Oklahoma is trying to treat people with severe mental illness in prison, but many are still languishing in cells waiting for hospital beds

Tulsa County Sheriff Vic Regalado has ordered the end of a program for treating people with serious mental illness at the David L. Moss Criminal Justice Center. County officials say the prison is unable to handle the needs of people so mentally ill that they do not understand their criminal charges. But one state hospital still has a months-long backlog of people waiting for admission.

At the Tulsa County Jail, some of the sickest are being held in a segregated unit, locked up 23 hours a day due to the risk of violence and other security concerns.

Prisoners were deemed unable to stand trial because mental illness rendered them unable to understand the legal process or help a lawyer with their defense. Such cases have typically been treated at the Oklahoma Forensic Center, a 216-bed facility in Vinita, where patients receive medications, talk therapy, and education about how the justice system works. The state’s new incarceration proficiency program provides drugs, but some other therapeutic services are available only at Vinita Hospital, according to court testimony in the case of a Tulsa County defendant.

When the Oklahoma Department of Mental Health and Substance Abuse Services launched the program to treat criminal defendants with serious mental illnesses in county jails in December 2022, more than 200 people were on the waiting list for a bed at the Oklahoma Forensic Center, some waiting a year or more. A few weeks earlier, the US Justice Department announced it had launched an investigation into Oklahoma’s mental health system.

There were also rumors of a federal lawsuit to be filed a few months later, accusing the state of violating the constitutional rights of Oklahoma’s mental patients languishing in county jails waiting for a hospital bed. The lawsuit is still pending.

After initiating the new prison program, the Mental Health Department said it no longer has a waiting list for treatment at Vinita State Hospital because it now offers services in county jails, said Lora Howard, Tulsa County’s acting chief public defender.

They started this prison reset thing just so they could say we don’t have a waiting list because they were getting really heated about having people who were a number 120 something and a number 130 something on a waiting list for a bed, Howard said. They don’t have adequate beds to do the necessary treatments. But the way around this is not to simply not do the treatment.

The Tulsa County Public Defenders office still has dozens of clients waiting for a hospital bed because they have not been able to recover probation in prison and are in need of more intensive help. The bureau estimates that it has typically had between 30 and 45 clients waiting in prison to go to Vinita since the program began.

Sheriff Regalado and the professionals who provide medical care to inmates at his jail believe these people should be in the state hospital, not a county jail. They have not been convicted of any crime. They are simply awaiting trial, the Tulsa County District Attorney’s office said in a written statement on behalf of Regalados. A hospital offers them greater freedom of movement, a staff of medical professionals dedicated to providing care rather than mere detention, and greater access to programs such as group and individual psychotherapy.

Tulsa County District Attorney Steve Kunzweiler said The frontier that the sheriff had previously refused to enter into a written agreement with the Department of Mental Health to provide outpatient care at the jail.

Sheriffs like me have long believed that no one who has been judged incompetent should be in a prison facility, and they must be in a therapeutic setting, Kunzweiler said.

The Department of Mental Health already operated a pilot proficiency program in about 60 county facilities statewide in May, when the Oklahoma Legislature passed a bill that would have made incarcerated treatment mandatory. But Governor Kevin Stitt vetoed the legislation, saying many jails were not equipped to treat people deemed incompetent to stand trial.

In response to The frontiers questions, Bonnie Campo, a spokeswoman for the Department of Mental Health, said some defendants have been successfully treated and have regained proficiency in prison. Antipsychotic drugs are the most common form of treatment to restore a person’s competence, she said.

Stabilization of the person’s mental illness generally must occur before other services can be effective, Campo said. Providing medication immediately is better than no treatment or inadequate treatment, she said.

This can help stabilize the person’s mental illness, which in many cases is the only reason the person is incompetent, he said.

The Department of Mental Health has asked Tulsa County officials to allow prison-related treatment to continue.

Allowing them to continue this treatment reduces their mental health symptoms and their level of danger to themselves or others and is a much better alternative than having them wait for a bed at the Oklahoma Forensic Center, Campo said. More importantly, stopping treatment immediately for those currently serving could cause potentially significant harm.

The state has a contract with provider Family & Children’s Services to operate the program in Tulsa County.

A spokesperson for Family & Children’s Services said in an email that the provider is working with the prison administration to ensure that inmates who received proficiency services are provided the psychiatric medications needed to maintain continuity of patient care after the program was abruptly terminated.

Under the Family & Children agreement with the state, the provider is required to see people in the prison program in person at least twice a month and ensure that appropriate medications are prescribed. Prisoners are to be monitored for suicidal and homicidal thoughts and to ensure they are taking their medication. Once stabilized, inmates are required to receive education and job training to help them understand the legal system.

Dr. Jason Beaman, interim president of the school of forensic sciences and former chair of psychiatry and behavioral sciences at the Oklahoma State University Center for Health Sciences, said twice-monthly in-person visits are inadequate. And telehealth visits can be very scarce and problematic in a prison setting, he said.

These are the sickest of the mentally ill and if they weren’t in prison, they would be in a hospital and we would see them every day, Beaman said. What about the individuals who can’t get out of their jail cells or are too dangerous, and the deputies won’t take them out of their jail cell, so they won’t get any treatment.

Some people also receive reskill care outside of prison.

MJ Denman, a private defense attorney in Tulsa, said he has a client, whom he declined to name, who is receiving proficiency treatment on an outpatient basis in Tulsa County through Family and Children’s Services. The client receives medications while at home, but is not receiving talk therapy or other services, she said. The client gives his word that he’s taking his meds, but no one checks, she said.

This is a band-aid and not even a band-aid that covers the entire wound, Denman said.

Some people waiting in prison for a hospital bed deteriorate further and are kept in solitary confinement in a segregated unit for the safety of themselves and others, Howard said. The Tulsa County Public Defenders Office appealed by filing motions for hearings to hold the Oklahoma Department of Mental Health and Substance Abuse Services in contempt of court for failing to treat clients who waited months or more for admission to the forensic hospital.

After a motion is filed, the Mental Health Department gives the client priority for a bed in Vinita and he is moved out of jail before a hearing can take place, Howard said.

Facing multiple charges, including sexual assault and obstruction of an officer, DeAndre Prince waited more than 17 months in the Tulsa County Jail for a hospital bed after being declared incapable of standing trial in January 2022. Federal courts have previously ruled in a case involving Washington state that criminal defendants have a constitutional right to treatment within a week after they were found incompetent to stand trial.

In prison, Prince racked up more charges, including assaulting and batteryting a detention officer and pouring bodily fluids on a government employee.

Prince was held in a segregated unit, locked up for much of his time in prison due to violent and disruptive behavior, according to a transcript of a court hearing.

Prince’s public defender filed a motion in May for a hearing to blame the Mental Health Department for failing to comply with a court order to treat him at the forensic hospital. In response, the agency argued in court documents that it was operating on a very limited budget and that Prince was already receiving treatment in prison.

A 2022 report from the state Legislative Bureau of Tax Transparency found that while Oklahoma’s allocations for mental health have increased 9% since 2013, funding had actually fallen 11% during that period, when adjusted for inflation. Meanwhile, the state has seen a 652 percent increase in people waiting for treatment at the Oklahoma Forensic Center in Vinita over the past five years, from 23 people in January 2017 to 173 people in April 2022.

In Prince’s case, a partial contempt hearing in court took place on May 30. A public defender said the hearing was the first time Prince had been released from his segregated prison unit in months.

A forensic hospital executive testified at the hearing that the treatment available in the prison program is limited and that Prince had been receiving drugs but not other therapeutic services that are typically part of the retraining process.

The hospital executive also testified that the defendants are getting priority for a bed at the Vinita after defense attorneys filed a motion for a contempt hearing with the Mental Health Department for failing to treat the person at the state hospital.

The Department of Mental Health transported Prince to Vinita for treatment six days after the hearing before further testimony could take place in court.

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