Monday, January 09, 2012

Growth in 'forensic' commitments exacerbate budget pressure on state mental hospitals

I ran across a "legislative primer" (pdf) published in February 2011 by Legislative Budget Board that I hadn't seen before which included this notable excerpt about the growth in demand for forensic beds at Texas state mental hospitals.

According to DSHS, the forensic population in SMHs [state mental hospitals] is increasing. The role of the SMH in the treatment of forensic patients has expanded in recent years as some SMHs have experienced a significant increase in the number of forensic patients they serve. As described earlier a forensic patient is one who is admitted to a SMH by judicial order because they have been determined unfit to stand trial or found not guilty by reason of insanity. Some of the forensic patients who are in SMHs for competency restoration have been accused of minor crimes such as trespassing and misdemeanor assault. In fiscal year 2010, the total number of beds at SMHs was 2,461 including 1,558 civil beds and 903 forensic beds....

Forensic commitments generally involve longer lengths of stays in the SMHs. According to DSHS, the average length of stay for a non-forensic patient is less than 30 days compared to more than 30 days and often more than 90 days for forensic patients.

As of December 14, 2010 there were a total of 282 persons on waiting lists at SMHs for forensic beds. According to DSHS, the wait for a forensic bed can be as long as six months in jail for some nonviolent offenders needing inpatient services. These long wait periods can have a negative effect on the forensic patients’ mental conditions.

Longer wait times and longer lengths of stay at the SMHs before a forensic patient is declared competent may result in offenders waiting in jail longer for competency restoration than their sentence would be if they were convicted. It is likely that before some forensic patients have had their competency restored, they have already served the maximum amount of jail time for sometimes minor criminal offenses and are released without sufficient on-going mental health services or resources. This situation may contribute to re-offending and cycling back into the judicial system.
Further, driven largely by the increased number of forensic beds: "SMHs have seen an increase in the average lengths of patient stay. The average length of stay at discharge from SMHs for each fiscal year were 44.5 days in fiscal year 2006, 43.5 days in fiscal year 2007, 47.3 days in fiscal year 2008, 46.3 days in fiscal year 2009 and 51.5 days in fiscal year 2010. The average length of stay increased 15.7 percent when comparing fiscal year 2006 to fiscal year 2010."

Legislation approved last year (HB 2725 by Will Hartnett, who will be missed upon his retirement) ordered judges to count time on the waiting list for restoration services against defendants' ultimate sentence, making it easier to get charges dismissed when time spent incarcerated reaches the maximum sentence length. The bill gave jails a back-end release valve for less serious cases, but it didn't even pretend to resolve the underlying trend. As judges have lately begun to order forensic commitments regardless of waiting lists, the situation in the near term will only worsen.

1 comment:

Arachne646 said...

Last I heard, the institution with the largest number of mentally ill residents was Rikers Island Jail. Mental illness and criminal justice have been mixed incompatibly for decades, and I don't know of any litigation that has been done on behalf of the many, often severely mentally ill people incarcerated, for their rights to health care. Very simplistic medication from staff with no health training, and the incarceration of people for "nuisance crimes" without violence, committed by the very people who can't get ER or community mental health care. People who don't fit into social "rules" on the outside don't usually do well in prison either, being victimized in both worlds, and/or confined to solitary for protection or not understanding/following the rules.

The issue of competence to stand trial, and the occupation of state mental hospitals' beds with "forensic committments" is only one part of the web of mental illness, prison, and poverty.