Mental competency consequences: the hidden, unreliable data Texas tracks… or doesn’t
This project was supported by the USC Annenberg Center for Health Journalism.
AUSTIN (KXAN) — Naquan Carter is a name members of the Joint Committee on Access and Forensics Services might never have heard, despite his tragic outcome on a waitlist considered the committee’s main focus. For more than eight months, he was among hundreds of people waiting and filtering through the state’s system of mental competency restoration.
In Texas, people charged with crimes and found mentally incompetent to stand trial most often obtain restoration treatment at a state hospital before returning to jail and being able to actively participate in their defense. In recent years, there have been efforts to increase other competency restoration alternatives – like jail-based or outpatient methods – but for some people, like Carter, those options are not always available.
Described by Travis County Sheriff Sally Hernandez as a “gentle giant, who became very dear to the corrections officers, counselors and medical staff who cared for him daily,” Carter had been previously diagnosed with bipolar and schizoaffective disorders stemming from mental and intellectual disabilities, according to past providers and jail records. After his Austin arrest in late 2017, medical forms indicated he had suicidal thoughts, heard noises and voices and was depressed. When jail staff found him dead in his cell in July 2018, he had been awaiting transfer to a state-supported living center to continue restoration efforts.
“We do our very best with the resources we have, to give quality care to this vulnerable population for as long as they’re required to be in our custody,” Hernandez said in a statement. Her office oversees the Travis County Correctional Complex, where Carter was housed. “I wish (he) had been receiving care in a proper mental health care facility from the beginning.”
Carter grew up bouncing from foster families to group homes. He was Black and had no way to support himself financially. When he died, he was just 23. It is unclear how his other physical health issues – including hypertension and obesity – could have factored into how long he waited for competency restoration treatment, and the sheriff’s office would not comment further on his case.
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The sheriff’s office said it does not inform the Texas Health and Human Services Commission, the umbrella state agency over the Joint Committee on Access and Forensics Services, when people on the waitlist – like Carter – die. The sheriff’s office said it reports such incidents to three agencies: the Texas Commission on Jail Standards, the Office of Attorney General of Texas and the Travis County District Attorney’s Office.
HHSC’s spokesperson said it “is dependent upon the reporting of the courts and county jails to provide reasons or factors why individuals are removed from the state hospital waitlist, including the death of the individual.” Regardless, Carter’s death would not have been part of any effort to measure possible waitlist trends by HHSC – beyond noting one less person waiting. KXAN investigators discovered deaths are just one of several crucial data points going untracked by the JCAFS, which makes recommendations to HHSC and state lawmakers, in part, to help drive down the waitlist numbers.
“A long waiting list is not a good thing,” JCAFS Chair Stephen Glazier told KXAN in October when the waitlist hit a new record, soaring beyond 1,830 people. “There are all kinds of negative consequences that come from that. It’s important, I think, to reinforce everybody’s motivation to work as hard as we can to fix this problem.”
During his conversation with KXAN, Glazier said he would make it a priority for the committee to address how it could track the housing status of people on the waitlist and other details related to homelessness. HHSC later told KXAN it had recently started collecting data on those individuals’ race and ethnicity and would be providing those details to the committee by January 2022.
Mental health advocates like Lynda Frost, formerly of the Hogg Foundation for Mental Health, acknowledge the committee, established in 2015, has improved its data initiatives in recent years. That work has largely focused on statewide aggregate overviews with a recently formed data analysis subcommittee and updates from the state’s forensic director. But, Frost agrees more information could help the state better deliver services to individuals on the waitlist and possibly reduce their wait times.
“We know that people are not treated equally across our criminal justice system,” she said. “We want to know how that plays out. And, if we don’t have that data, it’s harder to figure out what we can do to ensure that our justice systems are truly just.”