Greene County’s jail is set to become one of five in the state to offer mental health treatment to inmates who need to be restored to competency before standing trial, part of an attempt by the state to address the need for services quickly and efficiently.

When suspects arrive at jail and await trial, they may be ordered by the court to be evaluated for mental health competency. Those deemed to be incompetent to stand trial often are ordered to receive competency restoration treatment. Previously, the only option for this treatment was to go to a state hospital to receive inpatient mental health treatment. With a recent surge in people who were determined to need the services in order to proceed with their criminal cases, the limited number of available beds left many waiting in jail for months.

As of Sept. 28, there were 35 inmates at the Greene County Jail awaiting an inpatient bed to receive competency restoration services. Statewide, there were 253 individuals awaiting admission into state hospitals and 57 waiting to be added to that list as of Sept. 14. At the same time, there were 267 evaluations requested, with about 50% estimated to be found incompetent, according to a presentation to the state’s Mental Health Commission.

This summer, the Missouri legislature amended statute to allow mental health restoration services to be provided within county jails and out in the community. With the new law, the state allocated $2.5 million to establish jail-based restoration programs across five counties, including Greene.

Jeanette Simmons is the deputy director for the Missouri Division of Behavioral Health. She said the program was based on similar programs in other states that have faced the same problem.

“We have more individuals needing competency restoration services than we have inpatient hospital beds,” Simmons said. “This is not just a Missouri issue; this is a nationwide phenomenon.”

The program aims to solve this by easing the demand for inpatient beds while cutting down wait times for people to get treatment.

Sheriff’s office questions use of resources but state says moving ahead

Although state authorities said work to implement the program in Greene County is moving ahead, the sheriff’s office expressed doubts.

Deputy Paige Rippee, public information officer for the Greene County Sheriff’s Office and the jail, said that while many inmates have been waiting for treatment for several months, the program would not be the most efficient use of the jail’s resources.

Rippee said in order to create space for treatment, the jail would have to shut down one to two units. The inmates who would be housed there for treatment would not fill the units to full capacity, she said, which would mean the space is not used in the most cost-effective or efficient way.

“It is something we have looked into, but it’s just not in the cards for us,” she said of the jail-based model.

Debra Walker, spokesperson for the Missouri Department of Mental Health, reiterated however that the state is still moving forward with implementing the program in Greene County and currently working out the details of the contract.

Ironing out the details

The program will operate using the state’s Forensic Mobile Teams, which include nurses, nurse practitioners and social workers. Two staff members from a local community mental health center also will be hired to work at the jail.

The two existing Forensic Mobile Teams were expanded with state funding in the most recent budget. One of these teams was established a couple of years ago. Currently, the teams are serving those needing restoration services in jails across the state regardless of county while they await inpatient treatment.

The jail-based program will also be implemented in Clay County, the City of St. Louis, St. Louis County and Jackson County. Simmons said other counties have already requested to be included if the program expands, though currently the services are limited. She said the counties were selected based on the volume of referrals that come from each jail — no surprise considering that these are the most populated areas of the state.

While an option, the jail-based model will not become the default.

“We don’t anticipate that it will be the answer for every client, but I think individually we can look at it and make those types of assessments and ensure that people are receiving those treatment services while they’re there,” Simmons said. “That’s the intent they would receive the same types of treatment services they would receive in an inpatient setting.”

Stephanie Appleby, the executive director of NAMI Southwest Missouri, said she is grateful the department is putting time, energy and effort into providing more resources, which previously have been very limited.

“I think it’s fabulous and long overdue,” she said of the program. “I hope it works.”

Appleby said she hopes this program and any future efforts can establish a more continuous network of care providers. Creating a playbook on an individual’s care that both law enforcement agencies and mental health professionals can reference to determine best ways to support those needing care is a way to ensure a more sustainable approach to address mental health in the community, she said.

Other treatment options

Outpatient treatment will also be an option for some in need of competency restoration treatment. Simmons said this program would allow people to receive the needed services at their local community mental health centers. Providing this as an option would be a court decision for those demonstrating that they would be successful while free on bond, she said. Individuals held on dangerous felony charges are not eligible.

Rippee, with the sheriff’s office, said there are concerns about this model of service as well. In order for those out on bond to get to these services, they might have to rely on someone else for transportation, along with other potential obstacles.

“Homelessness often goes hand in hand with mental health issues,” she said.

Those who do not have the resources to actually get to their outpatient competency restoration treatment provider or keep on top of their medication may not fully benefit from the program, she said.

More: In the year since 988 went live, here’s what a Springfield mental health provider has seen

Appleby also has concerns about the outpatient portion of the effort. She said inpatient care is generally always a better option, since in order for patients to be successful in outpatient, they “have to really want to live a self-directed life.” Many who find themselves within the criminal justice system are not at that point in their recovery, she said.

But Simmons said the department hopes to work on more ways to connect individuals with treatment before they are within the criminal justice system. Increasing awareness and education of current resources like the 988 suicide and crisis hotline and local behavioral health programs is a large part of this.

“We’ve got to look at getting more upstream to try and help individuals engage in treatment services,” she said.

Marta Mieze covers local government at the News-Leader. Contact her with tips and story ideas at mmieze@news-leader.com.

This article originally appeared on Springfield News-Leader: Missouri plans new mental health restoration program at county jails

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Seven years after voters approved a greater investment in mental health and substance abuse services for Oklahoma counties, the money finally is on the way.

But advocates for criminal justice reform warn that wide swaths of the state are at a disadvantage, unable to provide proper mental health and substance abuse treatment.

For instance, jail officials in Woods County, Custer County and Noble County said they have no partnerships with nonprofit organizations and do not provide any formal mental health treatments.

“You have a problem that is systematic, and that’s kind of decades in the making,” said Damion Shade, a public policy analyst and executive director of Oklahomans for Criminal Justice Reform. “Your access to justice shouldn’t depend on what ZIP code you live in.”

In May, the state Legislature approved the transfer of $12.7 million into the County Community Investment Fund, set up by the passage of State Question 781 to help cover the costs of treatment in all 77 counties.

Even with the additional money, jails are ill-equipped to provide treatment, said Judge Ken Stoner, who presides over Oklahoma County drug court cases.

Tulsa County Sheriff Vic Regalado refused to sign an agreement with the state mental health department, which proposed leaving people who were found incompetent to stand trial in jail while they receive treatment. Regalado insisted people whose illness is that severe should be treated in a hospital, not an ill-equipped jail.

The mental health department instead signed an agreement with a Tulsa nonprofit to offer the services inside the jail without Regalado’s knowledge. Last month, the Tulsa district attorney sent a cease-and-desist letter to the nonprofit after Regalado found out about the unapproved services being provided in his jail.

Such cases typically are treated at the state’s 216-bed Oklahoma Forensic Center in Vinita, which has been burdened for years by a waiting list. And a dozen rural hospitals, including their psychological treatment services, have closed since 2007, according to state data.

Mental illness widespread in lockups

Nearly 70% of female offenders and 48% of male offenders in Oklahoma jails were diagnosed with a mental illness, according to 2015 state report. To help resolve the issue, voters approved State Question 781 to increase mental health and drug addiction treatments in jails in 2016. The law requires savings from State Question 780, which reduced the number of people in jails by lowering certain drug and property crimes to misdemeanors, to go into a mental health fund available to every county.

Local justice systems can use the money to add staff or provide employment training and assistance. They can bolster existing mental health and addiction diversion programs, such as Smart on Crime.

“We know that when we invest in mental health or substance use or job training, that it decreases crime,” said David Gateley, a criminal justice analyst at Oklahoma Policy Institute.

Felony filings decreased by 30% the first year after State Question 780 took effect, according to an Oklahoma Policy Institute analysis of court records. Gateley pointed to estimates provided by a group that includes the state’s Legislative Office for Fiscal Transparency, which show savings could reach $20 million by next year.

Although rural counties will find ways to use the extra money, they may never be able to catch up to urban areas, which have better proximity to nonprofits, Gateley said.

Large jails and prisons can rely on outside organizations such as Diversion Hub and The Education and Employment Ministry to provide treatment and transportation services to incarcerated individuals, but many of those nonprofits only operate in the metro area.

In Cleveland County, commissioners increased the jail’s budget this year to pay for a licensed counselor to work at the detention center five days per week.

But in many cases, the only mental health resource for rural jails is through a partnership with Oklahoma City-based Red Rock Behavioral Health Services, which has 13 state offices. Yet, limited staff and beds can present barriers to access. Ariel Joseph, a spokesperson at Red Rock Behavioral Health Services, said the providers find ways to cater to rural areas and limit their barriers, such as meeting virtually with clients.

But nonprofits can go the extra mile by developing individualized health and career plans for their metro-area clients, Joseph said.

A template in Michigan?

The same year Oklahoma voters approved State Question 781, Michigan funded pilot programs in eight counties aimed at applying psychotherapy, and expanded to 10 counties in 2017.

Analysts at the Center for Behavioral Health and Justice at the Wayne State University School of Social Work then compared the treatment-based pilot programs to traditional jails. The center documented how alternative services, such as treating detainees with therapy and medication, affected individual outcomes, said Lynn Sutfin, a Michigan Department of Health and Human Services spokesperson.

People who received those jail-based diversion services were 64% more likely to engage in treatment after release compared to those who did not receive jail-based diversion services.

“The consensus is the more you can connect people to community services, even while they’re incarcerated, the more likely they are to follow up,” Sutfin said.

After five years of data-collecting and research, the center determined the best practices for counties, which included expanding services for police training and substance abuse treatments.

Rahni Cason, jail diversion manager at the Center for Behavioral Health and Justice, said the biggest obstacle is establishing uniformity in Michigan’s justice system. Similar to Oklahoma, rural counties do not always have access to medication or other resources.

Cason said the organization partners rural counties with high-performing counties and provides extra funding when available to reduce the disparities. The center and council garner funds from the state and other third-party organizations.

Cason and Sutfin said statewide efforts are underway and said the extensive research has aided their progress. For states considering jail diversion approaches, Sutfins recommended identifying the problems first.

“I would do a landscape analysis of what’s going on in the state and not dive in with solutions before you understand what is actually already happening,” Sutfins said.

‘We now need to hold our legislators accountable’

Once the money is transferred to the fund, counties will have to request funding through the Oklahoma Department of Mental Health and Substance Abuse Services, similar to a grant system.

In Logan County, where they will receive approximately $161,491 for mental health and substance abuse initiatives, Sheriff Damon Devereaux said he would like to partner with the county’s health care provider, Turn Key Health Clinic, and invest in a mental health module. The program would either provide more mental health providers to jails or set up more beds for outpatient care.

Either way, Logan County inmates need a consistent mental health regimen, Devereaux said.

Devereaux said the county already spends about $250,000 on rehabilitation services, and the mental health module costs about $1,500 per month for four more hours of care a week.

Devereaux said he was excited about the passage of State Question 781 but remains uncertain about its effect because of the seven-year delay.

“We now need to hold our legislators accountable for what people voted for, and put the money where the mouth is,” Devereaux said.

Kay Thompson, chief of communications at the Oklahoma Department of Corrections, said the department has not discussed plans or recommendations for spending 781 money, but said there is a need for more staff.

Shade said all the programs can be built.

“There’s a hopeful story here that I hope remains at the center of this,” Shade said. “It’s going to be a transformative, transformational change for Oklahoma.”

Oklahoma Watch, at oklahomawatch.org, is a nonprofit, nonpartisan news organization that covers public-policy issues facing the state.

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The water fountain in Georgia Kay Baldwin’s jail cell was only inches from her bunk, but authorities suspect she died of dehydration.

Baldwin was in Tarrant County Jail custody, accused of leaving threatening voicemails for an Arlington police officer. When she died, she was living in a single cell at the Lon Evans Corrections Center, a red brick building that takes up a full city block in downtown Fort Worth.

Mental health practitioners who checked on Baldwin found her delusional, according to jail records obtained by KERA. She kept asking for a bus ticket to Arizona and insisted the government was out to kill her.

Baldwin’s mental illness was so severe that, on July 27, 2021, a judge ordered her transfer from jail to a state psychiatric hospital.

County jails in Texas make up the state’s biggest mental health system. Even when an inmate gets ordered to a state psychiatric hospital, the waitlist is thousands of people long, and it can take months or years to get a bed.

Baldwin would never make it to one. On Sept. 14, 2021, staff found Baldwin unresponsive in her cell. A doctor at John Peter Smith Hospital declared her dead an hour later.

Baldwin’s autopsy determined she died of severe hypernatremia, an imbalance of sodium that usually results from dehydration.

Georgia Kay Baldwin, pictured in this undated photo, died in Tarrant County jail custody in 2021. Her sons are suing the county over her death.

The long wait at state psychiatric hospitals leaves people like Baldwin stuck in legal limbo and in jail, where their mental health is likely to spiral, and their lives are in danger, advocates say.

“What is happening in Tarrant County and so many other jails across Texas, is people are being punished for having mental illness,” said Dean Malone, an attorney suing over Baldwin’s death.

Series of voicemails leads to arrest

Baldwin came to law enforcement’s attention in September 2020 because she called them.

That’s according to Arlington police, who accused Baldwin of leaving a series of threatening voicemails for then-Arlington police lieutenant Christopher Cook.

The voicemails, transcribed in Baldwin’s arrest warrant affidavit, urged police to make an arrest in the unsolved case of Amber Hagerman, an Arlington girl whose abduction and murder in 1996 led to the creation of the Amber Alert system.

“I want you dead like no other. Give me a gun… I just want to beat the [expletive] out of you. I want to pull your [expletive] hair out so bad. The governor of Mississippi needs to blow you away,” she said, according to police.

Detective R. Munoz investigated the calls.

“Lt. Cook felt that if she knew his personal home address or encountered him on the street and had the means to do violence, she would enact it towards him,” Munoz wrote.

Cook, who is now the police chief of White Settlement, declined an interview request for this story.

During his investigation, Munoz learned of Baldwin’s long history of mental illness. He talked to one of Baldwin’s sons, Joshua Mattix, who told Munoz that his mom had schizophrenia and was mentally unstable.

For the voicemails, Baldwin was charged with terroristic threat against a peace officer, a felony. She was booked into the Tarrant County Jail in April 2021.

Georgia Kay Baldwin was held in a single cell at the Lon Evans Corrections Center on West Weatherford Street in downtown Fort Worth.

She would die one year and five days after the last voicemail.

In June, Baldwin’s sons sued Tarrant County over their mother’s “tragic, completely unnecessary death.” Jail staff were negligent in caring for a woman whose severe mental illness was obvious from the voicemails alone, the lawsuit argues.

Dean Malone is the attorney representing Baldwin’s sons. He spoke to KERA about the lawsuit, as he advises his clients not to talk to the media.

Baldwin needed mental health treatment, not punishment, Malone said.

“What are they going to do, put her on trial for something that she had no clue of right from wrong when she did it?” he said.

The Tarrant County Sheriff’s Office, the agency in charge of the jail, declined a request for an interview for this story, citing the lawsuit.

The sheriff’s office also did not respond to questions unrelated to Baldwin’s case, like how many people in the jail have documented mental health issues.

Almost 40% of Tarrant County inmates “have consistently been identified with a mental health need,” according to the county’s proposed budget for the next fiscal year.

If authorities insist on arresting people with serious mental health concerns, they need to care for them, Malone said.

“I think that a jail has an obligation to assure that severely mentally ill people are eating and drinking,” he said.

A national problem demanding attention

A 2017 report from the federal Bureau of Justice Statistics found that 44% of jail inmates across the country had previously been diagnosed with a mental disorder.

As Baldwin’s case moved through the courts, it became clear she was too mentally ill to understand the charges against her.

Georgia Kay Baldwin, pictured in this undated photo, had a long history of mental illness before she was booked into the Tarrant County Jail.

On June 18, 2021, the court declared Baldwin incompetent to stand trial and ordered her into a treatment process called competency restoration.

The goal of competency restoration is not long-term recovery, according to the Texas Judicial Commission on Mental Health. People’s cases get put on pause until they’re stabilized enough to participate in their own defense.

Competency restoration usually has to happen at one of Texas’ state psychiatric hospitals, but the supply of beds has not kept up with demand. There’s been a 38% increase in the number of people declared incompetent to stand trial in the past 20 years, according to a state report from 2021. Hospitals lose even more capacity to understaffing, and as of June, the waitlist for a bed was more than 2,300 people long.

People can end up waiting for years, in jail, with no movement in their cases.

“I believe it’s a civil rights issue,” State Sen. Lois Kolkhorst, R-Brenham, said in April. “You shouldn’t be waiting in jail to have mental competency restored to wait to go to trial.”

MHMR CEO Susan Garnett explained what can happen to someone’s case during and after the competency restoration process.

• Sometimes, competency restoration doesn’t work, which means the charges get dropped.
• Others wait for competency restoration longer than their maximum potential sentence, so they can be released.
• After release, people with nowhere else to go can try to get one of the limited number of beds at a residential home. Others end up homeless.
• It’s not uncommon for people to go back out into the community, get picked up on other criminal charges and start the process all over again.

The court originally ordered Baldwin to try jail-based competency restoration – an alternative to the waitlist that offers treatment in jail instead of the hospital. But the program requires willing participation, and Baldwin wouldn’t participate. She declined to work with therapists throughout her time in jail, practitioners’ notes show.

Jail-based competency restoration isn’t right for everyone, but it provides another option alongside state hospitals, said Susan Garnett, CEO of My Health My Resources (MHMR), Tarrant County’s mental health authority.

“We think with those two resources together, we’ll be able to do a better job of meeting people’s needs and be able to get them in the program that’s right for them,” Garnett said.

But not everyone sees jail-based competency restoration programs as a worthwhile solution. Jails are “just the worst place for people to be,” said Beth Mitchell, an attorney with Disability Rights Texas.

“Even if the jail does provide some mental health care, the environment is not suitable or conducive to helping somebody who has a mental illness,” she said.

In fact, she said, jail makes people’s mental illness worse.

“They need constant interaction, not just sitting in a solitary cell where all they’re doing is hearing, potentially, the voices in their head,” Mitchell said.

State lawmakers approved billions of dollars in spending on the mental health system this year, funding revamps and rebuilds of state psychiatric hospitals and adding new beds.

Focusing on mental health treatment after arrest is funding the wrong end of the problem, said Krish Gundu, cofounder of the advocacy group the Texas Jail Project.

“If people got the right care, at the right time, at the right place, we would not be seeing this mental health crisis in the jails,” she said.

Baldwin’s death

After 39 days in the jail-based competency restoration program, the court ordered Baldwin to be transferred to the first available state psychiatric hospital “without unnecessary delay.”

The order came down on July 27, 2021, but Baldwin would stay in jail until her death that September, where she remained disconnected from reality.

“When greeted, patient immediately starts talking about ‘conspiracies,’ being taken hostage, and being extradited to a foreign country,” therapist Leandrea S. Williams wrote about a visit dated July 30, 2021.

Texas Commission on Jail Standards

Photos of the cell where jail staff tried to revive Georgia Kay Baldwin the morning she died, September 14, 2021.

On Sept. 14, the day Baldwin died, Williams found her on the floor of her filthy cell, which was covered in shreds of toilet paper, jail records show. Baldwin lay on the floor with her pants around her ankles, and she seemed shaky, like she’d been crying.

Williams tried to talk to her.

“I’m fine, I’m fine,” Baldwin said, and then refused to speak again.

Williams told a jailer that Baldwin didn’t seem like herself. The jailer said she’d check in with medical.

Baldwin was dead a few hours later. It’s unclear if medical staff ever checked on Baldwin that morning. The Sheriff’s Office declined to answer questions about her death, citing the lawsuit.

Texas Ranger Travis Dendy, who investigated Baldwin’s death, closed the case without criminal charges.

Although the Medical Examiner’s Office left the cause of Baldwin’s hypernatremia undetermined, the condition is common in people with “impaired mental judgment,” Dendy wrote in his investigation report. He pointed out there was a water fountain in her cell.

‘Disease, violence and death’

The state doesn’t track how many people die in jail while waiting for a psychiatric hospital bed, Texas Jail Project cofounder Krish Gundu said.

Baldwin is not the only person to die while waiting for a state psychiatric bed. Austin NBC affiliate KXAN identified a dozen people who died in jail custody after being declared incompetent.

In February 2023, a Tarrant County inmate named George William Zink died in jail custody while undergoing jail-based competency restoration, court records show. His cause of death is unknown, pending autopsy, according to the Texas Attorney General’s Office.

People with mental illnesses are the least able to advocate for themselves, putting them in the most danger in jail, Gundu said. She’s pushing the state to prevent people with mental illnesses from going to jail in the first place.

“We already know that jails are engines of disease, violence and death,” she said.

Tarrant County has taken some steps to alleviate the problem – like opening a Mental Health Diversion Center in 2022.

If police officers pick someone up for a misdemeanor like trespassing, marijuana possession or terroristic threat, they can bring them to the center for treatment and help finding housing. Most of the people brought in are homeless, according to MHMR, which runs the center.

If Baldwin had been arrested today, she still would not have been eligible for the diversion program. She was charged not with terroristic threat, but terroristic threat against a peace officer. Threatening a cop bumps the charge from a misdemeanor to a felony.

District attorneys and judges need to be part of the solution, too, Beth Mitchell with Disability Rights Texas said.

“If you have DAs that are not willing to drop charges, when you get these dumb charges like terroristic threat or trespass or any of the others, it doesn’t work,” she said.

Gundu called Baldwin’s case heartbreaking. In a different world, she might have gotten treatment instead of an arrest.

“Some prosecutor in the DA’s office made the decision to charge,” Gundu said. “And that’s where it begins.”

Got a tip? Email Miranda Suarez at msuarez@kera.org. You can follow Miranda on Twitter @MirandaRSuarez.

KERA News is made possible through the generosity of our members. If you find this reporting valuable, consider making a tax-deductible gift today. Thank you.

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Seven years after voters approved a greater investment in mental health and substance abuse services for Oklahoma counties, the money finally is on the way.

But advocates for criminal justice reform warn that wide swaths of the state are at a disadvantage, unable to provide proper mental health and substance abuse treatment.

For instance, jail officials in Woods County, Custer County, and Noble County said they have no partnerships with nonprofit organizations and do not provide any formal mental health treatments.

“You have a problem that is systematic, and that’s kind of decades in the making,” said Damion Shade, a public policy analyst and executive director of Oklahomans for Criminal Justice Reform. “Your access to justice shouldn’t depend on what ZIP code you live in.”

In May, the state Legislature approved the transfer of $12.7 million into the County Community Investment Fund, set up by the passage of State Question 781 to help cover the costs of treatment in all 77 counties.

Even with the additional money, jails are ill-equipped to provide treatment, said Judge Ken Stoner, who presides over Oklahoma County drug court cases.

Tulsa County Sheriff Vic Regalado recently ended his jail’s agreement with the state health department to provide treatment for those in custody with severe mental illness, insisting they belong in a hospital.

Such cases typically are treated at the state’s 216-bed Oklahoma Forensic Center in Vinita, which has been burdened for years by a waiting list. And a dozen rural hospitals, including their psychological treatment services, have closed since 2007, according to state data.

Nearly 70% of female offenders and 48% of male offenders in Oklahoma jails were diagnosed with a mental illness, according to 2015 state report. To help resolve the issue, voters approved State Question 781 to increase mental health and drug addiction treatments in jails in 2016. The law requires savings from State Question 780, which reduced the number of people in jails by lowering certain drug and property crimes to misdemeanors, to go into a mental health fund available to every county.

Local justice systems can use the money to add staff or provide employment training and assistance. They can bolster existing mental health and addiction diversion programs, such as Smart on Crime.

“We know that when we invest in mental health or substance use or job training, that it decreases crime,” said David Gateley, a criminal justice analyst at Oklahoma Policy Institute.

Felony filings decreased by 30% the first year after State Question 780 took effect, according to an Oklahoma Policy Institute analysis of court records. Gateley pointed to estimates provided by a group that includes the state’s Legislative Office for Fiscal Transparency, which show savings could reach $20 million by next year.

Although rural counties will find ways to use the extra money, they may never be able to catch up to urban areas, which have better proximity to nonprofits, Gateley said.

Large jails and prisons can rely on outside organizations such as Diversion Hub and The Education and Employment Ministry to provide treatment and transportation services to incarcerated individuals, but many of those nonprofits only operate in the metro area.

In Cleveland County, commissioners increased the jail’s budget this year to pay for a licensed counselor to work at the detention center five days per week.

But in many cases, the only mental health resource for rural jails is through a partnership with Oklahoma City-based Red Rock Behavioral Health Services, which has 13 state offices. Yet, limited staff and beds can present barriers to access. Ariel Joseph, a spokesperson at Red Rock Behavioral Health Services, said the providers find ways to cater to rural areas and limit their barriers, such as meeting virtually with clients.

But nonprofits can go the extra mile by developing individualized health and career plans for their metro-area clients, Joseph said.

Michigan’s model

The same year Oklahoma voters approved State Question 781, Michigan funded pilot programs in eight counties aimed at applying psychotherapy, and expanded to 10 counties in 2017.

Analysts at the Center for Behavioral Health and Justice at the Wayne State University School of Social Work then compared the treatment-based pilot programs to traditional jails. The center documented how alternative services, such as treating detainees with therapy and medication, affected individual outcomes, said Lynn Sutfin, a Michigan Department of Health and Human Services spokesperson.

People who received those jail-based diversion services were 64% more likely to engage in treatment after release compared to those who did not receive jail-based diversion services.

“The consensus is the more you can connect people to community services, even while they’re incarcerated, the more likely they are to follow up,” Sutfin said.

After five years of data-collecting and research, the center determined the best practices for counties, which included expanding services for police training and substance abuse treatments.

Rahni Cason, jail diversion manager at the Center for Behavioral Health and Justice, said the biggest obstacle is establishing uniformity in Michigan’s justice system. Similar to Oklahoma, rural counties do not always have access to medication or other resources.

Cason said the organization partners rural counties with high-performing counties and provides extra funding when available to reduce the disparities. The center and council garner funds from the state and other third-party organizations.

Cason and Sutfin said statewide efforts are underway, and said the extensive research has aided their progress. For states considering jail diversion approaches, Sutfins recommended identifying the problems first.

“I would do a landscape analysis of what’s going on in the state and not dive in with solutions before you understand what is actually already happening,” Sutfins said.

Oklahoma’s logistics

Once the money is transferred to the fund, counties will have to request funding through the Department of Corrections, similar to a grant system. However, counties have a maximum amount they can request based on population (see table).

In Logan County, where they will receive approximately $161,491 for mental health and substance abuse initiatives, Sheriff Damon Devereaux said he would like to partner with the county’s healthcare provider, Turn Key Health Clinic, and invest in a mental health module. The program would either provide more mental health providers to jails or set up more beds for outpatient care.

Either way, Logan County inmates need a consistent mental health regimen, Devereaux said.

Devereaux said the county already spends about $250,000 on rehabilitation services, and the mental health module costs about $1,500 per month for four more hours of care a week.

Devereaux said he was excited about the passage of State Question 781 but remains uncertain about its effect because of the seven-year delay.

“We now need to hold our legislators accountable for what people voted for, and put the money where the mouth is,” Devereaux said.

Kay Thompson, chief of communications at the Oklahoma Department of Correction, said the department has not discussed plans or recommendations for spending 781 money, but said there is a need for more staff.

Policy analyst Shade said all the programs can be built.

“There’s a hopeful story here that I hope remains at the center of this,” Shade said. “It’s going to be a transformative, transformational change for Oklahoma.”

Oklahoma Watch, at oklahomawatch.org, is a nonprofit, nonpartisan news organization that covers public-policy issues facing the state.

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Illustration depicting 37-year-old Devalos Perkins in the Mecklenburg County Detention Center. In jail, he’s in purgatory. In his mind, he’s in hell, mental health evaluations show.

Rachel Handley

rhandley@mcclatchy.com

Dr. Mark Hazelrigg sat in a quiet, private office at Central Regional Hospital.

A click of a button would transport him to the Mecklenburg County Jail.

On the other end of Hazelrigg’s Zoom screen was a mumbling Devalos Perkins. The forensic psychologist had spoken to the 35-year-old man before but his case was still puzzling.

Perkins had gained weight since they last spoke, and Hazelrigg hoped it would be a good sign.

“Nah, nah, nah,” an agitated Perkins said, according to the doctor’s notes.

“I don’t need no evaluation. I was in (Central Prison) safe keeping for nine months, I’m good.”

A few questions later, Hazelrigg learned Perkins was not taking his medication and in fact, was not “good.”

One question from the doctor set Perkins off more than the others: Are you hearing voices?

“You asked me about 10 questions, now this,” Perkins screamed at the camera. “I’m done!”

He stormed out.

Hazelrigg, a doctor at one of North Carolina’s state-run mental health hospitals, heard Perkins arguing with the guards who weren’t able to convince him to stay in the interview.

The doctor’s report for the court was summarized in one sentence: “Mr. Perkins is currently incapable to proceed.”

It wasn’t new for Perkins, and his day in court kept getting pushed further into the future.

Over the past nine years, he had been evaluated at least nine times — only twice, court records show, was he judged at least temporarily lucid enough to stand trial. Both times, he back-tracked and proceedings were paused again.

Perkins is still incarcerated, nearly 20 years after his alleged crime and 11 years after his arrest for murder.

A now-defunct provision in North Carolina law may keep him here, without a guilty verdict, until the day he dies.

Hazelrigg’s August 2021 patient notes describing the conversation and abrupt end would sum up Perkins’ state of mind much like he and others had done before:

“Psychotic symptoms.”

“Disorganized thoughts.”

“Unstable emotional control.”

“Paranoid.”

Probably having auditory hallucinations.

Devalos Perkins’ Purgatory

This 4-part news series by The Charlotte Observer examines how a cold case murder devolved into a man’s decade-long purgatory in jail, mental health hospitals and court. This chapter illuminates why Devalos Perkins, now 37, has been perpetually considered legally incapable of being put on trial. In Chapters 1 and 2, we tell the story of how he ended up in jail and show the resulting brokenness across three families after a robbery in a gas station parking lot led to murder.

Hidden struggles

Most of Perkins’ story has received little public attention. Instead, it lives in a thick pile of manila folders in the court clerk’s office, and in short paragraphs entered into a guard incident log.

Some of the unsealed records in his file highlight the grim truth of a psychotic man who is deeply paranoid, delusional, and unable to understand his charges.

Over a dozen other envelopes in his files remain sealed.

As he’s been awaiting trial in Charlotte since his arrest in 2012 on a first-degree murder charge, Perkins has been shuffled between the Mecklenburg County jail, Broughton Hospital, Central Prison, and Central Regional Hospital dozens of times.

Eventually, his behavior was considered so dangerous the court blocked him from returning to Broughton, one of the state’s three mental hospitals for the criminally insane. Instead, he’s now sent to Central Regional Hospital.

The Observer attempted to reach Perkins by sending him letters, and using the jail’s online messaging system but did not receive a response. The Observer also contacted his lawyer who did not respond.

He’s spent a large portion of his time in jail in solitary confinement. His mundane days have been peppered with assaults on guards, being Tased or punched, hunger strikes, and long hours in the jail’s restraint chair, incident reports show.

Just last year, following a detention center disciplinary hearing, he was issued a sanction and told he would spend 150 days in solitary confinement, according to jail incident logs. This punishment, jail records show, came after guards said Perkins assaulted an officer who was trying to clean up a massive pile of trash in his cell.

His list of diagnoses by various doctors over the last 20 years include schizophrenia, antisocial personality disorder, social anxiety disorder, and schizoaffective disorder, court records show.

He’s tried several forms of medication over the years, including at least six different antipsychotic drugs. He’s gone through the same cycle for years: Take meds; be considered able to stand trial for a few weeks; relapse to a state of complete delusion behind bars.

That is how Dr. Hazelrigg found Perkins in 2021 during the last significant evaluation on record the Observer was able to obtain in his case.

Officials with the North Carolina Department of Health and Human Services refused the Observer’s attempt to interview Hazelrigg. A spokesperson said DHHS is seeing an increase in court orders for capacity evaluations and defendants found incapable to proceed. This combined with a staffing shortage leaves fewer hospital beds and increased wait times for mentally-ill defendants.

Jail purgatory 2.0

The nearly 11 years Perkins has spent in jail isn’t the first time he’s been held in legal limbo.

A year after Justin Ervin’s death — but before Perkins was named a murder suspect — he was arrested in Charlotte on drug charges, illegally living in his car and armed robbery, court records show.

Over a two-year period facing charges, he was twice ordered to stay in a mental health hospital; once fired his lawyer; and twice deemed incapable of proceeding to trial due to his mental health.

The case — and that purgatory ended — when Perkins in 2008 took a plea deal that allowed him to plead guilty to a lesser charge.

Other times, for other crimes, Perkins has stood trial and been found guilty, public records show. Leading up to his 2012 arrest, Perkins had multiple convictions, including in 2003 for property damage; in 2005 for drug possession; and in 2006 for unauthorized use of a motor vehicle.

Over a dozen other times he was charged with a crime that was later dismissed without leave, according to public records.

Mental health evaluations in court documents related to the 2006 armed robbery case paint a disturbing portrait of Perkins in his early 20s.

In a forensic evaluation, an expert was brought in to interview Perkins.

Perkins, 22 at the time, shuffled into the room wearing a “malodorous” orange jumpsuit, the report says. He was in tears and shackles.

“Why do I feel like I’m going crazy,” he whimpered.

The evaluator gave Perkins an hour to calm down before the interview. At this time, Perkins had been diagnosed with an unspecified psychotic disorder and was being treated with medication meant for patients with schizophrenia, the evaluation report shows.

He attempted suicide in the past and had difficulty with anger management and anti-social behavior, the doctor wrote.

Perkins remained emotionally distraught and suspicious throughout the evaluation; he had a hard time sitting still, the doctor noted.

“Why we keep on doing this? Why this keep happening to me,” he tearfully asked.

In a later interview with another doctor in 2008, Perkins noted that at one point he had been held in seclusion and solitary confinement — “the hole” — for eight months.

“I hear voices, everyone punking me down.

“I am feeling like I am going crazy and everyone on the inside is trying to erase my memories of my family.”

The voices in Devalos Perkins’ mind

Over the years Perkins kept hearing voices that sounded like his family, according to court records. They promised him money and power, and they warned him about things.

It’s hard to know if he’s had real contact with his loved ones. The Observer spoke briefly to his mother, who lives in Charlotte. She was reluctant to talk and did not agree to be interviewed. She shared only that she had no information about her son’s case and that it had been years since she last spoke to him.

Perkins heard other voices, too.

There was a secret society trying to kill him. He knew it. The voices told him, and they said the government was using members of the court system to do it.

The voices were there to “study” his mind, to tell him how to answer questions, and to control his movements, he said. They warned him about the secret society, the “high secret service” the “aluminati” and about the other threats to his life, he told doctors throughout his hospital stays and evaluations.

Sometimes the voices sent him messages through the television in jail, he explained.

Doctor notes in his court file show he believed a microchip was installed in his brain to control his thoughts.

And while some days he could give detailed explanations of the legal system and his charges, on others he didn’t know what a judge or jury was.

The voices and behavior show up in Perkins’ evaluations by multiple doctors going back to at least 2006.

By the time he was charged with murder in 2012, Perkins believed the government could read his mind — but he could stop them by keeping his mouth open, he told one doctor. On that day, he opened his mouth, kept it open, and refused to answer any more questions.

Perkins’ delusions deeply concerned his attorney at the time, Grady Jessup, who requested an evaluation of Perkins in 2013.

“He feels the masons and/or the Illuminati are controlling his life,” Jessup wrote in court documents. “He stated he is an alien and not from this world, he is not human.”

For three weeks he had refused attorney visits. He had also stopped taking his medication. In the Mecklenburg County jail, he was accused of assaulting guards, breaking sprinklers, and smearing feces on his cell walls.

Months later, Perkins wrote to a judge — one of a series of letters, some more coherent than others — a short rambling single paragraph:

“This is inmate Devalos Perkins #323484, I want a new attorney I fill the one I got ain’t wit me he’s wit aluminati and want me sent away in prison.”

Almost ‘capable’

Dr. Hazelrigg has pages of notes from his years of evaluating Perkins.

Once, he’d thought, Perkins was doing better. And Hazelrigg noted his symptoms were under control because of his medication.

That finding would finally allow Perkins to return to court in 2015.

After more than three years in jail doctors determined he might be mentally stable.

But when called to evaluate Perkins just before his hearing, Hazelrigg found him delusional again — and markedly more paranoid.

Perkins still wanted to have a trial.

Hazelrigg noted that Perkins “concretely maintained he will just, ‘Tell them I didn’t do it,’” referring to the judge.

Hazelrigg testified Perkins could not stand trial. Instead, he was sent to a state mental health hospital.

While it’s unclear how long he stayed in the hospital, court records show he was soon after removed from the facility for assaulting staff and patients.

He’d repeatedly attacked multiple fellow patients; tackled a staff member so hard, the person’s head was injured; hit a nursing assistant four times in their face; directed sexually-inappropriate behavior toward a female worker; and attempted to break into the nurse’s station, a description in court documents shows.

The hospital staff called police after doctors reported they’d “lost clinical control of the unit” with Perkins there.

When police arrived they cuffed Perkins, pepper sprayed him, and left. The next day Perkins punched another staff member and was placed in restraints for hours due to “continued threats.” Two days later, he was back on his Mecklenburg jail bunk.

Records show this instance in 2016 of violence in the mental health hospital was at least the third time staff there reported abuse at the hands of Perkins.

During his previous admissions to Broughton in 2014 and 2013, Perkins’ records tell the same story. He repeatedly attacked nurses and patients until finally, the care staff said he was too dangerous to treat and sent him back to Central Prison, or the Mecklenburg County Jail.

For most mentally-ill suspects behind bars, these hospital stays are the best option for treating and stabilizing defendants so that they are considered legally-capable of standing trial, experts and officials have told the Observer. But in Perkins’ case, any progress in the hospital has eroded each time he’s returned to jail, records indicate.

His case file shows the seemingly-hopeless cycle whenever Perkins has grown closer to a potential end to his purgatory.

He once told his lawyer he wanted to accept a plea offer to reduce his murder charge — but he refused to answer the questions legally required on the paperwork in court.

When told he might be eligible for a more generous plea, Perkins changed his mind and told Jessup he didn’t want one.

Instead, he asked for the death penalty, which had already been taken off the table.

Jessup explained to the judge: “He wanted the death penalty, because the world is going to end in 2020 and he doesn’t want to be alive when the world ends.”

Five years later, in 2018, another plea deal was being discussed, according to his court records.

Perkins wrote to the district attorney’s office: “I been in jail over five years on a cold case murder & robbery charge that happen 2005 and I didn’t commit.

“Most of the time I’ve been incarcerated for this charge, I have been back and forth from the mental hospital for evaluations. Now I am compitint to go to trial.”

Two months later, he sent another letter asking to go to trial and for a third time, asking for a new attorney who he believed could better represent him.

“I don’t feel comfortable with this lawyer, he is working with (the) state DA. Can you please have these charges dismissed or give me a new attorney? Thank you.”

Soon after Jessup withdrew from the case. In court, Perkins said he wanted to fire him.

Norman Butler took over the case as his public defender and said while Perkins was initially able to assist in his defense and discuss the plea, he quickly deteriorated and refused to come to court. Butler requested another capacity evaluation, according to court records.

That was 2018 and it was the last time, based on court records, the case was potentially close to a plea deal or advancing to trial.

Devalos Perkins’ mental health

Incapable to proceed cases

Perkins insists he didn’t commit the murder. But his behavior in jail and mental hospitals shows he isn’t safe for society either.

When he’s deemed too dangerous for mental health institutions and too sick for jail, Perkins is sent to a ultra-high security “safekeeping” prison facility located in Central Prison in Raleigh.

Legal and mental health experts say there are no easy answers about where someone in Perkins’ condition should be detained or supervised. North Carolina’s mental health system for criminal defendants generally seeks to treat the most severe of cases outside of jail but in practice, that’s nearly impossible.

Across the state, hundreds of people were found incapable of proceeding over a recent four-year period, state data show.

Even with the most difficult cases, the law forbids indefinite pre-trial detention.

But Perkins is an exception.

Our investigation shows he’s caught in legal ambiguity — sentenced to purgatory due to a single word in state law that was amended a year after his arrest.

The law may have the power to imprison Perkins for the rest of his life.

Sources

Scenes not witnessed by the reporter in this series were compiled from research, interviews and public records including documents from the Mecklenburg County Detention Center and Clerk of Superior Court.

Credits

Kallie Cox | Reporter

Anna Douglas | Editor

Rachel Handley | Illustrations & Design

Gabby McCall | Page Design

David Newcomb | Development & Design

Kallie Cox covers public safety for The Charlotte Observer. They grew up in Springfield, Illinois and attended school at SIU Carbondale. They reported on police accountability and LGBTQ immigration barriers for the Pulitzer Center on Crisis Reporting. And, they previously worked at The Southern Illinoisan before moving to Charlotte.
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The Mental Health Project is a Seattle Times initiative focused on covering mental and behavioral health issues. It is funded by Ballmer Group, a national organization focused on economic mobility for children and families. The Seattle Times maintains editorial control over work produced by this team.

Wait times for people in Washington jails to get into state psychiatric facilities continue to “skyrocket” five years after a settlement promised to prevent that from happening, a court monitor told a federal judge in Seattle on Monday.

In downtown Seattle, federal Judge Marsha J. Pechman of the U.S. Western District Of Washington heard arguments in a civil dispute that’s gone on for nearly 10 years, regarding the rights of people in jail to access basic mental health services. Three more days of testimony are expected as the court, state officials and advocates try to decipher a way forward after years of a settlement agreement have not fixed the problem.

In the meantime, the state has racked up millions of dollars in fines, court cases are delayed, and people with mental illnesses are stuck in jail for months, at a cost to their own health and to local jails who care for them — potentially serving more time than they would if they were sentenced criminally.  

Dr. Danna Mauch, the court monitor for what’s known as the Trueblood Settlement, testified Monday that the current wait times are the longest she’s seen in the history of the case. In fact, wait times are worse than in 2015 when state officials faced initial litigation. 

Asked during cross-examination if she would describe the current wait times as “unprecedented,” Mauch said, “That’s one way to characterize it.” 

We’d like to hear from you.

The Mental Health Project team is listening. We’d like to know what questions you have about mental health and which stories you’d suggest we cover.

Get in touch with us at mentalhealth@seattletimes.com.

This week’s court hearing was called after plaintiffs with Disability Rights Washington accused Washington state officials of being in breach of their 2018 settlement agreement, which states people need to be provided evaluations within two weeks, to determine whether they are competent to stand trial, and treatment within another week. 

According to the court monitor’s early data from April, people in jail are now waiting an average of 130 days before they’re admitted to a state facility for inpatient services. 

Under the settlement, people in jail can receive compensatory sanctions — money from the state to make up for the excessive wait times defendants face. In addition, DSHS has paid an estimated $98 million in contempt fines as of November, the most recent data immediately available. Millions more in fines are suspended due to the terms of the settlement agreement, but could potentially be leveraged by Pechman if she finds the state is not doing enough to keep wait times down. 

State officials argue that both inside and outside the settlement agreement they are making progress on a number of programs to help people with mental illnesses, including the 988 hotline that serves Washington residents in crisis, a crisis facility that opened in Spokane and mobile crisis response teams that de-escalate crisis situations. Coupled with a future hospital currently under construction on the Western State grounds, officials stress they are working to meet the demands of the settlement agreement but are just facing overwhelming demand for services. 

Officials with King, Pierce, and Snohomish counties who previously submitted amicus briefs in the case say their counties are left with the financial burden of taking care of some of the sickest defendants in their jails, while they await a bed at a state facility. 

“We are grouped at the bottom of the hill,” David Hackett with the King County Prosecuting Attorney’s Office testified Monday, referencing the public safety crisis local municipalities face when people are not able to get services at state facilities.  

“Everything runs downhill.” 

However, state officials say part of the reason for the delays is that local prosecutors are sending more and more people to competency services. At Monday’s hearing, Pechman echoed that thought, shooting back, “Let’s look at who has a choice at stuffing that pipeline.”

Another sticking point among the parties has been the growing population of a particular kind of patient known as a “civil conversion.” These patients switch from being detained within the criminal legal system to a separate, civil system where they receive involuntary treatment because they’re believed to be a danger to themselves or others. 

As local prosecutors push for civil conversions in order to keep defendants off the streets and in care, those patients are competing with Trueblood class members for a limited number of available beds at state facilities like Western State Hospital — and that’s been leading to backlogs. 

The Trueblood Settlement, named for Cassie Cordell Trueblood, a public defender and plaintiff in the original case, aimed to prevent detained people from being warehoused in jail before they’ve had a fair trial. In 2014, when the class action first started, the American Civil Liberties Union of Washington and Disability Rights Washington also joined to represent the class members.

A compromise with state officials came the following year, establishing timelines for people in jail to access services.

The last major settlement occurred in 2018, when officials at the Department of Social and Health Services agreed to provide competency evaluations within two weeks and restoration treatment within another week. 

Wait times improved slightly the following year, but the COVID-19 pandemic ravaged progress. State facilities were forced to quarantine patients to mitigate outbreaks, creating backlogs as fewer patients were admitted. At the same time, they lost staff to burnout and more competitive salaries elsewhere. 

In the coming days, officials with the Washington Health Care Authority and DSHS are expected to also testify, including describing how defendants are triaged and prioritized into state beds. 

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Milena Castaneda has moved on. For two years after earning a degree, she worked as a caseworker, assisting people with chronic mental health problems. But now she’s working a new job.

“I love it and I miss it to this day. I miss doing direct service because I remember the change I would make on the individual level.”

CBS

 The pay was low and the work was hard. She made little more than minimum wage. She understands why there are staffing issues.

“You’re requiring them to go to get undergrad, graduate even licensure for little pay and they don’t see that as really worth it.”

It hits home with the mentally ill who live on the streets or reside in Colorado’s jails and end up in emergency rooms and in the courts in an inefficient system that leaves gaping holes.

“I think it’s one of the most pressing issues of our time. And I think we’re squeezed in a way,” said Vincent Atchity, CEO and President of Mental Health Colorado.

The state is short of beds at in-patient mental health facilities and people to staff them. People like 23-year-old Olivia Schack wait in jail.

“She’s been dealing with Jefferson County Mental Health since she was 17 and they told us that we needed to start pressing charges to get her in the system,” said her mother Kendra Anderson.

Schack, who has schizoaffective disorder and other mental health problems has lived on the streets, self-medicated with drugs and has been in and out of the criminal justice system. A judge ordered her to a state mental facility in December, but she remains in jail without conviction.

A lawsuit brought by Disability Law Colorado against the Department of Human Services for holding people with long term mental health needs in jail settings means the state has entered into a consent agreement to either get them to mental health facilities in a month or pay fines.

“We’re not in compliance with that. We have about 440 people in jail, many of whom have been waiting for one year for a bed,” said Leora Joseph, the Department of Human Services Director Office of Civil and Forensic Mental Health.

CBS

 The fine, fortunately is capped at $12 million a year. It could be far higher.

Colorado already had shortfalls before being hit with additional demands that came along with the pandemic.

“We do have approximately 84 beds that we had to close during the pandemic, but we are slowly building back,” said Joseph.

Many nurses left. In 2022, the state was only able to hire four. A $14,000 signing bonus this year has meant 11 have been added, but the state is still short. There are 100 beds at the state facility in Pueblo available, but that cannot be used due to staffing shortages. Demand has risen. There has been an 81% increase in the number of mental health referrals requested by judges adding to the backup.

“So our ability to serve patients in the hospital has decreased at the same time that we’ve seen this increase,” said Joseph.

The mental health community as a whole is aware of the problems.

“It’s a colossal disaster for the management of the population,” said Atchity. In addition to being ineffective, it is wasteful, he said.

“The state is paying out taxpayer dollars for our inability as a state to do what is legally essential and humanely appropriate for folks… If we could get ahead of the game and take care of people properly we’d manage the behavior and we’d be not in this endless loop of waste.”

“The system itself has always been broken, it’s always been flawed,” said Castenada. Health care is far better at treating visible problems like broken limbs, she said.

“I believe our system sees that if you don’t see it, it’s not an issue, so we ignore it.” Meantime, in addition to the 440 waiting in jails for treatment, many more with serious mental health problems remain on the streets, turned over and over in a system of jails, courts, emergency rooms and other costly services.

In 2022, the state legislature approved more beds. In 2023 lawmakers approved a study of potential solution for the problems. But decades of ignoring the problem have created a system of inefficiency and failure.

“There’s not going to be any quick fixes and no quick amount of money that will be saved quickly with a very quick fix. That’s just not what we’re dealing with here,” said Joseph.

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