On any given day within the Bexar County Jail, over 100 inmates aren’t ready for a lawyer or a courtroom date. They’re ready for a hospital mattress.
Some have already spent months behind bars, discovered incompetent to face trial and wrestle with psychological sickness. Stabilized with treatment inside a cell, they continue to be in limbo as a result of Texas doesn’t have sufficient forensic psychiatric beds — safe hospital beds reserved for legal defendants who want mental-health therapy earlier than their case can transfer ahead.
In Texas, a defendant is deemed incompetent to face trial when a decide finds they’ll’t perceive the costs or assist their lawyer on account of psychological sickness or mental incapacity. This pauses the case till competency restoration — the therapy course of that makes use of treatment, remedy and court-education to return somebody to trial readiness — is accomplished, which often occurs in a state psychiatric hospital.
However house is tight and the wait is lengthy.
Information from the Texas Well being and Human Providers Fee exhibits that between August 2024 and August 2025, a mean of two,058 defendants statewide have been on the forensic hospital waitlist every month. In Bexar County, the month-to-month common was 152.
These numbers cowl three teams: maximum-security sufferers — typically defendants with violent expenses who require essentially the most restrictive hospital setting; non-maximum-security sufferers, together with folks jailed on lower-level offenses, together with misdemeanors; and people discovered not responsible by purpose of madness.
The typical wait time throughout Texas is staggering. In Bexar County, the typical waits are 287 days for maximum-security inmates. And for non-maximum-security inmates it’s 277 days, which is a couple of month longer than the state common.
In Texas, the utmost sentence for a Class B misdemeanor is 180 days in jail; for a Class A, as much as one 12 months. For some non-maximum-security defendants discovered incompetent on misdemeanor expenses, the await a hospital mattress will be longer than the sentence itself.
When that occurs, defendants legally trip — reaching the utmost interval of confinement with out being restored — and instances are dismissed, typically with referrals to civil or outpatient therapy.
With so many caught on this cycle, a lot of the duty for psychological well being care falls again onto the jail itself.
Presently, the county’s psychological well being authority, Middle for Well being Care Providers (CHCS), and the county hospital district, College Well being, run the psychological well being providers inside the ability, starting with screenings as quickly as an individual is booked.
On the Justice Consumption and Evaluation Annex, CHCS supplies psychological well being screenings. Each inmate is requested about previous diagnoses, hospitalizations and coverings. When an inmate leaves the annex to be housed within the jail, CHCS communicates their must College Well being workers, which then assumes their care.
College Well being initiates therapy plans at reserving — typically persevering with current prescriptions and making referrals to psychiatry suppliers contained in the jail.
It’s an enormous operation. The jail has 52 acute psychological well being beds and 348 secure psychological well being beds, and on a mean day, about 550 inmates are underneath psychological well being care, based on knowledge supplied by College Well being.
Meaning the jail is treating extra sufferers every day than the newly rebuilt San Antonio State Hospital, which opened in April 2024 and has 268 on-line beds out of its deliberate 300. The remaining 32 beds are offline or not in use on account of development, upkeep, staffing and different points, based on state officers.
For defendants discovered incompetent to face trial, that care continues contained in the jail whereas they await a state hospital mattress.
“Sufferers awaiting competency restoration are handled by psychiatric suppliers who devise therapy plans that embrace psychiatric visits, drugs, assessments and diagnostic testing,” mentioned Elizabeth Allen, College Well being’s director of exterior communications in an e-mail.
As of Aug. 12, College Well being reported 145 inmates within the Bexar County Jail have been ready for a forensic mattress in a state hospital. County officers have turned to a stopgap: a jail-based competency restoration program meant to maintain defendants from languishing on the waitlist.
Two years in the past, CHCS launched the primary such program in Bexar County geared toward restoring defendants to competency contained in the jail quite than ready months — and even years — for a hospital switch.
“Once we first began this system again in 2023, there had been people that had been right here for a 12 months and a half, two years,” mentioned Nicole Bermejillo, medical administrator of this system. “Simply merely ready to get to the state hospital.”
This system started serving as much as 12 folks. With federal grant cash and later state funding, CHCS expanded this system in 2024 to incorporate ladies within the annex and as much as 18 members at a time.
Bermejillo mentioned the outcomes present progress. “This previous fiscal 12 months, we served 61 people,” she mentioned. “Out of these, 35 have been both restored or had their expenses dismissed — 31 restorations and 4 dismissals. Our common restoration price proper now could be about 55%, which can also be the state’s customary.”
On common, defendants in Bexar County’s jail-based competency program spend about 95 days from the time they’re courtroom ordered into this system earlier than being restored or having their instances dismissed, Bermejillo mentioned.
Against this, defendants with courtroom orders for competency restoration to state hospitals spend a mean of 240 to 300 days simply ready for a mattress to open up earlier than therapy even begins, based on HHSC knowledge.
Individuals within the county program stay on the state waitlist simply in case they should be transferred later — guaranteeing they don’t lose their place.
Even with these positive aspects, this system faces limits. Its cap of 18 members is a drop within the bucket in contrast with the practically 150 inmates ready for competency restoration.
And whereas it has proven success with felony instances, it has but to revive a single misdemeanor defendant.
“We’ve not but restored efficiently, a misdemeanor,” Bermejillo mentioned.“ We’ve truly labored actually intently with the district lawyer’s workplace to get some dismissals for these misdemeanors and coordinating entry with them into civil outpatient commitments to proceed psychological well being therapy locally.”
With the jail-based program solely reaching a fraction of the folks ready, some advocates say the very concept of restoring competency inside a jail factors to a deeper flaw within the system.
“This isn’t psychological well being care — it’s simply stabilizing folks sufficient to get them by way of courtroom,” mentioned Krishnaveni Gundu, co-founder and government director of the Texas Jail Venture, a nonprofit group that advocates for and with folks incarcerated in Texas county jails and their family members.
She described Texas jails because the state’s “de facto psychiatric establishments,” housing hundreds of people that would possibly in any other case be handled in hospitals or group packages.
Gundu warned that increasing jail-based packages dangers deepening that pattern.
“As an alternative of investing in disaster facilities and step-down amenities locally, the state is pouring cash into jails,” she mentioned. “We’re criminalizing sickness, homelessness and poverty, after which asking correctional officers to handle circumstances they have been by no means educated to deal with.”
She added that lengthy waits for competency restoration exemplify how the system punishes folks for being sick quite than providing well timed care.
“We’ve constructed a revolving door the place folks cycle by way of jails,” Gundu mentioned.”They get simply sufficient therapy to return to courtroom, after which return once more when their sickness flares up.”
Her critique comes as state officers level to new capability on the horizon. The state is working so as to add 193 new forensic psychiatric beds throughout Texas, together with 70 in rural communities.
Nonetheless, the typical statewide forensic waitlist has hovered above 2,000 folks a month for the previous 12 months — together with greater than 150 from Bexar County alone.
