USA’s Competency to Stand Trial Problem

A December 2017 article, entitled: “Colorado to spend $20 million to relieve ongoing backlog of mental competency evaluations; critics say problem was foreseeable,  in the Denver Post newspaper and recently reprised highlighted what has been a national crisis in the psychiatric inpatient care delivery system for at least the past decade.

Colorado’s problem has continued to balloon up so persistently that the article stated: “[the]State can’t keep up with monthly court orders for competency evaluation, which jumped from 146 to 215” swamping the entire state hospital bed capability. And as has happened in every other state, the regular emergent psychiatric admissions to the state’s public psychiatric hospitals were delayed, creating the all too familiar backups of patients in ERs statewide. And it must be remembered that almost all referrals for admission to state psychiatric hospitals are true emergencies.

A guard is reflected in a ...
Helen H. Davis, Denver Post file

A hallway at the Colorado Mental Health Institute at Pueblo, Denver Post file photo.

Judge Marsha Pechman of Washington state began fining Washington in the fall of 2017 $1500 daily after she found the state in contempt for not being able to deliver adequate care for the ITP patients. Her fines later escalated as she found the CEO of the Western State Hospital and the state mental health agency in contempt, to over $50M in total fines last year. By the time Judge Pechman began to levy the fines against Washington, its statewide monthly judicial orders, mirroring Colorado’s almost exactly were averaging 291 in-jail evaluation orders.
The issue is that most states in the USA continue to be flooded with mandated admissions of inmates from state judicial systems for psychiatric evaluations. These types of admissions are variously termed ITPs or incompetent to proceed to trial patients and other arcane terms derived from states’ laws designations. Washington state has struggled mightily more than most states with this issue so much that a Washington state judge has fined the state over $50M in the past two years because of the delays in care for other patients who had ended up warehoused for weeks to months at a time in general hospitals all over the state.
The Governor of Washington, Jay Inslee, who has been working at a furious pace with the Washington state legislature, recently announced new plans to try to have regional, non-state hospital-based forensic evaluation centers in different parts of the state by 2022 to handle all the ITP case needs. This is innovative in that most states do not have such a system.
In decades past, states had “forensic centers” that were designated the proper facilities to handle such cases. In the states that had such, their capacities were usually not increased from levels of the 1960’s. One such notable and nationally recognized center was and still is Michigan’s Center for Forensic Psychiatry south of Ann Arbor Michigan. Another has been the infamous Massachusetts facility Bridgewater state hospital’s forensic unit. Its heyday has long passed, and it has been the site of repeated scandals for a good decade and is not such a good example…
Nationally some of the forensic facilities were phased out as such units were incorporated into state psychiatric hospitals’ physical plants. But overall, the bed needs were not increased to keep up with population growth for over 50 years, hence the ‘sudden’ swamping of these facilities in whatever form they existed nationally.
Additionally, the impetus of the legal system has been to increasingly become scrupulous about ensuring inmates’ rights are protected to assure access to mental health evaluation and treatment. Issues of below average intelligence, organic mental conditions and medical conditions affecting legal issues such as the ability to know right from wrong, judgment, impairment of any sort at the times of commission of crimes, were more readily identified than ever in the past.
Also, it likely has become the standard of practice in the world of legal defense representation, to adequately refer to such psychiatric review whenever there is a question such an issue may exist with any defendant.
All these factors have fed into the current national crisis of explosion of need for such forensic psychiatric services at all levels and not just in infamous trials involving serial killers or cases involving the rich and famous.
All states who currently fall short of providing these mandated services will have to face the coming necessities of funding for such services along with all the other inadequacies of social, educational and human services gutted over the last 30 years. How all this will play out will in no small part shape the political and social policy debates in this country for decades.
Advertisements