Utah is working to get mentally ill jail inmates the treatment they need to stand trial. But because of funding, many of them now have to wait. The Utah legislature is finalizing the budget this week, which includes money to expand the state hospital. But some worry it’s just a temporary solution.
If someone commits a crime in Utah, and a judge says they’re too mentally ill to defend themself in court, they might be sent to the forensic unit of the Utah State Hospital. There are 100 beds for court-ordered inmates deemed incompetent to proceed with their criminal case.
“Often times we will obtain labs and maybe brain imaging to make sure there’s nothing reversible medically that’s causing their psychiatric issues,” says Psychologist Dr. Paul Whitehead. He says his job in the Forensic Unit is to get patients mentally ready for court.
“And then it’s tailoring a treatment plan, which typically encompasses medication if it’s needed, and education and individual and group therapy,” he says.
Whitehead’s patients are accused of committing a range of crimes, from shoplifting to homicide. But this is not like jail. They’re not locked in cells. And they’re not separated based on the seriousness of their charge.
“Most people who are here for homicide charges are usually very well mannered and easily managed from a psychiatric perspective,” he says.
While they’re restricted to the unit, they walk the halls and interact with one another. Don Rosenbaum, director of forensic and safety services says they play basketball, take classes and work. He walks to a small canteen in the forensic unit.
“Since there are clients in here we won’t go into the area. Some of our patients might work here three or four hours a day with the supervision of our kitchen staff,” he says.
On the other side of campus, is a shuttered 24-bed forensic unit, just collecting dust.
Hospital administrators asked the state legislature for $5.3 million this year to re-open this unit. The legislature is likely giving them half of that, for now — enough to open 12 beds.
Right now, the forensic unit is always full. Yet the courts continue to order an increasing number of inmates there. And many have to wait in jail until a hospital bed opens up. Some have committed suicide while they waited, adding to Utah’s high rate of in-custody jail deaths.
Don Rosenbaum says the state hospital freed up some forensic beds by moving some patients into the civil unit, which is usually reserved for patients who’ve not been accused of a crime.
“There are also individuals waiting to get into those beds,” Rosenbaum says. "So I think from a total system perspective it’s creating a little bit of difficulty with bed space for everyone.”
Karen Dolan calls that forensic creep.
She runs Four Corners Community Behavioral Health in Price, Utah, which treats anyone with substance abuse and mental health issues. Some of her patients’ care is state-funded. For her most serious cases, she turns to two dedicated civil beds at the state hospital, which she fears losing.
“The state hospital really understands schizophrenia and bipolar disorder and these really difficult illnesses, “Dolan says.
She’s worried that 12 more forensic beds won’t be enough to support Utah’s growing population of mentally ill, criminal defendants awaiting trial.
That may force Dolan to send more of her patients to expensive private hospitals. And, she says, it raises public safety concerns.
“If the forensic population takes over the civil beds, we won’t have that flexibility to place somebody into the hospital before they committed a crime or before they harm themselves or others,” Dolan says.
This already happened in Maryland. A judge there held state health officials in contempt of court for failing to increase the number of psychiatric hospital beds.
The Disability Law Center sued Utah in 2015. And as part of a settlement agreement, Utah must immediately shrink wait times for forensic beds. The court ordered that by the end of this month inmates will not be allowed to wait more than 60 days for treatment. And the court ruled that those wait times must get down to just two weeks by 2019.
Utah’s made some headway. In 2015, the Department of Health and Human Services started sending doctors out to jails to provide treatment to some inmates on site ... and last year the state opened a 22-bed forensic unit at the Salt Lake County Jail.
Kristen Cox with the governor’s office of management and budget says the state will meet the March deadline but there’s more work to do because this is a big system with a lot of moving parts.
“You can’t just look at the forensic side without looking at the civil side,” Cox says. “We started with forensic, but we’ll be moving into civil and understanding the flow of patient care between those two systems to make sure that we’re freeing up beds there in an appropriate manner that works for the individual and that they’re not languishing where they shouldn’t languish.”
Dallas Earnshaw, who heads up the state hospital, says right now there are about ten people on the waitlist. He fully expects to need the other twelve beds in the empty forensic unit soon.
If so, Cox says, the state may provide the necessary funding this fall.