On Tuesday, the Los Angeles County Board of Supervisors voted to expand reentry programs that provide community-based treatment to people found incompetent to stand trial who would otherwise languish in LA’s jail system — the largest mental health facility in the country — while they wait for state hospital beds to become available.
When people are deemed unable to stand trial — because judges find they are unable to understand the criminal proceedings against them or to assist in their own defense — they are supposed to be sent to a mental hospital for treatment until their competency is “restored” and they can understand the charges against them. But a dearth of state hospital beds that meet these individuals’ needs means that people declared incompetent to stand trial are warehoused in jails — without having been convicted of crimes — with their names on a state hospital waitlist.
For six months in 2017, California’s Department of State Hospitals took an average of 86 days to admit individuals declared incompetent to stand trial. Some people, however, waited more than 200 days to enter a hospital. In response to these delays, the ACLU sued the state. Throughout the course of the ongoing lawsuit, the organization has urged the state to increase community-based treatment, arguing that it is more humane and effective than the state hospital environment.
In May 2018, the waitlist to get into a state hospital included the names of nearly 500 people who were facing felony charges in LA County jails. At the time, the Department of State Hospitals had also experienced a 33 percent jump in the number of people it needed to serve in this capacity.
Meanwhile, LA’s Office of Diversion and Reentry (ODR) had experienced three successful years of diverting people accused of misdemeanors who were declared incapable of standing trial into community-based competency restoration program.
Thus, in June 2018, the California Department of State Hospitals issued a grant of a little over $44 million to ODR to pilot a similar program for individuals charged with felonies for three years. With state funding, ODR’s Felony Incompetent to Stand Trial Community-Based Restoration (FIST-CBR) program served more than 440 individuals during that time.
Between 2018 and 2021, the CBR program has had an 80 percent success rate — meaning that 80 percent of people in this very-difficult-to-treat population who received community-based restoration had not returned to jail.
But ODR doesn’t have the capacity to help all that would qualify for community-based restoration. There are approximately 375 people declared incompetent currently in the jails waiting for placement. And wait times have increased to six months or more during the pandemic.
The jails’ overall mental health population has increased, too, despite initial COVID-19 jail population reductions. Now, there are more than 6,000 people who are either held in mental health housing units, taking psychotropic medications, or both, in the jails, marking an increase of about 450 people over June 2019 numbers.
In order to further reduce the state mental health bed waitlist, the Dept. of State Hospitals offered the county $45.4 million — a sum that would allow ODR to help 200 more people through the end of the current fiscal year and through the next year.
The state budget also includes a pot of $468 million to fund three counties that agree to participate in a new Community Care Collaborative Pilot (CCCP), through which counties will take responsibility for the entirety of their own FIST population, rather than relying on the much-delayed state system. If LA participated, it would get the largest portion of the money.
But LA County leaders have appeared reluctant to take either of the pots of cash.
Months of inaction to take the state money prompted letters from the ACLU and other advocacy groups and an editorial in the LA Times urging the board to agree to expand community-based treatment for people found incompetent to stand trial.
Taking Ownership, Locally, of the Problem
Now, the LA County Board of Supervisors has voted to at least take the state money that will allow ODR to treat and house 200 more people from the jailed people in the FIST group.
A motion authored by Supervisors Janice Hahn and Hilda Solis directs the county officials to accept the state’s program augmentation award, which will “cover all costs related to the existing 215-bed program and to augment the program by an additional 200 beds at no cost to the County.”
A second motion endeavors to expand the net of the county’s existing diversion program to treat people accused of misdemeanors — rather than felonies — who are found incompetent to stand trial (MIST) in the community, rather than in jail, as well. As of March 2021, there were approximately 70 people in this population still in jail, rather than being treated in the community.
The motion, by Supervisors Sheila Kuehl and Holly Mitchell, directs county departments to work together to identify available community beds and services for the people in the MIST population who are still in jail, and to calculate the funding (and funding sources) needed to expand community care.
“The people who will benefit from today’s motion are individuals accused of minor crimes,” said Supervisor Sheila Kuehl, author of the motion. “If they did not have serious mental illness, chances are they would only be in jail for a few days, but because they have serious mental illness, and must be restored to competence before their case can be decided, they often remain in jail for a long time. That makes no sense legally, medically or financially.”
During Tuesday’s meeting, Brittney Weissmann, CEO of the LA County chapter of the National Alliance on Mental Illness (NAMI) urged the board to take steps to assume local responsibility for the FIST and MIST populations.
“LA County has devoted itself explicitly to alternatives to incarceration, community-based treatment in all possible cases, and using jail as a setting of last resort,” Weissmann told the supervisors. “We can’t continue to wait on the state for solutions because that contrasts sharply with our very home-grown, county-wide attitude on ATI. We are proven innovators and reformers here. This is within our grasp.”
Mark Gale, NAMI-LA’s Criminal Justice Chair added to Weissmann’s statement by saying that state leaders have “proven that they are incapable of solving this dilemma.” By contrast, ODR and DMH have “shown that we can manage this population successfully” at the local level. “This is why we believe the county should not just go forward with the expansion of 200 more beds,” Gale said, “but completely take over the entire population” two-thirds of which are held in county jails, awaiting care.
Emily Bell, director of Project 180, the “largest behavioral health provider for the justice-involved population in the county,” noted that of the FIST-categorized people to whom her organization provided services, “all 21 that remain in the area locally, are still voluntarily receiving services from Project 180.”
“I can’t stress enough how crucial continuity of care is for this population,” Bell said. “Too often, they fall through the cracks, and exiting the state hospital system can be one of those cracks.”
By contrast, people who receive community-based competency restoration services get to “reconnect with family and connect with their communities,” she said. “Living with a severe mental illness can be incredibly isolating. Beginning to weave a fabric of social support and connection to services during competency restoration is essential to the long-term stability and well-being for this population.”
Image: Twin Towers Correctional Facility, Los Angeles County