Addressing Mental Health in the Criminal Justice System

A new initiative spearheaded by UT Health Austin psychiatrist Stephen Strakowski, MD will improve mental health support for people incarcerated in Travis County

Reviewed by Stephen Strakowski, MD

Written by Lauren Schneider

Two inmates are sitting on a bench wearing bright orange jumpsuits while playing a game of chess.

A new effort seeks to improve mental health care for individuals incarcerated in Travis County. Known as the Travis County Forensic Mental Health Project, the initiative marks a collaboration between mental health experts at Dell Medical School and community partners including the Travis County Commissioners Court.

Steve Strakowski, MD, a psychiatrist affiliated with the Mulva Clinic for the Neurosciences and Associate Vice President for Regional Mental Health at Dell Med, will lead the project’s steering committee.

“The intent of this program is understand why jails became proxies for mental health waiting rooms and to identify alternatives that could get people appropriate care without them spending months sitting in jail,” he says.

Waiting for treatment

Dr. Strakowski identifies two pathways by which complex interactions between mental health services and the criminal legal system keep people in jail.

In some cases, people are stalled within the competency restoration system as they await an evaluation of whether they are competent to stand trial. Without this evaluation, a person cannot be tried in court. As many of these people cannot afford a bond payment, they remain stranded in jail with no court date in sight.

Other times, people are taken into police custody if an officer identifies that they need mental health support. “Responsibility falls onto the jail where they end up being housed, and where there’s inadequate services to help them.”

Complicating matters is the fact that Austin State Hospital, a psychiatric hospital, is funded by the state of Texas while Travis County funds jails and jail-based mental health services.

“Another challenge is solving money flow problems with people who cross systems,” says Dr. Strakowski, arguing that a more robust support system will prevent people from slipping through the cracks.

A mounting need for adequate care

As of May 2022, 42% of people incarcerated in Travis County were receiving mental health care in jail, marking an increase from 37% in October 2021.

Dr. Strakowski points out that the situation in Austin reflects a national problem, which he attributes to both high incarceration rates in general and overburdened mental health services.

“Lots of things need to be changed both in the legal and mental health systems,” he says.

By participating in the Travis County Forensic Mental Health Project, he hopes to help solve one piece of the problem.

Seeking community support

This February, those involved in the initiative will finalize a set of recommendations and projected costs to present to the county. Travis County officials will then decide whether to fund these recommendations.

Dr. Strakowski is uncertain what these final recommendations will entail since the working groups will drive those decisions, and notes that as the project moves forward, it will seek additional involvement from community members.

“As we move to the next phase of the project, we’ll start creating working groups that bring in community input,” he says. “These kind of projects only succeed with strong community support.”

About UT Health Austin

UT Health Austin is the clinical practice of the Dell Medical School at The University of Texas at Austin. We collaborate with our colleagues at the Dell Medical School and The University of Texas at Austin to utilize the latest research, diagnostic, and treatment techniques, allowing us to provide patients with an unparalleled quality of care. Our experienced healthcare professionals deliver personalized, whole-person care of uncompromising quality and treat each patient as an individual with unique circumstances, priorities, and beliefs. Working directly with you, your care team creates an individualized care plan to help you reach the goals that matter most to you — in the care room and beyond. For more information, call us at 1-833-UT-CARES or request an appointment here.