Mentally ill overwhelming budgets for courts, jails

A backlog of court-ordered competency evaluations at South Dakota's state mental hospital is forcing counties to pay five to 10 times more for exams by private psychiatrists.

The delays are also adding costs for the state's largest jails as mentally ill defendants wait weeks or months to find out if they are mentally competent enough for their cases to move forward.

"It's a heavy burden," Minnehaha County Commissioner Jeff Barth said. "The state hospital has emptied out and those people are now in our jail or in prison."

An Argus Leader Media investigation found mentally ill defendants being jailed for months before trial due to a lack of funding and psychiatrists to conduct court-ordered competency evaluations.

VIDEO: Interactive #100Eyes show takes a look at the special report on the mentally ill in the court system at 3 p.m. Monday. Watch here.

Argus Leader investigation: Locked in Limbo

South Dakota's state mental health facility, the Human Services Center in Yankton, will perform 36 evaluations per year, but the court system requested nearly quadruple that many last year.

"Our staff and our capacity, at the moment, is to provide in-patient care," said Amy Iverson-Pollreisz, deputy secretary of the Department of Social Services.

Minnehaha County is among those trying to shorten wait time for mentally ill defendants by hiring private psychiatrists. Of the 60 adult competency evaluations the county paid for in 2014, only 16 were done by the state. Forty-four were completed by private psychiatrists.

The county signed a contract with Avera McKennan in June 2014 to take some of the county's competency evaluation workload. The move helped shorten wait times for some defendants, but it has come at a price. The state charges counties a flat $600 for evaluations, while private doctors typically charge an hourly rate with final bills ranging from $700 to $7,500 per exam.

The county spent more than $100,000 last year paying for private evaluations to speed up the evaluation process.

"We had to get them done – we had to do something," said Commissioner Cindy Heiberger, who signed the contract with Avera on the county's behalf. She said the commission noticed wait times were excessively long and wanted to speed it up.

The problem is adding strain to Minnehaha County's already stressed jail budget. A typical inmate costs taxpayers about $80 per day, not including medication. In one case, for example, James Marken sat in jail for 212 days, most of which was waiting for a competency evaluation. The cost to taxpayers: about $17,000, not counting his medical care.

Heiberger said to fix the problem of people unnecessarily sitting in jail, the county will have to go back to the drawing board to find a more permanent solution.

Psychiatrist shortage worsens court bottleneck

The Minnehaha County jail has a mental ward with a two-person medical staff that offers limited services to inmates. The focus is strictly medication management, Warden Jeff Gromer said. They aim to make sure people don't hurt themselves, but they can't provide counseling services or tailored recovery plans.

"This is not a treatment facility. This is not a mental health therapeutic facility. This is a jail," Gromer said.

Commissioner Barth estimated the county spends hundreds of thousands of dollars addressing the needs of mentally ill defendants waiting in jail for their cases to proceed. It's reaching a boiling point, he said, and he thinks the state needs to do more to help.

It's the same story in Pennington County, where Sheriff Kevin Thom said South Dakota's second-largest jail is also burdened with a growing expense from mental health delays in the court system.

Thom said cities, counties and the state need to work together to find a solution.

"Although there are statutory obligations, there are also moral obligations," Thom said. "We have a lot of mental health issues that need to be addressed."

Competency delays threaten defendants' legal rights