Times Observer photo by Josh Cotton The Warren State Hospital currently houses about 140 patients and is certified to care for 152.

Local officials have been critical of a lack of state-provided mental health services for county residents convicted of crimes.

But state Department of Human Services officials say the problem isn’t the Commonwealth’s to solve. Instead, counties should be taking the lead to make sure those convicted of crimes have the mental health programs inmates need to prepare for life after their jail sentence is completed.

The situation came to a head recently when a Warren woman was sentenced to nearly four years in state prison last month. The charges stemmed from multiple assaults against staff at Warren State Hospital. One victim sustained a traumatic brain injury.

Both District Attorney Rob Greene and Chief Public Defender Kord Kinney were highly critical of the state’s ability to meet her psychiatric needs. Kinney detailed his client’s history that includes a litany of psychiatric institution admissions, state prison and state hospital commitments, explaining that his client is a “sick individual” and that the state may have violated both her civil and human rights by failing to provide appropriate treatment.

Greene was particularly critical of the state’s decision to close the forensic unit at the Warren State Hospital, a decision made over a decade ago.

Greene said the situation is the “impact of the legislature closing forensic units …. We deal with it every day.”

Ali Fogarty, state Department of Human Services communications director, told the Times Observer that the closures shouldn’t mean there aren’t services available. Rather than rely on the state, she said it is the state’s position that county programs be put in place with funding support from the state.

“The state hospitals are not intended to be, or resourced to be, first-level psychiatric care for anyone with any behavioral health need entering the criminal justice system,” Fogarty said. “We understand the need for greater county-level supports for people with mental illness in the county justice system, and we support efforts to increase funding to county-level mental health programs.”

MAINTAINING A BALANCE

Understanding the apparent disconnect that emerged in the criminal case requires understanding how the state hospital process works and who it is intended to serve.

“Warren State Hospital is a civil psychiatric hospital that serves Warren County and 12 other counties in Northwest Pennsylvania,” Fogarty explained. “Admissions to the hospital are made at the recommendation of private inpatient psychiatric hospitals for individuals who need ongoing, long-term psychiatric care and treatment. Admissions must be approved by the mental health authority for the patient’s home county.”

There are currently 143 patients at the state hospital. Maximum capacity is 152.

Fogarty discussed the “balance” that officials try to strike when it comes to determining when the conduct of a patient crosses the line from a side-effect of their mental illness to criminal conduct.

“We must maintain a balance between rights maintained by our staff and care and safety of both patients and staff,” she said. “There is not one procedure or criteria in place.”

However, she stressed that it’s their mission to “maintain a trauma-informed approach and recovery-oriented approach to care that provides a supportive, compassionate environment for patients and promotes safety for all working and residing in our state hospitals.”

The state stays involved when a patient is incarcerated, “but the exact role depends on the individual’s circumstances and length of incarceration,” she explained.

“Involvement could include medication management, continued engagement in an individual’s treatment plan, or a full return to their residential placement at the hospital.”

The Warren County Jail has at times been referred to at times as “Warren State Hospital South,” a place for criminally-ill mental patients to do without the specialized skills needed to meet those needs. That was a factor in the sentencing last month when the defendant herself told the court she was being kept in isolation while serving a 30-day county prison sentence on another state hospital assault case. Population at the state hospital is a fraction today compared to its high of more than 2,500 patients in the late-1940s.

‘BETWEEN A ROCK AND A HARD PLACE’

Greene was particularly critical of the state’s decision to close the forensic unit at the Warren State Hospital, a decision made over a decade ago.

“We deal with it on a daily basis,” Greene told the court, citing an eight-month waiting list to get into the remaining units. “In the meantime, people are getting hurt. Everyone is caught between a rock and a hard place.”

Greene had said there was an eight-month wait for admission to the remaining forensic units, but Fogarty said the average wait time to Norristown State Hospital is eight days and 30 days for Torrance State Hospital.

But long-term treatment for those convicted of crimes isn’t the purpose of those units.

“The state’s forensic units exist for pre-trial competency restoration,” Fogarty said, “or, if that is determined to not be possible, long-term treatment for people requiring ongoing psychiatric care.

“Psychiatric competency is a legal threshold, and having a mental illness or ongoing behavioral health needs does not automatically mean that they are not competent.”

And it’s the behavioral issues that complicated last month’s sentencing.

President Judge Maureen Skerda acknowledged that the situation generally “is tragic” but cited that there are also behavior issues at play.

“I don’t think any system addresses all your needs,” she told the defendant.

Fogarty insisted that the mental health of jail or prison inmates is not a role of the state-operated mental health hospital system.

“Counties should be coordinating necessary supports for people in their custody,” she said, “and that is why Pennsylvania’s Behavioral Health Commission for Adult Mental Health is recommending an investment in criminal justice and public safety supports as primary method of allocating $100 million for mental health services included in the 2022-2023 budget.”