Thursday, May 07, 2020

Data on waiting lists for TX competency restoration

The Appropriations bill during the last Texas legislative session required the Health and Human Services Commission to periodically report on waiting lists for mental health services. Here's the chart from the report related to forensic beds, where mentally ill folks are sent for "competency restoration" before they can stand for trial, plea, etc.:


This has been a problem now for many years. Once someone has been deemed incompetent, they can't even plea out and must typically remain incarcerated until they can get into a state hospital and receive treatment. For maximum security beds, that can take nearly a year. And that's just the wait to get in the door, it doesn't include treatment time! The Lege at one point created pilot programs to do outpatient competency restoration, but that system never scaled up to solve the problem.

7 comments:

Anonymous said...

Outpatient competency restoration? Is that an oxymoron? So now we've moved beyond the push to release as many "normal" criminals as possible to releasing the crazy ones too? Smart.

Anonymous said...

I am a community psychiatrist that has started to see more outpatient competency restoration clients come through my clinic/agency. I am not sure of the reason why this is happening now (agency policy change, or legal change), but so far it has been a positive experience in my small sample set. The client receives treatment in the community, with some legal caveats that maintain public safety. For one client in particular, it has led to life-altering insight and change.

As for the anonymous comment above. These clients have partially reversible symptoms stemming from a mental illness that contributed to their legal infraction. When appropriately treated, they pose no threat to you.

Gritsforbreakfast said...

Competency restoration is nothing more than medical treatment. There's no reason to believe it needs to happen in jail to be effective, and sending everyone to state hospitals is the most expensive, time consuming way to do it.

Mike Howard said...

Outpatient competency restoration actually IS smart. It's not willy-nilly releasing people who aren't competent into the community. It only applies when a) the person who's deemed not competent is deemed not a danger to others, b) the person may be safely treated on an outpatient basis with the specific objective of obtaining competency to stand trial, and c) an appropriate outpatient competency restoration program is available for them.

Mike Howard said...

Competency restoration wait times are a HUGE problem that I encounter all the time. I have clients who wait for months and sometimes a year plus for a bed to open up. While they wait they decompensate in the county jail, which is not only cruel but makes competency restoration harder and take longer once they finally get to the hospital. And then sometimes my client finally does get to the state hospital and they turn them right back around and send them back "competent" when they're clearly not. My most recent example of this waited a little over a year for a bed, got there, refused to cooperate in counseling sessions, was physically violent with staff and other patients, and yet they deemed him competent. In the competency report, they admitted that he had refused to participate in pretty much any therapy other than their classes where they teach the patients the roles of each of the players in the criminal justice system (cynics like myself believe that the hospital is just teaching them rote memorization so they can appear competent by regurgitating memorized descriptions of who the judge/prosecutor/defense lawyer is and what their role is to appear competent when they're actually not). Another criminal defense colleague of mine had a guy who was sent back even though he still believed in an imaginary leprechaun that only he could see that would tell him what to do. Somehow despite that clear delusion/hallucination, he was deemed competent. It's a joke.

Anonymous said...

Is it any surprise the wait times are so long? The state takes over a year to recalculate sex offender risk levels and the instructions on the static 99 are literally "divide by two." If they can't do middle school math why would you expect them to do something real any better?

Anonymous said...

Competency restoration does not mean the person is recovered, just that they understand their charge, and how the legal process works. It's actually a rather low bar, unfortunately.