Recently, the Deseret News brought greater public awareness to the plight facing those with mental illness in jails awaiting treatment to stand trial. Although the Deseret News investigation focused specifically on this issue in Utah, this is a nationwide crisis that deserves sustained attention and action. Nationally over the past few decades, the number of individuals with mental illness who are found "not competent to proceed" to trial and deferred to state custody for stabilization, and treatment has increased more than 300 percent for many states.
This is a national crisis straining capacity in the mental health system. According to the National Association of State Mental Health Program Directors, 78 percent of states, including Utah, have waiting lists for forensic services. While the problem is not unique, Utah's approach is proactive and comprehensive when compared to other states.
Although Utah, like all states, struggles to meet the needs of those on waiting lists for these specialized services, Utahns need to know that Utah is a model among Western state hospitals for its delivery of hope and treatment for people with mental illness. No one should minimize the challenges associated with this issue and the pain it creates for individuals and families seeking treatment, but Utah should be proud of its commitment to using best practices and finding solutions to often complex situations — particularly in addressing the increase in individuals who are court ordered to "forensic competency restoration" so they can participate in their own legal defense.
Until 2013, the Utah State Hospital, where forensic competency is administered, was admirably successful at managing the forensic demand with essentially no waiting list. Utah preemptively created a strategic plan in 2014 to address the growing trend, which included alternative treatment and service delivery options. The plan focuses on a comprehensive, efficient and cost-effective system that matches patient needs and resources.
For example, starting in June 2016, the Utah Legislature backed $700,000 in ongoing funds for an innovative community-based outreach program that treats low-risk forensic patients in the community to lessen the waiting time for a bed at the hospital. This program has already resolved over 90 cases at $16 per day versus $500 per day at the hospital.
The governor and Legislature also added $3 million in annual funding starting this fiscal year for the hospital to start an evidenced-based jail-based restoration program that will begin in Salt Lake County this fall. Also funded this year is $6 million for community-based behavioral health treatment for the state’s Justice Reinvestment Initiative.
The Treatment Advocacy Center, a national nonprofit organization dedicated to making treatment possible for severe mental illness, praised Utah, stating, “Among the 50 states, only Utah, Florida, California and Ohio are reaching at least 60 percent of their populations with each of the measured diversion practices.”
Utah, like many states, is experiencing litigation from advocacy groups working to protect the rights of people with mental illness, insisting defendants not be held in jail settings while awaiting treatment. While most states have addressed this legal challenge by closing other mental health services and redirecting resources to the forensic population, Utah has been unwilling to decrease access to inpatient beds to the “non-forensic” population. This strategy unduly shifts the burden of care to emergency rooms, jails and prisons, which are not equipped to provide people in long-term meaningful mental health care.
Other proven solutions Utah is elevating in its strategic plan and proactive discussions are to send those charged with a misdemeanor crime to community mental health services rather than the lengthier forensic competency processes (about one-third of Utah’s waiting list).
The criminal justice system was never intended to substitute as a mental health provider. But given the challenging reality that many who are caught up in our criminal justice system deal with serious mental health issues, it is incumbent upon public institutions and policymakers to find innovative ways to address this concern. There is no simple answer to this complex problem. But Utah is to be commended for identifying and implementing comprehensive evidence-based interventions that are pointing all of us in the mental health community to better outcomes.
Troy Jones, Psy.D., is president of the Western Psychiatric State Hospital Association.