State: Counties should take the lead with inmate mental health programs | News, Sports, Jobs

Times Observer photo by Josh Cotton Warren State Hospital currently houses about 140 patients and is certified to care for 152.

Local officials have criticized the lack of state-provided mental health services for county residents convicted of crimes.

But state Department of Social Services officials say the problem is not for the Commonwealth to solve. Instead, counties should take the lead in ensuring those convicted of crimes receive the mental health programs inmates need to prepare for life after their jail time ends.

The situation recently came to a head when a woman from Warren was sentenced to nearly four years in state prison last month. The charges stemmed from multiple assaults on staff at Warren State Hospital. One victim suffered head trauma.

District Attorney Rob Greene and Chief Public Defender Kord Kinney have both been highly critical of the state’s ability to meet his psychiatric needs. Kinney detailed his client’s story which includes a litany of admissions to mental institutions, commitments to state prisons and state hospitals, explaining that his client is a “sick person” and that the state may have violated his civil and human rights by failing to provide him with appropriate treatment.

Greene was particularly critical of the state’s decision to shut down the forensic unit at Warren State Hospital, a decision made more than a decade ago.

Greene said the situation is the “the impact of the closure of forensic units by the legislator…. We take care of it every day. »

Ali Fogarty, director of communications for the state Department of Human Services, told the Times Observer that closures should not mean there are no services available. Rather than relying on the state, she said it is the state’s position that county programs be implemented with state financial support.

“Public hospitals are not intended to be, nor resourced to be, first-level psychiatric care for anyone with behavioral health needs entering the criminal justice system,” said Fogarty. “We understand the need for greater county-level support for people with mental illness in the county court system, and we support efforts to increase funding for county-level mental health programs.”


To understand the apparent disconnect that emerged in the criminal case, one must understand how the public hospital process works and who it is for.

“Warren State Hospital is a civilian psychiatric hospital serving Warren County and 12 other northwestern Pennsylvania counties”, Fogarty explained. “Hospital admissions are made on the recommendation of private inpatient psychiatric hospitals for people who need ongoing, long-term psychiatric care and treatment. Admissions must be approved by the patient’s home county mental health authority.

There are currently 143 patients at the public hospital. The maximum capacity is 152.

Fogarty discussed the “balance” that officials try to hit when trying to determine when a patient’s conduct crosses the line between a side effect of their mental illness and criminal conduct.

“We must maintain a balance between the rights maintained by our staff and the care and safety of patients and staff,” she says. “There is not a procedure or criteria in place.”

However, she emphasized that it is their mission to “maintaining a trauma-informed and recovery-oriented approach to care that provides a supportive and compassionate environment for patients and promotes the safety of all who work and reside in our public hospitals.”

The state remains involved when a patient is incarcerated, “but the exact role depends on the circumstances of the individual and the length of their incarceration”, she explained.

“Involvement could include medication management, continued engagement in an individual’s treatment plan, or a full return to their residential placement in hospital.”

Warren County Jail has sometimes been called sometimes “Warren State Hospital South”, a place where the criminally mentally ill can dispense with the specialized skills needed to meet those needs. It was a factor in the sentencing last month when the defendant herself told the court that she was being kept in solitary confinement while serving a 30-day sentence in county jail for another case of assault in a state hospital. The state hospital’s population is a fraction today of its peak of more than 2,500 patients in the late 1940s.


Greene was particularly critical of the state’s decision to shut down the forensic unit at Warren State Hospital, a decision made more than a decade ago.

“We are confronted with it on a daily basis” Greene told the court, citing an eight-month waiting list to get into the remaining units. “In the meantime, people are hurting themselves. Everyone is caught between a rock and a hard place.

Greene had said there was an eight-month wait for admission to the remaining forensic units, but Fogarty said the average wait time at Norristown State Hospital was eight days and 30 days for Torrance State Hospital.

But the long-term treatment of those convicted of crimes is not the purpose of these units.

“State forensic units exist for pre-trial skill restoration,” Fogarty said, “or, if it is determined that this is not possible, long-term treatment for those in need of ongoing psychiatric care.

“Psychiatric competence is a legal threshold, and having mental illness or ongoing behavioral health needs does not automatically mean they are not competent.”

And it was behavioral issues that complicated last month’s sentencing.

Presiding Judge Maureen Skerda acknowledged that the general situation “is tragic” but quoted that there are also behavioral issues at play.

“I don’t think one system meets all your needs,” she said to the accused.

Fogarty insisted that inmate mental health is not a role of the state-run mental health hospital system.

“Counties should coordinate necessary supports for those in their care,” she says, “and that’s why the Pennsylvania Behavioral Health Commission for Adult Mental Health recommends investment in criminal justice and public safety supports as the primary method of allocating $100 million for health services included in the 2022-2023 budget.”

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