Long waits for Montana State Hospital leave psychiatric patients in jail

A woman experiencing delusions sat in Montana's Cascade County jail for 125 days while waiting for a bed at the state psychiatric hospital. A man with schizophrenia spent 100 days last year in the Flathead County jail on the hospital's waitlist, at times refusing food and water. A man complaining of voices in his head was jailed for 19 months awaiting a mental health evaluation.

Montana State Hospital's forensic facility, which evaluates and treats patients in the criminal justice system, has always had a waitlist, court records show, but the pandemic has lengthened it. As a result, people have been behind bars for months on pending charges without adequate mental health treatment.

Some have undergone long stretches in solitary confinement as jail staffers have struggled to respond to their needs. Others waited so long that courts dropped the criminal charges against them altogether. Some were arrested again on more serious charges.

In Montana, as elsewhere, mental health advocates, attorneys, and sheriffs say part of the problem is a widespread lack of services to help people with serious mental illnesses. So the criminal justice system functions as the catch basin for the nation's limited mental health system.

"The treatment system failed people," said Matt Kuntz, director of the Montana chapter of the National Alliance on Mental Illness. "They're locked in their mind, and they're locked in jail. It is the saddest end to a series of tragedies."

The psychiatric hospital, overseen by the Montana Department of Public Health and Human Services, is under intense scrutiny after a federal investigation revealed that as the facility struggled with massive staffing shortages its main campus failed to protect patients from falls and covid-19, which led to at least four deaths. The hospital's federal funding is now in jeopardy.

Its forensic facility — a few miles from the main campus — doesn't receive federal money, and so it wasn't part of that oversight. But staffing problems plague the forensic site, too. As of March 14, permanent staffers filled 46 of the facility's 81 full-time positions, said health department spokesperson Jon Ebelt. Contract workers and hospital employees trained for both the forensic site and the main campus helped plug some of the gaps.

As of March 1, 71 people were waiting for treatment or an evaluation at the 54-bed forensic unit, Ebelt said. People with an evaluation in hand or those facing especially serious criminal charges may jump ahead in line.

In one case, court documents show, state officials wrote to Flathead County prosecutors they couldn't "venture a guess as to when there will be a bed available." Attorneys were trying to get admitted Ilya Khmelev, who was diagnosed with schizophrenia and had allegedly violated a restraining order.

After he spent 85 days in jail, a judge dismissed the charges against Khmelev in June 2021, citing the hospital's "unreasonable delay." Within days, he was arrested again, this time for allegedly trying to push his way into a house. He waited 15 days for a transfer to the state hospital for treatment. A Kalispell judge dismissed that case in January because Khmelev was deemed unfit for trial. Khmelev could not be reached for comment. Flathead County Sheriff Brian Heino said caring for people with a mental illness while they await trial or treatment strains detention staffers.

"Everybody is really trying to do everything they can," Heino said, referring to jails, local mental health services, and the state hospital. "The limitations on how many mental health professionals we have, that's an issue across the board, an issue across the U.S. right now."

Some judges have rebuked the hospital for failing to meet its obligations.

In 2020, Cascade County District Court Judge John Kutzman dismissed the case of Jose Remigio Zapata, who was waiting in jail for a state evaluation while facing charges of child sexual abuse. "He is presumed innocent and he has spent the last year and seven months in jail," Kutzman wrote. "This train wreck lies at the feet of the State Hospital."

Remigio Zapata could not be reached, and his attorneys declined to comment. The health department declined a request for an interview with its director or the state hospital's top boss. Ebelt said staffing shortages at the hospital didn't directly affect the forensic unit's waitlist. He blamed the increasing delays on too few beds and psychiatrists, numerous court-ordered admissions, and pandemic protocols.

As of March 16, the state reported only 63% of the forensic facility's beds were full despite its waitlist. Ebelt said admissions are limited because units are broken out by gender and beds may be reserved for patients away for court or medical appointments.

Lewis and Clark County Attorney Leo Gallagher said the most frequent hang-up he's seen as a prosecutor has been people waiting for an evaluation by the state hospital, which assesses whether they are mentally competent to stand trial. Jurisdictions or defendants' attorneys can pay for a local evaluation instead, but that requires money and health professionals.

"These folks can be parked in the county jail anywhere from six months to eight months," Gallagher said. "It's been going on for years. It has become more acute lately."

Shylah Hanway, now 20, was arrested in 2020 for allegedly exposing herself to a minor and spent nearly four months on the hospital's waitlist. A Cascade County judge had ordered the forensic unit to treat her for disorganized schizophrenia.

Hanway, who continues to grapple with mental health issues, declined to make a statement through her lawyer.

In that case, she spent large chunks of time in solitary confinement in the Cascade County jail, records said, at times refusing to shower or clothe herself, and not eating for days. The initial charges against her were dropped after her attorney argued the wait violated her right to due process. But before that happened, she was charged with a separate felony for allegedly punching a detention officer who tried to persuade her to eat.

After 114 days, a bed opened at the hospital. But once released from treatment, she was sent back to jail to face the assault charge. Her lawyer, Daylon Martin, said she still believed she was someone else, a woman in her 30s with 23 kids.

Hanway got out on bail in May 2021 but was arrested again the next month. This time she was accused of kidnapping a child who, according to court records, Hanway thought was her daughter. Again, an evaluation deemed she needed treatment, and again she went on the hospital's waitlist, sitting in jail an additional 125 days.

"You put someone with a mental health issue by themselves in a cell, they're not getting what they need," Martin said. "They got worse waiting to go to the state hospital."

Cascade County Attorney Josh Racki said softer approaches are more likely if someone is charged with trespassing or damaging property. He said things get complicated if someone with a mental illness harms another person.

"I understand they're mentally ill, but I can't just let them go for fear that they will continue to victimize others," Racki said.

Although violent crimes committed by people with a mental illness often grab attention, they're rare. People with a mental disorder are much more likely to be the target of a crime than those without.

State lawmakers are studying Montana's criminal commitment process and have discussed the need to recruit more mental health providers and increase oversight of the state hospital. But the next legislative session isn't until 2023.

Meanwhile, Hanway, who already spent much of the past two years on the hospital's waitlist, is back in jail, this time on criminal mischief and theft charges. As of March 16, she had been in jail for 22 days.