generally and is not intended (nor claimed to be) about "treatment for mental illness" on an ongoing basis. This does nothing to stop prisons from warehousing the mentally ill, and neither I nor its proponents claimed it does: It's about the pretrial process of restoring competency, for which IMO this investment is significant and laudable, naysaying aside.

I agree with much of what you've written here, I just also think local jails need to find alternatives to state hospitals for competency restoration because of long waiting lists. Solving that won't solve everything, but it's not nothing.

Christine, I think most agencies apply the Reid technique across the board. A separate question is how do they determine competency, and I don't know much detail about the assessment instruments used for that task.

Mike Howard said...

IMO this is a good step in the right direction. One of the particularly frustrating things I see with my clients who come back from the state hospital is that, shortly after they return to the county jail their competency degrades substantially. I don't know if it's a problem with continuity of the medication regimine prescribed at the state hospital or if it's the shock of transport, or being moved from a more therapeutic environment to the isolation wing of the county jail... but hopefully in-house restoration will cut down on decompensation.

Counties also need to look at out-patient competency restoration pilot programs. I think Dallas is trying out-patient out for a small, select group of incompetent defendants.