Lawsuit: PA Denying Timely Treatment and Trial for Mentally Ill Defendants

ACLU says many patients languish in jail for more than a year before receiving the health care treatment needed to stand trial.


In July of 2014, a homeless, schizophrenic man smuggled three Peppermint Patty candies from a Philadelphia-area dollar store. Criminally charged with retail theft and deemed “incompetent to stand trial” by the city’s court system, J.H. was sent to Norristown State Hospital to undergo “competency restoration treatment” — care that would, at best, render him ready to take the stand.

But J.H. never made it to treatment. He’s still waiting in county jail – without access to medication or therapy – where he’s been for over 11 months. And given the messy current state of Pennsylvania’s mental health system, it’s likely he’ll be there for a while longer.

Competency restoration treatment is an amalgam of medication, therapy, and coaching about the legal system. The idea is that it can prepare patients to communicate effectively when they get their day in court.

According to a class-action federal lawsuit filed yesterday by the ACLU of Pennsylvania on behalf of J.H. and 10 other plaintiffs, there are at least 200 people awaiting competency restoration treatment in Pennsylvania jails. The lawsuit claims that, on average, pre-hospitalization sentences run 391 days, and that one patient was stuck in jail for almost two years. The suit further claims that two patients have died in jails awaiting competency restoration treatment – one by suicide, and one by murder.

“Federal courts have ruled that delays of more than seven days from the court’s commitment order to hospitalization for treatment are unconstitutional,” the lawsuit says, naming Pennsylvania Department of Human Services secretary Ted Dallas, along with the CEOs of the only two hospitals licensed to provide competency restoration treatment, as defendants.

The suit follows a 15-month ACLU investigation into what co-lead counsel on the case, Witold Walczak, calls the “black box” of the state’s competency treatment program. “DHS hasn’t been very forthcoming with information thus far,” he told us, adding that the upcoming discovery process will probably reveal more.

The problem as it stands is that between the two hospitals, there just aren’t enough beds to accommodate the patients who need them. And the wait lists appear to be growing at an alarming rate: records obtained by the ACLU show that, at Norristown, the wait list has jumped from 121 on August 21st to 174 yesterday.

Alyssa Schatz, director of advocacy and policy at the Mental Health Association of Southeastern Pennsylvania, believes that efforts to reduce overcrowding should be preventative and come much earlier in the street-to-jail pipeline, long before the vulnerable commit crimes.

She points to the negative impact of community-based services cuts made in 2012 under the Corbett administration, like the elimination of the state’s general assistance program, which gave $205 a month to those in drug and alcohol treatment programs, those with disabilities, and others. From 2014 to 2015, soon after those cuts were implemented, Philadelphia saw a 179 percent increase in its street-residing homeless population, according to data collected by the Mental Health Association.

“It has this ripple effect in our community,” Schatz says, adding that Governor Wolf has proposed the restoration of such funding. Thus far though, his efforts haven’t made substantial progress within the General Assembly.

Although news articles, court challenges, and interviews with experts have led Walczak to believe that Pennsylvania, and Philadelphia in particular, have some of the longest delays in the country, protracted wait times at competency restoration treatment programs due to overcrowding probably aren’t unique to our state. According to the Washington Post, in 2012, over 350,000 mentally ill patients resided in American prisons – that’s more than the population of Pittsburgh.

Kait Gillis, press secretary at the Pennsylvania Department of Human Services, told the Inquirer yesterday that since Gov. Wolf took office in January, his administration has had its eye on the state’s “long-standing issues regarding forensic services.”

“While we cannot comment on pending litigation, the department has been working with the courts and other stakeholders to improve services at our forensic units since that time,” she said.

When we pressed Gillis for details about the efforts, she emailed us what amounted to a mere revision of her earlier statement: “Every day we work with all stakeholders, including the courts, district attorneys, and public defenders, to help ensure that the entire system effectively provides the services that these individuals require,” she said. “Every day we work toward enhancing the services we provide.”

Walczak guesses that the issue at hand will turn out to be – as it so often is – resources. “But saying we don’t have enough money is not a defense to a constitutional violation.”

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  • cameo

    Not to fault the journalist, but this article discusses the severely mentally ill and putting them on trial without the bat of an eyelash. This is the end product of the
    criminalization of psychotic systomatic behaviors and just plain ignorance
    about psychotic diseases. Schizophrenia, Bi-Polar with psychosis, and Depression with psychotic features are not “personality disorders”, or “mental problems”, or “mental instability” as the media so often characterizes severe mental illness.
    This confusion is what leads to hybrid judgments such as in the Holmes
    case…where the accused is found guilty but then sentenced under so-called “mitigating factors. No one who truly understands the catastrophically-altered waking consciousness present in psychosis would find the accused culpable. Moreover, medical practitioners and prosecutors promote the false notion that a
    delineating line can be divined to arbitrarily determine that a person is
    psychotic one moment and sane the next. This is impossible. Period. That is why someone with a severe psychotic disease should not be prosecuted in the way that they are in this country.

    The way I see things, there should be no such thing as a forensic hospital –
    just a secured, specialized hospital. This sounds outlandish to most
    people because they have been conditioned by society to believe that the
    existence of forensic hospitals is perfectly normal.

    At a time when scientists are very slowly making discoveries about the human brain/the mind, the general public retreats further and further into ignorance about the nature of psychosis. So far, I have traced the beginning of the backlash against the insanity defense to the Victorian era. In this modern era, there was a renewed backlash in 1984 with the Insanity Defense Reform Act. I also blame the deeply entrenched ignorance about psychosis and culpability to the pernicious infiltration of forensic psychiatry, the fervent resistance of peer advocates and mental health practitioners who I deem to be “on the spectrum”, with some cognitive incapacity that I call “objective anosognosia”. Some of these people are not able
    to cognitively process psychotic disorders and having genetic causation –
    despite the highly heritable nature of diseases such as Schizophrenia and
    Bi-Polar. No amount of evidence or scientific discovery can modify their flawed

    I blame the psychiatric profession (which harbors plenty of objective
    anosognostics) for allowing medically trained doctors to call themselves
    “forensic” psychiatrists or psychologists. If this is the conceptual thinking of these “professionals” they should call themselves criminologists – not psychiatrists. The “forensic” psychiatrists, and even less qualified, “forensic” psychologists, along with
    the ones holding on with a death grip to discredited theories and narratives of
    the angry narcissistic shooter who just wants attention and glory, i.e. the
    quack Freudians, need to be shunned by real medical doctors. The media, judges, and prosecutors have plenty enough work for these quacks.

    It is a slap in the face to real medical doctors to have to be challenged by this quackery in courtrooms as they find themselves working against a brick wall of misconceptions (formalized in the defective and fallacious M’Naghten’s Rule), to desperately attempt to help jurors to comprehend psychosis as vengeful prosecutors seek to incarcerate, or even put to death their clients. Society
    has bullied and threatened those who even dare try to tell the truth about the
    medical condition of their clients, so this defense is rarely even attempted. It would seem to be amazing that jurors ever do find defendants not guilty by reason of insanity (a contrived legal word). However, what I think is that they are
    judging based on their instincts, not the reality of the medical state of the
    accused. How many times have I read the intuitive judgment that accused ‘had to be insane to do what he or she did’. This is pure gut instinct – not reality – not
    medical science. The same jury might find someone just as gravely ill to have ‘known what they were doing’ – based on their ignorance of the acutely complex nature of psychosis.