LUBBOCK, Texas — Long waitlists for competency examinations and restoration services mean some defendants with mental health disorders may be released from jail before they receive the services they need.
A shortage of doctors qualified to conduct competency examinations is contributing to the problem, but that is not the only waitlist some defendants face.
Jail becomes mental health provider
Sheriff Kelly Rowe says the Lubbock County Detention Center has become the largest mental health provider in the county.
“Unfortunately, in the United States, our jails become our de facto mental institutions. Once we moved away as a nation from the inpatient care model to the outpatient care model, that is where these individuals ultimately landed,” Rowe said.
Rowe said 50% of inmates at the Lubbock County Detention Center have received mental health services. About 25% to 26% require treatment while incarcerated, whether medication to keep them stable or additional services such as counseling.
The detention center has a contract with StarCare Specialty Health System, the state-designated Local Authority for mental health and intellectual disabilities in Lubbock.
Longer stays, higher costs
Rowe said those with mental health disorders often stay in jail longer, which costs taxpayers more.
“In terms of getting them processed, determining competency is going to be an issue…you are literally pushing people into years spent in jail,” Rowe said.
Rowe said one inmate who required mental health and medical services stayed in the Lubbock County Detention Center for more than two years. The inmate was ultimately deemed incompetent to stand trial, and the case was dismissed.
“I had staff go back and calculate and get with the hospital and calculate what kind of costs were associated with his stays. It was just under a million dollars for one guy, and there was ultimately no justice at the end of it,” Rowe said.
Doctor shortage drives waitlists
Dr. Sarah Kim, StarCare’s Director of Forensic Mental Health, said one of the challenges is the waitlist for competency evaluations.
“We have a severe shortage in forensic psychiatrists and psychologists who do competency evaluations. Our courts contract privately with these doctors to provide them, and they are so backed up because there are just not many of them,” Kim said.
Dr. Nancy Trevino, Director of the Texas Tech Mental Health Initiative, said this shortage means more time and more money.
“We are having providers that are really setting their own price. The evaluation can be anywhere from $700 to $1200 for one evaluation. In statute, there’s a certain time period to submit their report, but there is such a shortage, such a critical shortage, that sometimes there are some challenges with meeting that deadline as well,” Trevino said.
Local restoration program helps some
Lubbock County Assistant District Attorney Marlise Boyles has handled the competency docket in Lubbock County for about six years. She said the competency evaluation waitlist poses problems, but Lubbock is fortunate because the Lubbock County Detention Center, with the help of StarCare, offers restoration services for defendants found incompetent but restorable.
“Which is wonderful. That enables the defense attorneys to meet with their clients during the restoration process. We aren’t having to pay transport, we are not also having to wait on that state hospital wait list to undergo restoration because it’s not just Lubbock County that is sending them to the state hospital, it’s every other county here in Texas,” Boyles said.
However, Rowe said not every defendant qualifies for jail-based restoration services.
“If an individual has more serious charges, typically something that is aggravated, the state says no, they can’t work through jail-based competency; they have to use the state hospital system,” Rowe said.
According to StarCare, the state hospital waitlist for admission to a non-Maximum-Security Unit is 121 days. The average waitlist for admission to a Maximum-Security Unit is 140 days.
Some defendants released before evaluation
State law limits how long defendants can sit in jail awaiting trial, and long waitlists mean some defendants who suffer from a serious mental illness may walk free before ever seeing a psychiatrist.
“With the amount of defendants coming into the jail, there are some because of different deadlines and timelines, they are going to time out on their charge before we can even address competency,” Boyles said.
Boyles said the DA’s office has limited options.
“We can only work with the laws we are given, so it’s either file a case and proceed with a criminal case, which we can’t do, or we have to reject the case and dismiss the case, and then we are back at square one with certain people coming in frequently,” Boyles said.
Rusty Gunter, the Chief Defender for the Lubbock Private Defenders Office, said as the population continues to increase in Lubbock, so do the caseloads.
“Our mental health attorneys are getting them daily. I think our mental health case workers are rolling about 60 to 65 active cases on their caseloads right now,” Gunter said.
New Mexico pilot program offers alternative
The New Mexico justice system experienced similar challenges, so in 2024, the state launched a competency diversion pilot program. It allows qualifying non-violent offenders the chance to have their charges dropped if they complete mental health treatment.
New Mexico Supreme Court Justice Briana Zamora said they refer to this as leveraged treatment because the defendant has a choice.
“You can go through the criminal justice system and face its consequences — whatever it may be, and it may be dismissal — but you still have to go through everything in between, or you can get treatment, and your case will be dismissed,” Zamora said.
The KCBD Investigates Team spoke with attorneys and other stakeholders to find out if they think a similar program could work in Lubbock County. The team also spoke with Texas Tech about its efforts to grow the pipeline of forensic psychiatrists and psychologists — and keep them in Lubbock.
We’ll have more on these angle as we continue to investigate the mental health crisis.
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