Louisiana is failing to swiftly admit criminal defendants who need mental health treatment to the state’s only hospital equipped to care for them, creating a backlog so severe it has stalled hundreds of cases across the state.
The dire backlog persists even after a class-action settlement required the hospital to accept patients within roughly two weeks.
On average, murder and manslaughter defendants statewide spent nearly seven months last year waiting for a bed at the Eastern Louisiana Mental Health System, an analysis of homicide cases by The Times-Picayune shows. New Orleans’ defendants languished even longer: seven months and nine days.
The delays ripple through courts statewide, but the gridlock is felt acutely in New Orleans, where homicide prosecutions already move among the slowest in the nation. The crushing wait for admittance to the state mental hospital is just one force driving delays in a justice system so clogged that cases can take years to resolve, eroding public trust and upending the lives caught in its churn.
The Eastern Louisiana Mental Health System in Jackson, Louisiana, dates back to 1848, when it opened as the first state-operated mental health hospital. With more than 600 people there now, the vast majority of patients have been referred there through the criminal justice system. The Louisiana Department of Health, which operates the facility, is asking the state for $348 million to build a new forensic hospital. (Photo by Brett Duke, NOLA.com | The Times-Picayune)
(Photo by Brett Duke, NOLA.com | The Times-Picayune)
At the end of last year, 30 defendants from New Orleans were awaiting transfer to the hospital. By mid-October, 33 remained caught in the backlog, confined in a jail that a federal judge has ruled unequipped to handle defendants’ serious mental-health needs.
Jon Wool, the longtime former director of Vera Louisiana, a nonprofit researcher that advocates for criminal justice reform, called the hospital’s wait times “extraordinary.” That people in need of treatment “spend so much of that time not actually being restored to competency but being held in the local jail — where there’s no capacity to help them — is an extraordinary failure,” he said.
In the meantime, cases freeze. Under Louisiana law, once a defendant’s mental health is questioned, no other steps can be taken in the case until the competency process resolves.
The delays exact a toll on everyone, attorneys say: Victims’ families lose the chance for closure, defendants lose the right to a timely process and cases weaken as memories fade and evidence is lost.
Admission times have improved in recent months: Data from the state health department shows defendants have waited about four months to be admitted to the facility this year, after the state struck deals with four private hospitals to take in more than 200 of its patients.
But the state is still out of compliance with the lawsuit’s settlement agreement, records show, in which the hospital agreed to admit defendants within 15 days of receiving a judge’s order.
Barksdale Hortenstine Jr., the director of Orleans Public Defenders’ mental health unit, called ELMHS’ recent wait-time reductions a “huge improvement,” but “still far” from what’s needed.
“Wait times cause all sorts of problems,” Hortenstine said, “but chief among them is the prolonged suffering of people, presumed innocent, while they languish in jail.”
In one extreme case, second-degree murder defendant Tyrone Fountain has spent nearly seven years awaiting trial as he has repeatedly landed — and stayed stuck — on the hospital’s waitlist.
And some lawyers now debate whether the process itself has become a tool of delay — a system so backlogged that questions of competency, once raised to protect defendants’ rights, can also be used to stall cases.
Pandemic delays made backlog grow
New Orleans police arrested Fountain on Dec. 31, 2018, alleging he beat a local talent agent to death during a daytime purse snatching on a Seventh Ward sidewalk.
His arrest came four years after criminal defendants across the state in 2014 brought a class-action lawsuit against the Louisiana Department of Health, which runs the hospital, and top state health-officials. The lawsuit alleged prolonged, unconstitutional waits for detainees ordered for treatment.
Outside the fence at the forensic division of Eastern Louisiana Mental Health System “campus” at McManus, La. Hwy. 10, east of Jackson.
Photo by James Minton
The 573-bed hospital in Jackson serves all 64 parishes and treats criminal defendants found mentally ill and unfit to stand trial. But its waitlist has swelled because there simply aren’t enough beds to accommodate the number of people across Louisiana who need treatment.
In the aftermath of a 2016 settlement in the lawsuit, the state showed progress, reducing delays somewhat yet rarely meeting the 15-day deadline it had agreed to.
For example, the first time a judge ruled that Fountain was incompetent to stand trial, in 2019, he waited 16 days for admission to the hospital.
But then, the pandemic eroded the state’s gains.
The Eastern Louisiana Mental Health System, ELMHS, suspended admissions for four months amid pandemic shutdown orders. At the time, only 16 defendants from across the state were on its waitlist. But that number surged as admissions remained frozen and the backlog built.
By the second time a judge sent Fountain there during the throes of the pandemic, it took 10 months for him to be transferred. Last September, Fountain was ordered to the hospital a third time; it wasn’t until the following spring that he was admitted there, records indicate.
Other New Orleans homicide case logs reflect a similar crawl.
A judge ordered Loretta Norman to the hospital in November 2023, but five months later, she was still awaiting transfer and sat sixth on the waitlist. In a separate case, a judge also ordered Ariel Shelling to the facility on November 2023; more than a year later, court records show she was still waiting and moved into first place on the waitlist.
Emma Herrock, the health department’s communications director, said in an email that its yearlong contracts with the four private facilities have helped the state hospital make gains. But the deals expire in 2026. And several of the 220 patients transferred to the private facilities have also returned to ELMHS because of “aggressive [and] unmanageable behaviors,” Herrock wrote.
Herrock also said an “increase in orders for admission by the criminal courts” has meant the department’s strides haven’t been as strong as anticipated.
When asked what plans the hospital has to increase the number of patients it can serve, Herrock responded: “None.”
Nearly half of New Orleans jail population needed mental health services
Long wait-times for treatment can also worsen a defendant’s mental health struggles, especially when they are confined in the Orleans Justice Center, New Orleans’ jail.
The city of New Orleans owes the contractor building the Phase III addition to the jail more than $4.4 million, according to a lawsuit filed by the contractor last week. Workers were on the site Wednesday, July 2, 2025. The former House of Detention is right. (Staff photo by John McCusker, The Times-Picayune | NOLA.com)
STAFF PHOTO BY JOHN MCCUSKER
In 2013, a federal judge ordered the jail under a consent decree, citing widespread problems with mental health care along with violence, escapes and other problems.
Mental illness can drive some people to violence, and research shows that people with serious mental illness are arrested and jailed at disproportionately high rates. In a mental-health roundtable last spring, Aashia Bade, director of behavioral health for Wexford, the sole provider of health care services to New Orleans’ jail, said that trend is particularly acute in New Orleans.
Last year, 47% of the jail’s population received mental-health services and 52% were on psychotropic medication, according to Wexford.
Even so, Wexford’s contract does not include restoration services for incompetency, a complicated process that requires consistent, hands-on psychiatric care and close medication management — far beyond what many local jails are equipped to provide.
Restoration services instead fall solely onto the state hospital’s forensic psychiatrists, whether at its facility or virtually, via a jail-based program conducted on the jail’s often inadequate video screens.
Court-appointed psychiatrists have made clear that attempting to restore defendants detained in the jail has limitations. In one homicide defendant’s case, an ELMHS nurse wrote in a letter to a New Orleans judge that she was “unable to control volume, background distractions or quality of video screens” or use visual aids, all of which she deemed essential to proper restoration care.
Even defendants who are restored to competency at the state hospital can relapse once they return to jail, finding themselves in need of treatment again and again, like Fountain. In the hospital, Hortenstine said, defendants receive steady medication, expert monitoring and calmer surroundings. Back in jail, the noise, instability and inconsistent medical oversight can cause them to deteriorate.
“This is a well-known phenomenon common across the country. It’s not unique here,” he said. “But when we are already struggling with admissions, it can further stress the [hospital] system and lead to increased wait times.”
Time, he added, is crucial. Defendants who struggle with mental health issues, such as hearing voices, may rack up additional charges, further clogging the slow, crowded court system, Hortenstine said.
“If you’re constantly hearing voices in your head that drown out the people speaking around you, it’s easy to see how you might struggle to follow instructions [you’re] given,” he said.
As part of the jail’s consent decree, a federal judge ordered the addition of a mental-health unit, called Phase 3, scheduled to open next year. The project has been controversial, though, drawing criticism from newly unseated Orleans Parish Sheriff Susan Hutson, as well as the attorneys who represent incarcerated people in the consent-decree litigation.
The critics argue that the planned new building would still fall short of delivering meaningful, clinical restoration and care.
Calvin Johnson, a former judge in New Orleans’ criminal court who launched the first mental-health diversion program in the state, said Phase 3 is unlikely to have a significant impact for the people who need competency restoration.
“Unless it can do everything that is done at the state forensic facility,” he said, “then it won’t be enough.”
Delay tactic concerns
Cases are all but guaranteed to slow down when a mental competency evaluation is ordered, and attorneys argue that some intentionally use those delays to game the system.
“The moment an attorney stands before a court and says, ‘I believe my client may not be able to understand the proceedings against them,’ we cannot take any further steps in prosecution,” said Matthew Derbes, Orleans Parish District Attorney’s Office homicide unit chief. “If they’re found incompetent, you can just tack on another nine months to a year to the case right then and there.”
The entrance to the Eastern Louisiana Mental Health System’s Jackson campus is seen Thursday, May 11, 2023, in East Feliciana Parish, La.
STAFF PHOTO BY HILARY SCHEINUK
At least 24% of all homicide prosecutions over the last decade included a mental-competency hearing. Cases in which competency is challenged drag on about 17% longer than cases when it is not, regardless of whether the defendant is ultimately sent to the state hospital, The Times-Picayune’s analysis found.
It can take months for the court’s appointed psychiatrists to evaluate a defendant. Even after an evaluation, it can take weeks — or months — for the panel to submit reports and testify, a reflection of the chronic dysfunction inside the court, where even basic steps are often delayed by crowded dockets and scheduling backlogs. Then a judge must rule on a defendant’s competency and sign a formal order to send a defendant to ELMHS, which places him or her on the hospital’s waitlist.
The delays are so extreme that some prosecutors accuse defendants and their attorneys of exploiting the system for advantage, because case delays typically benefit the defense.
“You have to look at the nuances in terms of how this plays out in strategy,” said Orleans Parish District Attorney Jason Williams, who previously worked as a defense attorney. “Oftentimes, defense attorneys will re-urge competency. Obviously, competency needs to be dealt with. But you have to be very, very careful — very circumspect — if something gets raised at the eve of trial every trial setting, and the case gets continued again and again.”
Defense attorneys counter that it’s rare for defendants to fake or exaggerate symptoms of mental illness, known as malingering, and few formal diagnoses support the claim of widespread gaming of the system.
“I find that claim absurd,” said Hortenstine. “It is categorically untrue and offensive. Defense attorneys want their clients to be healthy and capable of assisting in their defense.”
Still, court records show isolated instances where psychiatrists have agreed that a defendant was magnifying or fabricating symptoms to avoid trial.
After police arrested Anfernee Steele on Oct. 27, 2020, accusing him of killing his girlfriend’s 4-year-old daughter, his defense attorney questioned his competency at least three times.
Psychiatrists repeatedly expressed concern that Steele was malingering.
In one instance, court-appointed psychiatrists took two months to evaluate him, citing a “heavy caseload of clients” that slowed them down, records show. Steele received three months of jail-based restoration, then waited eight months for a subsequent two-month stint at the state hospital.
Doctors later said they suspected he had been feigning his symptoms.
In another case, Jared Raymond was charged with second-degree murder in an April 17, 2023 killing in the Florida neighborhood. A judge ordered him to the state hospital on Oct. 24, 2024.
It took nearly five months to admit him.
After his release, court-appointed psychiatrists evaluated Raymond. They wrote in a report to the judge that Raymond’s many alleged symptoms — which ranged from delusions to visual hallucinations — were “atypical” and unlikely to be experienced simultaneously, as he claimed.
“We believe that not only is he feigning, but he is doing so poorly,” they concluded in the report.
Derbes said prosecutors spent more than a year “unable to do anything” on Raymond’s case while his competency was evaluated.
Still, amid the accusations of delay and manipulation, defense attorneys say the deeper truth is simpler: The criminal justice system isn’t built to help the people who need mental health care most.
“The absolute worst place for my clients living with serious mental illness or cognitive impairments is jail,” said Hortenstine. “It is destabilizing. It is dangerous.”
Staff writer Jeff Adelson contributed to this report.