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Mental health care waits slowing trials

Longview News-Journal - 12/18/2017

The judicial process is generally not known for speed, but it's made more complicated when the defendant is mentally incompetent of standing trial.

As of last week, four Gregg County inmates remained in jail in such cases waiting for beds to be available at maximum-security state mental health hospitals.

Kambresha Williams, 22, of Longview was judged to be incompetent of standing trial in April and has been waiting for treatment since. Williams, charged with murder, is the longest-waiting inmate, but she is not alone in the often monthslong wait.

Defendants are found incapable of standing trial when they lack the ability to consult with their attorney or understand court proceedings, said Judge Alfonso Charles of the 124th District Court.

But incompetency does not indicate insanity. He said insanity reflects a defendant's state at the time of the crime and occurs when the accused can't express remorse or understand their actions were wrong.

A waiting game

While state hospitals can accommodate about 3,000 psychiatric patients at once, there's a much smaller pool of maximum-security beds.

Maximum-security treatment - the kind Williams will eventually receive - is split between two facilities. They are the Rusk State Hospital and North Texas State Hospital and have a total capacity of 391 patients, according to Texas Health and Human Services Commission data.

As of Dec. 1, the average wait for one of those beds was 144 days and 338 people were on the waiting list, according to commission spokeswoman Christine Mann.

Already, Williams' wait has far exceeded that average. She has been in jail more than 240 days.

"We're doing everything we can to reduce the wait list and we're working on strategies to minimize the amount of time people have to wait for a spot at our hospitals," Mann said in an email response to questions. "We are exploring options for expanding maximum security capacity within the state hospital system as well as identifying opportunities to better manage the capacity we currently have."

The system is planning to increase the maximum-security beds at North Texas State Hospital by 24 in the next financial year, Mann said. In its last session, the Legislature also provided $300 million for adding new hospitals or beds.

At the hospitals

When defendants do arrive, doctors treat them with the goal of gaining a "rational and factual understanding of the legal proceedings they will encounter."

"Defendants who have been found incompetent to stand trial are provided treatment and education in our hospitals so they can face their charges," Mann said. "This involves stabilization, psychological testing, medication, education about the proceedings and also some basic rehabilitation therapies, such as life skills."

Charles said those accused of nonviolent crimes may be eligible for outpatient treatment or a non-maximum-security facility, which helps them get treatment sooner. But for those accused of violent crimes, incompetency can create a "serious delay" in the trial process.

"It's frustrating because if someone is not competent and we have to wait numerous months or even more than a year to get someone into the hospital, and then they can stay for up to 120 days, that's a year and a half right there," the judge said.

Trial standstill

Criminal defense attorney John W. Moore said he's worked with hundreds of clients deemed incompetent of standing trial and requiring mental health treatment. He's seen an uptick in cases where a client's competency has been in question.

"It can range from violent crimes to a homeless person accused of stealing candy bars," Moore said. "It runs the whole spectrum."

While the wait delays trial, Moore said the process is essential for both the prosecution and defense.

"If it happened on some rare chance (that an incompetent person went to trial), that defendant would get a new trial," he said. "That's why it is so incumbent on both sides to wait, because you don't want to do a trial twice."

Charles said the defense, prosecution or a judge can make a motion for a psychiatric evaluation at any point in the process if the defendant gives unusual answers or it appears he or she doesn't understand the proceedings.

"For many of them, we may get a motion from the defense lawyer even before the defendant has been indicted or formally charged," he said. "Most lawyers do it as soon as they recognize there could be a competency issue."

While he sees an increasing number of cases in which competency is a question, Charles said lawyers and judges have gotten better at recognizing and addressing those problems.

"Competency is an issue we have to address, but for all parties in the criminal justice system, mental health plays more and more of a role," Charles said.

Treatment in action

One recent case in which a defendant completed a treatment plan and returned to Gregg County Jail involves Gary Joe Murphy.

Murphy, 54, of Kilgore was indicted on murder charges more than two years ago. He is charged in the September 2015 stabbing death of Arnold Lee McCollaum Jr. at the American Dream Inn on East Marshall Avenue.

Murphy paid McCollaum, a motel employee, $300 for drugs he did not deliver, according to police. Later, Murphy told police what happened and said he would take them to where he'd discarded the knife he used in exchange for a cigarette.

His first psychiatric report was entered into court records in November 2016, and after issuing subpoenas for several doctors and state hospital records, Charles ruled Murphy was incompetent of standing trial. But Murphy was not transferred out of jail for that treatment until Aug. 23, about nine months later.

After more than three months in Rusk State Hospital, doctors said Murphy's "short-term and long-term memory abilities seemed intact" and he was capable of understanding courtroom proceedings.

"Murphy's account of circumstances surrounding his alleged offense was coherent and reality-based," according to court documents. "Overall, it appeared (Murphy) demonstrates the capacity to engage meaningfully in a reasoned discussion of his legal strategies and options."

Murphy, now on a medication regimen, was returned to Gregg County Jail on Dec. 7. His trial is set to begin Jan. 16.

Continued need

In some cases, 120 days of inpatient psychiatric treatment isn't enough, Charles said. But it is the maximum patients can receive from state facilities at once.

While Murphy's most recent care returned him to competency, court documents show he had been in state mental health hospitals before.

Kyron Rayshawn Templeton, 26, of Longview, charged with capital murder and aggravated assault with a deadly weapon, has twice been ruled incompetent for trial in that case, according to court records. However, he has yet to receive treatment after the rulings in August and October.

Templeton is accused in the November 2013 stabbing deaths of Good Shepherd Medical Center nurse Gail Sandidge, 57, and hospital visitor Harris Teel, 82, as well as injuring three other victims. Templeton, who was at the hospital for his mother's surgery, later told police that "they" were out to kill her.

Charles said there have been cases in which a defendant couldn't be restored to competency within the 120-day treatment window. In rare cases, some were deemed competent but regressed after returning to jail.

"When they get back or aren't on their medication or being in a jail atmosphere, sometimes they would lose competency again," Charles said. "Sometimes we can recommit them while they're still in a state hospital and just extend their period of treatment."

He said that while he would like to see wait times reduced, treatment is in the best interest of the defendants and can make a marked change in their behavior and understanding.

"Oftentimes, all of us can tell a difference (when they get back)," Charles said. "Jail is not the best place for somebody with mental health issues, so we try to get them help in other ways."



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