How Problems at the State Mental Health Hospital Are Destroying Colorado's Justice System

While Boulder County discussed the mental competency of the King Soopers shooter for two days in late September, roughly 450 people were locked up in county jails who aren't supposed to be there — waiting to be transported to the Colorado Mental Health Hospital in Pueblo for inpatient competency services.

In Denver alone, 112 individuals (both male and female) who have been found incompetent to proceed with their criminal cases are behind bars pending admission to the state hospital, according to the Denver Sheriff Department. Another 39 are waiting for their initial competency evaluations.

Arapahoe County says it has 49 offenders awaiting transport for restoration services; over a dozen have been waiting for six months or more. Fourteen others are awaiting evaluations.

As of September 27, Boulder County had 53 inmates in an already overcrowded jail facility who are "awaiting a bed at the state hospital," according to Sheriff Curtis Johnson.

Alamosa County — located in Colorado's 12th Judicial District, which is "one of the poorest in the state," notes District Attorney Anne Kelly — has just 85 inmates in its system; six of them are supposed to be at the state hospital. One individual was kept in jail for eight months without treatment while waiting for a response from the Colorado Mental Health Hospital, according to Kelly and Alamosa County Sheriff Robert Jackson.

"During that time, the inmate was throwing feces and urine at jail staff and would yell profanities nonstop at the deputies," Kelly remembers. "These types of situations not only affect the safety of the inmate, but have a dramatic effect on the morale of our jail staff."

Adds Jackson: "It was a common occurrence. That individual finally got to the same hospital and has since come back. And now with this new ruling, that we have to help these people out in general housing, it's tough. But so far, so good. He hasn't acted out. I don't know if he's on medication or what, but so far, he hasn't done anything to get him down in holding."

Although problems at the state hospital have impacted Colorado's justice system for over a decade, the initial issues focused on court delays and a lack of staffing. However, DAs from seven different judicial districts — as well as mental health professionals, the Office of the State Public Defender and sheriffs in three counties — say that there's much more involved, and that it's time for people, including legislators, to finally take notice.

"We're seeing some of the longest delays that I've ever seen in my career, and I've been working at the DA's office for almost seventeen years now," Mason says. "There are 22 judicial districts in the state of Colorado. The state hospital's inefficiency and inability to do its job is impacting every single judicial district in the state. And we, as a collective group of elected district attorneys, are all concerned about this."

"We, as a collective group of elected district attorneys, are all concerned about this."

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It's hard to miss the casualties of the state hospital debacle. Homicide cases sitting on dockets "for months and months and months," according to Denver DA Beth McCann; victims' families calling repeatedly and going to seemingly endless court proceedings in search of answers; mentally incompetent offenders stuck inside county jails without getting the help they need.

High-profile cases such as the Boulder King Soopers shooting and the Gannon Stauch killing in Colorado Springs have caught more attention as they languish in their respective districts and drag on because of various delays and overcrowding issues at the state hospital. But the low-level and lesser-known offenders actually often suffer most, according to legal experts and mental health professionals. This is because inmates typically remain behind bars until they are restored to competency or are found to be incompetent to stand trial, with many serving maximum jail sentences for their alleged crimes as a result of "timing out" — being released once the longest possible sentence is reached.

State law prevents any inmate from being kept in custody awaiting treatment for a longer period than the maximum sentence they would have received and served, which in the case of low-level offenders usually isn't determined by the DA's office or judges.

"It's rare that you see somebody charged with a misdemeanor serve the maximum sentence," says DA John Kellner of the 18th Judicial District, which covers Arapahoe, Douglas, Elbert and Lincoln counties. "Most cases are resolved with a plea agreement, which means a plea is something that's going to avoid the maximum possible sentence. So you can have people who are struggling with mental illness, who are found to be incompetent — waiting to have restoration services [at the state hospital] — be held in custody for the maximum amount of time possible, when if they had access to those restoration services and were able to participate in their own case, they probably would have been released much earlier. And, frankly, could have had probation services or services that would continue on and try to make sure that [the offender] stays on track."

According to Thain Bell, chief deputy district attorney and head of the behavioral health unit of the Denver District Attorney's Office, "releasing these people with nothing is the worst-case scenario." Others agree.


According to Bell, individuals who time out and are released without receiving care and mental health services are "more likely to reoffend in that situation than the alternatives."

Before trial, if defendants are found to not understand the court system, the charges against them or their basic legal rights, they (or their legal counsel) are legally allowed to raise the issue of competency. A judge will typically order an evaluation to be performed by trained psychiatrists or psychologists at the Colorado Mental Health Hospital in Pueblo or Fort Logan in Denver, where the state's other mental health services are located.

When the issue of competency is raised in a case, the prosecution is suspended indefinitely until the defendant can be evaluated and treated, according to state prosecutors. These delays have caused "a tremendous impact on the justice system and our communities," says DA Michael Dougherty of the 20th Judicial District, which was able to finally restore alleged King Soopers shooter Ahmad Al Aliwi Al-Issa to competency this year after numerous failed attempts to get him evaluated and into the state hospital.

"Our office strongly opposed another evaluation based on the number of evaluations and reports provided to the court throughout the past two years, his improvement over the past several months, and the fact that we were already set for a restoration hearing," Dougherty says. "The victim families were grateful for the judge’s decision, because the delays cause them to become outraged, frustrated and exhausted. As I stated in court, this case and its issues are consistent with the other cases caught up in the state hospital process."

When defendants are locked up in jail for an extended period of time instead of being treated and seen by state doctors, it can have a drastic effect on both their mental and physical health, according to DAs and mental health experts.

"They are suffering and deteriorating without care, and all the while, victims are left waiting for the case to move forward," Dougherty says. "The jails become backed up with these people who are supposed to be at the state hospital, and jail staff are left trying to care for them."

In Boulder, overcrowding at the county jail — which was built to house 275 inmates and currently has around 460 — has created a "significant issue for the safety and well-being of inmates, staff and our community," notes Dougherty.

"Due to the crowding, the jail encourages police officers to write tickets instead of make arrests, which can hurt community safety," he adds.

Stephen Redfearn, deputy chief of operations for the Boulder Police Department, tells Westword that the ticket-first policy was put in place in response to "restrictions on what types of criminal violations the jail will take," under a new order from the Boulder County Jail.

"We are not always privy to the reasons behind why the Boulder County Jail is not accepting some arrests, but we have been informed that some of the reasons for the arrest restrictions are due to a backlog of people waiting to go to the state hospital," Redfearn confirms. "We are no longer able to take some people to jail, and thus we don’t have as many tools in our possession to disrupt someone’s criminal behavior. At times, writing someone repeated tickets does not have the same impact as a physical arrest and may not deter people from committing crimes."

Sheriff Johnson says that the arrest standards have been set "for all of the law enforcement agencies in Boulder County," which ultimately determine who will be accepted at the jail. "If a case does not meet the arrest standards, the person can be issued a ticket or booked and released from the jail," he explains. "This is solely due to the capacity issues we face."

According to Johnson and Dougherty, one of the biggest challenges the county faces is freeing up space at the jail.

"We are at capacity due to the number of violent and/or severely mentally ill inmates we have in the jail today," says Johnson. "There are 48 individuals who must be housed alone in our jail, which means there are 96 beds that cannot be used by someone else. If the criminal cases for the 53 people we have awaiting restoration could move forward, that would help alleviate the crowding in our jail."

To make matters worse, Johnson says, "there have been assaults on deputies and mental health staff that include physical attacks as well as getting spit on." He and his staff feel "helpless in these situations, as what they need is treatment, not isolation, for up to a year waiting for admission."

Freeing up jail beds currently occupied by people who should be at the state hospital would not only give the sheriff's office more room to house criminals, it would also lead to more arrests and better security in the workplace, Dougherty argues. "Those beds could be put to use by law enforcement in Boulder County in ensuring public safety by making arrests when appropriate instead of being encouraged to simply write tickets," he says.

Colorado’s hospital backlog has become such a problem that in 2019, a federal court issued a consent decree in favor of creating a fine that Coloradans must pay when the state fails to meet standards. "The taxpayers of Colorado have been paying that fine ever since," Dougherty explains. "It is $10 million to $12 million per year that should be in the pocket of the taxpayers or used for better purposes."

All seven of the DAs who spoke with Westword agree: Competency evaluations are higher than ever before; delays at the hospitals are the worst they've ever seen; and mentally unstable and incompetent offenders are being released back into society without receiving help that they've been ordered to receive.

"We need a solution to this problem," says Mason. "It can't keep going on like it is now. It's hurting the state, it's hurting victims, it's hurting defendants. We need to make this a priority, and the state really needs to find a solution to this problem."

Letecia Stauch — a Colorado Springs woman convicted of stabbing, beating and shooting her eleven-year-old stepson to death in 2020 — is a classic example of cases being "dramatically and directly impacted" by the continued delays in the state hospital system and why in-house solutions are ultimately needed across the board, according to DA Michael Allen of the 4th Judicial District.



In Denver, the DA's office and Sheriff Elias Diggins are attempting to tackle the hospital crisis head-on with a "people-first approach," according to Diggins, which is aimed at getting inmates the help they need while they're waiting to go to Pueblo or Fort Logan.

This means providing self-restoration programs and competency evaluations for people locked up at both the Denver County Jail and the Downtown Detention Center.

"I don't think it's just the state's responsibility; I think it's all of our responsibility," Diggins says. "We can help the state if we can stand these programs up in each of our jurisdictions, because the problem belongs to everyone, not just the State of Colorado. So Denver County can help Arapahoe County can help Adams County. Every single county has this challenge in their jails. So if we all work toward it together, then we can have a much greater impact."

In Arapahoe County, the DA's office has started doing whatever it can to get prisoners looked at by evaluators as soon as the issue of competency is raised. "These evaluations are literally occurring at times through the food slot — right in a jail cell," DA Kellner says. "And that's because of what's going on [at the state hospital]."

According to McCann, Denver has been taking "innovative approaches" to getting inmates the help they need while they wait for a state hospital bed, including creating a competency court — known as REACH Court — within the Denver District Court system, which handles felony competency cases and "tries to figure out how best to handle them, and how to perhaps get [inmates] into services prior to a finding of competency," says the DA.

"This docket is aimed at addressing inadequacies in the mental health system, with the main goal being to find alternatives to incarceration for persons going through the competency process," says the Denver District Attorney's Office in an online description. "The success of this program relies on the cooperation and collaboration of essential criminal justice and community organizations including the District Attorney, Public Defender, City Attorney, Probate Court, Sheriffs Department, Guardian Ad Litems, Pretrial Services, Wellpower, Office of Behavioral Health, Brain Injury Alliance and local treatment providers."

The 8th Judicial District, which covers Larimer and Jackson counties, created a competency docket to provide access to resources for defendants with mental health needs, to "safely supervise" those who are out of custody waiting on the state, and to "ensure the criminal justice system can keep moving forward," according to DA Gordon P. McLaughlin.

In Boulder, county officials are "breaking ground" on an Alternative Sentencing Facility, which will "provide more space and treatment programs for individuals in custody at the jail," Dougherty says. "This is a very innovative, positive step, and one of the reasons that I am hopeful and excited for Boulder County."

Creating self-restoration programs and separate competency dockets — something the 18th District has also done, according to Kellner — is an aim of many Colorado jurisdictions these days. Other programs and services that Denver County has implemented include a Restoration Treatment Unit, a "competency diversion program" and Court Ordered Assertive Care Treatment, or COACT.

Denver's competency diversion program is used to identify defendants who have previously been found incompetent on lower-level offense charges and then tries to get them connected to resources immediately — ultimately keeping them out of the criminal justice system altogether, according to Chief Deputy DA Bell. The COACT program is "designed for people who are certifiable" and "can get a civil commitment," he says.

"We're trying to route these people out of the criminal justice system and into the probate courts, where they can focus on their treatment," Bell explains.

People who qualify for the district's competency diversion program must have non-violent records and "eligible charges," according to the DA's office and sheriff department. "We're obviously not going to admit someone for competency diversion who commits an aggravated robbery with a gun," Bell says. "But for lower-level offenses, if you've been previously found incompetent, you will be eligible to be screened. And then they do an initial evaluation to determine if you're likely still incompetent — and then you're eligible, basically."

The main purpose of the diversion program is to free up space in jail and the state hospital by preventing mentally ill individuals from "ever getting in the system," Bell says. "We know where the case is going to go if we don't."

According to DA McCann, cases in Denver are often dismissed so that the defendants can "go through the process of services without them clogging up the criminal system."

Bell says that the approach Denver is taking with REACH should be implemented across Colorado. "Instead of waiting for them to time out, we're trying to identify people who are going to time out prior to that and trying to release them in the community and get them treatment through out-of-custody [services] while they still have a pending case," Bell explains. "And then if they get in compliance with their treatment, we'll end up dismissing the case anyway — because we know that's where we're going. But instead of just releasing them from the jail, hopefully we're getting connected to services and in treatment situations so they won't re-offend."

Diggins says he believes that "leading with humanity" and compassion is something that can go a long way to mitigating the state hospital challenge, while also providing specific services for people who are affected.

"We have what we call in the department a 'dual mindset,' and the first half of that is we lead with our humanity," Diggins says. "The second is the deprivation of a person's freedom is their punishment. So I was actually given that vision by God before I became the sheriff. So as we, as a department, have made that a part of the fabric of what we do and who we are, you will find that the Denver Sheriff Department — all members of our department — believe that and understand that that's a part of what we do."

According to Diggins, the sheriff department currently has twelve beds as part of its Restoration Treatment Unit, which is completely separate from the main jail population and is intended to treat, restore and re-enter inmates into the criminal justice system. It will soon be adding six more beds following a September 18 vote by Denver City Council.

"It was passed unanimously," Diggins says. "We have tremendous support from the Denver City Council and the mayor's office, as well. Everyone in the city of Denver — the DA, the public defenders, the police, the sheriffs, the Department of Safety — everybody understands how important this program is. So that went through without any discussion."

But Sheriff Jackson notes how smaller communities, such as those in the 12th District, just don’t have the resources or monetary support that places like Denver do. “We lack in funding,” Jackson says. “We just do not have the funding — we just don’t. Most of that is based on property taxes.”
In the 17th Judicial District, it took more than five years to resolve one of the jurisdiction's most gruesome murder cases.

In 2017, Emanuel Doll, a 25-year-old Broomfield man, lured his four-year-old nephew down to the basement of Doll's parents' house and killed him with an ax. He was committed to the state hospital in 2018 for treatment to stand trial, but wasn't found not guilty by reason of insanity until 2022.
"That was a horrific case, which got delayed multiple years because of the state hospital," Mason says. "This has obviously been going on for a couple years now, but I mean, at what point does this end? Do you see an end in sight for this? Do we just keep dealing with these delays?"

For many district attorneys, including Mason, it's hard to hear state hospital officials complain about things like staffing and low wages when their departments have the same issues. "Blaming it on staffing is pretty hard for me to accept, honestly," he says. "We have staffing issues at the district attorney's office and are still getting these cases prosecuted. We're still getting our job done."

Kelly echoes Mason's sentiments. "We have been told repeatedly that the state hospital is experiencing a staffing shortage," she says. "As far as I am aware, that is the only cited cause of CMHHIP’s utter failure as a state organization. This explanation is unacceptable, and represents, in my opinion, a complete failure of leadership at CMHHIP."

Tied by a tight budget that makes it tough to find lawyers in the rural 4th District, Kelly says she's still managed to make things work — recruiting and hiring lawyers to put in her courtrooms because "that is the challenge as a leader to solve."

So why can't the state hospital do the same thing?

"It is inconceivable to me that CMHHIP continues to use the excuse of inability to recruit professionals when they are spending tens of millions of dollars to pay non-compliance fines," Kelly says. "The institution does not have a recruiting problem, it has a leadership problem. Recruiting challenges are solvable, and they clearly have taxpayer money to solve them. Instead, they continue to use the staff shortage excuse to utterly fail to do the only job they have been mandated by the state to do."

The Colorado Department of Human Services, which oversees the state hospital, offers multiple reasons for what, specifically, has caused the problems:

"The delays in the competency system are due to two main factors: Dramatic increase in referrals for competency services...[and] nursing and physician staff shortages," says Jordan Saenz, communications manager for the CDHS-run Office of Civil and Forensic Mental Health, which is in charge of the state hospital system.

"Fiscal Year 2022-23 had an 80.4 percent increase in inpatient restoration treatment court orders since Fiscal Year 2017-18," Saenz reports. "Nursing and physician staff shortages prevent hospitals from operating at full capacity. Fifty-three beds are closed at the Colorado Mental Health Hospital in Pueblo, and 22 of 44 new forensic beds cannot open at the Colorado Mental Health Hospital in Fort Logan. That means 75 beds are closed, meaning 249 individuals are not served per year."

In July, CMHHIP was able to open an additional 39 beds "thanks to staffing initiatives" that will "allow the state to serve approximately 129 more Coloradans per year," Saenz notes. This, coupled with extra staffing, is something that CDHS officials hope will alleviate the pain being felt across the state by DAs and the courts. But mental health experts say it's still not enough.


According to Saenz, the state hospital and OCFMH have been unable to comply with the 2019 consent decree because both have been focused on solving staffing issues. "We have been aggressively pursuing increased staffing levels by offering $14,000 hiring bonuses for nurses and hosting same-day hiring events," she says. "With an initial $7,000 bonus (from September 2022 through February 2023), the mental health hospitals hired an average of 2.6 nurses per month. With the $14,000 bonus, the hospitals hired about 8.7 nurses per month."

For many people — including Sheriff Diggins and several DAs — the bonuses aren't enough, and they suggest that the state seems to be nickel-and-diming its CMHHIP employees until the delays just somehow go away on their own.

"They've tried to get creative and come up with some hiring incentives, monetary incentives to bring in new staff," says Kellner. "That's all well and good, and it should happen. But this is a problem that's been going on."

The issues with delays and backups have been grabbing headlines since 2011, when the nonprofit group Disability Law Colorado sued CDHS over the state hospital's mounting problems. The two parties eventually reached a settlement, which led to the 2019 consent decree.

With counties having to compete against the private sector for staffers, Diggins says it's been hard to keep up with what the outside world is paying.

One possible solution presented by several DAs and sheriffs is to find a way to end the 2019 consent decree fines and reallocate that $10 million to $12 million that state hospital delays are costing each year.

"The idea that the state — the taxpayers — are paying around $12 million in fines every single year because of this problem, with no end in sight, it's absolutely unacceptable," Kellner says. "I appreciate that they're trying to hire more folks, but if we can find apparently $12 million to pay a fine, why can't we put that kind of money into the state hospital system?"

"Instead of spending money on salaries for providers," Kelly notes, "they continue to pay massive penalties for their complete failure to abide by Colorado statutory deadlines. CMHHIP has been able to brazenly ignore statutory deadlines for years while failing to provide any reasonable explanation for why the leadership has not been able to solve the alleged staffing shortage issue."

Adds Allen, "The fines levied by the federal court highlight exactly how impactful this crisis has become, and the dollars paid in fines would have been much better spent on improving staffing and response times."

"When you have a homicide case that is delayed for years — plural, years — that costs the taxpayer significantly more money."

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DA McCann points out that the millions of dollars in fines is money that can be accessed for treatments and procedures for mental health. "Anyone can apply to get funding from the fines committee," she says. "So I think it's actually not a bad thing that [the money] is being made available. ... I think Denver's used some of it to purchase a motel that they're renovating. DA's offices can apply, and even service providers."

Mason remains skeptical, however.

"Where does that money go?" he asks. "I don't know where those fines are going. I don't have any firsthand knowledge of that. There is no question that the state hospital's failures are impacting the Colorado taxpayer in a negative way — there's just no question about it.

"When you have a homicide case that is delayed for years — plural, years— that costs the taxpayer significantly more money," Mason charges. "It costs money in resources for the district attorney's office, it costs money in resources for the court, it costs money in resources for the public defender's office. And that is, without question, one of the many consequences of [the state hospital's] inability to process these cases quickly."
If there's anyone who serves as proof of Colorado's failing mental health system — and the need to make statewide legislative changes — it's Cole Priest.

The Boulder County man — who is accused of attacking and detaining a thirteen-year-old girl against her will as she was walking home from school — was arrested in September and found to have a prior case from 2018 resulting in misdemeanor charges of unlawful sexual contact, assault in the third degree and harassment. Priest allegedly grabbed a female victim's buttocks and chased her as she ran home. His attorney raised competency issues, and the court found him incompetent to proceed before eventually dismissing his charges in 2020.

CMHHIP determined that "there was not a substantial probability that he would be restored to competency in the foreseeable future," but also ruled that he didn't meet the criteria for civil commitment — so Priest was allowed to walk free without any further mental health treatment or services, according to Dougherty's office.

"Our office believes that finding that someone is permanently incompetent should then allow for treatment," says 20th Judicial District spokesperson Shannon Carbone. "It is the right thing to do for the person and for the community."

To solve the competency-hearing backups, prosecutors and mental health experts believe that legislators ultimately will have to take the lead.

"There are some big public-policy questions and challenges that are wrapped up in all this," says Mason. "Until we start actually addressing these issues, community safety will suffer, victims will be subjected to painful delays, and defendants will go without care."

The hospital backlogs and delays are "unprecedented," Kellner says. "It's unfair to everybody involved. It's unfair to the defendants, to the victims, to the entire court system, [especially] when these unprecedented delays are really impacting every courtroom across our state. So this is something that I hope the legislature and other statewide leaders can take to heart and really try to find solutions to reopen as many of the beds as possible at the state hospitals and get these folks the restoration services that they need."

CDHS and the OCFMH team agree that the state's leaders must work on solutions; the agencies have already started meeting with officials to try and get ideas off the ground.

"OCFMH agrees that the number of individuals waiting in jail for inpatient competency services is unacceptable and is a systemic problem," Saenz says. "Over the last several months, OCFMH has pulled together leaders from across the system, including DA Dougherty, law enforcement officials, community advocates, the public defender’s office and more to form a Consent Decree Steering Committee. This group meets bi-monthly to dig deep into the problems and is developing innovative solutions related to the wait list that will help Coloradans. The challenges are systemic, and therefore the solutions must be systemic."

State Representative Judy Amabile, of House District 49 — which covers Boulder, Gilpin, Clear Creek and unincorporated Larimer counties — is planning to introduce a bill about competency evaluations that she hopes will make a difference. "It's about tightening up the time frame," she says. "It's also about rendering someone permanently incompetent and taking them off the wait list faster. We know these people won't be restored, so waiting in jail is useless."

Amabile tells Westword she's been "at this for a few years now" — floating pieces of legislation that put "millions of dollars" toward the issue of competency and help pay for private hospital beds and better wages for nurses. Still, she says, no real change has come about.

"Four bills later, lots of money spent, and the numbers are still going up," she adds, noting that the state hospital backlog was at around 320 people when she entered the legislature in 2021. 

Amabile's theory is that prosecutors and state leaders have been "barking up the wrong tree," refusing to address what it would really take to make a difference at the state hospital.

"It takes money," she says. "It sounds simple, but it's hard to convince the powers-that-be that we have to have another state hospital. Or at least a significant amount of additional hospital beds — for both people who are criminally involved and people who are not. Legislators need to take the lead, but that's a cop-out. The people need to demand that we solve this problem. We need more beds, we need more hospital stays, we need people to be able to stay in a care setting that's appropriate for them as long as they need it — and we need to pay for that."

The situation hits close to home for Amabile. Not only does she represent the district where the Boulder shooting took place, but her son has schizoaffective disorder and has been behind bars in the past, without access to mental health services.

"We know how to operate these systems, and we've never been able to get the care he needs," she says. "Something has to finally change."