Colorado’s plan for evaluating and treating mentally incompetent criminal defendants is “scattershot” and “untethered to a unified, cohesive vision,” a court-ordered, independent report recently found.
The findings by court-appointed special masters in a federal lawsuit against the state set the stage for a new round of talks planned this week over how state officials can improve their care of criminal defendants who are too mentally ill to understand court proceedings.
Already, the state has agreed to several demands by Disability Law Colorado, a Denver-based nonprofit that has battled the state agency for years over the management of two state psychiatric hospitals, said Alison Butler, the nonprofit’s director of legal services.
Chief among those demands was ending a controversial admissions freeze that left severely mentally ill people without any chance of receiving care through the state’s psychiatric hospital system, unless they committed a crime. From late December through early February, the only options for people not already facing criminal charges were private hospitals, which could be difficult to access while offering fewer services, patient advocates said.
“We were very pleased to see they were willing to unfreeze it, to show that, yes, they’re willing to work with us and our concerns,” Butler said.
The report comes as mediation talks are scheduled to begin Friday between the state and Disability Law Colorado, which last year reignited its legal battle over the state’s handling of monthslong delays that criminal defendants face for treatment. The report was first reported by Colorado Public Radio.
State officials have blamed the delays on a significant increase in such defendants needing treatment. Since 2000, the state has seen a nearly six-fold increase in the number of people ordered to undergo mental competency evaluations, which help determine whether a person understands court proceedings and can aid in their defense. It’s also seen a 12-fold increase in people ordered to undergo restorative treatment after being found mentally incompetent.
While the special masters commended state officials’ dedication to patient care, they stressed that far more work is needed to address systemic issues at the agency.
In all, the report issued seven recommendations for improving management of the state’s psychiatric hospitals — highlighted by a need for the state to take a more comprehensive and cohesive approach to ending those treatment delays.
Currently, the state’s plan “does not link to any broader vision” for improving care, and it “reads more like a list of isolated interventions for a cohesive network of complementary, interrelated services,” the report said.
The report suggested the state focus more on community and outpatient-based treatment programs, rather than relying on the creation of more inpatient beds to solve the competency crisis.
Also, the state could better triage people being held in county jails, to ensure they’re being directed to the right type of care. And the state should collect better data, while focusing more on quality — rather than just speed — while caring for mentally ill criminal defendants.
“They really want to focus on community resources and getting people to live and be treated in the community, before and after an evaluation,” Butler said. “It’s not just a pie in the sky idea.”
Repeatedly, the report’s authors said state officials could learn from programs in other states, including Arizona, Virginia, Hawaii, Pennsylvania, Florida and Washington.
In a statement, Robert Werthwein, director of the Office of Behavioral Health, said “we appreciate the feedback and look forward to continuing to work with the special masters to improve the competency system statewide.”
The report gave no indication for how much its recommendations would cost to implement, or how the state should go about paying for those initiatives.
Legislation is being drafted that would seek a “significant” funding boost for housing, transportation, case management and other social work programs to help alleviate those wait times, Butler said. Often, those programs could allow more people to receive outpatient treatment, rather than take up beds at the state’s psychiatric hospital.
A bipartisan measure failed last year amid strong opposition by Disability Law Colorado, which pilloried the legislation for not relying enough on community-based services.