Proposal: Allow Private Firms to Provide Mental Health Services in Jails

Legislators are considering a measure that would allow private companies to offer jail-based mental health restoration services to people accused of crimes who have been found incompetent to be tried.

“It sort of fills a niche there in the continuum of care for individuals that are unfit to stand trial,” state Rep. John Zerwas, R-Simonton, told members of the House Corrections Committee this week during discussion about House Bill 2349.

The bill, which has a Senate companion by state Sen. Robert Duncan, R-Lubbock, sets out specific guidelines for a pilot program that would operate in select jails and allow mental health providers to help restore inmates to competency so that they can stand trial. Initially, the measure raised concern among mental health and criminal justice reform advocates, who are typically leery of private entities seeking to profit from providing services to the incarcerated. After discussion with the bills’ authors, advocates said, they are not opposing the proposal — but they’re not endorsing it just yet, either.

“County jails are not therapeutic settings, and I’m not so convinced that can be overcome,” Gyl Switzer, public policy director of Mental Health America of Texas, told the House committee. “But I’m open-minded.”

The bill follows a 2007 lawsuit filed against the Texas Department of State Health Services by Disability Rights Texas, a civil rights advocacy group, which argued that mentally ill inmates were being held far too long in jail awaiting space in state hospitals where that they could receive treatment that would make them competent for trial. Because of a shortage of beds in state psychiatric hospitals, it sometimes took months for inmates to receive treatment. A judge in that case ordered the state to make hospital beds available to incompetent inmates within 21 days of a decision on their need for competency treatment.

Currently, there are just two options for mentally ill inmates found incompetent to stand trial. They can wait in jail for space in a state psychiatric hospital, or, for some inmates charged with nonviolent misdemeanors, they can receive treatment in an outpatient restoration program. 

If lawmakers approve the jail-based treatment proposal, certain counties would be able to participate in a pilot program. Companies would be required to bid on contracts to provide services, and the measures set out specific standards for the provision of care inside jails.

Sheriffs across the state have complained about the increasing population of mentally ill inmates in their cells who present dangers to themselves, other inmates and staff. 

“I haven’t met a single sheriff who is happy to have people in their jail that suffer from mental health problems,” said Ana Yáñez-Correa, executive director of the Texas Criminal Justice Coalition.

Proposals to turn to private providers for another alternative for mental health care, she said, show the level of desperation among law enforcement officials. 

“It’s a cry out for help for something that has not been historically adequately addressed,” Yáñez-Correa told the committee.

State Rep. Toni Rose, D-Dallas, a mental health professional who worked in the Dallas County Jail, said she was concerned that most jails do not have the appropriate clinical setting to provide treatment for mentally incompetent inmates.

In Dallas, she said, the county is working to build a facility specifically for mentally ill inmates. Most counties, though, don’t have the resources to do that.

“The main concern I would have is, I don’t think all our jails would accommodate a program like this,” Rose said. 

Kenneth Carabello, vice president of operations for Liberty Healthcare Corporation, said his company has provided competency restoration services in San Bernadino County, Calif., facilities for two years.

The program, he said, is meant for inmates who can be quickly restored to competency and don’t need the complex services a state hospital provides. In California, he said, the program has been successful and saves money because it is less expensive than state hospital treatment. Other states, including Colorado, are also considering adopting the jail-based restoration model, Carabello told the committee.

“It’s a positive for the system, certainly financially, but also I think for the defendant, the patient, in terms speeding up the trial,” Carabello said.