Long wait for justice: People in prison face delays in receiving mental health care before they can stand trial

Beau Hampton’s long wait for psychiatric treatment began last year, after he was accused of assaulting his adoptive father and charged with a misdemeanor.

Hampton, 18, who has a long history of mental illness, spent four months in jail in east Atlanta while waiting for an expert to assess whether he was mentally fit to stand trial. In February, a state psychologist declared Hampton incompetent.

Then Hampton had to wait to get placement in a state psychiatric hospital so he could receive treatment to meet the legal threshold of competence. The delay in treatment frustrated a Walton County judge, who said Hampton’s condition had worsened in the overcrowded jail and in March ordered he be moved within 24 hours to a public hospital. The Georgia Department of Behavioral Health and Developmental Disabilities, which operates these psychiatric hospitals, did not comply, and the judge found the agency’s commissioner in contempt of court a month later.

Such long wait times for state psychiatric hospital services are taking place in prisons across the United States. Prisoners with serious mental illness – and who cannot stand trial because of their condition – wait months or even more than a year to begin receiving the care needed to “restore” their ability to stand trial. The legal standard is that a person accused of a crime must be able to participate in his defence.

In Georgia, 368 people deemed incompetent are sitting in local jails awaiting treatment for trial, according to the state. More than 900 are just waiting for the first step in the process, a “medico-legal assessment”.

Similar delays have sparked litigation in many other states.

The Indiana Protective and Defense Services Commission filed a lawsuit in May against state officials for delay in psychiatric services, saying the delays violate the defendants’ due process rights. Oregon faced strict deadlines set by a 2002 court case, and its backlog stood at 55 as of May 20.

Alabama is facing a consent decree, but “people are still waiting, on average, a few hundred days to be admitted to facilities to undergo these assessments or treatment,” said Shandra Monterastelli, senior attorney for Alabama Disabilities. Advocacy Program. .

North Carolina’s waiting list for “restoration” treatment has grown to 140, while Colorado – another state under a consent decree – has 364 waiting. In Texas, the number is much higher – more than 2,000 – a backlog that prompted a lawsuit. Montana also had dozens waiting.

“It would be hard to overstate how concerning mental health issues are in county jails,” said Michele Deitch, a criminal justice expert at the University of Texas’ Lyndon B. Johnson School of Public Affairs. Austin.

More than 2 million people with serious mental illness are incarcerated each year across the country, often for non-violent “nuisance” offenses such as loitering or vagrancy, according to a 2020 report by the National Association of Principals. state mental health programs. Once imprisoned, people with mental illness are incarcerated twice as long as other defendants, according to the report, and few receive treatment for their condition.

People with mental illness also typically get worse in prison during long waits for a psychiatric hospital bed, said Philip Fornaci, senior attorney for the National Disability Rights Network. “It’s an obvious constitutional problem,” he said. “Prisons are really chaotic and quite violent places.”

For some people charged with a misdemeanor, the wait for what is known as in-hospital skill restoration may be longer than if the individual had been tried, convicted and sentenced on such charges, said Dr. Robert Trestman, chairman of the American Psychiatric Association’s Council on Health Systems and Funding.

Delays in transfers to inpatient treatment facilities, state officials say, have increased during the pandemic, amid a worsening state hospital staffing shortage. Yet several court cases — including those from Alabama, Colorado, Oregon and Washington state — were filed years before covid-19 surfaced.

Shannon Scully, senior justice and crisis response policy adviser at the National Alliance on Mental Illness, said that as the shortage of mental health care providers continues, delays in the recovery of the mental capacity of the defendants would probably worsen.

In Georgia, the state mental health agency said it has lost nearly a third of its psychiatric hospital staff since January 2020. Temporary workers are filling some vacancies, but the state is reporting several unfilled jobs for forensic psychologists responsible for assess the competence of detainees.

Beau Hampton has a history of psychiatric treatment since he was 3 years old, including multiple hospitalizations, according to court documents. He is described as having autism, bipolar disorder and other mental health diagnoses.

In March, while being held in Walton County Jail, Hampton was injured in a fight and required stitches. He also faced an ongoing felony assault and misdemeanor battery charge in a nearby county.

But state officials said Hampton did not make it to the top of the waiting list for hospital treatment despite the court order, his age, his diagnoses and his struggles in prison. The list is based on the date of a person’s hospitalization order and the patient’s condition.

The average wait for a male inmate who needs such care in Georgia is 10 months, state officials said during a hearing on the Hampton case in April. The judge, Cheveda McCamy, gave the state 21 days under the contempt order to have Hampton placed in a hospital.

Hampton could not be reached for comment. The public defender assigned to his case, Julia Holley, said the jurisdictional issues — not his actual criminal charges — took up much of his time. Due to Hampton’s age and medical condition, and her placement in the foster care system, she said, the case “broke my heart the most.” She added: “He deserves a chance.”

Jails like Walton County are feeling the burden of caring for people with mental illnesses. These inmates often cannot afford bail or bond, Trestman said, and smaller prisons have fewer services than larger ones. Prisons are “not places designed for treatment”, he added. “It’s not a warm, fuzzy environment.”

Incarceration costs are much higher for people with mental illness — about four times higher than for others, said Captain Terry Mays, administrator of the Wayne County Jail in southeast Georgia. .

In southwest Georgia, Capt. Steven Jones, acting administrator of the Thomas County Jail, said a man had waited more than a year for such a placement. During this, Jones said, the man attempted suicide by jumping off a railing, breaking both ankles and damaging his spine. The delay for the mental hospital bed “was ridiculously long,” Jones said.

Especially for misdemeanors, experts said, getting faster treatment in a community setting can make sense. And several states are moving to increase outpatient treatment.

Neil Gowensmith, an associate professor of forensic psychology at the University of Denver, said restoring ambulatory skills has several benefits. “It costs a lot less,” he said. “Public safety is not compromised. From a humanitarian point of view, it is a question of civil liberty.

He cited the 1999 Supreme Court decision in Olmstead v. LC, a groundbreaking decision that supported the least restrictive level of care for people with disabilities. “It can be a group home, it can be supervised living, it can be independent living,” Gowensmith said.

South Carolina passed legislation this year that will allow outpatient and in-prison dining options.

Georgia has limited options for outpatient services. Ashley Fielding, deputy commissioner of the state mental health agency, said in a statement that she was “actively working on solutions” to the skills backlog, citing raises given to all employees at the Status and expansion of non-hospital dining alternatives.

On the 20th day of the Walton County judge’s contempt order—one day before its due date—the agency transferred Hampton to a state mental institution in Milledgeville. The state mental health agency declined to comment on the case except to say it complied with the judge’s order. More than eight months had passed since Hampton’s arrest.

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