Slowly but surely, the state of Texas is trying to turn a complicated, costly, and often heartbreaking saga into a coordinated, comprehensive service delivery system – and counties are right in the thick of it.
Anywhere from 16 percent to 20 percent of offenders in the Texas criminal justice system have a mental health diagnosis, said Leon Evans, director of the Center for Health Care Services (CHCS), the mental health authority in Bexar County. Hundreds of these offenders, usually arrested for non-violent crimes, are sitting in Texas county jails without access to much-needed treatment and medication.
These offenders normally remain in custody three or four times longer than the general population because they cannot bond out, are homeless, or become increasingly ill due to lack of medication, Evans said. Judges often will not allow inmates with mental illness into court until they are lucid, further lengthening time spent in custody.
A small number of counties across the state have implemented programs to serve this population during incarceration. For example, in 1997 the Lubbock County Sheriff’s Office and the Lubbock Regional Mental Health Mental Retardation Center developed a Memorandum of Understanding allowing those with severe and persistent mental illness to be treated while in jail.
However, these types of programs have been the exception to the rule, with the majority of mentally ill offenders remaining in custody without help. The problem is multifaceted. First, there’s the plight of the offenders, many of whom are hampered by bipolar disorder, schizophrenia, or a depressive disorder.
“Mental illness is an equal opportunity illness,” said Bexar County Clerk Gerry Rickhoff, who has a background in special needs. “It can strike anyone.”
“We wouldn’t put people in jail because of cancer or diabetes,” Evans said. Yet, those with a mental illness are locked up and sometimes helpless.
“The very people who have the greatest needs cannot advocate for themselves,” Rickhoff said. “The demand for services is enormous, and it’s a societal responsibility to be borne in large part by the county.”
While considering the needs of this population, the county must continue to ration scarce resources to fund jail operations along with a myriad of other services. According to the Texas Access Project, conducted in Bexar County in 1999, each arrest episode has an estimated total cost of up to $2,295. Additional significant costs include maintaining the offender while in jail, and mentally ill inmates often need expensive medication.
By statute, a county is liable for all expenses incurred in the safekeeping of prisoners confined in the county jail or kept under guard by the county. On the other hand, the state is the primary funding entity of mental health services either through the state hospitals or the local mental health mental retardation authorities (MH/MRAs), according to a mental health study conducted by the Texas Commission on Jail Standards (TCJS). The county or city may contribute some level of funding for mental health, but there are no mandatory requirements on the local level of contributions.
County jails are required to complete a Mental Disabilities/Suicide Prevention Screening on all offenders immediately upon arrival, said Beverly Scott, program specialist with the TCJS. If the inmate displays signs of mental illness, the jails are required to contact their local mental health authority.
In most cases, the jail staff administering the screening has little or no training in mental illness, creating a frustrating environment for both the offender and the county. In addition, studies have indicated that mentally ill offenders continue to pass through the system unnoticed.
For instance, the Texas Correctional Office on Offenders with Medical or Mental Impairments (TCOOMMI) conducted a study using medical reports submitted by local jails to the Texas Department of Criminal Justice for all inmates committed to state confinement. This study consisted of a random sample of 100 new inmate admissions in March 2004. The majority of inmates had a health status form, and 15 had a mental health diagnosis noted. Of the remaining 85, 29 inmates – or 34 percent – were current or former clients of the state’s mental health system, but no such diagnosis was indicated by the jail.
The statewide effort to divert mentally ill offenders from the criminal justice system kicked into high gear following the 2001 Texas State Legislature, when the National Alliance for the Mentally Ill (NAMI) told lawmakers that Texas had a failed public mental health system. NAMI-Texas had conducted a study in 2004 that rendered a sobering conclusion: More than 100,000 individuals out of the 628,343 who were in prison, on probation or on parole had at one time been a part of the public mental health system.
Other studies emerged citing equally alarming figures. Data presented by the Texas Criminal Justice Policy Council indicated a disproportionate percentage of mentally ill individuals in the justice system. Estimated figures revealed that mentally ill offenders comprised:
13.3 percent of those on adult probation;
27.1 percent of parolees with the Texas Department of Criminal Justice;
22.4 percent of offenders under the Texas Juvenile Probation Commission; and
44.5 percent of those on parole through the Texas Youth Commission.
In the meantime, counties across the state continued to house mentally ill offenders at the local level. Bexar County, which spends 75 percent of its public funds on law enforcement, detention and the justice system, estimated that 16 percent of its jail population was comprised of mentally ill offenders, and approximately 60 percent to 75 percent of those brought in for non-violent offenses remained in custody longer than other offenders because no one knew where to send the mentally impaired.
The county jail was being used as a mental hospital, said Rickhoff.
Feedback from other counties and mental health authorities indicated a statewide trend, with experts and jail staff describing their local jails and prisons as “dumping grounds,” “warehouses” and “revolving doors” for those with mental illness.
In response, the 77th Legislature approved a $35 million appropriation for a Mental Health/Criminal Justice Initiative, to be funneled through a newly established oversight entity, the Texas Correctional Office on Offenders with Medical or Mental Impairments.
As a result, programs began to take root whereby the local MH/MRAs began collaborating with the community supervision and corrections departments (CSCDs) to facilitate continuous interaction between criminal justice staff and mental health staff.
For example, Tom Green County, Tarrant County, and CSCDs in other counties now have allocated space within their offices to house mental health staff, said Dee Wilson, director of TCOOMMI.
Harris County initiated a mental health court liaison program providing technical assistance to its 23 felony courts in cases involving offenders with mental illnesses. Harris County also contracts with its MH/MRA to provide jail-based mental health services, including screening assessments and treatment.
Dallas County launched its Jail Diversion Instant Messaging System in July 2004, allowing for diversion within 24 hours of a person being booked into jail, said Carol Todd, mental health diversion coordinator for Dallas County. Eligible defendants are adults charged with non-violent Class A or B misdemeanor offenses or certain defendants on non-violent felony probation with technical violations. Defendants must have a diagnosis of schizophrenia, bipolar disorder, or a major depressive disorder, Todd said. These defendants enter a 180-day program that culminates in a special graduation ceremony. Successful completion of the program results in dismissal of the case; in the case of felony probation, the Motion of Revoke is withdrawn.
While several of these programs are still collecting data, there is a clear indication that more of the mentally ill offender population is being served.
Interim results of the Bexar County Jail Diversion Program, which receives both state and federal funding, revealed more than 1,700 jail diversions in 2004 resulting in an estimated range of $3.8 million to $5 million in cost savings to the Bexar County criminal justice system.
“The objective of the program is very simple,” said Gilbert Gonzales, director of jail diversion initiatives at the CHCS in Bexar County. “We divert persons with mental illness from inappropriate hospitalization or inappropriate incarceration.”
Step by Step
The state of Texas bolstered its efforts to serve mentally ill offenders during the 78th Legislature with the passage of House Bill 2292, which requires local mental health authorities to develop jail diversion strategies for adults with bipolar disorder, schizophrenia or severe depression, and children with serious emotional illness.
In addition, Senate Bill 1145, also passed in 2003, gives MH/MRAs the flexibility to maximize local resources to meet community needs such as jail diversion.
Another bill enabled TCOOMMI to pay medication costs for offenders coming out of state hospitals and returning to the county jail after competency determinations. Prior to the funding, counties were paying for less expensive medication, as they were unable to afford the high-priced prescriptions some inmates required. TCOOMMI now pays for the medication the patient was previously taking, which is in everyone’s best interest, Wilson said.
These steps are part of a process initiated by the passage of legislation in 2003 requiring the state to develop a continuity of care system for those with special needs. Texas is the only state in the country to pass such legislation.
“We’re taking things incrementally,” Wilson said. “The Texas Legislature has enacted some of the most progressive statutory and policy initiatives for those offenders with special needs.”
Texas also is the only state in the nation to allow a variety of agencies to share and exchange information on individuals in the special needs population including those in the criminal justice system.
Along these lines, as of Jan. 1, 2005, the Texas Commission on Jail Standards now requires jails to send a list of inmate names to their local MH/MRA every day that the mental health facility is open; most facilities are only open on weekdays. If the jail has a mental health representative within the jail facility 24/7, then the list is also communicated on the weekends. The MH/MRA then cross-references this list of names with the state’s Case Assignment and Registration (CARE) system. This procedure will indicate whether or not any of the inmates have been treated by the state for mental health conditions. If the MH/MRA finds a match, a representative is sent to the jail, Wilson said.
“The mental health authorities want to find these offenders,” she said. “If they’re sitting in your jail, this is one way to let MH/MR know that you have their clients.”
What You Can Do
While the primary role of jail diversion falls to the mental health authorities, the county, and therefore the commissioners court, plays a role in the process, especially considering the amount of money counties spend on the jail, inmates, and law enforcement.
County judges and commissioners will be called upon to be stakeholders in working groups and on committees to help put programs into place. For example, Bexar County Judge Nelson Wolff helped organize the collaborative effort that eventually led to the Bexar County program.
In addition, Wilson said the commissioners court could ensure that the jail is complying with the new standard to submit names of inmates to the local MH/MRA for cross-referencing with the state mental health database.
Finally, officials should invest themselves in the process, Rickhoff said, ensuring a smooth transition for not only the offenders but for the families and caregivers who interact with the county because of these inmates.
“Get away from your desk and go see where these people are,” Rickhoff said. “The squeaky wheel always gets the grease,” he continued, “but these people can’t always speak for themselves.”
Julie Anderson