In a recent report, Texas ranked 51st among the states and the District of Columbia in access to mental health care services. This is not a new situation. Texas has consistently funded its services near the bottom of all states. The unfortunate results are easy to document. Early intervention and treatment are unavailable. Law enforcement, the courts, jails, detention centers, emergency rooms, and mental health professionals are regularly overwhelmed by the re-occurring crises that mark untreated severe illnesses. Families have reached the point of despair when unable to obtain voluntary services and have been forced to seek incarceration to protect their loved ones from themselves. Retail businesses and transportation services regularly call upon law enforcement to intervene with uncontrollable customer episodes. While there are no easy answers to mental illness, it is clear that the present lack of early diagnosis and treatment contributes to the severity of the problem. While the state avoids its responsibility to fund these services, the local taxpayer is burdened with excessive costs to protect public safety from the effects of untreated patients.
The escalating cost of this neglect is clearly exposed at the county level. When criminal defendants are unable to assist in their defense, the court must order restoration services at a state hospital operated by the Texas Health and Human Services Commission. More than 840 in-patient psychiatric beds at Texas state hospitals are offline at the present time. This is over a third of the state hospital forensic beds. These are beds that the hospitals are funded to operate, but a persistent staff shortage has resulted in the closure of these beds for months. The patients who would receive services in these beds are backlogged in county jails at local taxpayers’ expense. These incompetent patients are the most difficult and expensive inmates in county jails. They require separation from the general population and constant supervision. Their medical services and medications are extremely expensive. Most egregious, their mental condition will continue to deteriorate, and their ability to resolve their alleged criminal conduct will be postponed. The current waiting period for an average incompetent inmate to be admitted to the state hospital is over one year. The waiting period for an incompetent inmate with a violent history is over two years.
The backlog of patients in the county jails has escalated in recent years. Staffing at the state hospitals has not returned to pre-COVID levels. The state hospitals have approximately 1,400 fewer full-time staff members compared to November 2019. The Health and Human Services Commission has requested over $34 million in additional funding from the legislature to address “critical workforce needs.” The Executive Board of the County Judges and Commissioners Association of Texas has requested that the Legislative Budget Board immediately transfer funds to the counties to compensate local taxpayers for the expense of holding these state-responsibility patients in county jails.
Since the State of Texas is not meeting its responsibility for treating these persons, counties are seeking temporary alternatives. Recognizing that the county jail is not an appropriate facility for mental patients, commissioners courts are obtaining beds in private behavioral health facilities to return these inmates to competency in the criminal court system. The Dallas County Commissioners Court recently approved a contract with the North Texas Behavioral Health Authority to transfer waiting inmates from the county jail to private mental health facilities at a cost of $4.3 million during the current fiscal year.
If the state is unable or unwilling to provide the court-ordered treatment needed by these patients, it should at least compensate the counties for the expense of this service. The legislature should adopt an emergency funding measure to 1) provide sufficient funding to the Texas Health and Human Services Commission to operate its authorized mental health beds, and 2) provide full reimbursement to counties for the expense of holding and treating incompetent defendants. Please consult with your sheriff and county auditor to provide an estimate of the cost of this service to your legislators and request immediate action on this matter.