In Texas, the Waitlist for a Bed at a State Mental Hospital Hits an All-Time High

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Texas' mental hospitals passed a grim threshold last week.
During her years as a Burnet County criminal magistrate judge, Roxanne Nelson was at the jail every Monday through Friday, from 8 a.m. until 5 p.m. She saw how county jails dealt with people with mental illnesses accused of committing crimes.

"When I started in March 2010, if I couldn't get someone into a bed within 21 days, I was upset. Because I thought 21 days is a long time for somebody to stay in a county jail with a mental illness," she said. 

Nelson left her judgeship in 2016. She now serves on the state's Judicial Commission on Mental Health (JCMH), a group of current and former judicial and law enforcement officials, psychiatric experts and policy experts from across the state.

Her hopes for the people with mental illness waiting in county jails for a state hospital bed have since grown dim. "I thought 21 days was terribly long time for somebody to be stuck in our county jails," Nelson said. "Now, if someone told me they could get someone a bed in 21 days, I'd be thanking the lord."

Nelson's outlook reflects a growing crisis within Texas' mental health system, which hit a grim milestone on Friday. According to sources at the JCMH, there are now at least 1,813 people waiting for a bed in a state mental hospital.

Texas laws are meant to protect people with mental illness from criminal prosecution if experts conclude they were suffering a mental health crisis when they allegedly committed a crime.

The Texas Health and Human Services Commission and the Texas Department of Criminal Justice administer "competency restoration" programs to these individuals. The goal is not therapeutic; they hope to restore individuals' psychological state to the minimum threshold of mental function necessary to prosecute them.

"We have a moral obligation to do everything in our power to reduce the waitlist." - Krish Gundu, Texas Jail Project

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People accused of offenses ranging from petty misdemeanors to violent felonies can be deemed incompetent to stand trial and left to wait in jail while they await one of the state hospitals' 3,000 or so beds.

The milestone reached last week marks the latest in an ongoing crisis within Texas' mental health system. Experts say the crisis has been driven in part by lawmakers' failure to grow state hospitals in tandem with the states' ballooning population. 

From 1964 to 2016, Texas' population rose from 10.3 to 28.2 million people, almost tripling in just over 50 years, according to the Texas Council of Community Centers. But as the population swelled, the number of inpatient psychiatric beds in Texas state hospitals shrank by almost 80% during this time, dropping from 14,921 to 3,013 beds.

In 2015, Sandra Bland's death in Waller County Jail, which was ruled a suicide by authorities, spurred Texas lawmakers to pass a number of new policies and procedures aimed at protecting those with serious, chronic mental illness from county jail and criminal prosecution. 

Still, the number of individuals incarcerated in Texas' county jails awaiting competency restoration has only grown since. A 2016 HHSC report said the waitlist had reached "crisis levels," and called for nearly 2,000 additional beds. (As lawmakers spent more than $1 billion during the past two legislative sessions on rebuilds of state hospitals, Texas' bed count increased by only 350.)

In just the past year, the waitlist nearly doubled, rising from 970 in 2020 to 1,813. 

Krish Gundu, the Texas Jail Project's executive director, said the growing waitlist will make life a lot harder for Texans with mental illnesses who are caught up in the justice system.

"Every stakeholder in the healthcare and criminal punishment system can choose to prevent vulnerable folks from being stuck on the competency restoration waitlist," she said. "We have a moral obligation to do everything in our power to reduce the waitlist."