DHHS opposes injunction in jail mental health lawsuit

North Carolina Department of Health and Human Services Secretary Kody Kinsley (Image from ncdhhs.gov)

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  • The state Department of Health and Human Services opposes an injunction in a federal lawsuit targeting mental health services for inmates in county jails.
  • Disability Rights North Carolina filed suit in April against DHHS and Secretary Kody Kinsley. The suit cites a "statewide crisis" in getting inmates timely access to mental health services.
  • Lawyers for DHHS respond that the delays are tied to a national problem stemming from the COVID-19 pandemic. DHHS argues that wait times have decreased since 2022.

The state Department of Health and Human Services opposes an injunction in a federal lawsuit targeting mental health services for inmates in county jails. The suit labels the situation a “statewide crisis.”

Critics contend that inmates languish in county jails for months before getting required services. Affected inmates are admitted to the state’s three psychiatric hospitals through a process known as “incapacity to proceed.”

“At present, the demand for ITP assessment and restoration treatment greatly exceeds the available supply in North Carolina,” state Justice Department lawyers wrote in a court filing Monday. Those lawyers represent DHHS and Secretary Kody Kinsley.

“Due to factors beyond anyone’s control, stemming in large part from the COVID-19 pandemic, ITP wait times are a ‘national crisis,’ and Plaintiff’s expert says North Carolina ‘is not alone in facing such challenges.’ In many states, ITP detainees must be put on waiting lists,” state lawyers wrote.

“DHHS alone did not cause and cannot reduce ITP wait times,” the court filing continued. “It is undisputed that reductions require collaboration among multiple stakeholders (including state court judges and clerks, the Administrative Office of the Courts, District Attorneys, the county jails and jail officials, the local sheriffs, and DHHS).”

“But DHHS remains deeply committed to reducing ITP wait times,” Justice Department lawyers wrote. “In close partnership with stakeholders across the State, DHHS already is pursuing multiple initiatives to reduce wait times. This work shows positive results – wait times are trending down. Currently, the median wait time is 16 days for a detainee to receive an ITP assessment (down from 33 days in 2022).”

“The median and median wait time for admission to two of the [state psychiatric hospitals] also is coming down, and number of individuals on the waiting list has been reduced from 213 in June 2023 to 148 today. These initiatives are working, and DHHS expects that wait times will continue to improve,” the court filing continued.

“In contrast, Plaintiff seeks a drastic remedy that is not feasible at the present time,” state lawyers wrote. “If this Court ordered a 14-day mandate for ‘completed capacity restorations’ and ‘access to restorative treatment or initiation of IVC treatment,’ as Plaintiff demands, this ‘would have catastrophic effects on the behavioral health system in North Carolina’ and ITP detainees.”

The suit filed in April blames DHHS and Kinsley for the delayed services for jailed inmates.

“Under the Fourteenth Amendment’s Due Process Clause, a person with a mental health disability who is charged with a crime and detained ‘solely on account of his incapacity to proceed to trial cannot be held more than the reasonable period of time necessary to determine whether there is a substantial probability that he will attain that capacity in the foreseeable future,’” wrote lawyers representing Disability Rights North Carolina, the group that filed suit.

“In violation of this bedrock principle, North Carolinians with serious mental health disabilities and other cognitive disabilities are languishing in jails for months, and in some severe cases, years at a time,” the complaint continued. “Their prolonged detention extends well beyond what is reasonable under the circumstances for an evaluation and determination of whether they possess the requisite mental capacity to proceed to trial.”

The lawsuit aims “to reduce the profoundly harmful and unconstitutionally prolonged detention times.”

DHHS “is systemically violating the Fourteenth Amendment, [Americans With Disabilities Act], and [Rehabilitation Act] by failing to provide capacity assessments and restoration services to pretrial detainees who are suspected of, or adjudicated to be, incapable to proceed (collectively, “ITP detainees”), in a timely and adequate manner,” according to the complaint.

Disability Rights points to two main problems. First, people “who have been charged with a crime and had their capacity to stand trial questioned often spend months waiting for a capacity assessment by Local Management Entities/Managed Care Organizations (“LME/MCOs”) or Central Regional Hospital (“Central Regional”).”

“Second, individuals in North Carolina who have been charged with a crime, adjudicated incapable to proceed to trial, and ordered to a state psychiatric hospital to undergo an involuntary commitment examination or capacity restoration services wait months for bed space necessary to receive these court-ordered services,” the complaint alleged.

Detainees “wait an average of two months for their capacity assessment to be completed and nearly five months for treatment at a state psychiatric hospital,” according to the suit.  In contrast, the average wait time for a capacity assessment in Virginia is seven days.

Because of long wait times, some “detainees spend more time in pretrial detention awaiting a capacity assessment and subsequent treatment than they ever would receive as a sentence if convicted.”

The number of state beds for mental health treatment has dropped from 892 to 453 in the last seven years, the lawsuit argued. Of the remaining beds, “about 35% are occupied by individuals who are ready for discharge but unable to leave,” according to the suit. “Most often in these instances, individuals who are ready for discharge are unable to be discharged because of a lack of appropriate services available in the community.”

Disability Rights blames DHHS for failing to ensure “that LME/MCOs fulfill their statutory and contractual duties to develop and maintain adequate provider networks in the community.”

“County jails are intense and stress-inducing environments, generally not suitable for those diagnosed with any kind of debilitating ailment, let alone severe mental health disabilities,” the lawsuit contended. “Prolonged detention in such environments can lead ITP detainees to experience a further decline in mental health, which can result in self-harm and threats to ITP detainee safety.”

“This is a statewide crisis. NCDHHS’s mismanagement and failure to provide essential mental health services on a timely basis exacerbates existing problems and inflicts cruel and unusual pain and suffering on ITP detainees who wait at length for the services NCDHHS is legally obligated to provide,” Disability Rights’ lawyers argued.