With state hospitals packed, mentally ill inmates wait in county jails that aren’t equipped for them


More than 380 men and women statewide are waiting in county lockups, sometimes for months on end, because state mental health facilities don’t have enough beds to provide treatment for inmates declared incompetent to stand trial.

“The county jail is not the place to be warehousing people with mental illnesses, and that’s what’s happening,” said Limestone County Sheriff Dennis Wilson. “We’ve got to stop that.”

More than four years ago, the state faced the same situation – hundreds of mentally ill inmates languishing in ill-equipped local jails, waiting for space in a state hospital. A state judge ordered Texas state mental health providers to fix the problem and reduce wait times to no more than 21 days.

But the number of inmates waiting for spot in a state mental hospital has skyrocketed in the last year, along with the wait time. As of April 1, the average wait for a maximum security bed – reserved for those charged with serious violent crimes – was 122 days, according to the Department of State Health Services.

Waiting for hospital beds in Texas

Taxpayers in large counties, such as Dallas, bear the brunt of the cost. Sheriffs, prosecutors and mental health advocates across the state are urging lawmakers and the department to find more space at state hospitals for mentally ill inmates. Jails, they say, don’t have the resources or the funds to deal with severely mentally ill inmates.

It leaves sheriffs in constant fear that their facility might see a suicide or face a lawsuit. The waits also complicate court cases for prosecutors. And advocates for the mentally ill say defendants’ constitutional rights are violated when they are forced to stay in lockups instead of getting the treatment courts have ordered. Another lawsuit against the state may be inevitable.

“We’re aware of the increase in wait times and numbers of people waiting,” said Peter Hofer, a lawyer for Disability Rights Texas, a nonprofit group that advocates for the mentally ill. “We’re certainly looking at what we can do to help these individuals.”

Officials at the state health department, which oversees mental hospitals, say that they are working to reduce waits and get more inmates into treatment faster. But there are only 1,047 beds statewide reserved for inmates.

“Even though we’ve worked steadily to add capacity, because Texas is growing so rapidly, keeping pace is challenging,” said Lauren Lacefield Lewis, assistant commissioner of the mental health and substance abuse division at the health services department.

Disability Rights Texas first sued Texas mental health officials in 2007 on behalf of three inmates, including two at Dallas County Jail, who had been ordered to state hospitals because the courts found them mentally incompetent to stand trial.At the time, about 170 inmates across Texas were waiting for state hospital beds — less than half as many as are now housed in jails.

Travis County state district Judge Orlinda Naranjo in February 2012, ordered the state to reduce the wait time, which had grown to as much as six months in some cases, to 21 days.

“Keeping incompetent pretrial criminal defendants confined in county jail for unreasonable periods of time … violates the incompetent detainees’ due process rights as guaranteed by the Texas Constitution,” Naranjo wrote.

A series of small fixes helped bring down wait times. The department opened up more beds in its own facilities and contracted with other mental health providers. In all, the state added about 200 spots for mental health patients.

By early 2014, the wait list had dropped to about 100 people, and the average wait time was about 20 days.

“What we know is they can do it,” said Hofer, the disability rights lawyer. “They can get people into state hospitals timely.”

In May of that year, though, an appeals court tossed out Naranjo’s ruling on a legal technicality, rendering the 21-day deadline obsolete.

Wait Time

The wait list has climbed steeply and steadily since, growing from about 170 inmates in June 2014 to more than 420 in February. Wait times have also spiked, and by February inmates needing both maximum and nonmaximum security beds waited an average of nearly 41 days in local jails. As of April 1, the longest wait time for a nonmaximum security bed was 275 days, about nine months.

In the Dallas County Jail, more than 100 inmates found incompetent to stand trial were waiting for a state hospital bed on April 1, said Ron Stretcher, the county’s director of criminal justice. Twenty of those inmates had waited more than 90 days.

“They never allocate more money to make the problem go away,” Stretcher said. “Our waiting time is as bad as it’s been in the 10 years I’ve been watching it.”

The jail, he said, doesn’t offer the kind of treatment mentally ill inmates need to stabilize enough to face trial. While they wait for care, he said, often their condition deteriorates, making the inmate more expensive for the jail and local taxpayers who foot the bill.

Kendall McKimmey, chief prosecutor over competency cases in Dallas County, said the waits also are confounding for state lawyers. The longer it takes to get an inmate to trial, the more likely it is that key witnesses will move away or forget crucial elements — and the longer victims must wait to get some measure of closure.

“A lot of them have bad memories of what happened, and they want to have their day in court,” McKimmey said.

State officials say they’ve seen a sudden and dramatic uptick in the number of inmates who require stabilization, particularly inmates who need maximum security beds. Those are the facilities most severely lacking. The state has only 314 maximum security beds. Lewis, the health services department official, said the agency is zealously hunting for solutions, knowing that another lawsuit over wait times could be looming.

Among the potential solutions is a pilot program the agency is preparing to launch this year that would allow some inmates to be treated inside county jails.

But that won’t solve the agency’s biggest problem, a 20 percent increase in orders from judges for competency restoration of inmates who require maximum security. Those beds are few and far between. And the agency can’t simply convert existing beds to meet the security requirements, which include higher fencing, additional staff and hardened ceilings.

To make matters worse, it also takes longer to restore those inmates with complex mental problems to competency, Lewis said.

The incremental changes the agency made to increase bed count in 2012 won’t be sufficient.

“The challenges are large and potentially costly,” Lewis said.

Sen. John Whitmire, D-Houston, was shocked to learn about the backlog of inmates in a recent hearing of the Senate Criminal Justice Committee, which he leads. He said he was disappointed that state mental health officials hadn’t previously alerted lawmakers to the growing problem.

“You need to come up with a plan,” Whitmire said. “You’re going to have to find some more beds somewhere.”

Finding those beds, though, will require money from lawmakers. Last year, the Department of State Health Services reported to lawmakers that most of its hospital facilities are aging, in poor and critical condition, needing tens of millions of dollars in improvements. By 2024, the agency estimates that it will need more than 600 additional beds for inmates and Texans who can’t afford private mental health treatment.

Source: Dallas Morning News