by Eike Blohm, MD
Defendants nationwide who require competency restoration are suffering irreparable harm awaiting psychiatric beds in solitary confinement.
Here’s what happens: An individual with major mental illness, such as schizophrenia or bipolar disorder, comes to the attention of law enforcement due to the delusions or mania that are part of the condition. After arrest, a determination must be made whether the defendant is competent to stand trial. If not, competency must be restored in a psychiatric hospital. But there the system breaks down, with too many people waiting in jail for too few psychiatric beds. Meanwhile, the way most jails deal with severe mental illness is with solitary confinement.
In Texas, about 2,241 public psychiatric beds are available for competency restoration. But staff shortages typically keep one-third of those offline. Consequently, a defendant usually waits about eight months for placement. Those who need a maximum-security facility wait even longer – 699 days, on average, or nearly two years.
While waiting for a psychiatric bed, most defendants are held in county jails. But lacking sufficient budget resources for mental healthcare, jails often leave mental illness untreated or undertreated. Resulting behavioral issues, as well as friction with other prisoners and staff, then often lands defendants in solitary confinement.
Languishing alone in a cell wreaks havoc on an already fragile mind. The lack of social interactions deepens depression. Absence of stimulation can worsen or even cause psychosis. Isolation leads to decompensation, resulting in permanent harm.
The most obvious problem is suicidality and self-harming behavior. But not all wounds are visible. The longer a person suffers psychosis, the harder it is to remediate. This in turn leads to prolonged hospitalizations, slowing the turnover of limited psychiatric beds. As the wait time for the next person increases, the problem is exacerbated. In the state of Washington, the number of jailed detainees waiting for a psychiatric bed has exploded, from 996 in 2015 to 2,397 in 2022.
Some efforts have been made to alleviate the problem. In Washington, a new 58-bed facility opened on January 27, 2023. Civil Center for Behavioral Health at Maple Lane, however, treats only those deemed too dangerous to be released; they’ve already had their criminal charges dropped. Moreover, since psychiatric hospitalizations often require months, the impact of this new facility will be limited.
Ultimately, the root problem must be addressed: Citizens with major mental illness need affordable access to mental health services to prevent behavior that results in arrest. Failing this, lawmakers effectively criminalize mental illness.
Our society by now should have moved beyond locking away men and women who struggle with psychiatric conditions. Instead we must provide them with treatment on par with the treatment provided for other medical conditions.
Sources: Dallas Morning News, KING
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