Judge: State mental hospitals must take incompetent inmates within 21 days

Big news for mentally ill defendants in Texas declared incompetent to stand trial, not to mention the state agency that is supposed to provide "competency restoration" services, which presently has a months-long waiting list. After a court ruling this week, such long delays have been deemed unconstitutional and state mental hospitals have been ordered to begin taking inmates within 21 days after they've been declared incompetent. Reports Andrea Ball at the Austin Statesman ("Judge: Mentally incompetent inmates being kept in jail too long," Jan. 26):

Texas routinely violates the constitutional rights of mentally incompetent prisoners by forcing them to stay in jail for up to six months before moving them to psychiatric hospitals, a Travis County judge ruled this week.

State District Judge Orlinda Naranjo ruled that the Department of State Health Services must start moving "forensic commitments" — people accused of crimes who have been ruled incompetent to stand trial because of mental illness — to state psychiatric hospitals within 21 days of receiving a judge's order. Over the past two years , the average prisoner spent six months in jail waiting for a hospital bed, the ruling states.

"Keeping incompetent pretrial criminal defendants confined in county jail for unreasonable periods of time violates the incompetent detainees' due process rights as guaranteed by the Texas Constitution," Naranjo wrote.

A final order that would specifically lay out how the health department should proceed has not been issued, said Tom Kelley , spokesman for the attorney general's office. That agency has not decided whether it will appeal the case. Right now, there is no timetable for when the changes might be instituted.

 I contacted the attorney in the case from the group Disability Rights Texas, Beth Mitchell, who forwarded a copy of Judge Naranjo's ruling (uploaded here on Google Documents).

The lawsuit is aimed at the Commissioner of the Department of State Health Services, and while everyone thinks it'd be a good idea to reduce waiting times, the decision raises as many questions as it answers. The state cut state hospital funding and other mental health services this year, so seeking more resources in the near term will be like squeezing blood from a stone. Meanwhile, the average waiting list for beds in 2011 was about 300 people, wrote Judge Naranjo, with about 800 beds designated for "forensic" use.

How will DSHS comply with this ruling or will they balk and appeal? If they comply, will they contract for beds, and if so where, and with what money? Will they shift more beds to forensic purposes, and if so what impact will that have on other severely mentally ill folks with civil commitments (69% of state hospital patients, says the ruling)? Will the Legislative Budget Board authorize extra interim expenditures - as they did for the $5 million per month extra being spent on TDCJ healthcare - or will they let the system limp along, noncompliant, until the 2013 session? And what remedy might Judge Naranjo be able to muster to compel them to act sooner? ¿Quien sabe?

This is a welcome ruling, but it doesn't manufacture extra hospital beds out of thin air. Perhaps, though, it will set in motion a process that forces the Legislature to focus on the question much more seriously, and immediately, than they have in the past.