Mentally Incompetent Inmates
In many Texas counties, the county jail has become a de facto mental institution housing mentally ill inmates awaiting due process without their medications and/or life-sustaining therapies.
Some 1,753 inmates in Texas county jails are awaiting transfer to state hospital beds, as reported by the Health and Human Services Commission to the Joint Committee on Access and Forensic Services (JCAFS) in January. The average wait time for transfer to a maximum-security unit (MSU) is 233 days, while the average wait for non-MSU beds is 189 days.
The state hospital system has fewer MSU beds than non-MSU beds. Only three state hospitals have MSU beds: Kerrville State Hospital, North Texas State Hospital – Vernon and Wichita Falls campuses, and Rusk State Hospital.
Senate Bill 1677 passed by the 88th Texas Legislature required the State Auditor’s Office to conduct an audit of inmates in county jails who are waiting for a forensic hospital bed for the provision of competency restoration services. The resulting report released in November 2024 stated that along with the shortage of beds, the Commission “has also experienced additional challenges related to hiring and retaining medical staff necessary for providing competency restoration in state hospitals…The availability of a bed for competency restoration depends on having the medical staff necessary to manage an individual’s treatment.”
County Perspective
Henderson County Judge Wade McKinney was appointed to JCAFS in October 2024.
“Since the last legislative session, Texas made a huge down payment in pushing state resources into the treatment of mental health,” McKinney observed. “But due to a decades-long period of inadequate funding, we’re playing catch up.”
The rising demand for mental health services continues to exceed available resources, McKinney underscored.
McMullen County Judge Jim Teal is the chairman of Camino Real Community Services, the Local Mental Health Authority and the Authority for Intellectual and Developmental Disabilities for McMullen County and eight other counties. As chairman of Camino Real and as a member of the judiciary, Teal knows firsthand the challenges faced by all parties and the irreplaceable benefit of therapeutic services.
“There are instances where inmates found to be mentally incompetent wait for a year or more in the county jail without any therapeutic response,” Teal stated. While some services may be provided, they are often temporary and may result in the inmate spiraling down to his or her original condition, or even worse due to confinement.
While the financial burden to counties is significant, the cost cannot be adequately quantified, emphasized Teal. The emotional toll on all parties and the related threats to public safety and safety within the jail are constant.
The situation is lose-lose-lose, as the inmates and their families, fellow inmates and jail staff, and the taxpayers are all affected, Teal reiterated.
Members of Commissioners Court worked with the CJCAT to develop the following resolution:
Mental Health Patients
WHEREAS, Texas counties are being forced to hold mentally incompetent prisoners for up to two years while awaiting court-ordered transfer to a state mental facility for treatment; and
WHEREAS, these pre-trial inmates cost the local taxpayers approximately $430 million per year during this period of incarceration; and
WHEREAS, the county jail is not an appropriate facility for the mentally ill, and these prisoners pose a high risk of injury to themselves, the jail staff, and other prisoners; and
WHEREAS, the North Texas State Mental Hospital recently refused to accept any additional court-ordered mental patients without providing any financial assistance to counties for this state responsibility; and
WHEREAS, this delay and refused admissions by the state are increasing the cost to our taxpayers and continuing this improper practice;
NOW, THEREFORE, BE IT RESOLVED that the County Judges and Commissioners Association of Texas hereby requests that the State of Texas implement additional funding for mental health services and implement the state mental health plan to ensure the efficient and effective use of these resources, reimburse counties for the costs of operating diversion centers that serve individuals ruled incompetent to stand trial until a state mental health bed is available, and immediately reimburse counties for the cost of incarceration of offenders who have been committed to state facilities.