Thursday, December 16, 2010

Cuts to state mental hospitals would be massive unfunded mandate for county jails

Brandi Grissom at The Texas Tribune reports that "sheriffs across Texas are increasingly frustrated and worried about the ever-decreasing amount of bed space available at state mental hospitals." She writes:
Too often, when mentally ill offenders come to their jails, sheriffs who are required to provide appropriate care for their inmates say they are forced to either drive hundreds of miles, wait for days in hospital emergency rooms guarding patients or try to make do in their local jails until a mental health bed becomes available. The looming budget shortfall  that legislators will be grappling with in 2011 has sheriffs concerned that the problem will mutate into a crisis. “We’ve cut way too far, and it’s just not working,” [Van Zandt County Sheriff Pat] Burnett says.

The number of beds at Texas’ state mental hospitals has gradually declined from 2,800 in 1996 to about 2,400 now. As the number of beds shrinks, treatment waiting lists expand. That means treatment delays for both law-abiding Texans and criminal offenders with mental illness.
Sheriffs are reacting to concerns, expressed frequently in the past here on Grits, that cuts to the Department of State Health Services could strand inmates in county jails for months awaiting competency restoration services. As part of its budget cut suggestions reacting to recent demands from state leaders, Grissom reports, "One of the options the agency proposed is eliminating even more beds — more than 190 of them — from five of the state’s 10 mental hospitals." Half of beds at state hospitals are designated as "forensic beds" used by the criminal justice system to restore competency when courts declare a defendant incompetent to stand trial. Such defendants can't even plead guilty until the services are rendered; they just sit in jail, often for months on end, waiting for space to open up.

As a practical matter, the state already is at risk of expensive litigation if they can't find a way to reduce waiting lists for forensic beds at state mental hospitals. This is a bit of a sleeper issue, but cuts to state mental hospitals would be a massive unfunded mandate for counties.

See prior, related Grits posts:


Anonymous said...

Wishful thinking, the talking heads in Austin will cut social service programs to the bone everytime they get the chance. Just look at the numbers, $100 per capita spending on average for mental health care in other states. Anyone have a guess what Texas spends? A whopping $36..Disgusting, heads in Austin should be ashamed of themselves..

Anonymous said...

Around the nation beds in mental health institutions are being closed but I am not seeing the reasoning behind this decision. Are there studies out there that have the facts in numbers, nationa sheriffs concern and the increase in dollars spent as a result of these closings?

Gritsforbreakfast said...

This is really a Texas-specific issue, 5:50, because of how we handle "competency restoration," which historically has meant sending somebody to a state hospital until they're stable and back on their meds.

Some jails have begun doing competency restoration in-house, and there have also been experiments here in Travis and elsewhere with outpatient competency restoration while people are out on bail, particularly for misdemeanors. I don't know about "studies," but if you read the links at the end of this post it's an issue that many counties are struggling with, judging from recurring anecdotes.

Anonymous said...

Sorry to correct you, but this is not just a Texas issue. Forensic bed issues is a nation-wide issue. In Texas, forensic beds make up about 30-35% of state hospital beds. Some other states have about 100% of their beds going to forensic commitments. Some states even have just one state hospital. Unfortunately, this article mixes some of its facts between forensic and civil beds. Just to note, Van Zandt County hasn't had a forensic commitment to El Paso in a very long time. 5:50, you may be interested in the report, "More Mentally Ill Persons are in Jails and Prisons than Hospitals: A Survey of the States" available on the Treatment Advocacy Center's website. This was a report sponsored by the Treatment Advocacy Center and the National Sheriff's Association. Grits may have a link to it that he's referring to but I'm not sure (don't know how to toggle back and forth without losing my comments). The reasoning behind the decisions to close beds are generally two-fold - there is a push from two very different "groups." The civil rights groups push to get folks into the least restrictive environment as possible (historically, mental institutions were quite oppressive to say the least, and many quite abusive). And, conservative groups generally push against spending money on expensive welfare programs (state hospitals included). You can Google, "De-institutionalization" or "Trans-institutionalization" and find the information that you are looking for. This process began way back in the late 50's and early 60's when we discovered that Thorazine can accomplish in the community setting, what a straight jacket can do in the asylum (and a lot cheaper). This is the short / dirty re-cap.
Just to note, if you decrease the availability of civil beds, you will thus increase the demand for forensic beds. This is what is happening across the nation, and is not specific to Texas.

Anonymous said...

What if you have an inmate that will NEVER be competent? One who is an immediate danger to everyone around him if he is released? The state wants to have him sent to a nursing facility, which will result in who knows how many sexual assaults and most likely a homicide or two..This man is a sexual deviant, predator, and is absolutely nuts, and will never be anything different. Who wants him in their neighborhood? Who wants him in the same nursing home as your Mom or Grandmother or your wife?

zeety said...

Cool beans, raise taxes to pay for it or let everyone go. You get what you pay for...or not.