PA public defender here. Let me paint a common picture and talk about an important term along the way.

What does the word forensic mean? Well, forensic is a code word for involved in the criminal justice system. Why's that word important here? It renders treatment options virtually non existent.

Suppose someone with mental health issues is charged and put in jail because they are perceived as dangerous and unable or unwilling to stop. They don't have family resources, housing, or insurance. They don't have a job. They maybe trespassed at Walmart after arguing with an employee. Or gotten into a fight with family. Or the like.

Before being incarcerated, they can be taken to a local hospital and involuntarily committed for mental health treatment until their mental health becomes relatively stable. The hospital can't or doesn't refuse treatment.

After being incarcerated, the treatment needs are labeled as "forensic." The private hospitals won't accept them anymore. They say they have to go to a forensic hospital, because their needs are now "forensic." And local judges are disinclined to let mentally unstable, untreated, homeless persons out of jail.

But there are virtually no forensic hospitals in PA. There are two IN THE ENTIRE STATE. They are state run. They have to be shipped there after a very long waiting list, usually months. And then, when they are relatively stable, they are shipped back to the county jail. And when they get back they have the same local treatment options. Some of these people who are really stuck literally wait in prison a year or more before ever going to trial or pleading guilty. Just trying to sort out the mental health component.

The state and counties are not funding indigent mental health treatment. It's just non existent. And there is no where for these people to go.