‘INSTEAD, HE’S DEAD’
Texas families seek help for mental health but spin in vicious cycle
On a humid May evening in 2018, Trevor Cook collapsed on the hot concrete in front of South Main Baptist Church in downtown Houston.
A nearby psychiatric hospital had released Trevor, 31, hours earlier without alerting his father, Cary, who’d begged hospital workers to give him a few hours notice so he could take off work. They didn’t listen.
Cary had known for years, ever since Trevor fell off the bleachers and cracked his skull at age 19, that his son had suffered permanent brain damage. That, coupled with bipolar disorder, made Trevor erratic and impulsive. He heard voices that told him to do bad things. Three times in the past five years, judges had found him incompetent to stand trial for minor offenses, referring him repeatedly for civil mental commitment hearings instead of jail time. That put him temporar
ily in a psychiatric hospital in Harris County, where his father felt he was safer than out on the street.
But when Trevor was charged with indecent exposure a month earlier, in April 2018, a Harris County judge didn’t refer him for a civil commitment hearing. Instead, Trevor was released from jail and ordered to get an evaluation to see if he was competent to stand trial.
Trevor didn’t live long enough to be found incompetent again. His death that spring day reveals the shortcomings of the state’s mental health system, which has failed for decades to break away from the criminalization of people who are so sick they do not understand their actions.
It shows how the civil commitment system — the supposed safety net for mentally ill Texans who desperately need help in order to protect themselves and others from harm — has served as a kind of Band-Aid for many critical cases. For those ill enough to be committed, it stabilizes them, then spits them back out.
The Houston Chronicle examined a list of 400 people charged between 2009 and 2019 and found incompetent to stand trial by Harris County courts. About half of them were found incompetent to stand trial three or more times dating back to the 1980s, the Chronicle found. Many of the charges in the nearly 5,200 cases reviewed were for nonviolent offenses, such as trespassing, failure to provide identification to police officers and criminal mischief.
But instead of getting the necessary care for their mental illness, some found themselves trapped in the revolving door of the criminal justice system.
Experts trace these problems back to the early 2000s. Texas community mental health programs — meant to act as a first line of defense for those experiencing a mental crisis — have struggled to recover after lawmakers slashed their funding by $101 million — to $399 million — in 2003. That, coupled with a law that streamlined the process of finding someone incompetent to stand trial, left the state unable to keep up with the rapid population growth in Texas, creating a bed shortage that has left some mentally ill people awaiting trial languishing for months in county jails with little support.
As an alternative to state hospital beds, Harris County often turns to its local inpatient mental health facility, Harris County Psychiatric Center, to help those in need. The courts often use the center to treat people deemed incompetent to stand trial — both for competency restoration and civil commitment. With the exception of competency restoration programs, the center’s average stay is seven to 10 days.
Although Texas has recently pumped money into its state psychiatric hospitals for additional beds — and provided funds for jail diversion programs in some areas of the state — many counties still bear the brunt of these costs.
And some are experimenting with solutions.
In Dallas, for example, mental health technicians work in 9-1-1 call centers and can dispatch a clinician alongside police for a call involving someone suffering from mental illness.
But many individuals still find themselves trapped in a system that does little to help them.
In Harris County, officials have jump-started a number of programs to help reduce the revolving door for the mentally ill. They’ve implemented programs to restore an individual’s competency to stand trial without needing a hospital bed, both out in the community and in jail. They’ve also started a jail diversion center to try to keep mentally ill residents out of jail.
But without adequate state funding, these programs cannot be implemented statewide, an expansion some experts say is desperately needed.
“You can either pay now or pay later,” said Sen. John Whitmire, D-Houston. “It costs more to incarcerate a person than to treat their mental illness.”
The only way to fix this system, critics say, is to rebuild it from the ground up: Dealing with mental health issues shouldn’t only be up to police officers or the court system, they say. Instead, it should primarily be handled by clinicians and paramedics.
“America has embedded its mental illness response in policing,” said Andy Keller, president and CEO of the Meadows Mental Health Policy Institute, a Texasbased nonprofit focused on improving mental health care. “Very few are a danger to anyone, and most of those are a danger only to themselves.”
In the years leading up to Trevor Cook’s collapse, his father begged the court system to transfer Trevor to a state psychiatric hospital where he could be held long-term.
“I just wanted to see my son actually get some help,” Cary Cook, 65, said. “I’m a taxpayer. They needed to help him get real help. Instead, he’s dead.”
Trevor Cook had always struggled with mental health problems.
At 4, he was diagnosed with bipolar disorder and, two years later, was sexually abused at a day care center, Cary said. The post-traumatic stress disorder it caused resulted in years of therapy and medication.
By the time he was a teenager, Trevor led a mostly normal life. At 19, he dreamed of going into the Navy, like his grandfather. Then one summer day in 2005, he slipped while balancing on top of the chain-link fence at a baseball field near his home.
For three hours, he lay in a crumpled heap on the metal stands behind the dugout.
By the time his family found him, his brain had hemorrhaged. He awoke from a coma a week later.
From that day forward, Trevor struggled with impulse control and decision-making, his father said. He couldn’t hold a job. The voices in his head — a product of his bipolar disorder — grew louder and louder.
Then, in 2012, he was arrested for exposing himself at a Starbucks. He pleaded guilty and was placed on probation for two years. He was arrested twice for exposing himself the following year.
That’s when Cary pushed for a competency evaluation.
“He told me, ‘I have a voice telling me to do this, Dad. I don’t want to do it, and I just can’t stop myself,’ ” Cary said.
The roots of police involvement in the treatment of the mentally ill can be traced back to the move away from mental health hospitals in the 1950s.
Amid reports of intolerable conditions at the nation’s mental hospitals, then-President John F. Kennedy signed the Community Mental Health Act in 1963, aiming to switch national policy away from institutionalization and toward community care. Under the act, states would receive federal funding to build centers to provide treatment and diagnosis services for the mentally ill in their own communities.
But it was never adequately funded.
Two decades later, then-President Ronald Reagan’s Omnibus Budget and Reconciliation Act created block grants for community mental health centers as federal mental health spending decreased.
In the meantime, psychiatric hospital beds in Texas and across the nation continued to shrink.
The number of public mental hospital beds in Texas on a percapita basis has declined roughly 95 percent. There were nearly 16,500 available beds in Texas mental hospitals in 1955 — roughly 190 beds per 100,000 people. Today, there are fewer than 8 beds per 100,000.
With nowhere to go, more and more people ended up on the streets and, ultimately, in jail.
In the fall of 2018, Harris County established the Judge Ed Emmett Mental Health Diversion Center, where people picked up on low-level misdemeanors can be sent for mental health support instead of jail.
If police encounter someone with a mental health issue, they can call the District Attorney’s Office Intake Line, said Wayne Young, CEO of the Harris Center, which runs the jail diversion program. An official with the DA’s office — in collaboration with the officer involved — can determine that jail diversion is a good fit or decide to file charges.
But jail diversion is voluntary. And the average stay is just 55 hours, enough to get them stabilized, connected to a psychiatrist and help them with medication management, employment and housing.
Young said the center continues to work with many individuals diverted on a long-term basis, helping them transition into ongoing mental health services.
“Our team at the Harris Center works hard every day to try and reduce the footprint of the criminal justice system in the lives of those we serve with serious mental illness,” Young said. “We continue to look for ways to reduce the interactions that occur between those we serve and law enforcement as a result of their illness.”
It’s a good program in theory, Keller said, but it still puts the onus on police to be the first responders to mental health calls.
“Data I have seen suggests that the Harris Center is helping many of the people it serves step down into services that keep them from reoffending,” Keller
said. “But the larger picture is that it doesn’t change the underlying dynamic of police as the front door and jail is still the primary place people are sent.”
Cary was working at his home in Wallis in 2016 when his phone rang: Trevor had just pleaded guilty to trespassing near downtown Houston.
He was sentenced to 30 days in jail.
Cary was irate. Trevor had already been found incompetent, most recently in 2015. He slammed the phone down and immediately called Trevor’s court-appointed attorney, Cynthia Henley, demanding to know why his son signed a plea agreement when he’d been repeatedly found to be incompetent to stand trial.
“They just run (the mentally ill) through just like a cattle chute,” Cary said. “They say ‘Hey you’re guilty, see ya, sign right here.’ ”
Cary threatened to report Henley to the state bar, records show. His son should be placed in a psychiatric hospital, he declared.
In court documents, Henley wrote that she had “received no notice that defendant had any psychological issues.” Trevor told her he didn’t need to be evaluated by a doctor, court documents state, and Henley thought he seemed fine when she negotiated a plea.
After Cary called Henley, Trevor was given a new attorney and a new trial. Trevor again was found incompetent to stand trial and transferred for civil commitment.
“What would he have done if I wasn’t there to advocate for him?” Cary asked. “How often does this happen?”
By September 2016, Cary Cook was exhausted.
He had tried everything he could to help his son, offering him a bed when he had nowhere else to go. He lent him money, knowing his son couldn’t hold down a job.
But Trevor kept getting into trouble with the law.
He was referred for civil commitment three times, but he often didn’t fit the stringent requirements for commitment of being a danger to himself or others.
Trevor was sent to the Harris County Psychiatric Center, a short-term inpatient facility run by the University of Texas, just once, Cary said, but he wasn't held long enough to do any good.
Wayne Young, CEO of the Harris Center, said it’s possible for someone to be committed to a state hospital through this process.
However, beds are more readily accessible at the county facility than in state hospitals.
But the center is largely meant for short-term care, not for patients such as Trevor, who need more intensive care than the stabilization services the center can provide.
With the exception of competency restoration programs, the average length of stay is seven to 10 days — enough time to get a person back on their medication and to ensure they are not a danger to themselves and others.
The Chronicle found that about 94 percent of the 400 people charged between 2009 and 2019 and found incompetent in Harris County were referred to the probate court for civil commitment at least once.
It’s unknown how many of those cases actually ended in commitments — those records are not available to the public.
But court records do indicate that roughly 40 percent of the 400 individuals analyzed by the Chronicle were repeatedly referred for civil commitment as early as the 1990s.
Some, like Trevor, appeared every couple of years. Others returned month after month to receive the same end result.
One Harris County man, for example, was found incompetent more than 40 times dating back to 2005. He was referred for civil commitment 78 percent of the time, returning to court sometimes every two to four months.
Harris County officials say the new jail diversion center will decrease the number of mentally ill individuals who cycle through the revolving door and, in turn, are often referred for civil commitment.
“This is a model program for our state and the country on how to divert those with a mental illness from the criminal justice system,” said Michele Oncken, division chief of the Mental Health Division at the Harris County District Attorney’s Office.
A report published in October 2020 by Justice System Partners, a Massachusetts-based nonprofit that provides consulting and technical assistance on criminal justice matters, found that the number of overall jail stays for new offenses was reduced by more than half after a person had been connected to the diversion center. The report looked at nearly 1,200 people who came into contact with the center between September 2018 and February 2020.
As of Jan. 31, 2021, there have been about 3,500 diversions to the center, according to the district attorney’s office.
Oncken also pointed to other programs, such as the outpatient competency restoration program and felony mental health court, as ways they’re trying to end the revolving door.
“We are committed to seeking treatment and connection to services for the mentally ill while remaining dedicated to our mission of public safety,” she said.
The county also is trying to accommodate individuals who need longer-term care but are unable to get a bed in a state hospital. The 240-bed, $125 million building is scheduled to open in early 2022, but funding to run it may be in jeopardy because of COVID-19’s impact on the state budget.
Cary’s heart aches when he thinks about the decision Harris County Judge Diane Bull made in April 2018 to order another competency evaluation for Trevor.
His son, then 31, was first found incompetent five years prior. His traumatic brain injury was lasting — something that couldn’t be fixed with medication or therapy.
But Bull disagreed. While out on bail and awaiting his competency evaluation, Trevor was picked up by a police officer for trespassing, Cary said. The officer recognized Trevor’s mental illness, he added, and got him to a mental health clinic in Rosenberg. Trevor was transferred to a psychiatric hospital in Harris County on April 30.
Hospital personnel released him May 14, 2018, and, despite Cary’s request for several hours’ notice, let him walk out the door without a family member or guardian there to pick him up.
Cary was in The Woodlands when Trevor called to say he had been released, he said, and begged Trevor to return to the hospital.
He didn’t.
About 10 that night, Cary got a call from St. Joseph’s that Trevor had died.
The Harris County medical examiner determined that Trevor’s cause of death was accidental toxicity to synthetic cannabinoid. Cary didn’t believe it.
He had a second autopsy done, which found it unlikely that medications or drugs played a role in Trevor’s death.
Cary still doesn’t know what killed Trevor.
Judge Bull, who is now retired, declined to comment about the case, saying she had no recollection of it.
“What would he have done if I wasn’t there to advocate for him?” Cary asked. “How often does this happen?”
Trevor left behind a 2-year-old daughter and his longtime partner, Lissethe, on that muggy May evening in 2018. He was planning to propose and had even picked out a ring.
In the years since Trevor’s death, Cary has escorted Lissethe and Lieah, to the church where he died. Cary finds peace in the fountain there and often lingers after the service to watch it flow.
He sees signs of Trevor everywhere — in the whisper of the wind through the trees, in the sun shining on his skin, in the hymns sung from inside the church.
Cary said he can’t bring back his son for Lieah, who will grow up without a father, or for Lissethe. But he’s determined to help them as best he can. He’s been saving to build them a house on a 50-acre tract of land so he can watch his granddaughter grow up.