Those referred for treatment in order to stand trial can wait behind bars longer than the sentence for the crime they’re charged with

Week after week, Barbara Vassis watches as her daughter sinks deeper into a delusional world while sitting in a Boulder, Colo., jail cell.

Vassis can still picture Erin Brown as a gifted artist and chef who bubbled with energy. But last summer the 32-year-old, who had long battled schizoaffective disorder and struggled with meth addiction, was charged with breaking into her mother’s home. Vassis said her daughter stole tools, electronics and other valuables, as well as her pickup truck.

Brown was found not competent to stand trial. A judge ordered that she receive inpatient psychiatric treatment so she could face the charges.

Nine months after her arrest, Colorado’s state hospitals still have no free bed for her.

An exploding number of mentally ill jail inmates is overwhelming space in psychiatric hospitals across the U.S., a Wall Street Journal analysis of state data shows. It is a mounting crisis as more inmates languish in jail without court-ordered treatment, not convicted and unable to stand trial.

Brown is among around 450 inmates in Colorado alone stuck in this situation, their condition often steadily deteriorating. She now writes rambling letters to her mother, saying she is finishing up details to save the universe and has met her husband, somebody named Brandon.

State mental-health and jail officials are frustrated but say they are struggling against a tide of people in crisis. “It’s such an inept system we are working in...She has been here 226 days, as of today,” the Boulder jail’s mental-health supervisor, Pam Levett, wrote to Vassis in April about her daughter.

The Journal queried all 50 states in March on the number of people accused of crimes who are waiting in jail for inpatient treatment so they can be stabilized enough to stand trial. Of the 39 states that provided complete data, 34 saw their wait lists for such treatment lengthen since before the pandemic. Many of the lists are triple or even quadruple what they were. In some cases, inmates are waiting behind bars longer than the maximum sentence for the crimes of which they’re accused.

In Texas, the number of jail inmates waiting for competency treatment has more than doubled since 2019 to 2,466. That is nearly a thousand more than the number of state psychiatric beds in operation.

Maryland had no jail inmates in 2019 waiting for psychiatric treatment to get them fit for trial. The number grew so high since then—126 as of earlier this year—that state health officials last September formed an “incident command system” to try to reduce it.

Oklahoma’s wait list grew so long that health officials recently scrapped it and began medicating mentally ill inmates in the jails, trying to restore them to competency for trial there.

Among causes of the logjam, the number of people accused of crimes and referred for psychiatric treatment rose as mental health worsened during the pandemic. Covid-related disruptions to community mental-health care and addiction treatment also contributed to more episodes leading to arrests, state officials and mental-health advocates say.

Unlike psychiatric hospitals, jails typically won’t or can’t force inmates to take medication. Prescriptions available in jails are often more limited, adjusting them is more complicated, and practitioners aren’t always on hand to monitor patients. Confinement and the presence of law enforcement can contribute to psychotic delusions, experts said.

Compounding the problem is a scarcity of behavioral-health services and workers that has grown dire, state leaders and mental-health advocates say.

At the Kentucky Correctional Psychiatric Center, staffing shortages mean that only 35 of the 87 beds for jail inmates needing treatment are in use.

In Texas, a new high-security psychiatric unit sat empty for six months because the state couldn’t find employees to open it. The unit has begun accepting patients, but only nine of 70 beds are available due to lack of staff, a state health spokeswoman said. Jail inmates in Texas wait an average of eight months for a state hospital bed, nearly double the time in January 2020.

Last November, a 32-year-old Missouri man set a Bible on fire on the steps of a St. Louis church.

The man—who had a pre-existing diagnosis of schizophrenia, according to his public defender—spent the next five months in jail waiting for a competency evaluation to see if he was fit for trial. That process is typically initiated by defense lawyers concerned about a client’s mental health.

The exam determined he was unable to understand the charges against him. He was placed on a wait list to be transferred to a state hospital for treatment to stabilize him sufficiently so his legal case could proceed.

The man is now among 229 inmates waiting for one of Missouri’s 897 psychiatric-hospital beds, all already occupied.

Given the six-months-plus that inmates are waiting for beds, he may spend more time in jail before getting treatment than the maximum one-year sentence for his misdemeanor charge for setting the fire, said his public defender, Susan Bauer. She said her client isn’t well enough to give her permission to share his name.

Bauer, who is also a licensed professional counselor, said she has seen her client’s delusions worsen while he waits in jail. Initially, he was clearly ill, she said, but she could converse with him. Now he is refusing to take medication, and a recent meeting ended with him banging on the jail doors and yelling at guards to chop off her head, Bauer said.

“The longer he stays in this state, the worse his prognosis becomes,” she said.

Jeanette Simmons, deputy division director at Missouri’s mental-health department, said the agency faced severe staffing shortages during the pandemic alongside nonstop court orders for competency treatment. The state is adding 40 beds to treat more inmates. “Currently, what we’re doing is not sustainable,” Simmons said.

Inmates who are declared fit for trial after a competency evaluation, and those successfully restored for trial in state hospitals, sometimes regress while then waiting in jail for their cases to be heard, counselors said. That triggers the entire process to restart.

In Kentucky, defense lawyers said that a few years ago, their clients could typically get competency evaluations within 60 days of an arrest. Now it can take 10 to 12 months in jail waiting just for that initial assessment, they said.

In central Appalachia, a Kentucky man named Bobby Kilbourne Jr. was arrested in late 2019 after police responded to a call he had made saying he was a federal marshal and was being shot at.

He was declared fit for trial after an evaluation at the state’s correctional psychiatric hospital, but his case was pushed back, and he remained in jail.

In July 2021, 20 months after his arrest, his father, Bobby Kilbourne Sr., sent the jail a handwritten letter saying his son had been diagnosed with bipolar disorder and schizophrenia, wasn’t able to access his medications behind bars and needed to be sent back to the psychiatric hospital.

The father wrote that he had talked to a judge, who he said told him “Bobby don’t need to be in jail. But there are no places around here to help him.”

“I hope you read this,” the father wrote.

A few days later, another competency evaluation was ordered. This time, the son waited more than a year before being sent to the psychiatric hospital for the evaluation. He was kept there for weeks of treatment and then declared competent a second time.

In January, Kilbourne Jr. was released from jail under the condition that he receive outpatient treatment for mental health and substance abuse for one year, after agreeing to a pretrial diversion program.

Reached by phone, he said his “mental health has nothing to do with me being a federal agent” before hanging up. His father said in an interview that someone had indeed shot at his son before he was arrested. Kilbourne Sr. said his son should have been hospitalized instead of jailed.

The son’s release came more than three years after his arrest.

“He’d been waiting in jail all this time on a crime he’d not been convicted of,” said Bill Melton, a public defender who represented him.

Kentucky health officials didn’t respond to requests for comment.

Health officials in Oklahoma, facing a wait list for state-hospital beds that had jumped to 280 from 41 in 2019, plus a critical report by a legal advocacy group, switched last December to medicating mentally ill inmates in jail. Inmates now may or may not receive inpatient care as part of their state treatment. Thus, the state says, there no longer is a wait list for the state hospital.

“The main reason people are incompetent due to mental illness is due to psychosis, and you treat that with medication,” said Duran Crosby, chief of staff and operations for the state mental-health department.

He said starting medications quickly and keeping them consistent is more important than transferring someone to a hospital. “It’s much cheaper in the long run, and it’s better for the patient too,” he said.

In Tulsa, the new strategy has infuriated prosecutors, defense attorneys, mental-health-care advocates and law-enforcement personnel, who say the state is dumping the problem on local authorities and trying to avoid litigation. Representatives of four jail inmates sued the state in March alleging unconstitutional delays in competency treatment.

Tulsa County District Attorney Steve Kunzweiler and Chief Public Defender Corbin Brewster, both critics of the new policy, meet regularly to discuss defendants whose lawyers have raised competency concerns. Their offices share a color-coded spreadsheet of cases. While the state says there’s no longer a waiting list for competency treatment, the two track where they believe defendants would be in a queue for such treatment in a hospital.

The issue is personal for Kunzweiler. In September, his 31-year-old daughter, Jennifer Kunzweiler, was arrested after she stabbed him, and herself, several times during a psychotic episode. Both were hospitalized.

She was declared fit to stand trial, spent four months in jail and then was found not guilty by reason of mental illness before being committed to the state hospital.

The D.A., a Republican, said the episode heightened his concern for mentally ill jail inmates and left him angry that the state wasn’t pushing to fund treatment in medical settings. “I can’t help being frustrated, as a parent and a taxpayer and prosecutor and a Catholic,” he said.

In the Tulsa County jail, the sickest men are isolated in individual cells, some with posted memos warning that the occupant is “highly assaultive” or “will spit on you.” A back row of cells holds those deemed suicidal, naked and watched by a guard.

On an April morning, some inmates lay motionless in their beds and others sat staring into space, several with trash or crushed food containers shoved up against cell doors.

The 41-year-old man in cell V1 first waved at visitors, then motioned no, furrowed his eyebrows, began talking to himself and dropped his jumpsuit pants.

Accused in 2021 of obstructing a police officer and grabbing a woman’s behind, the man had been waiting in jail 418 days since a judge ordered him transferred to the state hospital for an attempt to restore his competency for trial, according to documents provided by defense attorneys.

Sheriff Vic Regalado, a Republican whose office runs the county jail, said it was no place for people so sick.

“We currently run the largest mental-health facility in the state of Oklahoma and it’s in a jail, and that’s just wrong,” he said.

Several states are under federal court orders or agreements, some from well before the pandemic, to accelerate competency treatment. The surge in mentally ill inmates has made it impossible to meet the mandates.

In Washington, a federal judge in 2015 ordered the state to hospitalize jail inmates for competency-restoration treatment within seven days of a court order. According to the state health department, wait times currently range from about four months to nearly 11 months.

The Washington health department said it has invested hundreds of millions of dollars in new bed capacity. Legislation signed by Democratic Gov. Jay Inslee on May 15 would add mental-health workers in jails to expedite restoration. Inslee said the number of inmates needing competency treatment had grown unmanageable.

Colorado, which has been under a 2019 federal court agreement to speed competency treatment, has since paid $29.7 million in fines for failing to reduce wait times. The money is distributed to mental-health programs aimed at decreasing the backlog.

Leora Joseph, a former prosecutor who heads Colorado’s Office of Civil and Forensic Mental Health, said many jail inmates waiting to have their competency for trial restored in a state hospital are low-level offenders, and about half are homeless. She said the state is seeking to join with private facilities to add beds and is offering bonuses to hire more mental-health nurses.

“We have about 460 people waiting in jail. They haven’t been adjudicated yet, and they’re really sick,” she said earlier this year.

Barbara Vassis, the mother of Erin Brown, spends a chunk of her week sifting through options for her jailed daughter. There’s a chance of getting her released to a community treatment facility that could help restore her competency outside of jail. But beds are rarely available there, and Brown has to consent to go, Vassis said she was told.

Levett, the Boulder jail’s mental health supervisor, said she’d been informed that Brown may finally get admitted to a state hospital soon.

“246, 253, 223, 302…” she said, rattling off the number of days inmates have been waiting for a state-hospital bed. “It’s heart-wrenching for us because we feel hopeless.”

Vassis, a retired state education administrator, said that on a recent video call from jail her daughter appeared worse than she’d ever seen her, talking about how she’d soon be taken to a palace with gold laces, her voice trailing off midsentence.

Vassis still believes Brown could one day be a productive member of society. She doubted her daughter would ever be ruled competent to stand trial until she was out of jail and in a mental-health facility.

“How long does this cycle continue?” she said.