On Thursday, Harris County Sheriff Ron Hickman headed to the Legislature to call on lawmakers to address the state's shortcomings when it comes to mental health-care funding, which Hickman said is taking a toll on his jail and county taxpayers alike.
On any given day, roughly one quarter of inmates in the Harris County jail are mentally ill. As a result, county taxpayers spend roughly $22 million a year to take care of them — and, as Hickman notes, they are “curiously” still forced to pay for it even though the majority of those inmates have not been convicted of crimes and are presumed innocent.
“I’ve said it before: When the state of Texas does not provide sufficient solutions for addressing mental health,” Hickman said, “that fiscal burden is passed to county taxpayers. Jails and county mental health authorities are woefully underfunded, yet forced to act as the de facto providers for the majority of mental health care services in their communities.”
Many advocates have identified the state's longstanding forensic bed shortages at the state hospital level as one of the main culprits affecting overburdened county jails and mental health centers. Extra attention was brought to the issue this year after Shannon Miles, the man accused of killing Harris County Deputy Darren Goforth, was found incompetent to stand trial, diagnosed with schizophrenia. Then he was placed on a long waiting list of people who generally sit in jail for three months before they are transferred to a state hospital for competency restoration.
State Senator John Whitmire was so irritated upon hearing of the lengthy wait time that he tried to intervene in Miles's case, asking that Miles be transferred immediately because, as a schizophrenic man accused of killing a cop, he was not safe in the care of Goforth's colleagues.
Whitmire wasn't successful. But what he did manage to do was rouse support among lawmakers for addressing the bed shortage problem causing such long waits — on taxpayers' dimes.
The consequences resulting from forensic bed shortages, however, extend far beyond long wait lists.
As we reported in March, state hospitals devote more resources to competency restoration for accused criminals than to handling everyday mental health crises. Dr. Floyd Jennings, chief of the misdemeanor mental health division at the Harris County Public Defender's Office, told us at the time that this results in overburdened local mental health centers; the Harris County Psychiatric Center, in fact, is at capacity nearly every day. As a result, it also becomes harder for regular patients, who are not charged with crimes, to be admitted for care, unless they are suffering an extreme crisis.
“This is a time of bed scarcity,” he said. “And in times of bed scarcity, you have to be real careful about how you use those beds. They’re only going to take the worst of the worst.”
In our March story, we also looked at how this affects the most severely affected mental health patients, who often end up cycling in and out of the jail for petty crimes like trespassing, and who are sometimes homeless. In the criminal justice system, these are people whom the state considers so mentally deteriorated that it doesn't bother sending them to the state hospital for competency restoration, because officials don't believe there's a chance anymore. Instead, they'll dismiss the charges, and transfer the person to the local mental health care center for services.
Here's what ends up happening, though, to people like Tyrone Dolphin, who was arrested eight times in 2015, mostly on trespassing, and found permanently incompetent each time: Not only did he have to wait in jail for up to 15 days, in one case, without charges against him before a bed opened up at the Harris County Psychiatric Center, but once he got there, HCPC kept him for only a few days — probably a week at most — and would have to release him back to the streets. Only for him to be arrested again, because he does not have access to the proper care.
As Hickman addressed in his testimony: “The mentally ill enter the criminal justice system, are treated at the county level to the best of our ability, and returned to the community to await their next trigger event causing the cycle to continue without intervention or reimbursement from the state. It is in the state’s best interest to assist in resolving these mental health issues to keep serious incidents from occurring in our communities.”
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And it would probably require reform beyond just fixing the competency restoration bed shortage issue. Hickman acknowledged that, according to stats from the budget office, the state had 300 beds available per 100,000 people in 1955 — and now that has dwindled to 22 per 100,000, which he said was sad. But the context that Hickman does not include is that, following the mass exodus of mentally ill people from state hospitals in the 1960s and '70s, after advocates and medical professionals realized that essentially warehousing people for years was inhumane and helpful to no one, the state never adequately funded community mental health care, Jennings said.
Which left hundreds of people with a lack of access to the care that they need.. And that's even truer in the case of the severely mentally ill, who are not even eligible for Harris County's diversion program because they are considered too incompetent to participate.
Dr. Reginia Hicks, who is in charge of that mental health diversion program, which also seeks to provide housing for homeless mentally ill people, told the Press in March that the state has failed to ever fund residential facilities for severely mentally ill patients, who need independence but also 24/7 access to care.
While no one would disagree that additional programs and facilities like the one Hicks described are important, it always goes back to the Legislature. As Jennings had said: Until the Lege decides to cough up the funding, “it has failed its most vulnerable citizens.”