Tracy McClain remembers clearly the first time her son was arrested and charged with a crime because she was the one who placed the 911 call.
She told dispatchers that her son JohnRobert Holmes III, 21 at the time, was at risk of hurting himself, hoping that he would get the help he needed — a pathway to a bed at a state psychiatric hospital. When officers arrived and tried to detain him for a mental evaluation, Holmes ran, according to an arrest affidavit. He was booked into Williamson County Jail and released the same day without meaningful mental care, McClain said, and his charge — interfering with public duties — was dropped four months later.
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Since that arrest 11 years ago, Holmes would go on to be arrested 10 more times and deemed mentally incompetent to stand trial at least three times, often for minor crimes such as trespassing, according to county records.
And, each time, he never got a psychiatric bed nor substantive mental health treatment, McClain said.
“I’m not asking for funding. I’m asking just to have him put into a hospital and receive care for longer than three weeks, so that I can get my son back,” McClain told The Texas Tribune.
The Tribune was unable to contact Holmes, who McClain says suffers from schizophrenia and acute psychosis, and does not have a phone and is unhoused. A public defender assigned to him on four occasions declined to comment without permission from Holmes.
Although the state must provide treatment to defendants deemed mentally incompetent to stand trial, a chronic shortage of beds at state-run psychiatric hospitals, also called state hospitals, have forced defendants to wait up to two years for care.
Last month, U.S. District Judge David Ezra ordered the Texas Health and Human Services Commission to cut wait times to 21 days over the next four years, but attorneys for the state have since appealed the ruling, delaying relief for McClain’s son and the 1,600 Texans waiting for a state hospital bed.
“It’s really sad that we had to bring this suit, and that it takes a court order for the state to do what’s right,” said Lisa Snead, an attorney working with Disability Rights Texas. “The state’s appeal is not surprising but is disappointing.”
Stemming from a lawsuit filed by Disability Rights Texas in 2016, Ezra found that Texas’ system of making incompetent defendants wait in jail for treatment was unconstitutional. He also found that HHSC knew it lacked the capacity to treat these defendants but failed to fix the problem, leaving them to wait months or even years for state hospital beds.
“Lack of funding cannot justify the continued detention of defendants who have not been convicted of any crime, who are not awaiting trial, and who are receiving next to no mental-health services,” he wrote in his ruling.
Compared to jail-based programs, state hospitals are better equipped and they offer better environments for recovery, mental health experts say. Because state law requires mentally incompetent defendants be provided with restorative mental care, it is often free of cost unlike private options.
As of June, about 1,626 people were on the state hospital waitlist, said Thomas Vazquez, spokesperson for HHSC. Of them, 447 people were waiting for a maximum-security unit bed, with an average wait time of seven months. Another 1,179 people were waiting for a lesser security bed, with an average wait time of over five months.
At its 10-year height in December 2022, the wait time for a maximum security bed was two years.
Ezra gave HHSC four years to comply with the 21-day requirement and ordered the agency to identify compliance benchmarks within 45 days.
State attorneys are asking the 5th U.S. Circuit Court of Appeals to postpone setting those benchmarks, according to court records. They argue that the 21-day requirement would force the agency to begin “irreversible work” rebuilding part of its system on a court-set schedule and to spend “unrecoverable funds” on a remedy the 5th Circuit may ultimately find the Constitution never required.
Vasquez declined to comment on last month’s ruling, including on how many more beds the state would need to add to meet the court mandate and how much it would cost.
Timing out of jail
Waitlists for state psychiatric beds are long because demand for mental health treatment has outpaced capacity for years. Staffing shortages, rundown facilities, and a lack of investment in psychiatric care have kept hospitals from adding enough beds, while many existing beds are in long-term use or out of commission.
Roughly 70% of the state’s 3,600 mental hospital beds are forensic, meaning for those criminally detained, and the rest are for civil commitments and for youth. In June, 1,663 forensic patients received treatment.
Many waitlisted defendants never receive restorative treatment because they wind up “timing out.” That means they serve their maximum possible sentence for their charge — many of them are charged with minor crimes with short sentences — before a bed frees up.
“You had folks who were charged with offenses for which the maximum penalty was only 180 days, essentially serving their entire sentence waiting for HHSC to make a bed available to them,” said Snead.
Holmes is one of them. He was booked into jail three times for trespassing and was found incompetent to stand trial for those offenses and ordered to be given restorative treatment. But, he ended up serving the maximum sentence for standard criminal trespassing — 180 days — each of those times and was released from jail without getting a spot at the state hospital.
“I thought for sure that time they were going to get him into the state hospital,” McClain said. “He just timed out and was on the streets again.”
The current system is effectively giving those who commit worse crimes a higher chance at accessing a state hospital bed, she said.
“I was informed that because it’s a misdemeanor, more than likely he’ll time out before a bed is available. But if he committed a felony and was there longer, more than likely they would be able to locate a bed,” said McClain.
Push for state hospital care
McClain said her son never received restorative care in Williamson County Jail and was prescribed medication upon release on one occasion.
McClain wants him committed to a state hospital because he is constitutionally entitled to it. She also said she would not be able to afford the private route, which would require her to obtain guardianship, a process that costs thousands, to privately place her son, a legal adult, in a private facility.
“It’s for the wealthy,” she said. “We all love our children just as well as someone who’s financially capable of putting a person in a [private] institution.”
With their jails bloated with detainees waiting for mental health services, local officials welcome the most recent ruling, which is the furthest this issue has gotten in the court system; Disability Rights Texas unsuccessfully sued the state over the waitlist in 2012. While Williamson County officials did not comment on Holmes’ cases, they welcome the state’s efforts to reduce the state hospital bed waitlist, said Phyllis Shaffer, spokesperson for the sheriff’s office.
In county jail, patients have limited access to mental health care, medication, and lesser restorative treatment. In Travis County Jail, there is one full-time psychiatrist serving a population where 40% to 50% of inmates need psychiatric help, said Melissa Shearer, mental health division director at the Travis County Public Defender’s Office.
“Jails are, to say the least, not appropriate places for people with mental illness,” said Snead. “Jail-based competency restoration programs in practice are often just not the same caliber of services that detainees receive in a hospital.”
Some severely ill defendants can jump the state hospital bed waitlist, according to health and human services. But, there are so few state hospital beds that meeting the criteria for expedited admission does not always guarantee someone will get in, even if they are a danger to themselves or others.
“We had a young woman who was incompetent and very, very, very ill, and was deteriorating in the jail, doing a lot of self harm, not eating, not drinking, and not improving at all, and was continually getting worse, and the jail was concerned about the self harm. And that young person had been waiting for over a year,” said Shearer.
McClain echoed similar concerns, saying that her son’s health would decline each time he went to jail.
Shearer said the ruling will provide relief for people needlessly suffering in jail.
“They would have less time isolated in a single cell, which we know causes deterioration in mental health long term,” Shearer said. “You will see a lot more people get well and stay well because the longer a person’s serious mental illness is untreated, the worse it gets.”
Over the years, McClain admits she had lost trust in the state to help her son, but is holding on to some hope that last month’s ruling, if it survives the appeal, will help bring back the son she used to know.
McClain said Holmes was a normal — maybe a little quiet — basketball-loving child growing up in Round Rock. He went on to attend the prestigious historically Black university Morehouse College in Atlanta where he enjoyed reading psychology so much he majored in it. His mother told police he became sick after he was assaulted at a pick-up basketball game and suffered a brain injury a few weeks before his first arrest, according to the arrest affidavit from his first offense.
“He was a career counselor for an online university, so he was helping people set their career,” McClain said. “He had his own apartment, and he was doing great, interacting with family.”
In recent years, McClain has shown up at the Texas Commission on Jail Standards meetings to call for the health agency to implement more mental health care options for those who cycle in and out of jail. Outcomes for people like her son would look different if the criminal justice system offered a real plan of care, McClain said.
“They’d be viable members of society as opposed to being walked over and forgotten about.”
Alex Nguyen contributed to this report.