Mental Health Care in Texas
Texas Health and Human Services urges individuals to “shake the stigma” that hinders them from seeking assistance Various services, including family-based support programs, family violence initiatives, mental health first aid training, prevention and early intervention, and substance abuse services, offer vital support to families and individuals facing mental or behavioral challenges The mental health care movement involves multiple agencies and partnerships dedicated to enhancing access to mental health care, treatment, and support Despite these efforts, the public health crisis persists.
6 Phil Magers, Analysis: Texas Reviews Insanity Defense, UPI (May 7,
2004, 5:19 PM) https://www.upi.com/Analysis-Texas-reviews-insanity-defense/22801083964762/
I don't know!
Harriet O’Neill highlights in the Fort Worth Star-Telegram that the conventional crime and punishment system is inadequately prepared to address the needs of defendants with mental health issues This underscores the necessity for a more effective approach in the judicial process to support individuals facing mental health challenges.
8 See id (“Those who come into the court system suffering from unmet needs deserve jurists trained to identify and address the problem.”)
The Texas Health and Human Services Commission provides essential resources for mental health and substance use support Visit their official website to discover available mental health services and find assistance tailored to your needs Ensure you are accessing a secure and official government site for reliable information and services.
10 Mental Health and Substance Use Resources, T EX H EALTH & H UM S ERV , https://hhs.texas gov/services/mental-health-substance-use/mental-health-substance-use-resources [http://perma.cc/
The Suicide Prevention Resource Center offers essential training and resources for professionals in suicide prevention In Texas, the Law Enforcement Crisis Intervention program trains police officers on effective intervention protocols for individuals in crisis Additionally, Mental Health America—Texas supports recovery from mental illnesses and addictions through innovative education, advocacy, and services The initiative "Ask About Suicide to Save a Life" further emphasizes the importance of proactive engagement in suicide prevention efforts.
The rising prevalence of mental health issues is exacerbated by a shortage of inpatient care, highlighting the urgent need for prevention training focused on recognizing warning signs and implementing effective referral strategies In 2017, Texas's mental health care system faced intense scrutiny following the tragic Sutherland Springs church shooting, where the gunman had previously escaped from a psychiatric hospital This incident, described by Governor Abbott as the largest attack of its kind in Texas's history, underscores the critical importance of addressing mental health as a serious and pressing issue.
Rates of Mental Illnesses
As of 2017, around one million adults in Texas were affected by serious mental illnesses, alongside approximately half a million children experiencing severe emotional disturbances Nationwide, an estimated 3.4% of Americans, equating to over 8 million individuals, struggle with significant psychological issues Notably, the demographic most impacted by mental health challenges has evolved, with middle-aged adults now among those at higher risk.
Mental illness and suicidal tendencies are increasingly prevalent among individuals with lower incomes and less education, with projections indicating that by the end of this year, one in five adults in Texas will face a mental health issue Furthermore, a significant 75% of registered voters in Texas support partnerships aimed at assisting those with mental health conditions and substance abuse issues, highlighting the importance of collaborative efforts to provide essential resources and programs for affected individuals.
12 See Jennifer Calfas & Mahita Gajanan, What to Know About the South Texas Church
On November 5, 2017, a gunman opened fire at a church in a small town southeast of San Antonio, resulting in the tragic deaths of at least twenty-six people and injuring twenty others This incident has been recognized as one of the largest mass shootings in modern U.S history, highlighting the ongoing issues surrounding gun violence in the country.
13 Jan Ross Piedad, 1 Million Texas Adults Suffer from Serious Mental Illness, T EX
Approximately one million adults in Texas experience serious mental illnesses, including depression, post-traumatic stress disorder, schizophrenia, and bipolar disorder Additionally, around half a million children under the age of 17 are affected by severe emotional disturbances.
14 See id (discussing the mental health statistics in Texas)
Mental health conditions are increasingly prevalent in the U.S., particularly among adults aged 45 to 64, with middle-aged women experiencing the highest levels of severe psychological distress Factors contributing to this rise include the impact of social media, feelings of isolation, and the effects of the COVID-19 pandemic, which exacerbated existing mental health issues Additionally, barriers to accessing mental health care, such as lack of insurance and availability of providers, further complicate the situation Addressing these challenges is crucial for improving mental well-being across all demographics.
Mental health concerns are increasingly prevalent, with many individuals personally affected through the experiences of friends or family members The rate of mental illness is on the rise, leading to unprecedented levels of emotional and mental distress.
Mental Health Resources
Mental Illness and the TDCJ
The Texas Department of Criminal Justice is dedicated to ensuring public safety, fostering positive changes in offender behavior, facilitating their reintegration into society, and supporting crime victims In recent years, there has been a notable increase in interactions between Texas law enforcement and individuals with severe mental illnesses Currently, approximately 146,000 offenders are housed within the Texas Department of Criminal Justice, with around 25,000 (17%) identified as having a current mental health disorder or a history of such disorders.
39 The budget provides “$10 billion over a period of five years to combat the opioid epidemic and serious mental illness.” An additional $15 million will be provided to implement a new Assertive Community Treatment, which supports and aids individuals suffering from serious mental illnesses
The Fiscal Year 2019 budget also gives $500 million to the National Institutes of Health in order to
“support and supplement existing efforts with a research initiative on opioid abuse.” See id
(detailing the Fiscal Year 2019 budget and its effect on people with mental health and substance abuse conditions)
40 See id (finding critical changes in the President’s budget)
41 T EX D EP ’ T OF C RIM J UST , H ANDBOOK FOR V OLUNTEERS 4 (2018)
42 Frank M Webb, Criminal Justice and the Mentally Ill: Strange Bedfellows, 49 T EX T ECH L R EV
43 Mental Health Program and Services, T EX D EP ’ T C RIM J UST 2, http://tdcj.state.tx.us/ divisions/cmhc/docs/CMHC_MH_Overview.pdf [http://perma.cc/2WSK-QFY9] [hereinafter
44 Id Daily, health care staff for the Texas Department of Corrections care for “1,514 inpatient psychiatric patients, 450 patients enrolled in the Program for the Aggressive Mentally-ill Offender, 725 patients in the Mentally Retarded Offender Program, and approximately 15,300 mental health outpatients.” Id become the “de facto” mental health asylum of our time 45
The Texas Criminal Justice Process
Sentencing
During the sentencing phase, judges or juries evaluate the specifics of the case and the offender's criminal history to determine an appropriate punishment This phase must adhere to the constitutional rights outlined in the United States Constitution Courts should focus on the necessity of punishment while also considering public safety and the potential for rehabilitation It is essential to protect the public from future offenses by the defendant, while also providing them with educational, medical, or corrective treatment Ultimately, the sentence should be both purposeful and meaningful.
Probation and Supervised Release
Probation, often referred to as community supervision, is a court-mandated conditional release that allows defendants to remain in the community under specific guidelines Courts are required to establish mandatory conditions for probation, while also having the discretion to impose additional conditions This approach is particularly beneficial for mentally impaired offenders, aiming to keep them out of jail Although probation serves as a positive alternative to incarceration, its effectiveness can vary, necessitating judicial assessment of appropriate punishments based on the offense.
57 See id art 42.02 (“The sentence is that part of the judgment, or order revoking a suspension of the imposition of a sentence, that orders that the punishment be carried into execution in the manner prescribed by law.”)
58 See, e.g., U.S C ONST amend VIII (“Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.”)
59 See 18 U.S.C § 3553(a)(2)(C) (2018) (listing factors to be considered in imposing a sentence);
Id § 3553(a)(2)(D) (listing the statutory sentencing purposes of public protection and rehabilitation)
60 C ITIZEN ’ S G UIDE , supra note 47, at 10
61 See 18 U.S.C § 3563(a) (listing the mandatory conditions for a sentence of probation)
62 See id § 3563(b)(9) (“The court may provide, as further conditions of a sentence of probation that the defendant undergo available medical, psychiatric, or psychological treatment, including treatment for drug or alcohol dependency, as specified by the court, and remain in a specified institution if required for that purpose[.]”)
63 See id (providing possible conditions of probation as determined by the court) many affected mentally ill offenders find themselves in jail anyway 64 For example, in 2015, defendant Zachariah Tyre pled guilty to the second-degree felony offense of burglary of a habitation, at which time he was granted deferred adjudication and sentenced to three years’ probation 65 As part of his probation, Tyre was referred to Pecan Valley Centers for Behavioral and Developmental Healthcare, where his Bipolar I disorder was confirmed 66 However, before the end of the probationary period, Tyre’s close family began contacting the court to express concern over Tyre, saying he may be “spiraling out of control” and that “he had not been taking his medication as prescribed.” 67 In December 2017, Tyre was arrested while leaving a bar, and in January 2018, Tyre began sending harassing and threatening messages to his ex-wife, whose house he had initially broken into 68
During Tyre's probation revocation hearing, the court recognized his mental health issues, with his family and ex-wife advocating for alternative treatment rather than incarceration However, Texas law fails to offer adequate support for offenders like Tyre, leading to his sentencing in the Texas Department of Corrections after probation was revoked This raises the question of why the probation system, designed to assist individuals in need, did not succeed in Tyre's case Ultimately, Tyre's situation highlights a troubling trend where more mentally ill offenders are being incarcerated instead of receiving the help they require.
64 See generally Chronological Record of Contacts, State of Texas v Tyre, No 1397289 (2015)
(on file with author) (indicating the failure of probation with mentally ill offenders)
65 Consultation Setting Plea Offer Acknowledgement, State v Tyre, No 1397289 (Tarrant Cty Crim Ct No 3, Tex Mar 17, 2015)
66 Chronological Record of Contacts, supra note 64, at 1–2
67 Chronological Record of Contacts, supra note 64, at 44
68 Id at 9, 57; Petition to Proceed to Adjudication, State v Tyre, No 1397289 (Tarrant Cty
Crim Ct No 3, Tex Feb 6, 2018)
69 See generally T EX C ODE C RIM P ROC A NN (providing the law for criminal proceedings in Texas)
70 See Webb, supra note 42, at 818 (discussing the “ramifications of the oftentimes dysfunctional relationship between criminal justice and mental health”).
Diversion Programs
Diversion programs aim to prevent the formal processing of offenders within the criminal justice system by directing individuals accused of crimes into treatment or care programs instead of prosecution and imprisonment These programs are particularly beneficial for mentally ill offenders, as they provide essential services that help them manage their mental health and remain integrated within the community.
Diversion plays a significant role in the criminal justice process, particularly when police officers choose not to cite or arrest suspects despite substantial evidence of a crime This discretionary power allows officers to exercise judgment in their decisions Additionally, the criminal justice system may mandate that offenders participate in social-service diversion programs The conditions under which an individual awaits trial can greatly affect not only the offender but also their families Jail diversion programs are essential as they help mitigate economic burdens and provide support during this challenging time.
71 Harry R Dammer & Carrie A Weise-Pengelly, Diversion: Criminal Justice System,
E NCYCLOPặDIA B RITANNICA , https://www.britannica.com/topic/diversion [http://perma.cc/UF 6V-MRCT]
Diversion in the justice system can be categorized into two types: informal and formal Informal diversion takes place when a justice official exercises discretion to keep a case out of the formal judicial process Conversely, formal diversion involves structured programs that the accused must complete as a prerequisite for diversion.
72 See id (“Diversion, any of a variety of programs that implement strategies seeking to avoid the formal processing of an offender by the criminal justice system.”)
Jail diversion and competency restoration programs play a crucial role in assisting individuals who are either involved in or at risk of entering the criminal justice system These programs provide essential services that enable individuals to remain in their communities while receiving the necessary treatment for their health needs For more information, visit the official Texas Health and Human Services website on Jail Diversion Services.
74 Dammer & Weise-Pengelly, supra note 71, (“Diversion occurs at different stages of the system.”)
75 Id Cases in which law enforcement interaction results in diversion are commonly traffic offenses where the officer will only give the offender a warning Id
Forcing offenders into treatment programs is based on the belief that addressing personal issues like substance abuse or anger management can reduce criminal behavior and prevent reoffending Additionally, the social consequences of imprisoning offenders while they await trial highlight the importance of jail diversion strategies These diversion opportunities not only exist before trial but also extend throughout the prosecution process, even after a conviction.
Most felonies result in confinement, yet many offenders do not serve their full incarceration term In Texas, mentally ill offenders often benefit from diversion programs that provide court-ordered outpatient mental health services These services may involve temporary or extended commitments for mental health treatment, allowing offenders to receive necessary care without facing jail time The state's mental health diversion programs aim to support these individuals in accessing treatment while avoiding incarceration.
“For the offender, the main goal of diversion is rehabilitation.” 83 Supporters of diversion programs “hope[] that diversion will allow offenders to establish a normal lifestyle without the burden of a criminal
77 Id Jail diversion is a discretionary option frequently utilized by an arresting officer
In cases of minor offenses, a summons is issued, specifying a date and time for the accused to appear in court, similar to a traffic ticket Although the accused is technically arrested, they are released after agreeing to the court date Due to concerns that a summons may downplay the seriousness of criminal charges, its use is limited to minor misdemeanors Another alternative, known as release on recognizance (ROR), occurs after the suspect is booked at the police station, where they promise to appear in court at a designated time in exchange for their release from custody.
79 Id In these cases, the offender will be considered for probation or community service Id
80 Jail Diversion Services, supra note 73
Under Texas Health and Safety Code, Chapter 574, courts can mandate temporary inpatient mental health services for offenders, known as "proposed patients," if a judge or jury finds clear and convincing evidence of their mental illness and the likelihood of causing serious harm to themselves or others Additionally, such treatment may be ordered if the offender experiences severe mental, emotional, or physical distress that impairs their ability to make rational decisions regarding their treatment.
Mental health diversion programs involve a team of professionals, including nurses, doctors, and counselors, dedicated to assisting offenders with mental illness These programs provide court-ordered outpatient mental health services aimed at individuals mandated to receive treatment outside of a jail setting.
Diversion programs play a crucial role in addressing the root causes of criminal behavior, such as substance abuse, by providing essential services to offenders These programs are more cost-effective compared to traditional justice system alternatives, allowing participants to evade the financial and punitive burdens associated with full criminal proceedings Despite these benefits, diversion programs face criticism, particularly regarding their perceived prioritization of offenders' needs over those of victims Additionally, concerns about the overall effectiveness of diversion programs continue to be a significant point of contention.
In 2015, 50% of grievances from incarcerated individuals to the Texas Commission on Jail Standards (TCJS) were related to medical services, including mental health care, highlighting a significant need for improved access to jail diversion programs With over half of incarcerated adults estimated to have at least one mental health condition, enhancing these programs is essential The Texas Health and Safety Code permits counties to prioritize funding for collaboration between law enforcement and judicial systems in developing jail diversion initiatives However, only a small percentage of eligible Texans with mental illness actually receive these diversion services, often due to poorly designed programs or non-compliance with diversion requirements, which may not always be intentional.
For example, in Houston, the number one reason offenders were unable to complete a particular diversion program is the fact that they could not afford
86 Id (“The controversies surrounding diversion programs often are presented as though diversion reflects some sort of unusual undercutting of the penal system.”)
87 Id (“Diversion is also criticized because not all programs are successful.”)
88 Texas Department of Criminal Justice and Local Criminal Justice Agencies, H OGG F OUND FOR
M ENTAL H EALTH (2018), http://hogg.utexas.edu/mh-guide/public-behavioral-health-services-in- texas/texas-department-of-criminal-justice-and-local-criminal-justice-agencies
[http://perma.cc/G9NX-ADXN] [hereinafter Texas Department of Criminal Justice]
89 See id (“A significant number of individuals involved in the Texas criminal justice system live with one or more mental health conditions, and many have co-occurring substance use disorders.”)
90 See T EX H EALTH & S AFETY C ODE A NN § 533.108 (granting authority to develop and prioritize funding for “a system to divert members of the priority population”)
Diversion programs within the Texas Department of Criminal Justice differ significantly across counties, with some communities providing comprehensive opportunities that target various stages of the sequential intercept model In contrast, many rural and urban areas lack the necessary resources to establish any diversion strategies, highlighting a disparity in access to these critical programs.
When diversion programs fail, they can significantly hinder the rehabilitation of offenders, which is the primary objective of these initiatives Additionally, the costs associated with the necessary treatment classes can further complicate the situation.
Specialty Courts
In Texas, certain counties are recognizing that individuals with serious mental illnesses or substance abuse issues may be better served outside the traditional jail system To address this, specialty court programs are implemented to divert these offenders from incarceration, offering a pathway out of the criminal justice cycle through intervention, supervision, treatment, and rehabilitation These programs require collaboration among judges, attorneys, law enforcement, and mental health professionals to provide effective alternatives to incarceration By focusing on the underlying issues that contribute to criminal behavior, specialty courts—such as drug courts, DWI courts, Veterans courts, family courts, and mental health courts—aim to break the cycle of crime for mentally ill offenders.
Mental health courts in Texas offer a specialized alternative within the criminal justice system, focusing on low-level offenses committed by individuals with mental health issues According to the Texas Government Code, the "mental health court program" is designed to address the unique needs of these individuals, providing a tailored prosecutorial option that emphasizes rehabilitation over punishment.
93 Meagan Flynn, Not Having $150 “No 1 Reason” Nearly 300 Have Failed Marijuana Diversion
Many individuals have struggled to complete Ogg's marijuana diversion program, primarily due to financial constraints, with the most cited reason being the inability to pay the $150 fee required for participation.
When diversion programs fail, they lead to significant negative consequences, including increased suffering for individuals, wasted tax dollars, heightened victimization, and a loss of credibility in the justice system In some instances, these programs can be more costly than traditional processing, as offenders may require reprocessing and potential incarceration later on.
95 Texas Department of Criminal Justice, supra note 88 In 2016, Texas had 191 specialty courts in operation Id
Specialty Court Programs in Texas, as highlighted by Governor Greg Abbott, address the significant resource drain caused by repeat offenders in the prison system These courts offer high-risk offenders a vital alternative, focusing on stern intervention, intensive supervision, and tailored rehabilitation, ultimately aiming to break the cycle of recidivism.
97 Texas Department of Criminal Justice, supra note 88
98 Specialty Court Programs, supra note 96
99 See id (listing the various Specialty Court programs)
100 Mental health specialty courts and drug specialty courts operate in a similar manner:
(1) the integration of mental illness treatment services and mental retardation services in the processing of cases in the judicial system;
(2) the use of a nonadversarial approach involving prosecutors and defense attorneys to promote public safety and to protect the due process rights of program participants;
(3) early identification and prompt placement of eligible participants in the program;
(4) access to mental illness treatment services and mental retardation services;
(5) ongoing judicial interaction with program participants;
(6) diversion of potentially mentally ill or mentally retarded defendants to needed services as an alternative to subjecting those defendants to the criminal justice system;
(7) monitoring and evaluation of program goals and effectiveness;
(8) continuing interdisciplinary education to promote effective program planning, implementation, and operations; and
(9) development of partnerships with public agencies and community organizations, including local mental retardation authorities 101
Mental health specialty courts typically incorporate several key components, including risk assessments and clinical psychosocial evaluations Participants are required to make frequent appearances before a mental health court judge and receive treatment from qualified mental health care professionals Additionally, these courts often mandate substance use treatment and implement random alcohol and drug testing to ensure compliance and support recovery.
While specialty courts operate to be advantageous for both offenders and the criminal justice system, the program also has its unique
Mental health courts were established nationwide as an alternative to traditional legal proceedings for individuals with mental illness facing low-level offenses Similar to drug courts, these specialized courts utilize non-adversarial, judicially-supervised treatment plans aimed at reducing recidivism linked to untreated mental health and substance use issues However, a key distinction lies in their approach; while drug courts often implement structured treatment protocols and punitive measures for noncompliance, mental health courts tend to focus more on therapeutic interventions without the same level of punitive action.
Texas Department of Criminal Justice, supra note 88
The Harris County felony mental health court program presents several disadvantages, including the potential loss of funding and resources for the general court system when cases are diverted to specialized courts These courts may inadvertently create a hierarchy among defendants, categorizing them as 'good' or 'bad' based on their participation The success of specialty courts, much like diversion programs, is contingent on available funding and access for offenders Furthermore, racial and ethnic disparities can hinder an offender's ability to utilize these specialized services, ultimately compromising the goal of rehabilitation for mentally ill offenders.
Insanity as a Defense
Not Guilty by Reason of Insanity
The Texas Code of Criminal Procedure outlines the process for determining a defendant's sanity When a defendant is acquitted due to insanity, the involved parties can agree to dismiss the indictment or information related to the criminal misdemeanor, resulting in a judgment of dismissal based on the defendant's insanity.
In Texas, the success rate for insanity pleas is under twenty-five percent, a statistic that can be misleading since most successful pleas pertain to lesser crimes where the state does not challenge the defense.
Texas courts, including the Court of Criminal Appeals, typically determine that most defendants with mental illness are aware of their actions, as highlighted in Michael Hall's article, "Is Andre Thomas Too Crazy to be Executed?" published in Texas Monthly.
123 See T EX P ENAL C ODE A NN § 8.01(a) (“[A]t the time of the conduct charged, the actor, as a result of severe mental disease or defect, did not know that his conduct was wrong.”);
Texas courts, including the Court of Criminal Appeals, typically conclude that most defendants with mental illness are aware of their actions Additionally, there are calls for legal reform to ensure that the right-wrong test does not serve as the sole criterion for determining sanity in all cases.
According to Texas Code of Criminal Procedure Article 46C.153, a defendant can be found "not guilty by reason of insanity" if two conditions are met: first, the prosecution must prove beyond a reasonable doubt that the defendant committed the alleged offense; second, the defense must demonstrate by a preponderance of the evidence that the defendant was insane at the time of the conduct in question.
An acquittal due to a verdict of not guilty by reason of insanity is not the final step in the judicial process for the defendant Following this verdict, the court is required to assess the dangerousness of the defendant's actions If the court determines that the individual poses a danger, they will remain under the court's jurisdiction.
The court maintains jurisdiction over individuals who have been acquitted and is required to commit them to the maximum security unit of a designated facility Following a thirty-day involuntary hold, a hearing on disposition must be conducted, similar to an involuntary commitment hearing Various outcomes may arise from this court hearing.
127 “[A] defendant who is found not guilty by reason of insanity stands acquitted of the offense charged and may not be considered a person charged with an offense.” Id art 46C.155(a)
When a defendant is acquitted due to insanity, the court must promptly assess if the offense involved actions that resulted in serious bodily injury to another individual or posed an imminent threat of such injury to someone else.
(3) consisted of a threat of serious bodily injury to another person through the use of a deadly weapon
If a court finds that an offense involved serious bodily injury, imminent danger to another person, or threats of serious bodily injury using a deadly weapon, it maintains jurisdiction over the acquitted individual until either the court discharges them or the total duration of institutionalization and community-based treatment reaches the legal maximum term, at which point the court's jurisdiction is automatically terminated.
According to Article 46C.251(a), the court is required to order an evaluation and treatment for individuals found not guilty by reason of insanity, committing them to a designated facility for a maximum of 30 days For instance, a legally insane individual may be committed to the North Texas State Hospital, with the primary objective of addressing their mental health issues to facilitate a safe reintegration into the community.
131 T EX C ODE C RIM P ROC A NN art 46C.253(a) At the hearing on disposition, the court should address three things:
When determining the disposition of a person acquitted by reason of insanity, three critical factors must be considered: the presence of severe mental illness or mental retardation, the likelihood of causing serious harm to others due to these conditions, and the availability of suitable treatment and supervision post-hearing, which the court may mandate through commitment.
Laws governing inpatient, outpatient, and community-based treatment aim to ensure that defendants who lack the necessary culpability due to insanity are not classified as "guilty" and subjected to conventional criminal justice processes.
The insanity defense is not always applicable, even when substantial evidence supports it In 2001, Lorenzo Reyna shot at passing cars on a highway after walking several miles from his mother's home in Clint, Texas Dr Marvasti, Reyna’s psychiatrist, testified that Reyna was insane at the time of the shooting and unable to understand the wrongfulness of his actions.
Dr Marvasti concluded with "reasonable medical certainty" that Reyna was experiencing a psychosis characterized by auditory and visual hallucinations, impairing his ability to recognize the wrongfulness of his actions—an essential aspect of any insanity defense Despite compelling evidence supporting this defense, the jury convicted Reyna, imposing sentences of ten and five years of confinement for the respective charges This outcome raises critical questions about the types of mental illnesses or conditions that can be managed safely and effectively through outpatient or community-based treatment and supervision.
The insanity defense serves specific purposes in the legal system, as discussed by Arnold H Loewy in "The Two Faces of Insanity." According to Texas Penal Code § 6.02(a), an offense is not considered committed unless the offender acts with a culpable mental state, which includes intentional, knowing, reckless, or criminally negligent conduct as defined by the statute.
Offenders with Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder (PTSD) is a significant mental health issue that can affect criminal defendants, arising from life-threatening experiences such as military combat, natural disasters, and violent assaults Approximately 7.8% of Americans will encounter PTSD at some stage in their lives, with around 3.6% of U.S adults aged 18 to 54—equating to 5.2 million individuals—experiencing PTSD within a single year.
In the case of Travis v State, the defendant, Travis, pleaded guilty to burglary with the intent to commit aggravated assault using a deadly weapon Evidence presented during the trial revealed that Travis had been diagnosed with PTSD and polysubstance use disorder due to his military service in Iraq The jury recommended a sentence of fifty-five years in prison, which was imposed Travis later appealed, claiming there was an error in the jury selection process, specifically regarding "Venire Member No 3," who was dismissed for cause after disclosing his background as a military veteran and veterans' service officer, highlighting the significance of proper care for PTSD patients.
The Court of Appeals in El Paso overturned the trial court's judgment, citing substantial evidence that Reyna lacked understanding of the wrongfulness of his actions when he fired at anonymous motorists on a highway.
141 Our Mission, PTSD F OUND A MERICA , http://ptsdusa.org [http://perma.cc/KA96- 69PU] There are three types of symptoms which are prevalent in patients with PTSD See id
Post-Traumatic Stress Disorder (PTSD) manifests through several key symptoms One primary symptom involves reliving the trauma, which can occur when confronting reminders of the event or struggling to concentrate on other tasks Another significant symptom is avoidance, where individuals may steer clear of places or people that trigger memories of the trauma, leading to isolation and emotional numbness Lastly, those with PTSD often experience heightened anxiety, characterized by a persistent sense of being on guard, irritability, and an increased startle response.
143 Travis v State, No 04–14–00560–CR, 2015 WL 6876830 (Tex App.—San Antonio Nov 10, 2015, pet ref’d) (mem op., not designated for publication)
Inadequate treatment for conditions like PTSD can lead to serious consequences, including substance abuse During the jury selection process, the prosecutor posed a critical question to potential jurors, asking if they could consider a 99-year sentence in a case involving evidence of PTSD.
The dismissal of Venire Member No 3, a veteran knowledgeable about PTSD, raised concerns about the judicial system's prioritization of potential juror bias over the mental health needs of offenders suffering from PTSD The trial court's decision was upheld by the Court of Appeals in San Antonio, suggesting a lack of consideration for the unique perspectives that veterans could bring to the jury In response to such challenges, the PTSD Foundation of America, a dedicated non-profit organization, focuses on supporting veterans by addressing the "unseen wounds of war." Their mission includes helping veterans reintegrate into society and meet their mental health needs, highlighting the importance of addressing PTSD in the veteran community.
152 Id The State based this argument on the Texas Code of Criminal Procedure, which
Jurors must avoid sharing their personal knowledge or experiences with fellow jurors during deliberations, as mandated by legal guidelines According to Texas Code of Criminal Procedure Article 36.13, the jury is required to accept and adhere to the law as presented by the court.
153 See Travis, 2015 WL 6876830, at *2 (affirming the dismissal of a potential juror on the basis of his beliefs on convicting a defendant with PTSD)
154 Id at *4 Where a potential juror responds with vacillating answers, deference is granted to the trial court’s ruling on the challenge for cause See Davis v State, 329 S.W.3d 798, 807 (Tex
In reviewing a trial court's decision regarding a challenge for cause, we afford significant deference to the trial judge's ruling, as they are uniquely positioned to assess the demeanor and responses of potential jurors.
According to Texas Code of Criminal Procedure Article 35.16(a)(9), bias or prejudice can be grounds for challenging a juror for cause In the case of Travis (2015), the court upheld the trial court's decision to dismiss a potential juror due to concerns about potential bias.
156 See Our Mission, supra note 141 (“[P]roviding hope and healing for the unseen wounds of war.”)
The PTSD Foundation of America is dedicated to mentoring combat veterans and their families as they navigate post-traumatic stress This foundation acknowledges the mental health challenges faced by veterans and advocates for their rights and quality of life, an important issue that Texas courts should consider Additionally, Camp Hope plays a vital role in supporting these efforts.
Camp Hope is an out-patient, community-based treatment program that focuses on the care of veterans with PTSD 160 Camp Hope opened in 2012
“in a quiet and safe setting in Houston, Texas” and stands on a platform of helping veterans and their families “find healing, help and hope” through an
“intensive peer support and mentoring program for Post-Traumatic Stress.” 161 Additionally, Camp Hope offers:
Our 90+ day PTSD recovery program offers residents the opportunity to engage in group lessons and support sessions, receive individual mentoring, and participate in off-site activities such as fishing and hiking Additionally, residents can connect with local churches, businesses, and volunteer organizations, fostering community involvement and support throughout their recovery journey.
1 Bring healing to our military community (Active duty, Reserves and National Guard, veterans, and their families) through pastoral counseling, and peer mentoring, both on an individual basis, and in group settings
2 Raise awareness of the increasing needs of the military community through public events, media outlets, social media, service organizations, and churches
3 Networking government agencies, service organizations, churches and private sector businesses into a united “Corps of Compassion,” to bring their combined resources together to meet the needs of the military community on a personal and individual/family level
Many military service members return home with invisible wounds, such as PTSD, that are not immediately apparent The PTSD Foundation of America is committed to supporting these brave warriors and their families as they navigate their journey to adjust and establish a new normal.
159 See id (discussing the foundation’s duty to help those in need)
Camp Hope is dedicated to supporting veterans and troops who have selflessly served, particularly those dealing with PTSD Their mission focuses on "providing hope and healing for the unseen wounds of war," ensuring that these brave individuals receive the care and assistance they deserve.
161 Camp Hope: Interim Housing for Veterans, PTSD F OUND A MERICA , http://ptsdusa.org/ camp-hope/ [http://perma.cc/Y5QJ-4PJN]
The Camp Hope staff is trained and specialized in all things related to PTSD 163
The Reality of Mental Health and Criminal Justice
Mental Health Reform
Given the potentially devastating impact on Texas communities, urgent societal and legal reforms are necessary in the mental health sector, particularly in its intersection with the criminal justice system.
168 See id (describing the interaction between law enforcement and MHMR)
169 Troy Collum II, a law enforcement officer with 17 years of experience, has described having to “really push” MHMR representatives to help people in mental crisis, especially those threatening suicide Id
In a recent statement, an individual emphasized the necessity of holding the MHMR representative accountable, indicating that they felt compelled to disclose the situation in detail within their report This disclosure included the representative's name, highlighting the seriousness of the potential consequences if someone were to get injured as a result.
171 About Us, MHMR T ARRANT , http://www.mhmrtc.org/About-Us/About-Us [http:// perma.cc/25LE-HT4B]
172 E-mail from Troy Collum II, supra note 167
Before his career as a police officer, Troy Collum II worked in nursing, which he believes has significantly enhanced his ability to handle crisis situations His nursing background has equipped him with the skills to identify individuals experiencing mental health episodes, fostering greater patience and empathy in his interactions with the community.
174 See id (discussing the effects of a nursing background for law enforcement)
The lack of information sharing between the health and criminal justice systems significantly contributes to the crisis in mental health care Over the past few decades, the number of psychiatric hospital beds has drastically decreased by nearly 97%, leaving mentally ill individuals with few alternatives, often resulting in incarceration in jails and prisons that lack adequate mental health resources Our mental health system is fundamentally broken; in 2014, ten times more people with serious mental illnesses were found in prisons and jails than in state mental hospitals This issue has been recognized at the highest levels, with President Trump acknowledging the critical state of mental health care following the tragic Parkland, Florida school shooting.
Years ago, numerous mental hospitals existed, but many have since closed, leaving the criminal justice system as a primary provider of mental health treatment To address the gap between mental health care and the criminal justice system, a crucial solution is to reverse the effects of deinstitutionalization by increasing the availability of psychiatric hospital beds Texas lawmakers must work to bridge the divide between criminal justice and mental health to establish a necessary balance between punishment and healing.
To achieve optimal outcomes and prevent individuals from slipping through systemic gaps, it is essential to create integrated data systems These gaps can manifest in various ways, such as individuals being incarcerated without access to their mental health history and treatment plans, or being released back into the community without any coordination with mental health services for necessary follow-up care.
176 See John Snook & E Fuller Torrey, America Badly Needs More Psychiatric-Treatment Beds,
The lack of psychiatric treatment beds in America has led to the criminal justice system effectively serving as the primary mental health system, highlighting a critical need for more mental health resources.
Prisons are inadequate for housing mentally ill individuals, as highlighted in a 2003 report, which emphasizes the need for better alternatives Additionally, the ongoing mental health crisis is exacerbated by a significant shortage of inpatient care facilities, further underscoring the urgency for reform in mental health treatment options.
President Trump has expressed the intention to seriously discuss the reopening of mental health institutions, highlighting the ongoing conversation about mental health care in the country.
Institutions?, H EALTHLINE (Mar 6, 2018), https://www.healthline.com/health-news/president-trump- should-we-open-more-mental-institutions#1 [http://perma.cc/GW7W-RH4Q]
179 Docherty, supra note 4 (“In 44 out of 50 states, prisons and jails hold more individuals with serious mental illness than the largest state hospital.”)
180 With the availability of treatment, mentally ill individuals could possibly avoid the criminal justice system altogether by never even becoming offenders Snook & Torrey, supra note 176
Shane Levesque discusses the challenges of mental illness within the criminal justice system in his article "Closing the Door," highlighting the need for a consistent mental health policy to address the "revolving door problem" faced by individuals with mental health issues This issue leads to a continuous cycle of entanglement in the legal system, underscoring the urgency for reform and better support for the mentally ill.
Recidivism Rates of Mentally Ill Offenders
The first six months post-release from prison pose the highest risk of recidivism for offenders, particularly for those with mental illnesses who face significant challenges in readjusting to life outside During this critical period, individuals must secure housing and employment while reconnecting with family and friends Unfortunately, many mentally ill offenders lack the necessary preparation or ongoing mental health treatment, exacerbating their difficulties According to the Bureau of Justice Statistics, nearly 25% of incarcerated individuals with mental health issues have experienced three or more incarcerations, compared to 20% of those without such problems A 2005 Department of Justice study indicated that 75% of incarcerated individuals with a medical diagnosis had prior arrests, and 81.2% of mentally ill offenders in state prisons have a criminal history, highlighting the urgent need for effective support and treatment during reentry.
A 2017 Department of Justice study provided that diagnosed offenders
Research indicates that individuals released from incarceration face a 9% higher risk of recidivism within the first year and a 15% increase after five years This heightened risk may be linked to the negative impact of incarceration on mental health Following recent tragic mass shootings, there is a pressing need to prioritize expanded access to inpatient care for individuals with mental health issues, as emphasized by discussions among the Supreme Court of Texas and the Court of Criminal Appeals regarding mental health considerations.
182 H UMAN R IGHTS W ATCH , supra note 28, at 193 Recidivism refers to “a tendency to relapse into a previous condition or mode of behavior, especially pertaining to criminal behavior.” Recidivism,
M ERRIAM -W EBSTER , https://www.merriam-webster.com/dictionary/recidivism [http://perma.cc/
Newly discharged offenders often face significant challenges as they reintegrate into society, particularly those struggling with mental illness Many states fail to provide adequate discharge planning services to support these individuals, despite evidence suggesting that such services can substantially reduce the risk of recidivism.
Without adequate mental health treatment and support for housing, employment, and income, individuals with mental illness who commit crimes are at a high risk of reoffending, leading to a continuous cycle of incarceration.
185 See Levesque, supra note 181, at 726 (citing statistics from 2004 that suggest nearly half of all mentally ill offenders had multiple periods of incarceration or probation); Doris J James & Lauren
The report by E Glaze highlights the significant prevalence of mental health issues among prison and jail inmates Published by the Bureau of Justice Statistics in September 2006, it provides crucial statistics that underscore the urgent need for mental health care in correctional environments This document serves as a vital resource for understanding the mental health landscape within the criminal justice system, emphasizing the challenges faced by incarcerated individuals For more detailed insights, the full report can be accessed at the Bureau's official website.
186 Jo Sahlin, The Prison Problem: Recidivism Rates and Mental Health, G OOD T HERAPY (May 20, 2018), https://www.goodtherapy.org/blog/prison-problem-recidivism-rates-mental-health-
187 H UMAN R IGHTS W ATCH , supra note 28, at 193
Strict incarceration rules and isolation can heighten stress levels, potentially resulting in further mental health issues as individuals navigate their transition This compromised mental health frequently leads to substance abuse, rapidly spreading among offender populations Alarmingly, many offenders with mental illnesses resort to self-medicating with illegal drugs or alcohol, creating a troubling and continuous cycle of self-medication.
The population of incarcerated individuals with mental health needs has reached crisis levels, exacerbated by high rates of rearrest Although some mentally ill offenders receive psychiatric treatment while in prison, the effectiveness of this treatment often diminishes after release due to the discontinuation of care This decline in mental health significantly hampers their ability to reintegrate into society, leading to increased recidivism rates Consequently, this cycle undermines the Texas Department of Criminal Justice's mission to foster positive changes in offender behavior.
190 See id (“[A]lcohol and drug addiction can spread through populations of offenders The sale, trade, and consumption of drugs can broaden one’s criminal network.”)
191 See Chronological Record of Contacts, State of Texas v Tyre, No 1397289 (2015)
The interactions with a bipolar offender ultimately resulted in his probation revocation, highlighting the challenges faced by mentally ill individuals within the criminal justice system In a telephone interview on September 13, 2018, Kathryn Owens, Assistant District Attorney for Tarrant County, discussed how mentally ill offenders often resort to self-medication when the system fails to provide adequate support It is crucial to address the fact that ninety percent of the mentally ill offender population has a diagnosable substance abuse or dependence disorder, emphasizing the need for effective treatment programs.
Offenders convicted of DUI/DWI or possession of controlled substances are ineligible for a medical mental health diagnosis, which prevents them from receiving necessary treatment This lack of treatment often leads mentally ill offenders to self-medicate with illegal drugs or alcohol, resulting in a cycle of further convictions and increased prison time.
194 See Levesque, supra note 181, at 713 (noting that because many offenders are unable to afford mental health care, their release often creates a “revolving door”)
196 Levesque, supra note 181, at 714; Sahlin, supra note 186 reintegrate offenders into society.” 197
Texas Courts on Reform
Conclusion
The Texas Criminal Justice system consistently fails to adequately address the needs of mentally ill offenders, leading to an overpopulation of these individuals in jails and prisons It is crucial for Texas to recognize the importance of mental health treatment facilities, as the Texas Department of Criminal Justice is ill-equipped to provide the necessary care Despite the existence of diversion programs and specialty courts, the system continues to inadequately serve the mentally ill, with many slipping through the cracks due to the overly stringent standards of the insanity defense Once these individuals enter the criminal justice system, they often find it nearly impossible to escape, creating a cycle of recidivism that perpetuates their lack of access to proper mental health support.
To achieve true justice for mentally ill offenders, it is crucial to significantly expand the availability of mental health treatment facilities By prioritizing treatment centers over incarceration, society can offer a more compassionate and effective alternative to the criminal justice system Embracing mental health care is essential for fostering a fair and just approach to handling those in need.