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Thousands are stuck in Texas county jails, mentally unable to stand trial and waiting for treatment. Some die before they get it.

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Reporting published Wednesday shows that thousands of individuals experiencing mental illness languish in Texas’ county jails awaiting treatment at a state hospital. Some die on the waitlist, but the true number and circumstances of those lost to or still waiting because of the backlog has been largely unknown.

KXAN’s team worked for two years to expose the truth and consequences of this treatment backlog for individuals deemed mentally unfit, after discovering the state itself does not track critical details about those who are jailed and waiting for mental health care at a state hospital.

Their investigation found that over the past two decades, Texas has seen a 38% increase in the rate of people found mentally incompetent to stand trial. People who are criminally charged but deemed incapable of participating in their own defense are usually sent to a state hospital for restorative mental health treatment, then returned to jail when considered competent.

After collecting county-by-county data, KXAN says the number of jailed individuals waiting for such treatment hit a record high in October 2021.

Why does the state have such a backlogged state hospital system? How long do inmates typically wait for care that’s considered necessary to get them to trial? Why are people languishing or dying in jail before getting treatment?

Why is the state’s data about waitlisted individuals so unreliable? How have officials responded to these revelations? What new plans or promises have been made to fix these systemic flaws? Why have previous efforts failed?

Are efforts being made to increase access to treatment at state hospitals or to expand jail-based or outpatient competency restoration alternatives to reduce the backlog? How else can the system be improved in Texas?


  • Josh Hinkle, director of investigations and innovation, executive producer of political coverage and host of “State of Texas" program at KXAN
  • Lynda Frost, JD, Ph.D., mental health and criminal justice consultant and former director of planning and programs at the Hogg Foundation for Mental Health
  • Matthew Lovitt, peer policy fellow at NAMI Texas

"The Source" is a live call-in program airing Mondays through Thursdays from 12-1 p.m. Leave a message before the program at (210) 615-8982. During the live show, call 833-877-8255, email thesource@tpr.org or tweet @TPRSource.

*This interview was recorded on Thursday, December 9.

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