Lack of mental health services is spurring a ‘capacity crisis’ in NC jails

Across North Carolina, more than 200 people with serious mental illnesses are waiting in jail for a bed in a state psychiatric hospital before their criminal cases can proceed.

“Many people do sit months and months, over a year, not getting the treatment that they need,” said Dr. Robert Cochrane, the statewide director of the Forensic Services Division of State-Operated Healthcare Facilities at the Department of Health and Human Services. “And the jails… just don’t have the resources. You know, they’re not hospitals, they’re not clinics.”

Cochrane was a panelist on a virtual discussion Wednesday afternoon about the ways the criminal justice and mental health care systems fail those with serious mental illnesses who wind up in jail. Much of the conversation was based on reporting for an 11-part series by Charlotte’s WFAE, including a documentary titled Fractured, about the long waits endured by those deemed unable to stand trial before they can receive mental health treatment.

“We refer to it as the ‘competency crisis’ or the ‘capacity crisis,'” said Dr. Debra Pinals, a professor at Michigan Law School and the University of Michigan Medical School, during the panel discussion. “And everywhere, pretty much, in the country, there are challenges with people with mental illness sitting in jails.”

The discussion, hosted by the Wilson Center for Science and Justice at Duke Law and Frontline PBS, examined how the state and nation got to this point. Pinals said the reasoning was complex: judges are ordering more evaluations for those with mental health conditions, likely because of a greater understanding than in years past; the mental health system has been significantly underfunded for years; and there is a broader agreement — and a legal framework, through the Americans with Disabilities Act — that people with disabilities have the right to live full and inclusive lives in community-based settings.

“We didn’t get here overnight, and the solutions are complex,” said Pinals.

WFAE’s reporting revealed that over half of those in North Carolina jail who were found incapable of standing trial wait longer than 300 days before they get a bed. But that just accounts for the time between when a person is deemed incapable to proceed and when they get into the state hospital, said Dana Ervin, the lead reporter on the project. That does not account for the time it takes for jails to transport incarcerated people to get evaluated, sometimes multiple times, and then transport them back to court so a judge can decide if they are capable of proceeding.

“It takes about twice as long as we think for them to get a bed, because they’re trying to spend all that time trying to get evaluations,” said Ervin.

All that waiting can have a serious negative impact on those in jail, said Chief Deputy Durwin Briscoe, from the Cleveland County Sheriff’s Office, another panelist.

“Their mental status is depleting, even more than when they first came into the facility,” Briscoe said.

And that, in turn, can impact jail staff, Briscoe said, as their deteriorating mental state can make them lash out and put employees in danger.

“They’re in our facility, and we’re responsible for the safety and care of those individuals,” Briscoe said. “We don’t have the opportunity to turn them away.”

Those waiting for a bed have not been convicted of a crime. Their criminal charges are pending. Pinals said national data show that it is common for charges to be dismissed after a person’s mental capacity is restored.

“The time and restoration in a jail counts as ‘time served,'” she said. “So, by the time they wait a year, two years, and then have a restoration period even in the hospital, which also counts as ‘time served,’ they’ve been incarcerated or detained for a long period of time. And so very often it makes it more likely for charges to be dismissed.”

Cochrane said DHHS is pursuing several solutions to deal with the crisis, including:

• seeking changes in state law during the upcoming legislative session that could reduce wait times,
• trying to restore people’s capacity in community facilities and jails, so they don’t have to wait for a state hospital bed to become available,
• investing in diversion and prison reentry programs throughout the state, and
• trying to increase recruitment and retention at state hospitals, which are struggling with staff vacancy rates of as high as 32% and turnover rates that are even higher.

“The state hospitals don’t have to be the only game in town,” said Cochrane.

Click here to watch the documentary, Fractured.