An Austin federal judge ordered a state health agency to admit all mentally incompetent jail detainees to state facilities within 21 days to have their mental health restored before trial.
The order came as part of an injunction U.S. District Judge David Ezra issued in a class action lawsuit over people spending long periods in state jails awaiting transfer to facilities where they can receive mental health treatment. Mentally ill inmates deemed incompetent to stand trial by a judge must have their competency restored in psychiatric care before criminal proceedings.
Ezra gave the Texas Health and Human Services Commission, which operates state-owned hospitals, four years to comply with the 21-day mandate.
"Wait times beyond twenty-one days are not constitutionally permissible in this case because longer wait times destroy the reasonable relation between the nature and duration of confinement and its purpose," Ezra wrote.
The advocacy agency Disability Rights Texas sued the agency in 2016 on behalf of all who have been charged with a state crime and have spent more than 21 days in jail after being deemed incompetent to stand trial.
"This is a significant victory for the thousands of people with mental illness who have been left in Texas jails for months—and, in many cases, more than a year—without the treatment and competency restoration services they were ordered to receive," Beth Mitchell, lead counsel for Disability Rights Texas, said in a press release.
KERA News reached out to the Health and Human Services Commission, or HHSC, for comment and will update this story with any response.
The commission has a waitlist for detainees who need competency restoration that operates on a first-come, first-served basis. Those on the waitlist must wait in jail until there's space for them at a facility.
The plaintiffs allege HHSC has failed to make state hospital beds available for detainees found incompetent to stand trial within a timely manner, violating their Fourteenth Amendment rights to due process.
The plaintiffs say the delay harms the detainees' criminal cases, and detainees spend more time in jail than they ordinarily would, especially for misdemeanor cases.
Some people wait so long for competency restoration that they spend their maximum possible sentence in jail and are released without being tried or restored to competency.
The suit also argues extended time in jail can severely affect detainees' mental and physical health by worsening the person's symptoms, leading to medical complications and sometimes death.
As of August 2025, the average wait time for inmates needing transfer to maximum security units, or MSUs, was 202 days after being deemed incompetent to stand trial. For non-MSUs, the average was 178 days.
The Dallas County Sheriff's Office sued HHSC in state court over the same issue. The county had more than 300 detainees who had been on HHSC's waitlist for more than 45 days, according to court filings. The county argued holding detainees longer costs its taxpayers millions of dollars.
The 15th Court of Appeals ruled last year that all counties have to bear the cost of detaining inmates, and Texas law doesn't force HHSC to move detainees into state hospitals within a certain time frame. The Texas Supreme Court declined to take up the Dallas County appeal in the case in June.
HHSC has tried to shorten the waitlist with funding from the Texas Legislature, jail-based competency programs and diversion initiatives. But Ezra ruled the efforts haven't worked to reduce the number of waiting detainees. HHSC leadership told state lawmakers the state still wouldn't have enough beds for incompetent inmates by the end of next year.
Another Texas court previously imposed the 21-day deadline on HHSC in 2012, although the order was soon paused. Still, Ezra wrote, HHSC was able to comply at the time.
After a brief trial without a jury in December, attorneys for Gov. Greg Abbott submitted a brief to the court in support of HHSC. Abbott argued the case is governed by the Prison Litigation Reform Act, which prevents inmates from filing federal lawsuits about prison conditions until they've exhausted their administrative options. Therefore, Abbott's office said, the judge should side with the state.
Ezra ruled that detainees aren't challenging their individual jail conditions, but the constitutionality of their long confinement without restoration, so the reform act isn't applicable.
Ezra ordered both sides to agree to benchmarks and a monitoring plan for HHSC to implement the 21-day mandate.
Toluwani Osibamowo is KERA's law and justice reporter. Got a tip? Email Toluwani at tosibamowo@kera.org.
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