\n\tAaron Bolton<\/span><\/p>\n

KALISPELL, Mont. \u2014 Inside the white-brick hallways of the Flathead County Detention Center, Jail Commander Jen Root walked up to a steel door with a small window and pointed inside.<\/p>\n

\u201cShe\u2019s been here almost a year, just laying on her bed,\u201d she said.<\/p>\n

Inside the cell, dimly lit by a single window, a woman was curled up under a fleece blanket, only her bright-pink fingernails sticking out.<\/p>\n

This woman was charged with burglary in September 2022, Root said. An evaluation after her arrest determined that mental illness prevented her from standing trial and that she required treatment at the Montana State Hospital, the state-run inpatient psychiatric hospital.<\/p>\n

Like many inmates deemed unfit for trial due to a mental health condition, she has been stuck on a waiting list for the Montana State Hospital\u2019s 54-bed forensic unit, which stabilizes inmates through medication and treatment so they are competent to stand trial. The woman in the Kalispell jail was No. 2 on the unit\u2019s waiting list of 70 people as of June 30. Meanwhile, the northwestern Montana jail where she\u2019s waiting isn\u2019t equipped to treat mental illness, and the jail staff can\u2019t force her to take medication.<\/p>\n

\u201cSo, they just deteriorate within our facility,\u201d Root said of her and other inmates with mental health conditions.<\/p>\n

Before their legal case can proceed, people charged with crimes in Montana must understand the charges they face<\/a> and participate in their own defense. But because of bottlenecks in services across the country, people in jail with serious mental illness are waiting months<\/a> to receive the care needed to \u201crestore\u201d their competency to stand trial.<\/p>\n

The Montana State Hospital for years has struggled to keep up with the number of people who are criminally committed to the facility, but Root said the number of such people at the Flathead County jail has grown since the pandemic and as Montana\u2019s recent population boom has pushed up housing costs.<\/p>\n

This year, state lawmakers began to address the woes of the troubled state hospital, which lost its federal funding and accreditation in 2022 amid a rash of patient deaths, by creating a $300 million fund<\/a> to improve behavioral health care in the state and passing bills to increase transparency.<\/a><\/p>\n

Now, state health officials are asking lawmakers to change criminal commitment laws so the Montana Department of Public Health and Human Services has a say before a judge orders a patient committed to the Montana State Hospital or another state-run facility.<\/p>\n

\u201cThat is something we would like to address with you,\u201d Chad Parker, an attorney for the health department, told the Children, Families, Health, and Human Services Interim Committee in July. \u201cThat is something we\u2019d like to look at to try and change, to give the department some more control, to at least give us a place at the table.\u201d<\/p>\n

But Republican Rep. Jennifer Carlson<\/a>, a member of the interim committee, said that there is nowhere else to send patients facing criminal charges for evaluation and treatment, and that the health department should focus on improving patient care instead of denying patients access.<\/p>\n

Parker said judges rarely order patients to be committed at community care facilities as an alternative to the state hospital system, though he acknowledged that community service options have dwindled, in part due to low Medicaid reimbursement rates. Lawmakers raised those rates by about 20% this year, but it will take time to determine whether that increase is enough to rebuild mental health services that have shuttered.<\/p>\n

In the meantime, patients are funneled to the state hospital as it\u2019s the only option for many inmates who need mental health care.<\/p>\n

\u201cWhen there are no available patient beds or they are not available for some time, the department can be held in contempt or receive another sanction,\u201d Parker told the legislative committee. \u201cAnd we need to address that, as well.\u201d<\/p>\n

In an emailed statement, health department spokesperson Jon Ebelt said that state law doesn\u2019t require courts to consider wait times before committing inmates to the state hospital for mental health care. Neither Ebelt nor Parker pointed to specific community services or other mental health facilities that could treat inmates in the criminal justice system to become fit to stand criminal trial.<\/p>\n

Interim legislative committees study issues during the Montana Legislature\u2019s off years (it is in session only in odd-numbered years), and can draft bills for the next session, scheduled to start in January 2025. During their July meeting, lawmakers on the Children, Families, Health, and Human Services Interim Committee decided to explore what community mental health services are available but did not commit to drafting the legislation sought by the health department. The committee next meets on Sept. 12<\/a>.<\/p>\n