AUSTIN (KXAN) – State mental hospitals are struggling with low staffing, causing hundreds of beds to sit unused and backlogging over 2,100 mentally ill people – a record high – in county jails across Texas for months as they wait for competency restoration treatment, according to records and discussion at a Wednesday meeting of the Joint Committee on Access and Forensic Services.

“We need an emergency action plan to address this,” said committee member Jim Allison, general counsel for the County Judges and Commissioners Association of Texas. Allison said the state should consider calling on Gov. Greg Abbott to bring in the National Guard to assist.

People on the waitlist typically have been arrested and found incompetent to stand trial. They are ordered by a court to receive mental health restoration in a state hospital before they can proceed with their case.

“This system is going to break soon because counties are not going to be able to find enough employees,” said newly selected committee chairman Dennis Wilson, a representative of the Sheriff’s Association of Texas and former Limestone County Sheriff. “We understand the problems you are having at the state level, but, please, drop down to our level and see the problems we are dealing with. It is heartbreaking.”  

Staffing crisis

Nearly a third of all funded state hospital beds – 731 of 2,241 – are now offline and cannot be used because of staffing shortages and issues related to the pandemic, according to JCAFS, which oversees the waitlist and serves as an advisory committee for the Texas Health and Human Services Commission.

Scott Schalchlin, an HHSC deputy executive commissioner, said the agency did a recent “media blitz” to publicize $5,000 hiring bonuses for certain state hospital positions. More staff would open more beds and improve the situation, but hiring has slowed.

“Prior to the pandemic, we were getting about 15,000 applications a month. We now get about 6,000,” Schalchlin said. “There are just not that many people out looking for employment or looking at us for employment.”

New race data shows longer waits for Black people

Aside from the staffing crisis, the advisory committee released new waitlist data that includes, for the first time, a basic breakdown of race and ethnicity.

That data shows Black people are stuck on the maximum-security waitlist longer, on average, than white and Hispanic people. The data also shows white people wait the shortest amount of time of all races and ethnicities for both maximum and non-maximum security state hospital beds.

“The new data really highlights the value of disaggregating data by race and ethnicity so that we can have a clearer understanding of what is going on,” said mental health and criminal justice expert Lynda Frost. “We know there are significant racial and ethnic disparities through the criminal legal system. It’s disappointing – but not surprising – to see disparities showing up in the wait times in addition to so many other points in the process.

Though the data shows Black people are waiting longer, it doesn’t explain why. Answering the whys would require more questions. Is there bias in assigning beds, or is this a consequence of over-charging a disproportionate number of people of color, asked Frost, who is an attorney and former assistant director of the Hogg Foundation for Mental Health, a University of Texas foundation that works to improve mental health in the state.

“We are stunned and deeply disturbed by these data. The fact that Black community members with disabilities are being forced to wait, on average, more than 100 days longer than their white counterparts for certain state hospital beds is a damning indictment of the structural racism baked into every aspect of Texas’ public health, forensic, and criminal legal systems,” said Krishnaveni Gundu, co-founder and executive director of the Texas Jail Project.

The disparity mirrors racism in the criminal justice system and the way Black people with disabilities are arrested and jailed, Gundu said.

“These data points are begging state policy makers to urgently respond with a clear action plan to address the racial inequities in our legal and mental health systems,” she added.

KXAN’s investigation of the waitlist data found race and ethnicity information are likely recorded incorrectly by law enforcement agencies and courts, which are where HHSC and JCAFS get their records. In particular, we found dozens of waitlisted individuals in Texas’ largest counties were recorded as white despite having common Hispanic first and last names. We also found varying methods for recording ethnicity between counties. The Tarrant County Sheriff’s Office, for example, said it does not record ethnicity.

Data still untracked

The Wednesday committee meeting was the first since KXAN published an investigation in December that spotlighted shortfalls in how the state collects information of people on the waitlist. That investigation found the committee had not previously tracked the race or ethnicity of people on the waitlist. The committee and HHSC also do not track important socioeconomic factors that can impact mental health treatment outcomes, like if a person on the waitlist is indigent or experienced homelessness. We also discovered at least a dozen people died while on the waitlist since 2015 in Texas’ largest counties, but HHSC does not track or record those deaths.

In October, former JCAFS committee chairman Stephen Glazier told KXAN his group would look at addressing data collection issues found by KXAN, including tracking deaths and socioeconomic factors on the waitlist.

It is not clear what work has been done on those topics. An HHSC spokesperson said the agency has not received any request from the committee to begin trying to collect information that would shed light on whether people on the waitlist were homeless.

KXAN’s investigation found 44% of the people on the waitlist in Travis County from January 2018 through August 2021 had experienced homelessness prior to being arrested.

State officials still are not tracking the number of people that die while on the waitlist. It is not clear if those deaths will ever be officially tallied. HHSC spokesperson Christine Mann said the people on the waitlist are not “in the care” of the agency. HHSC receives limited information on those people and depends on courts and law enforcement to provide “reasons or factors why individuals are removed” from the waitlist, she said in an email.

Wilson said recording those deaths would likely need to be done by HHSC, and it would require more paperwork by a local sheriff to respond to an agency’s request.

“It could come down as a legislative issue. It could come down as a legislative mandate,” Wilson said.

The story is part of the KXAN investigation, “Mental Competency Consequences,” a project supported by the USC Annenberg Center for Health Journalism.