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Salt Lake County Sheriff's Office
A patient at the Utah State Hospital's competency restoration unit in the Salt Lake County Jail decorates a box to be used for a Meals on Wheels delivery.

PROVO — The Utah State Hospital hit its first benchmark Saturday after settling a lawsuit requiring the facility to reduce wait times for mentally ill individuals requiring treatment before they are able to face criminal charges.

Six months after the clock started ticking on the hospital's mandate to reduce the wait, representatives on both sides of the lawsuit are reporting remarkable progress.

"It's a whole different world," said Aaron Kinikini, legal director of the Disability Law Center, the non-profit advocacy group behind the claim.

Where mentally ill Utahns before were being warehoused for as much as six months in jail cells waiting for a spot in the hospital, now they are spending fewer than 60 days on the wait-list.

In another year, that wait time must be down to just two weeks.

A special report by the Deseret News last May highlighted the lengthy wait times — which are considerably longer than those in other Western states — and the toll it was taking on mentally ill Utahns and their families.

Less than a month after the investigation was published, the Utah State Hospital — the only facility in the state able to provide competency restoration treatment for mentally ill or deficient defendants — settled the lawsuit that had been dragging through federal court since September 2015.

The Disability Law Center's claim alleged that because the wait times were so long, the state was holding people in custody longer than is constitutionally allowed.

Dallas Earnshaw, Utah State Hospital superintendent, said several changes have been made to reduce the wait times, but one of the biggest steps forward has been the addition of a 22-bed competency restoration unit that opened in the Salt Lake County Jail in October. The beds are a needed addition to the 100 spots in constant demand at the Utah State Hospital in Provo.

"When you look at all the different components of everything we've been working on, it's been very helpful to be able to meet our mandate," Earnshaw said.

The department has also sought to increase its efficiency wherever it can, like calling up and requesting a new court date as soon as someone has been restored to competency rather than waiting for the next date on the calendar, Earnshaw said. If someone can't be restored to competency and is instead going to be placed in a civil committment, he or she is moved as soon as possible into the hospital's civil unit in order to open up a bed.

To continue reducing the wait, the hospital was granted $2.7 million by the 2018 Utah Legislature, which will allow for the addition of 24 beds. But as the state continues to grow, and its citizens' mental health needs along with it, Kinikini believes further funding and expansion will be needed.

"The concern going forward is I think it's going to take just a persistent commitment to funding. You know, you might need to add another 25 beds to the forensic unit, because when people are waiting in this kind of pipeline system it's because they're waiting for a bed at the hospital, so it's the sickest people there that are still waiting," Kinikini said. "The state needs to be prepared; If they need to add another 25 beds then they're going to … grit their teeth and write a check, I guess."

Beds in the unit that the Department of Human Services has leased from the jail are used to treat mid-level patients — those who require more treatment than the department's outreach team can provide but who don't need the full resources of the hospital. While the patients are still in a jail, Kinikini acknowledges, efforts have been made to soften the area and make it feel more rehabilitative and less like a correctional facility.

"It's in a jail, but all the cell doors are open," Kinikini explained. "When I went there the patients were playing a ball game with the rec therapist. … It's as hospital-like as I think you'd to be able to make a jail look."

The Deseret News was granted a tour of the unit this month. At the time, the all-male unit housed 15 patients and was preparing to receive another. Since the unit opened, 25 patients have been treated. Nine of them have been restored to legal competency.

In the competency restoration unit, residents are referred to as patients, not inmates or prisoners. Doors to patients' cells are kept open throughout the day, allowing them to move about as they please. A few soft couches and a television have been added to the common area, and art supplies and puzzles are set out on a game table. Completed drawings and puzzles are displayed on a wall in a meeting room

From 9 a.m. to 6 p.m. on weekdays and for half the day on Saturdays, patients participate in competency restoration classes, group therapy and individual therapy.

Don Rosenbaum, director of forensic services, said the changes to the unit are a deliberate attempt to put a focus on treatment.

"We wanted to set up a program where we were able to keep people engaged in the learning process, but at the same time be able to assess them as they interact with others and be able to treat them," Rosenbaum said.

The unit is run by employees from the Department of Human Services, including a full-time psychiatrist, nurses and technicians, in addition to a team of sheriff's deputies who have been specially trained to work with the patients.

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Deputy Dustin Hunzeker, a seven-year employee in the jail, is one of the deputies who have agreed to spend three years working in the unit in an attempt to keep trained, familiar faces working with the patients. Each of the deputies has completed crisis intervention training, become familiarized with common mental illnesses and learned that what may appear to be disruptive behavior may actually be a reaction to psychological manifestations.

When he eventually leaves the unit, Hunzeker believes the training he has received will continue to serve him, and could benefit deputies throughout the jail.

"I've always been patient, and then I came here and found I could be more patient," Hunzeker said with a smile.