New jail program would help mentally ill inmates get well enough to stand trial - MMHPI - Meadows Mental Health Policy Institute
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New jail program would help mentally ill inmates get well enough to stand trial

This article was published by the San Antonio Report on April 3, 2023.

Some of the roughly 300 inmates in Bexar County’s jail who have been deemed incompetent to stand trial could benefit from a new pilot program that was unanimously approved by Bexar County commissioners Tuesday.

The Jail Based Competency Restoration program will treat inmates’ mental health issues with the goal of restoring their competency, meaning they understand the basic elements of the justice system and can assist in their own defense, and so can stand trial.

If successful, the program could reduce the jail population and the long waitlist for a bed at the state psychiatric hospital by moving these inmates through the justice system.

Inmates cannot be tried for a crime unless they are deemed competent, so they often languish in jail where there is limited access to mental health care and an 18-24 month wait for a bed in the San Antonio State Hospital, which serves 64 counties, Monica Torres, director of justice programs at the Center for Health Care Services (CHCS), said during a press conference on Monday.

Currently, there is no program within the jail dedicated to restoring legal competency. That job typically belongs to the state, which has taken hundreds of its mental health beds out of service due to severe staffing shortages. While Dallas County is suing the state over that shortcoming, Bexar County leaders have decided instead to take matters into their own hands.

Under the pilot, funded by a $1.6 million grant from the U.S. Department of Justice, CHCS will hire seven clinical and medical staff who will provide medication management, group and individual therapy sessions and perform competency evaluations “to determine if the program participant is competent to stand trial and continue due process,” Torres said.

To establish competency, she said, inmates need to be able to answer basic questions such as: What does the judge do? What is your charge? What are the pleas that you can plead for those charges? What does a defense attorney do?

Some people have been in jail longer than the sentence for their crime would be, Salazar said. Once declared competent, a judge could set them free, but until then, he said,” they’re going to sit in that jail, and they’re going to continue to decompensate on us despite our best efforts.”

CHCS estimates that the program could serve about 40 inmates through the end of this year and 80 in 2024, Torres said. They expect that more than half will leave jail by either going to trial or having their charges dropped.

The team will prioritize the 150-175 inmates who have been waiting the longest for inpatient competency restoration services and are not in maximum security units, she said. Those inmates will also undergo a risk assessment to make sure they can safely work with other inmates and staff.

Not all inmates are capable of competency restoration, Salazar said. “We know that there is a certain population [of inmates] … that just simply are not going to be good candidates for this.”

But this program will ultimately shorten the waitlist for psychiatric beds for the inmates that need it most by diverting others to trial or release.

Commissioner Grant Moody (Pct. 3) said the program will be a “win-win-win” for the inmates, victims, the Bexar County Sheriff’s Office and local taxpayers.

“Personally, I’m excited about it,” Moody said. “I think this is part of a holistic solution when it comes to mental health services and dealing with those found incompetent.”

People with mental health or substance abuse challenges have “no business” in jail, said Jelynne LeBlanc Jamison, president and CEO of CHCS. “But we’re trying to work within the system.”

Jamison said she hopes that the pilot competency restoration program will demonstrate success to the Department of Justice and will be funded again once the grant expires in 2024.

The Bexar County jail doesn’t have the staff nor the expertise to give inmates the mental health care they need, Salazar said, and the jail is already woefully understaffed.

The county is also planning on building its own psychiatric hospital, he noted. The Meadows Mental Health Policy Institute was commissioned by Bexar County to study the need for a new facility, which may be funded by the state.

“We are very excited about the findings from the Meadows Policy Institute study, which identified that we need a psychiatric campus in Bexar County to serve civil and forensic needs in this community,” Jamison said. “Houston has one, Dallas has one. It’s Bexar County’s time. … We’re very hopeful that we can make that a reality in the coming years.”

Commissioner Justin Rodriguez (Pct. 2) said he spoke with county leaders from across the state last week who described similar challenges.

“They’ve got crowded jails,” Rodriguez said Tuesday ahead of the vote. “I appreciate the collaboration [of this program] because we’re trying to get people’s lives turned around and… we can’t wait on the state — we’ll be waiting forever.”

The state is building a new psychiatric hospital on the same South Side campus as its current hospital, which could free up the existing building to become the county-run psychiatric hospital for inmates deemed incompetent, county officials have said. The state’s new hospital is slated to open in January 2024. County commissioners approved a contract with a consultant last week to create an adaptive reuse study for the existing building.

During a commissioner’s court meeting last week, Bexar County Judge Peter Sakai said he would like the county to focus on diversion programs that prevent people with mental health issues from going to jail in the first place.

“We’re just building bigger jails for this particular population,” Sakai said. “I think we need diversionary programs and wraparound services for this population if we’re truly going to intervene and provide services … to get people out of the cycle of mental health mental illness.”

This story is available on San Antonio Report’s website here.