Incompetent to stand trial: A backlog of cases is straining Louisiana’s mental health system

The number of people in East Baton Rouge Parish who were ruled incompetent to stand trial more than doubled between 2020 and 2022, court records show, straining a mental health system that was already dealing with overcrowding.

In 2020, 35 defendants were ruled incompetent to stand trial in East Baton Rouge Parish, and 41 were ruled incompetent in 2021. In 2022, the number grew to 73.

Chief Judge Don Johnson blames COVID shutdowns for the increase.

“We closed the court around March 2020, and then of course we weren’t able to do some work for a while,” he said. “These individuals have to be evaluated by doctors and psychologists, who were also not able to work during that time. It’s problematic when we’re not able to get those individuals involved. It causes delays.”

As of April, 157 people were on the waitlist for a bed at the hospital. Many have languished in local jails while waiting for a place there, which has led to a federal lawsuit.

“This is something very important to the state and we need to do something about it to get them out of local jails,” said Commissioner of the Administration Jay Dardenne. “The state is under a lot of pressure from a lawsuit standpoint and federal justice department standpoint to find a place for those folks to land.”

To create more space and try to get patients out of jails, state officials have been pushing to open a new treatment facility in the Baton Rouge area. But Harmony Health Services, the organization contracted to open and run that facility, has faced fierce pushback from nearby residents concerned for their safety and property values — first in Baton Rouge, then in East Feliciana. 

How competency hearings work

When someone is ruled incompetent to stand trial, it means they do not have the mental capacity to understand the charges against them or assist their lawyer in their defense.

“When you’re arrested there’s a presumption that you are competent, and it’s your burden as a defendant to show you lack competency,” Judge Johnson said. 

Defendants could be suffering short- or long-term mental incapacity, or permanent mental illness.

“That’s the purpose of ordering a competency evaluation,” Johnson said.

During the evaluation, which is like a mental health assessment, psychiatrists and other experts provide evidence for a judge to evaluate.

“We engage in a very challenging process,” Johnson said. “The court has an obligation that if the defendant is exhibiting behavior that appears to be irrational, we’re required to act.”

Sometimes, based on observation, judges will themselves order a competency evaluation before a defendant or lawyer does so.

“We do that early on, so we don’t have to wait until it gets to court,” he said.

If the evaluation finds the defendant is incompetent, they are taken to a state-run facility to be treated until they are competent. They are often ordered to stay in the facility, depending on the nature and level of the offense.

Most of the time, Johnson said, the person is able to get treatment and medication and is later ruled competent to stand trial.

Hurricanes and pandemics: a pile-on crisis

The backlog in competency hearings is not the only factor driving the overcrowding in mental health facilities, some state leaders say. The pandemic could generally exacerbated mental health issues across Louisiana and the country.

“Over the past few years, COVID and hurricanes and storms and floods and the opioid crisis have caused major challenges,” said Louisiana Department of Health Office of Behavioral Health Medical Director James Hussey

Hurricane Laura, for example, hit rural areas in the middle of the pandemic.

“We had all of these refugees who just got spread across the state,” said Kevin Litten, press secretary at LDH. “A lot of people fleeing from hurricanes are poor people, and poor people are more likely to be in a mental health crisis.”

The Bridge Center for Hope, a taxpayer-funded crisis mental health center in Baton Rouge, said in its 2022 annual report that Hurricane Ida also contributed to mental health issues.

Overcrowding isn’t only an issue in Louisiana. In Colorado, around 450 people were ruled incompetent to stand trial, but are waiting in county jails for a bed in a facility that can provide inpatient psychiatric treatment, according to a Wall Street Journal analysis. In Texas, the number of jail inmates waiting for competency treatment is 2,466.

The analysis found that 34 out of 39 states that submitted data have longer wait lists than before the pandemic.

Judge Johnson said despite backlash from residents who don’t want mental health patients living near them, and despite the backlog of cases, competency evaluations are a critical part of the judicial system.

“If your family member is suffering with a mental illness and you do not believe that we’re aware of it, then come to assist your loved one and let us know. It has to be made known, and it has to be real of course. But if that is an issue, we want to know about it, because we’re not in the mindset of ignoring that issue.”