Eastern State Hospital has seen a surge of cases. A state senator has short-term fix.

A flood of criminal court-ordered admissions swamping Eastern State Hospital has sparked what state Sen. Monty Mason, D-Williamsburg, hopes will be a short-term fix.

“It’s like a mental health docket-light,” he said, describing his proposal tweak to the part of Code of Virginia criminal procedure title addressing the competency of defendants to stand trial. Those dockets, like the longer-established drug court program, suspend criminal charges while defendants follow a treatment program. Charges are dismissed if the defendant completes the program.

Mason’s SB198 says that when judges find a defendant is incompetent, they should have the option of ordering mental health treatment rather than launching the often-lengthy process of ordering an attempt to restore competency.

His bill would allow that option only if the prosecutor and defense attorney agree. It says the judge should order a “nolle prosequi” of the underlying charge – dropping the complaint but with the option of reintroducing it – while the defendant is complying with treatment.

Eastern State Hospital, which has been operating at or above capacity, has seen a surge in admissions from the court system and jails over the past few years, a Daily Press investigation last year found.

Much of the increase is from competency-restoration orders, which ballooned to 324 in 2020 from 194 admissions in fiscal year 2017, when a new law set a 10-day deadline for placing individuals found incompetent to stand trial into a state hospital for treatment. Over the same period, the number of jail inmates sent to Eastern State under temporary detention orders climbed from 96 to 158

Mason said he sees the bill as a stop-gap to ease strains on Virginia’s overcrowded state mental hospitals while a legislative work group continues wrestling with major reform of laws dealing with hospitalization for mental illness.

“We can’t keep sending people to a state hospital for substance abuse treatment,” a common reason for a competency restoration order, he said.

“For seniors with dementia,” who also see a large number of such orders, “a state hospital can be the worst place to be,” he said. “We need to keep chipping away at this.”

Competency restoration patients at Eastern State stay an average of 52 days, and the jail TDOs, 15 days before they are sent back. When their numbers are added to the 98 longer-stay individuals hospitalized after a court found them not guilty by reason of insanity, a large majority of patients at Eastern State are there because they’ve run into some kind of trouble with the law.

Treatment and medication regimens at Eastern State are the same for competency cases as for TDOs and longer-term involuntary commitment, based on the patients’ diagnoses.

The main difference is that instead of some group sessions, competency restoration patients will have weekly one-on-one sessions, and sometimes more often, with members of Eastern State’s specialist restoration team.

These focus on enhancing reasoning and the ability to understand reality — competency, under Virginia law, is not a finding of mental illness, but simply a finding that a defendant cannot participate in his or her own defense. That means Eastern State has to treat the mental illness enough to make sure it is not blinding a defendant to the challenges to be faced at trial, which is not quite the same thing as the goal for longer-term patients of preparing them to live with their illness in the community.

Roughly 80 percent of Eastern State’s competency admissions are restored and head back to court for their trials. Those who can’t be generally have other conditions, such as dementia, or an intellectual or developmental disability. That poses a challenge for the hospital of finding a safe place for those individuals.

Dave Ress, 757-247-4535, dress@dailypress.com