-What happens when someone is found incompetent to stand trial, and what responsibility does the State have in those cases?

That's this week on Nevada Week.

♪♪ Support for Nevada Week is provided by Senator William H. Hernstadt and other supporters.

-Welcome to Nevada Week.

I'm Amber Renee Dixon.

According to the Nevada Division of Public and Behavioral Health, as of June 17, there were 180 people in the state waiting for an open bed in order to receive inpatient competency restoration treatment.

A court can order that treatment after someone charged with a crime is found incompetent to stand trial.

In Nevada, there are two facilities that provide this treatment, aimed at restoring the defendant's competency so their criminal case can proceed.

One is Lakes Crossing Center in Northern Nevada.

The other is Stein Forensic Hospital in Southern Nevada on West Charleston near Jones.

That's also where earlier this month the State broke ground on the new Southern Nevada Forensic Facility.

Expected to be complete in 2029, the 327,000 square foot psychiatric facility will replace Stein Forensic Hospital, and its 298 beds will increase Nevada's total forensic capacity by more than 100 beds.

(Governor Joe Lombardo) Too many individuals have waited for treatment they need, and those delays create challenges not only for patients and families, but also for our courts and communities.

The Southern Nevada Forensic Facility is one of the most significant investments Nevada has ever made in behavioral health infrastructure.

(Drew Cross) A cutting-edge facility staffed with highly trained clinicians that are going to expedite the process.

These additional beds will be utilized.

It gives us additional turnover and discharges, allowing us to take in any individuals that need forensic services.

So we're going to have a more efficient, higher capacity system.

-The State says the new forensic hospital will cost nearly $400 million to construct.

Over roughly the past two years, the State has faced more than $2 million in court-ordered fines for failing to transfer defendants for competency restoration treatment within seven days of a court order.

Delays have also led judges to dismiss criminal charges.

And here now to help us understand why that's happening, what competency restoration looks like, and what more can be done while the state awaits the opening of the Southern Nevada Forensic Facility are Nevada Assembly Speaker Steve Yeager; Dr.

Lesley Dickson, a board-certified psychiatrist and a past president of the Nevada Psychiatric Association; and Dayvid Figler, an attorney with decades of experience as a public defender.

Thank you all for joining Nevada Week.

-Thank you.

-When we hear about cases in which criminal charges are being dismissed, Dayvid, from a public safety perspective, how often is this happening?

How violent are these people?

Is this a threat to the public?

(Dayvid Figler) I don't think it happens very often, so people can rest assured that it's only as a last resort.

In fact, the Nevada Supreme Court has said that they will support those dismissals when there are what they call "graduated sanctions."

So every individual who is charged with a crime--and they haven't been convicted of anything yet, so we have to remain convinced of their presumption of innocence--has a right to have the proceedings move forward.

But if they are incompetent, I mean no cause of their own, but if they cannot understand the proceedings, assist their own counsel, if they're acting very erratically in court and they're doing it only because their minds aren't working correctly at the time, their functioning is disrupted, they have a right to get some manner of restoration or to make them competent.

Now, it's been determined that a person really needs, once they have been determined to be incompetent by independent doctors who evaluate them, if they come to the same conclusion, typically what will happen is they then have seven days to get to one of these psychiatric facilities to begin the process of attempt restoration.

But people are waiting.

And they're not waiting seven days.

They're waiting months, sometimes many months, sometimes over 100 days.

And so what the courts have been doing to try to incentivize a quicker turnaround, if you will, to get people into this restoration is to start with different kinds of sanctions directed towards those facilities themselves.

If it is not productive-- In other words, if the person still languishes, waiting and having their due process rights interfered with because of delay, the Court can exercise the right to dismiss.

Now, when they dismiss cases, sometimes it's already well past the amount of time that that person would have done if they were found guilty of the offense and served all the maximum time at all.

And when they do dismiss, it's dismissed without prejudice, meaning that the State can refile the charges if they deem it to be appropriate.

-But you are involved in a case right now, which I know you can't comment a lot on.

But Chad Ollinger, he is known for his role on a reality TV show on the Discovery Channel, he is accused of murdering his cellmate yet did not get competency restoration treatment until more than 100 days after it was ordered, which resulted in you filing a motion to dismiss the charges.

-Mm-hmm.

-That might scare people.

What if that judge had granted that and someone accused of murder would be, what, released?

-Well, so I represent him with my co-counsel, her name is Sophie Salcido.

Look, there are public defenders like Sarah Hawkins in the competency court every day making these challenges, because we have to represent our clients.

We have to do what we can to protect their due process and their constitutional rights.

We don't have as much concern about the impact, but the courts also realize.

And the courts aren't typically throwing out murder cases because of the delays.

And I would say, Amber, that the example, which I cannot specifically speak on, is yet one in hundreds of cases, one of hundreds of cases that is expressing to our community that this is a critical issue and we do need to come up with those solves now.

It's a priority.

-Assembly Speaker Yeager, you were a big part of getting this legislation through that helped create the soon to be Southern Nevada Forensic Facility.

It took two legislative sessions to get the funding through.

It was a bipartisan effort.

But in the project notes, the State says there were requests for this project in 2017, '19, and 2021.

Why do you think it finally got through these past two sessions?

(Steve Yeager) Yeah.

It's been a long-time need for the state.

As long as I've been in the legislature, this is an issue that we've talked about.

We simply don't have enough capacity, not enough beds.

The request did come, I think, in all those sessions.

The difficulty in those sessions is the state was in a much bleaker financial position.

2017-- Things were looking good in 2019, and then COVID happened in 2020, as you know.

And that really decimated the state budget.

So coming out of COVID in 2021, we just didn't have the funds to be able to do it.

What really changed for the state was that influx of federal money, the federal relief money that came in from the federal government.

That allowed us to take a look at what we had in the state as far as needs and say, Where can we best put this money?

And this project raised to the top because finally we had some funding to be able to do it.

You know that funding from the federal government was one-time funding, so we really want to use it for something that's a one-time expense, like constructing a new Southern Nevada Mental Health Forensic Facility.

So we were able to get that passed in 2023 and then have some companion funding last session in 2025.

And as you noted, we broke ground I think a month ago.

And it's going to take some time to build, but at least we've started that process.

And it's just been much needed.

So really proud that we were actually able to get that done.

And, as you mentioned, it was a bipartisan effort with Governor Lombardo and the Democratically controlled legislature.

-We'll come back to you on what can be done in the meantime, but, Dr.

Dickson, will you help us understand what is the difference between someone who needs competency restoration and then someone who is insane.

(Dr.

Lesley Dickson) Well, insane would be-- It's not a psychiatric term, first.

-My apologies.

Should I rephrase that?

-No.

But anyway, who's mentally not doing well, let's say.

And there's a lot of different diagnoses that can be put under that category.

But the idea is that they're not thinking properly, and they're not, as he was saying, either that they're not able to work with their lawyer, they're not able to understand the process.

And then there's a lot of different reasons that people get into that situation.

Some are very sick, mentally very ill.

Others are maybe what we call malingering.

And so this is one of the things that a forensic hospital can do is try to figure out do they really have a mental illness, DSM-5 sort of thing, or are they-- is something else going on that explains why they did what they did or why they can't work with a court or with that lawyer.

-The reason I say "insane" is because there are people who are found to be not guilty by insanity, right?

-Right.

-So what's the difference between them and someone who needs competency treatment?

-Well, that "not guilty by reason of insanity" refers to the time they committed the act that they're being charged with.

That's a difficult situation, because it could have been months to years ago.

And so, but anyway, at the moment of committing their crime, they were what we might call insane.

Competency is now today, whatever.

Can they actually work with the court and with a lawyer?

And so, but looking retrospectively to back at the time of the crime can be very difficult.

-What does competency restoration entail?

What does it look like?

-Well, in the hospital, someone has already thought that they might be incompetent and not able to stand trial in their present mental state.

In the hospital what we would do would be in a way like a psych hospital, regular psych hospital.

We'll diagnose them with whatever mental illness they might have, and then we would treat them.

And the treatment for a lot of these illnesses would be medications, some non.

Some would be trying to understand.

Some of them could be mentally retarded, in which case they're not probably going to get better.

And some may be getting demented, like Alzheimer's, and they're probably going to get worse.

So part of it's differentiating what's really going on, and part of it is treating what can be treated.

-Okay.

Assembly Speaker Yeager, there is a percentage of this population who will never get better, correct?

And so what happens to them?

-Yeah.

So there is a percentage, and that's called the incompetent without probability.

Basically, in a doctor's opinion, they're never going to restore to competency.

So it depends what happens to them.

If they're-- if they're serious felonies, A felonies and B felonies, which are some of the most serious ones, they actually can be held.

And it used to be up to 10 years they'd be held in state custody and treated.

There was a change in the law that happened about 20 years ago that allows for extension of that.

So I think those folks can actually be held now up to 25 years.

There has to be some court requests.

-And that's part of the reason for this need for extra beds, because-- -Yeah.

I mean, you think about that, these are people charged with very serious crimes.

They haven't been convicted, but the crimes are serious.

And so the concern on the state level is we probably shouldn't just release them to the community.

That doesn't seem smart.

But at the same time, they also have rights to not be held against their will.

So I think it's a bit of a balancing act, but there are people, and I think right now it's somewhere in the neighborhood of about 20% of the beds that the state has that are being filled by folks who just are not going to retain competency, so they're still being treated, but they're not released to the street.

And you think that's someone there that's there for a very long time.

They're not going to be returned to the court, most likely, to be able to stand trial.

And so that's-- You know, that was a change in the law, and I think there were some unanticipated consequences to that law.

I was not there when it was passed.

But what we're seeing is a further strain on state resources.

And so the folks that can be restored to competency are competing sometimes with those who cannot for beds, which is one of the reasons that we did this project to add to the capacity that the state has.

-All right.

Were you going to add?

-Yeah.

And that's one of the problems.

And I talked with one of our psychiatrists at Stein.

Even just restoring competency, these patients tend to stay in the hospital a long time.

In the private psychiatric civil situation, you can usually turn your patients around within five to ten days, so you have, you know.

But their average length of stay at Stein is between 70 and 80 days.

So you can see how, what he was pointing at, some never can leave and some it's going to take a long time.

I think-- I seem to remember at one point you could actually keep them for up to six months trying to restore competency before you say it's not going to happen.

And so, yeah, so it's-- And that's one of my concerns, even about the new hospital, is it'll be full eventually, and we will have to figure this out again.

-I just want to add that, you know, if it takes like six months to restore someone's competency, there are a lot of red flags that should be going off right away just about how we can ever really trust that the criminal justice system is going to adequately and fairly deal with that individual.

I mean, this brings up a bigger issue.

I know we're talking just about the competency in the moment, but really, I mean, there's a wide spectrum of mental disorders.

It could be Alzheimer's.

It could be schizophrenia.

It could be any number of neurological or environmental issues that have impacted a person, right?

A lot of people who get involved in criminality, who commit crimes, who get arrested for crimes have a lot of issues, right, but our criminal justice system is not squarely set up to deal with that in the most effective way.

I mean, we're a carceral system.

The prosecutors really have one tool in their box, which is to move forward in the prosecution of a case.

Now, luckily, we have some other outlets in the system.

We have an outstanding mental health court that's been led by a remarkable judge, who I think Assembly Speaker Yeager knows.

But Judge Bita Yeager-- -Christy Craig?

-Oh, no.

Judge Bita Yeager, the head of the mental health court, does remarkable work in working with individuals as they kind of work their way through the system.

But they have a limited space as well.

So, I mean, really, it's all part of a much bigger conversation on how Las Vegas--let's talk about Las Vegas--deals with individuals in our community before they commit crimes, as they've been accused of crimes, and through the process and beyond.

And I think we fall really short all the time.

So these measures, building these new hospitals, vital, important.

We do have to wait to 2029 for this one, and, you know, as the doctor indicated, it's going to be filled up really quick.

So, you know, while these are nice stopgap measures--perhaps to help the backlog, the inevitable backlog that's going to happen because of the way that the criminal justice system works--I think we also, and I think Assemblyman would agree with me, that we have to address the bigger systemic issues in our community and why is Nevada and Las Vegas doing such a poor job when it comes to mental health compared to all the other places in the country?

We really do rank very low in national standards with regard to these services and the ability to serve our community than a lot of other places of our size.

-Granted, this is a national issue, the lack of forensic beds, and there are wait lists in other states.

Did you want to add something?

-Well, I kind of want to talk about what is happening to the main, the regular community, the rest of the community is because of what's happening here with Stein.

Stein, it actually is a very small building, a very small hospital and at one point had 46 beds.

I don't know how many they have now.

But what they have had to do is start putting more and more of these folks in Rawson-Neal Hospital, which is, was originally the civil psychiatric facility, state facility.

That is almost all forensic patients now.

So now we're having trouble with all the patients that end up in the emergency rooms around town waiting for a psych bed.

And there's a certain population that needs to go to Rawson-Neal, and they wait, and they can be waiting.

So there's usually around 100 of those also.

-So this is impacting people who are not charged with crimes, who are in need of a psychiatric care facility?

-Right.

-Okay.

I think the State said there are 178 beds at Stein's Forensic Hospital and Rawson-Neal, so it's increased over the years from that number that you mentioned.

I want to run a sound bite from Kevin McMahill, the sheriff in Clark County.

This is from an interview we did in 2025, and this is what he had to say about the competency restoration process.

(Sheriff Kevin McMahill) There's a very small number of beds in the entire state that does this.

In fact, most of the detention, or the folks in detention that we send from Clark County, we send up to a place called Lakes Crossing up in Northern Nevada, where they then get sort of stabilized, deemed competent, and then they're brought back to Las Vegas to stand trial.

Well, what happens almost every time is that they're now competent, they're back here getting ready to stand trial, and the case gets continued, continued, continued, and now they stop taking the medication that we're providing to them.

There's lots of different things, and they end up getting to a place where they're not deemed competent again.

Now that we have very few beds, we have to wait till a bed reopens to send that person back up again to be declared competent to then come back down, and the cycle continues.

-What do you think about that?

I'll start with you, Dayvid.

-Sure.

You know, and I don't like disagreeing with the sheriff.

You know, he carries a gun.

But I will say this: I would take exception that this happens all the time.

In fact, I think it's very rare indeed when one of our clients-- So I represent an individual.

For whatever reason in my interaction I believe to refer him to the competency court, or her to the competency court.

There is going to be an evaluation by independent psychiatrists to-- or mental health professionals who are going to say, yes, this person is incompetent, and they are going to be sent up.

I understand that sometimes those processes are heavily reliant on medication and don't guarantee a lifelong restoration of competency.

But I think if they've gone through the process of restoration, as much as we may disagree with how effective it is or how long lasting it is, we would be, on the defense side, very cautious in continually bringing that back to the courts.

And I don't think it happens very often, where we say, Oh, well, they were competent for a second, but they're not.

And there's also this issue of forced medication.

So if the sheriff's issue is that they're not taking their meds, would seem to be his main point, there is a process.

And it is utilized more than I think Sheriff McMahill may know to force the medications on the individuals.

Like, look, all these things have different parts where the defense attorneys can have hearings, the prosecution is involved in these conversations, too.

You are in front of judges like Judge Christy Craig who is in charge of the competency court, and she makes the call.

But ultimately I think that the issue isn't that people are not taking their meds and going back and there's this endless cycle of competency, incompetency.

But I would agree that, as a defense attorney, it is very challenging when you see your client who has been told to you by others that they've been restored, exhibiting some of the same behaviors.

And, you know, sometimes just--and I say this from the defense perspective, so there's no disrespect to the professionals at the table here--that a lot of times restoration, because there is this pressure to turn over the beds, might rely a little too heavily on medications, which tend to, and we say euphemistically, dope up our clients so that they're very controllable in courts, they're not having the same kind of outbursts and stuff.

I don't know that that benefits anyone, but that is kind of a natural outgrowth of what occurs.

But, yeah, I would take a little bit of exception to what the sheriff indicated.

-Dr.

Dickson, do you want to respond to the "doped up" comment?

-Well-- -I mean, you get my perspective on that, right?

-Yeah.

This is, this is what psychiatry is all about.

Our patients frequently don't take their medications as soon as they-- In fact, several sessions ago we got what was called an outpatient commitment clinic going and where you-- they're usually coming out of the hospital.

And you send them there, and then they get their medications, frequently long-acting injections, and then keep track of them.

And if they don't come for the next shot, you send someone out to find out where they are and get them back in.

It is an ongoing problem.

Psych medications are not pleasant to feel.

They have bad side effects frequently, and I listen to pharmaceutical talks all the time.

They're constantly trying to come up with medications that are more tolerable so that the patient will take them.

-And then what about what Dayvid said of people returning, being restored, but appearing really doped up?

-There's no question some of these medications can make you look that way.

So... -And does that impact your ability to provide the defense with what they need?

-I don't know.

I don't work in the court.

I would think so.

I mean, if they're too doped up to cooperate, if they're falling asleep, yeah.

-Assemblyman Yeager, what else is being done to help this situation, and what can be done in the meantime before the facility opens?

-The other main thing that's being done is, as a legislature we put some additional funding to jail-based competency restoration.

Now, I will say jail-based competency restoration is not without its controversy.

It has believers, it has detractors.

But essentially it allows folks to get some of the treatment they would get in an inpatient setting in the jail.

And that's both here in Las Vegas and in the city of Reno.

Both jurisdictions asked for us to continue to fund that.

And so the hope there is like maybe there are some folks where you can restore competency without having to transport them to an inpatient facility, because that's really where the delays happen.

You've got to transport someone, that's law enforcement resources and state resources.

And so if we can treat in the jail, some folks will be restored to competency without having to go either to Lakes Crossing up in Sparks or to one of the facilities here in Las Vegas.

So-- -What would be the opposition to that?

-I think there are just some purists who think that competency restoration must happen in a hospital setting and in an inpatient setting.

And obviously, the jail is not, it's not a hospital, right?

Jail is not a great place to be, no matter what jail you're in.

So you know, that that's some of the opposition is that it's not really a clinical setting, but we're, you know, we're desperate at the state for solutions to this, as you know I think you've noted states being fined.

We've been fined, I think, over $2 million because instead of transporting people in seven days, it's taking 60, 90 days.

And that's just-- it's not acceptable.

It's not acceptable for the criminal defendant.

And when you look at the larger picture, it's not acceptable for the criminal justice system, because that's a delay in a trial or a proceeding.

And you know, these cases have victims as well who are due-- They get their day in court.

And every delay that happens is, you know, one day that they have to wait to be able to get into court.

So you know, I think that's a solution that we funded the last legislative session in the special session.

It seems to be promising.

Hopefully something will continue to fund.

But in my ideal world, we just have enough beds in a forensic setting for everyone in the state.

-Okay.

I think you said the state is desperate for solutions.

So in the State's desperation, what about staffing this new facility in 2029?

How difficult will that be?

-The doctor I was interacting with from Stein, same thing, staffing.

And besides staffing, there's also the bills to be paid for gas, electric, you know, water, everything.

I don't know where any of this ongoing money is coming from, but staffing is definitely, definitely a big problem.

We don't-- Right at the moment, a lot of our psychiatrists that are at Stein are actually contract psychiatrists versus state employees.

And state employees are not paid as well as doctors in the private sector or doctors across the border into California, and it's very hard to retain staff.

And I'm not just talking about psychiatrists either.

You need nurses, you need techs, and you need security in a forensic setting.

And that's all going to cost a ton of money.

-We have run out of time, but thank you all for joining us.

And thank you for watching.

For any of the resources discussed, including a link to an article from the Marshall Project that provides a national perspective on this issue, go to vegaspbs.org.

And I'll see you next week on Nevada Week.

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