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State Seeking Room for Mentally Ill Inmates

A judge's expected ruling forcing the state to find room to treat mentally ill inmates is sending officials in search of space at already-full mental hospitals.

Inmates in the Harris County Jail in 2011.

State officials are trying to figure out what to do with about 400 mentally incompetent local jail inmates across the state ahead of a state district judge’s expected ruling to require state hospitals to find beds to treat them. 

“It boils down to space,” said Carrie Williams, a spokeswoman for the Texas Department of State Health Services. 

Judge Orlinda Naranjo of Austin is poised to finalize a ruling this week that will require jails to send mentally incompetent inmates for treatment at a state hospital within 21 days of the time they are ordered committed.

She said in a letter last week outlining her expected ruling that the current average wait of six months for a spot at a state mental hospital violates the constitutional rights of inmates who have been found incompetent to stand trial and are awaiting psychological assessment and treatment. To comply with her ruling, the cash-strapped Department of State Health Services, which runs the hospitals, will have to find the room and the resources for all those inmates. 

“These economic decisions made by the state do not outweigh the incompetent detainees’ liberty interests,” Naranjo wrote.

The ruling comes in response to a 2007 lawsuit filed by Disability Rights Texas, an advocacy organization, on behalf of inmates who had waited in county jails for four to 17 weeks before getting psychiatric treatment. The organization argued that many mentally ill inmates, particularly those charged with nonviolent offenses, have spent more time waiting in jail for treatment than they would have spent in jail under a sentence for the crime of which they were accused.

“Many of those people who should be in state hospitals remain in local jails for months, or even years, without regard for their presumed innocence and without the ability to go to trial,” said Beth Mitchell, supervising attorney at Disability Rights Texas.

There are nine state mental hospitals in Texas with a total of 2,477 beds to treat civil and criminal patients. About a third of the beds are reserved for criminal commitments, and in 2006, the Department of State Health Services started a waiting list for the beds, because the demand exceeded availability.

For the last two years, incompetent detainees have had to wait an average of six months for a bed to open up so that a doctor could evaluate them and determine whether and how they could be restored to a stable state for trial.

The shortage of state hospital beds is a problem that local law enforcement officials have been grappling with for years as sheriffs cope with overflowing jails, in which many of the inmates are mentally ill. Williamson County District Attorney John Bradley, chairman of the Advisory Committee on Offenders with Medical or Mental Impairments, which coordinates with state agencies on mental health issues, said he hopes the judge’s ruling will force state and local officials to develop solutions.

Part of the problem, Bradley said, is that there is no clear division between which kinds of mentally ill inmates ought to be the responsibility of local officials, and which ones the state should take care of. Such a delineation, he said, would make it possible for state and local governments to better align their budgets with the expected needs.

But even if such an agreement can be reached, Bradley said, the state will probably have to spend more money to treat more patients.

“Part of the solution is going to have to be an increase in beds,” he said.

Mitchell agreed, but she said the state should also focus more on providing mental health care services on the front end to prevent the mentally ill from ending up in jail. Right now, Texas is last among the states in its spending on mental health, and community-based services statewide are facing major budget cuts, she said. 

“It’s hard to imagine how we can appropriately serve the population when that’s the funding level we have,” Mitchell said.

Tom Kelley, a spokesman for the Texas attorney general’s office, which is representing the state in the lawsuit, said lawyers there had not decided whether they would appeal Judge Naranjo's ruling.

In the meantime, Williams, at DSHS, said the agency is considering all of its options to comply and accommodate the additional patients, including adding more beds.

“We haven’t ruled anything out or in at this point,” she said.

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