Florida is leaving mentally ill defendants to languish in county jails for months after judges order their transfer to psychiatric hospitals, often locking them in cramped solitary cells, according to a federal lawsuit filed Wednesday by a coalition of civil and disability-rights groups. Sometimes, those defendants died in harsh conditions before ever making it to a hospital.

The complaint accuses the Florida Department of Children and Families of routinely violating a state law requiring the agency to transfer defendants deemed incompetent — and therefore unable to proceed in their criminal cases — to state psychiatric hospitals within 15 days of receiving a court order. Instead, DCF’s own data show admissions take an average of 124 days, more than eight times the legal limit, and often stretch past six months, according to the complaint filed by Disability Rights Florida, the Southern Poverty Law Center, and the Florida Justice Institute in the U.S. District Court for the Southern District of Florida.

Over the last few years, the state has maintained a waitlist of between 650 and 880 people waiting for court-ordered competency restoration treatment. “DCF’s practice of delaying state hospital admissions relegates people with serious mental illness to legal limbo,” the complaint says.

“People with serious mental health disabilities who have been found incompetent to proceed in their criminal cases have been languishing in county jails for years, and they’ve waited long enough,” Kelly Knapp, senior staff attorney for the Southern Poverty Law Center, told The Florida Trib. “County jails are wholly inappropriate for someone who is suffering from such severe symptoms that the court has ordered them to the state hospital. They can’t wait any longer for the Department of Children and Families to start transferring them on time.”

DCF told The Florida Trib in an email that the department doesn’t comment on pending litigation.

A cycle of decompensation

The lawsuit paints a picture of people with severe mental health disabilities living in confinement under grim conditions. Because county jails lack the resources to provide intensive psychiatric care, defendants waiting for transfer routinely suffer from severe psychiatric symptoms, including hallucinations, delusions, mania, suicidality, depression, and self-starvation, the complaint says.

Jail staff often respond by isolating defendants experiencing a mental health crisis in solitary confinement, perpetuating what the complaint calls “a vicious cycle of decompensation.” Those in solitary are confined to cells roughly the size of a king-size bed for at least 23 hours a day with little human contact or environmental stimulation.

The complaint documents 11 cases showing patterns of severe psychiatric decline while in jail and says Disability Rights Florida identified at least three people who died in county jails while waiting for transfer. One man, identified in the lawsuit as A.L., died of hyponatremic dehydration in a Duval County jail cell four weeks after the statutory transfer deadline had passed. And a woman, A.M., also held in a Duval County jail, was severely beaten by her cellmate and later pronounced dead while waiting for a state hospital bed.

A history of underfunding

Lawyers for the plaintiffs say litigation over DCF’s delays stretches back nearly 50 years — including a wave of contempt rulings around 2006 that led to the resignation of the agency’s secretary and a legislative funding increase. Florida met the 15-day deadline consistently for roughly a decade after that, Knapp said, before the state let it slip again.

“Florida fixed this problem at one point in time after the state courts ordered them to,” Knapp said. “If Florida has the political will, it can fix the problem again, and it appears that they need a lawsuit to find that political will again.”

While DCF has historically blamed a lack of resources, the lawsuit counters that Florida spends just $19.63 per capita on community mental health funding — the lowest in the nation and far below the national average of $93.39. Florida’s 15-day transfer deadline falls roughly in the middle of the range nationally; some states, including California, require transfer within seven days, while a Texas court set a 21-day deadline earlier this year, Knapp said.

A January 2025 behavioral health gap analysis DCF provided to the legislature found that to maintain an occupancy rate that meets industry standards, the state’s mental health facilities would need to add more than 2,000 forensic beds by 2029. Despite that projected gap, DCF requested no funding for additional state hospital forensic beds in its 2026–2027 legislative budget request, the complaint says.

Less costly alternatives

The plaintiffs are seeking injunctive relief to force DCF to create a remedial plan ensuring timely admissions. Knapp said the state has several less costly alternatives to state hospital beds it could fund instead, including mental health clinicians who respond alongside police, diversion programs at the point of arrest, mental health treatment courts, and forensic alternative treatment centers. State law also allows DCF to divert people to community treatment even after they’ve been committed to a state hospital, she said — reserving hospital beds as a last resort for those who cannot be treated any other way.

“Regardless of its resources, DCF cannot surrender its constitutional obligation to provide the treatment that courts have determined it must provide,” the complaint says.

“The state of Florida has options,” Knapp said. “It could build more hospital beds. It could fund forensic alternative treatment centers. It could fund local residential treatment facilities. It could fund more diversion programs. It could fund more case management programs. There are a lot of options that are available to the state of Florida, in addition to state hospital beds, to address this problem.”

The human cost of legal limbo

The delays aren’t simply administrative inconveniences but constitutional violations that cause irreparable harm, Knapp said. For many people, the jail environment is so destabilizing that it makes recovery more difficult, lengthening the time they remain mentally unwell and increasing the cost to taxpayers.

Counties are “getting a raw deal,” Knapp said. Jails “are not equipped or designed to provide the level of mental health care that people who’ve been found incompetent need. This is the state’s obligation to treat them, and it’s unfair for the state to abandon its obligation to the county jails without an increase in state resources.”

DRF interviewed at least 129 clients across 25 Florida counties to document these experiences. Even the shortest wait time among that sample was 51 days, more than triple the legal limit.

“DCF has been able to have its cake and eat it too — it has wantonly ignored its statutory obligations and violated the constitutional rights of individuals with mental illness who have been found incompetent, while relieving itself of the financial costs it would take to meet its legal obligations and placing a huge financial burden on each of the county jails throughout the State of Florida,” the complaint alleges.

The plaintiffs argue that once a defendant is found incompetent, all criminal proceedings must stop, and the only lawful purpose for continued confinement is to receive competency restoration services. Failing to provide that treatment in a timely manner, they argue, effectively punishes people who have not been convicted of a crime.

Unlike the individual contempt motions and writs that public defenders have filed against the state for decades, Knapp said this is the first case to challenge DCF’s failures on a systemic, statewide basis, rather than on behalf of a single defendant. In this case, Southern Poverty Law Center is representing Disability Rights Florida, which represents people across Florida who have been found incompetent to stand trial.. 

“This type of case has been brought in many states across the nation over the last few decades, and most of them have been successful,” Knapp said. “We also believe that we should succeed because this is a clear due process violation, and we’re committed to litigating until we achieve the relief that our clients need.”

Sharmila Venkatasubban is The Trib’s senior editor and health reporter and a Report for America corps member. You can reach her at sharmila.venkatasubban@floridatrib.org.