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Oklahoma is trying to treat people with severe mental illness in jail, but many still languish in cells waiting for hospital beds

Tulsa Jail
KWGS News-File photo
Tulsa Jail

Tulsa County Sheriff Vic Regalado has ordered the end of a program to treat people with severe mental illness at the David L. Moss Criminal Justice Center. County officials say the jail can’t handle the needs of people so mentally ill they don’t understand their criminal charges. But a state hospital still has a months-long backlog of people waiting for admission.

At the Tulsa County jail, some of the sickest are held in a segregated unit, locked down for 23 hours a day because of the risk of violence and other security issues.

The prisoners have been found incompetent to stand trial because mental illness has left them unable to understand the legal process or help an attorney attorney with their defense. Such cases have typically been treated at the Oklahoma Forensic Center, a 216-bed facility in Vinita, where patients receive medications, talk therapy and education on how the court system works. The state’s new jail-based competency program provides medication, but some other therapeutic services are only available at the hospital in Vinita, according to court testimony in the case of one Tulsa County defendant.

When the Oklahoma Department of Mental Health and Substance Abuse Services launched the program to treat criminal defendants with severe mental illness in county jails in December 2022, more than 200 peoplewere on a waitlist for a bed at the Oklahoma Forensic Center — some waited a year or more. Weeks earlier, the U.S. Department of Justice announced it had launched an investigation into Oklahoma’s mental health system.

There were also rumblings of a federal lawsuit that would be filed a few months later, accusing the state of violating the constitutional rights of mentally ill Oklahomans who languish in county jails waiting for a hospital bed. The lawsuit is still pending.

After starting the new jail program, the Department of Mental Health has claimed it no longer has a waitlist for treatment at the state hospital in Vinita because it now offers services in county jails, said Lora Howard, interim chief public defender for Tulsa County.

“They started this jail restoration thing solely so they could say ‘we don’t have a waitlist’ because they were getting a lot of heat for having people that were a number 120-something and number 130-something on a waitlist for a bed,” Howard said. “They don’t have adequate beds to do the treatment that’s needed. But the way around that isn’t to just not do the treatment.”

The Tulsa County Public Defender’s Office still has dozens of clients waiting for a hospital bed because they haven’t been able to regain competence in jail and need more intensive help. The office estimates it has typically had between 30 and 45 clients waiting in jail to go to Vinita since the program started.

“Sheriff Regalado and the professionals who provide medical care to inmates at his jail believe that these people should be in the state hospital, not in a county jail. They have not been convicted of any crime. They are simply awaiting trial,” the Tulsa County District Attorney’s Office said in a written statement on Regalado’s behalf. “A hospital offers them greater freedom of movement, a staff of medical professionals committed to providing treatment rather than mere detention, and more access to programs such as group and individual psychotherapy.”

Tulsa County District Attorney Steve Kunzweiler told The Frontier that the sheriff had previously declined to enter into a written agreement with the Department of Mental Health to do competency treatment at the jail.

“The sheriff — like I — has long believed that nobody who’s been adjudicated incompetent needs to be in a jail facility, and they need to be in a therapeutic setting,” Kunzweiler said.

The Department of Mental Health already operated a pilot competency program in about 60 county facilities across the state in May when the Oklahoma Legislature passed a bill that would have made jail treatment mandatory. But Gov. Kevin Stitt vetoed the legislation, saying many jails weren’t equipped to treat people found incompetent to stand trial.

In response to The Frontier’s questions, Bonnie Campo, a spokesperson for the Department of Mental Health, said that some defendants have been successfully treated and regained competency in jail. Antipsychotic medication is the most common form of treatment to restore a person’s competency, she said.

“Stabilizing the person’s mental illness generally needs to occur before other services can be effective,” Campo said. Providing medication immediately is “better than no treatment or inadequate treatment,” she said.

“This can help stabilize the person’s mental illness, which in many cases is the sole reason for the person being incompetent,” she said.

The Department of Mental Health has asked Tulsa County officials to allow jail competency treatment to continue.

“Allowing them to continue this treatment reduces their mental health symptoms as well as their level of dangerous to self or others and is a much better alternative than having them wait for a bed at the Oklahoma Forensic Center,” Campo said. “More importantly, immediately ceasing treatment for those that they are currently serving could result in potentially significant harm. “

The state has a contract with the provider Family & Children’s Services to run the program in Tulsa County.

A spokesperson for Family & Children’s Services said in an email that the provider is working with the jail administration to “ensure that inmates who have been receiving competency restoration services are provided the necessary psychiatric medications to maintain continuity of patient care” after the program was abruptly halted.

Under Family & Children’s contract with the state, the provider is required to see people in the jail program at least twice a month in person and ensure they are prescribed appropriate medication. The prisoners are required to be monitored for suicidal and homicidal thoughts and to ensure they are taking their medication. Once stabilized, the prisoners are required to receive “education and skills training” to help them understand the legal system.

Dr. Jason Beaman, interim chair of the school of Forensic Sciences and former chair psychiatry and behavioral sciences at the Oklahoma State University Center for Health Sciences, said twice-monthly, in-person visits are inadequate. And telehealth visits can be “very poor” and problematic in a jail setting, he said.

“These are the sickest mentally ill people and if they weren’t in jail, they’d be in a hospital and we would see them every day,” Beaman said. “What about the individuals that cannot — won’t come out of their jail cells — or they’re too dangerous, and the deputies won’t take them out of their jail cell, then they get zero treatment.”

Some people are also receiving competency restoration treatment out of jail.

M.J. Denman, a private Tulsa defense attorney, said he has a client, who he declined to name, who is getting competency restoration treatment on an outpatient basis in Tulsa County through Family & Children’s Services. The client receives medication while out on bond at home but gets no talk therapy or other services, he said. The client gives his word that he’s taking his medication, but nobody checks, he said.

“This is a band-aid and not even a band-aid that covers the whole wound,” Denman said.

Some people waiting in jail for a hospital bed deteriorate further and are held in isolation in a segregated unit for the safety of themselves and others, Howard said. The Tulsa County Public Defender’s Office has resorted to filing motions for hearings to hold the Oklahoma Department of Mental Health and Substance Abuse Services in contempt of court for failing to treat clients who have waited months or longer for admission to the forensic hospital.

After a motion is filed, the Department of Mental Health gives the client priority for a bed at Vinita and they are transferred out of the jail before a hearing can take place, Howard said.

Facing multiple charges, including sexual battery and obstructing an officer, DeAndre Prince waited more than 17 months in the Tulsa County jail for a hospital bed after he was found incompetent to stand trial in January 2022. Federal courts have previously ruled in a case involving the state of Washington that criminal defendants have a constitutional right to treatment within a week after being found incompetent to stand trial.

In jail, Prince racked up additional charges, including assault and battery upon a detention officer and placing bodily fluids on a government employee.

Prince was held in a segregated unit, in lockdown for much of his time in jail because of violent, disruptive behavior, according to a transcript of a court hearing.

Prince’s public defender filed a motion in May for a hearing to hold the Department of Mental Health in contempt for failing to comply with a court order to treat him at the forensic hospital. In response, the agency argued in court documents that it operated on a “very tight budget,” and that Prince was already receiving treatment at the jail.

A 2022 reportby the state Legislative Office of Fiscal Transparency found that while Oklahoma appropriations for mental health have increased by 9% since 2013, funding had actually decreased by 11% percent during that period when adjusted for inflation. Meanwhile, the state has seen a 652% increase in people waiting for treatment at the Oklahoma Forensic Center in Vinita over the last five years, from 23 people in January 2017 to 173 people in April 2022.

In Prince’s case, a partial contempt of court hearing did take place on May 30. A public defender said the hearing was the first time Prince had been out of his segregated jail unit in months.

A forensic hospital leader testified at the hearing that treatment available in the jail-based program is limited and that Prince had received medication but not other therapeutic services that are typically part of the competency restoration process.

The hospital leader also testified that defendants are prioritized for a bed at Vinita after defense attorneys file a motion for a hearing to hold the Department of Mental Health in contempt for failing to treat the person at the state hospital.

The Department of Mental Health transported Prince to Vinita for treatment six days after the hearing, before additional court testimony could take place.

The Frontier is a nonprofit newsroom that produces fearless journalism with impact in Oklahoma. Read more at www.readfrontier.org.
The Frontier is a nonprofit newsroom that produces fearless journalism with impact in Oklahoma. Read more at www.readfrontier.org.