This is the sixth in a series of seven articles about the Travis County Forensic Mental Health Project. This series of articles was named the Best Series of Articles – General Interest by the State Bar of Texas‘ Division III Stars of Texas Bars Awards.
The Travis County Forensic Mental Health Project delivered its recommendations to the Travis County Commissioners in March 2023. The goal of these recommendations is to provide solutions other than jail to address mental health and substance abuse disorders in the county.
Recommendation #5
The Project’s fifth recommendation is for the county to establish a permanent counsel at first appearance program at Central Booking.
“(We) believe it is a fundamental right of every individual to have appropriate legal counsel,” the document says.
The recommendation is based on a 2022 pilot program funded by a $500,000 grant from the Texas A&M Public Policy Research Institute to the Travis County Sheriff’s Office (TCSO). TCSO partnered with the Capital Area Private Defender Service to implement the counsel at first appearance program to ensure counsel was present at first appearance for all people, primarily at magistrate court.
“Anecdotal evidence from both the prosecuting and defense attorneys indicated improved outcomes for individuals when the program was in place, albeit very briefly,” the document says.
The pilot program was shut down after only nine days due to staffing shortages and space limitations at TCSO.
“(Defense attorneys) were able to lower charges from felonies to misdemeanors, obtain bail/bond when an individual would have otherwise been remanded to wait in jail, and ensure safety for domestic violence charges,” the document says.
The funding is still available, the document says, and the Project recommends reinstatement of the one-year pilot program, during which time the county can evaluate how to finance the program in perpetuity.
To address the spacing issue, the Project proposes two solutions: (1) Use $1.5 million approved by the county in January 2023 to renovate a space adjacent to Central Booking, and (2) Develop an alternative facility, such as the diversion center.1
The Project recommends a total of 23 full-time TCSO personnel to support the counsel at first appearance program, in addition to:
- 1 full-time county attorney/administrative assistant;
- 2 full-time district attorneys;
- 7.5 full-time employees from the Travis County Public Defender’s Office;
- 2 full-time employees from the Capital Area Private Defender Service; and
- An undetermined number of employees from the Mental Health Public Defender’s Office.
“The county is already working with the sheriff’s office to identify ways to improve recruiting and retention (of TCSO personnel),” the document says.
The total annual operating cost for the counsel at first appearance program would be about $4 million, the document says.
Other Gaps and Preliminary Solutions
In addition to the five big recommendations, the Project also cites several other “gaps” and offers recommendations on how to address them.
One is “insufficient acute inpatient care for individuals.”
Most of the individuals who are arrested as a result of a mental health crisis do not have medical insurance, the document says. That means they can’t get treatment at private psychiatric facilities and are sent instead to state hospitals, which are severely understaffed and were so even before COVID-19.
Additionally, private psychiatric facilities, such as Austin Oaks, have closed, and emergency bed units, such as 16 at Brackenridge, have been removed. Currently there are only about five psychiatric emergency beds in the Dell Seton Medical Center’s emergency department, the document says.
“Many people who are indigent with a mental health disorder end up being detained by police for their behavior and ultimately land in jail awaiting alternatives,” the document says. “With alternative facilities in the community other than jail or the emergency department, arrests could often be avoided altogether.”
The Project recommends that Travis County partner with available psychiatric facilities to eliminate arrests and lengthy emergency stays.
Another gap identified is “insufficient outpatient services of all types.”
“With explosive growth, it is difficult to maintain community-based services at scale,” the document says. “Improving and expanding existing community-based outpatient services is necessary to prevent mental health disorder crises, provide needed services to the community, and assist in preventing recidivism by ensuring individuals released from jail can continue with their treatment.”
To address this gap, the Project recommends expanding Integral Care’s Expanded Mobile Crisis Outreach Team (EMCOT)’s full-time staff from 47 to 88.5, at a cost of $10.5 million annually.
“This would support Austin-Travis County EMS and APD, as well as calls fielded from other partners such as Travis County Sheriff’s Office, Pflugerville Police Department, and The University of Texas Police Department,” the document says.
Another gap identified is an “unwieldy competency restoration process.”
In 2022, the Mental Health Public Defender’s Office represented 180 individuals seeking competency restoration. Of those cases, none were successfully referred to a state hospital due to the current barriers to admission.
In such cases, the individuals remain in jail while solutions are sought, leading to weeks or months of detainment, the document says.
“Alternatives to referrals to the state hospitals require more outpatient or other types of and locations for competency restoration,” the document says. “Additionally, some individuals may be able to be processed through dismissing charges in concert with treatment to manage the behaviors that led to incarceration.”
The project recommends the county implement a program similar to the Miami-Dade Forensic Alternative Center, a 90- to 120-day program for second- and third-degree felonies focusing on community reintegration while providing competency restoration services.
“If an individual is referred and approved for this program, their charges are dismissed, and they are released back into the community upon effective treatment,” the document says.
The program has “largely eliminated competency restoration for misdemeanors through charge dismissal and clinical support.” It has also led to 68 percent fewer bookings and 94 percent fewer jail days for participants as opposed to nonparticipants.2
The final gap noted by the Project is a lack of alternatives to jail or competency restoration programs for individuals with more complex disorders, such as intellectual/developmental disorders, traumatic brain injuries, dementia, and Alzheimer’s.
The Project makes a distinction between these individuals, which “are relatively uncommon in the total service demand,” and those who have “mental health conditions—specifically substance use,” though brain-health conditions and mental-health conditions can be co-occurring.
These types of co-occurrent individuals’ needs are further complicated by criminal charges or histories, the document says, and alternatives to languishing in jail or participation in competency restoration programs, “though their condition may preclude them from ever regaining competency status,” are few.
One example of this gap is the SMART program, which only offers substance-abuse treatment.
“The SMART program does not accept individuals with
I/DD as they are unlikely to remain compliant with the program,” the document says. “Consequently, alternatives are needed.”
ENDNOTES
1 See “Decriminalizing Mental Health in Travis 2 County: Part 4,” Austin Lawyer Nov. 2023
2 https://utexas.app.box.com/s/6ytzxonrf75ahknn9r3owq82p8m0mh30