June 4, 2007

Should jails be designated "treatment facilities"?

When criminal defendants are found incompetent to stand trial, they go to state hospitals for competency restoration treatment. But hospitals around the country have run out of beds, forcing psychotic defendants to linger in county jails for many months.

In response to this crisis, California is proposing to designate county jails as "treatment facilities" that can provide pretrial defendants with competency restoration treatment for up to six months.

Under Senate Bill 568, jails will gain the authority to forcibly medicate incompetent defendants. (This is a complicated area of law governed by the 2002 U.S. Supreme Court case of U.S. v. Sell. For background, see: www.jaapl.org/cgi/reprint/32/1/83.pdf.)

Forensic psychologists are voicing concern about this move.

First of all, jails are unlikely to do much more than administer antipsychotic medications, in some cases without proper legal review and oversight. Jail psychiatric services tend to be minimal and underfunded. They are not set up to provide effective competency restoration training.

A second concern is that the jail environment is not conducive to mental health. Prisoners with severe (and often complex) mental disorders need around-the-clock services from highly trained professionals in a therapeutic setting in order to become competent to stand trial.

The bill, backed by the sheriff’s departments that run county jails, appears to be in response to a recent Sacramento court ruling that incompetent defendants must be transferred quickly to state hospitals for treatment. A competing bill, Assembly Bill 1121, would require that defendants be transferred to state hospitals within 14 days of being found incompetent.

If SB 568 passes, other states with similar crises will likely try this solution as well, foisting their fiscal burdens onto cash-strapped county governments. It’s all part of the trickle-down effect of the criminalization of the mentally ill that began in the 1970s with the defunding of community mental health programs and escalated with the prison boom of the 1980s and 1990s.

Thanks to Robert D. Canning, Ph.D., Paul G. Mattiuzzi, Ph.D., and Philip J. Davis, Ph.D. for their contributions to this analysis.

Senate Bill 568 is available at: http://tinyurl.com/37rl53

Assembly Bill 1121 is available at: