{"id":33645,"date":"2022-07-10T10:11:55","date_gmt":"2022-07-10T10:11:55","guid":{"rendered":"https:\/\/cjstudents.com\/index.php\/2022\/07\/10\/some-mentally-ill-dallas-inmates-are-waiting-two-years-to-get-into-state-hospitals\/"},"modified":"2022-07-10T10:11:55","modified_gmt":"2022-07-10T10:11:55","slug":"some-mentally-ill-dallas-inmates-are-waiting-two-years-to-get-into-state-hospitals","status":"publish","type":"post","link":"https:\/\/cjstudents.com\/index.php\/2022\/07\/10\/some-mentally-ill-dallas-inmates-are-waiting-two-years-to-get-into-state-hospitals\/","title":{"rendered":"Some mentally ill Dallas inmates are waiting two years to get into state hospitals"},"content":{"rendered":"

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Some defendants with mental illnesses are waiting in the Dallas County jail for more than two years before they are being transferred to state hospitals.<\/p>\n

Dallas County officials say 400 inmates who have been deemed to be \u201cincompetent to stand trial\u201d have waited an average of either 160 days on nonviolent charges or 330 days on violent charges. Dallas County\u2019s average wait time for a state psychiatric hospital bed is longer than any other urban county in Texas, with some waiting more than 800 days for hospital admittance, according to state data.<\/p>\n

Dallas County District Attorney John Creuzot said the wait times can surpass the maximum sentence of some misdemeanor charges, compelling the county to dismiss cases entirely.<\/p>\n

\u201cThey just take them to the door and let them out,\u201d Creuzot told The Dallas Morning News.<\/i> \u201cThey may or may not have gotten case management or medication they need.\u201d<\/p>\n

The county blames the state for the delay in getting mentally distressed defendants into state hospital beds for treatment. Such defendants are required to receive treatment, usually in state care, before they can be declared mentally competent by a judge to then stand trial.<\/p>\n

Ty Bishop, spokesman for the Texas Health and Human Services Commission, which runs the state psychiatric hospitals, said staffing shortages and the coronavirus pandemic have resulted in dwindling capacity at state hospitals.<\/p>\n

Dallas County Sheriff Marian Brown, who oversees the Lew Sterrett Justice Center<\/a>, said the long waits are increasing the size of the overall jail population \u2014 which hovers at about 6,000 inmates \u2014 and is exacerbating staffing needs as inmates deemed mentally ill languish in county custody.<\/p>\n

\u201cDue to the lack of availability of these state facilities and the failure to take more people, the county jail has to hold these people longer than we would like,\u201d Brown wrote in an email.<\/p>\n

Dr. Steve Strakowski, associate vice president for regional mental health at the University of Texas\u2019 Dell Medical School, said the broken process makes it more difficult to get criminally charged but incompetent people back on their feet to face justice.<\/p>\n

\u201cLong periods of no treatment are not good for your brain,\u201d he said. \u201cIt makes it harder to get you to respond to treatment later. We certainly don\u2019t want delays in treatment from being in jail, but that is what often happens.\u201d<\/p>\n

Legal incompetency<\/h3>\n

To preserve the constitutional right of due process, courts have determined that defendants have an absolute right to understand the proceedings against them. If they are incapable of understanding, they are determined to be legally incompetent.<\/p>\n

Alycia Welch, associate director of the Prison and Jail Innovation Lab at the University of Texas, says holding people for months, sometimes years without a trial raises questions about whether the constitutional right to due process is being violated.<\/p>\n

\u201cThey\u2019re held pretrial before they\u2019ve been convicted of an offense in jail with a known mental health challenge,\u201d she said. \u201cWhen they\u2019re pretrial, they\u2019re presumed innocent. Yet many of them will spend far longer in jail than if they were convicted of that offense.\u201d<\/p>\n

With evidence, a judge can request a competency evaluation for someone with a pending criminal charge. If granted by a judge, a qualified expert conducts the evaluation. A competency hearing before a judge is advised to be held 30 days following the evaluation.<\/p>\n

\u201cFailure to do so will result in unnecessary delays and incarceration for the client, the wrath of the judge and unnecessary expenses to the taxpayer,\u201d a Dallas County district attorney webpage says.<\/p>\n

<\/figure>\n

Dallas County Commissioner John Wiley Price, who heads committees on both the county jail and behavioral health, said this 30-day recommendation often is not followed.<\/p>\n

If deemed incompetent to stand trial, the inmate is placed on a waiting list for a state hospital bed.<\/p>\n

Usually, those charged with a violent offense are wait-listed for bed space in maximum-security state hospitals such as Vernon and Rusk, while most others wait for minimum-security beds in Terrell, Montgomery and Palestine. The state determines the most appropriate clinical placement, Bishop said.<\/p>\n

Psychiatrists appointed by the judge and hospital staff determine whether \u201ccompetency\u201d can be restored, the time frame, and potential treatment options. If restoration is possible, hospital staff work to do so before the person is returned to the jail to stand trial.<\/p>\n

State law limits the amount of time committed to the maximum amount of time of the charged offense.<\/p>\n

If restoration is determined to not be possible, there is a hearing to determine further state psychiatric commitment, a defendant\u2019s case is dismissed and they remain at the state hospital.<\/p>\n

In some cases, Price said the trial for a person returning from the state hospital is not scheduled soon enough, and the inmate lapses back into legal incompetency.<\/p>\n

\u201cWe are in a circular firing squad, and I\u2019m a little perturbed by it,\u201d Price said.<\/p>\n

Strakowski is working with Travis County officials to address the long wait times for competency restoration. He believes that the process of requiring competency restoration was well-intended, but it has morphed into something else.<\/p>\n

\u201cWe don\u2019t want people who have a mental illness to fail to participate in their own defense. So it is absolutely good and right to try to protect that ability,\u201d he said. \u201cOn the other hand, when you require them to have a higher knowledge of participation, particularly for minor offenses and misdemeanors, and low-level felonies, you end up waiting in jail to treat it longer than just serving your time.\u201d<\/p>\n

Bed scarcity<\/h3>\n

Ultimately, too many defendants are vying for too few beds<\/a>.<\/p>\n

\u201cThe challenge in the last several years is that there aren\u2019t enough state hospital beds to provide restoration services to people who are deemed incompetent to stand trial. That means people are waiting for a state hospital bed in jail,\u201d prison and jail policy expert Welch said.<\/p>\n

Dallas County reports that its average monthly admittance to a state hospital has dropped from 35 people in 2017 to nine people this year.<\/p>\n

The state blames much of the reduced admission rates on extenuating circumstances.<\/p>\n

To follow federal guidelines on social distancing and quarantining during the pandemic, the state reduced hospital capacity, Bishop said. The state is still at limited capacity. As of July 6, the statewide psychiatric hospital and contracted facility capacity is 1,734 beds.<\/p>\n

The national staffing shortage has also hit the Texas Health and Human Services Commission. As of May 2022, state hospitals have about 1,300 fewer employees than the year prior, Bishop said.<\/p>\n

Jails can provide court-ordered medication to target the symptoms of mental illness affecting defendants\u2019 competency to stand trial, Bishop said.<\/p>\n

\u201cHealth, medical and mental needs are met in jail while they wait for available beds in the state hospitals,\u201d Sheriff Brown said in an email.<\/p>\n

Medication isn\u2019t usually enough to restore these inmates to competency.<\/p>\n

\u201cIf you can get medicines, but the rest of the care that you would have in health care facilities just isn\u2019t present in a jail or prison, you don\u2019t get optimal care,\u201d Strakowski said.<\/p>\n

Problems affecting other urban counties may be worsened in Dallas by the lack of a state psychiatric hospital in the Dallas-Fort Worth area.<\/p>\n

The Texas Health and Human Services Commission has partnered with UT Southwestern Medical Center to build a $282.5 million state psychiatric hospital in an unannounced location in D-FW <\/a>with 200 beds. The final number of beds dedicated to civil or criminal cases has not been determined, Bishop said.<\/p>\n

\u201cMy staff has been told these beds are for civil cases, not for competency restoration. It\u2019s actually not going to help,\u201d Creuzot said.<\/p>\n

\"Lew
Lew Sterrett Justice Center pictured in Dallas, Friday, July 8, 2022.(Elias Valverde II \/ Staff Photographer)<\/span><\/figcaption><\/figure>\n

The North Texas Behavioral Health Authority has had state funding for a pilot program that provides in-jail competency restoration services for Dallas County inmates since 2018, said the health authority\u2019s Director of Forensic Services Chad Anderson. The program has room for 24 men and eight women. Turnaround time is about four weeks, a much shorter wait time than that of a state psychiatric bed.<\/p>\n

The program is voluntary, requires referral by an attorney or judge, and some inmates prefer to wait for services at the state hospital.<\/p>\n

Strakowski is also concerned that mental competency has become an entry point for many to receive mental health services, even for those legally competent. While he wants people with mental and behavioral illnesses to be treated, he doesn\u2019t believe heading to jail and then a state hospital is right for everyone.<\/p>\n

\u201cPart of the problem we\u2019ve had is people have conflated having a mental illness with being incompetent, and they are not the same,\u201d he said. \u201cThere are people with very significant psychiatric problems, who are still completely able to make decisions and take care of themselves and participate in the legal process. At times, the courts believe that a person has to be fully recovered, in order to be able to participate, and that\u2019s not always true.\u201d<\/p>\n

For those inmates who are legally incompetent, the mental toll these wait times have is concerning, Welch said.<\/p>\n

\u201cThe jail environment is a stressful environment,\u201d she said. \u201cFor people with serious and persistent mental illness, that stressful environment can exacerbate their symptoms.\u201d<\/p>\n

County differences<\/h3>\n

There are more Dallas inmates facing longer wait times for state hospital admission than any other metropolitan county.<\/p>\n

According to state data, 392 Dallas County inmates are waiting for a bed.<\/p>\n

Tarrant County has a similar population size to Dallas County\u2019s 2.6 million residents. But there, the state reports that 153 inmates are waiting for a bed.<\/p>\n

Despite facing the same state hospital bed scarcity, Harris County does not have the same wait times. Harris County Sheriff\u2019s Office spokesperson Deputy Thomas Gilliland said state hospitals\u2019 average monthly intake is 10, close to Dallas County\u2019s monthly average of nine.<\/p>\n

Yet Harris County, a county with nearly twice the population of Dallas County, has 219 people waiting for a bed.<\/p>\n

<\/figure>\n

Asked why Dallas County has more inmates waiting for longer than any other metropolitan county in Texas, Sheriff Brown said, \u201cDallas County is the second-largest county in the state of Texas, so we are going to have more inmates on the waiting list than most counties.\u201d<\/p>\n

Gilliland attributes the shorter wait time to oversight from the Harris County Health Center.<\/p>\n

That health center took over the mental health and competency of inmates in March. Gilliland said having a separate mental health organization rather than law enforcement oversee the mental health of inmates helps smooth the process.<\/p>\n

The state has started a program to vet whether all those waiting for a state hospital bed fit the definition of legally incompetent. The jail in-reach learning collaborative began September 2021 with 15 counties.<\/p>\n

\u201cLearning collaborative teams can work directly with HHSC to reevaluate people who were previously deemed incompetent to stand trial,\u201d Bishop said.<\/p>\n

Dallas County does not participate in the state collaborative, but will next year, North Texas Behavioral Health Authority\u2019s Anderson said.<\/p>\n

Costs, solutions<\/h3>\n

This wait is costing the county thousands of dollars each day.<\/p>\n

Price gave a presentation about the wait time and costs in the June 21 Commissioners Court meeting.<\/p>\n

\u201cThis is a disservice to them [inmates] and the taxpayers,\u201d Price told The News.<\/i> \u201cThe jail has become the repository for mental health<\/a>.\u201d<\/p>\n

A prisoner costs Dallas County an average of $67 per day, without additional mental services or health care. Price\u2019s presentation estimates the county has spent more than $13.6 million on inmates waiting for state hospital admittance.<\/p>\n

\u201cWe have 400 people paper-ready, ready to go to the state for mental health,\u201d Price said. \u201cWe are getting tasked with the cost of maintaining them.\u201d<\/p>\n

Dallas County commissioners told Creuzot on June 21 they intend to address this problem quickly.<\/p>\n

District Attorney Creuzot has petitioned for more mental health staff in the 2023 budget. He has asked for three attorneys and a legal assistant for a total budget request of $511,900.<\/p>\n

\u201cWhen we\u2019re overwhelmed with cases, you\u2019re just running from one to the other, and you don\u2019t necessarily get an opportunity to sit down and do a thorough job, which means a better outcome for the person and a community,\u201d he said.<\/p>\n

The state has taken measures to mitigate staffing issues, such as contracted staff, pay raises, recruitment bonuses, and flexible shifts and emergency staffing through the Texas Department of Emergency Management, Bishop said.<\/p>\n

\u201cAs staffing increases, so will the available capacity. Increased capacity will allow us to care for more patients,\u201d he said in an email.<\/p>\n

As for longer-term solutions, many want to restructure the mental health pipeline entirely.<\/p>\n

Mental health and jail experts say these long wait times would be alleviated by more funding for community mental health clinics and outpatient care, which could become alternatives to state hospitals.<\/p>\n

\u201cWe have to manage mental health illnesses. But that\u2019s a clinical problem, not a legal one. So that needs to have its own pathway that doesn\u2019t necessarily require hospitalization,\u201d Strakowski said.<\/p>\n

The state agrees. Since 2017, the state has appropriated more than $1.2 billion toward forensic and jail diversion services for those with mental and behavioral illnesses. The state Senate Bill 292 that passed in 2017 provided funding for jail-based competency restoration, including North Texas Behavioral Health Authority\u2019s program.<\/p>\n

\u201cOutpatient care in the community can help individuals avoid unnecessary contact with the criminal justice system, keeping them off the waitlist,\u201d Bishop said.<\/p>\n

The North Texas Behavioral Health Authority said there are adequate outpatient services, but they aren\u2019t being fully used.<\/p>\n

\u201cThere may be something, either one or the other of the attorneys or the court feels that it is more appropriate to keep that individual in jail as opposed to releasing into the community,\u201d Anderson said. \u201cWe\u2019ve never called the county to say \u2018No stop. We\u2019re not taking any more outpatient cases.\u2019\u201d<\/p>\n

Welch would also like to see jails keep data on inmates waiting for competency restoration to help the Legislature make long-term decisions.<\/p>\n

\u201cIf we don\u2019t understand the outcomes the jails are seeing, what\u2019s happening with people who are awaiting restoration services, it\u2019s going to be harder for the Legislature to understand where resources need to be directed in order to keep people safe,\u201d she said.<\/p>\n

Kids in rooms up to 22 hours a day in Texas juvenile lockups from staffing shortage<\/a><\/article>\n
Dallas, Collin juvenile lockups strained by state refusal to take more kids <\/a><\/article>\n<\/div>\n

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