VERNON, Texas (KTRK) -- Six miles from the Oklahoma border and a world away from Houston, 450 of Texas' most violent accused killers, rapists, and otherwise criminally charged defendants wander the campus of a renovated geriatric treatment center getting mental health treatment.
It's a treatment that will lead them right back to jail -- and in some cases, facing death row -- if it works.
Vernon is home to the North Texas State Hospital, Texas' only maximum security mental health facility. It is the only place in Texas where violent accused criminals get treatment designed to restore their competency to stand trial.
Defendants who can't help their attorneys or understand the criminal proceedings against them cannot be tried under the U.S. Constitution. Instead judges send them for mental health treatment with the hope they can be restored to mental health competency.
In 2016, the wait list was thrust into the public spotlight after state Sen, John Whitmire, D-Houston, urged the hospital to admit Deputy Darren Goforth's accused killer, Shannon Miles faster.
"No one should be waiting," Whitmire told abc13. "There should not be a waiting list for state mental health services. For the system to work you can't have a backlog of people waiting to go to trial. It's not good for defendants, victims, everybody."
While Miles has to wait, we did not. Ted Oberg Investigates made the seven-hour trip to Vernon to see the hospital for ourselves.
Surrounding the facility is a 15-foot-high unclimbable fence. Any visitors must be buzzed in.
"Once they're admitted, the handcuffs and shackles come off and they become patients of the public mental health system," Jeff Bearden, director of the hospital's Forensic Psychiatric Program, told abc13.
The treatment will likely be a dramatic departure for any inmate at a county lock-up.
Hospital CEO James Smith described the hospital as "maybe the last best place for people who are hopeless."
At North Texas Hospital, visitors are encouraged to look at name badges to determine who is a patient and who is a staff member. There are no handcuffs, no shackles, dormitory doors are locked only at shift changes; guards are out of sight.
"When patients come in and see this is not jail, not prison," Smith said. "The vast majority adapt quickly."
All of that is very intentional, according to Bearden.
"Believe me the security staff knows exactly where we are, everywhere we've been and where we will be all day," he said. "It's just a calculated effort to not make it oppressive."
Patients -- they are not called inmates -- are almost all on psychiatric medication. They have the same rights as any other Texas patient in the free world. They live in dormitory style rooms. Men and women are in the same buildings, but do not share dorms. Their freedom of movement is not restricted within the facility. They have the right to refuse treatment. Both Smith and Bearden told abc13 few do, despite knowing that once they leave Vernon they will be on trial.
Some could face the death penalty.
"If you get well in this hospital, you're going back to jail, so there have to be incentives to do treatment," Bearden told us. "We're not here to be the judge or jury. We're here to help you have your day in court."
There are classes on courtroom etiquette, courtroom personnel and job skills training. On the day of abc13's visit, some of the mentally ill accused criminals were silk-screening shirts for a nearby school, while others were pruning plants for an on-site nursery.
While it may seem out of place to some in 'tough-on-crime' Texas, it is hard to argue with Vernon's success.
The campus is not all free-roaming. Actively violent patients are kept in a more secure, constantly locked unit where staff work behind fortified glass and locked doors. There is a seclusion room with heavy locks and hinges. It was unused during abc13's visit and officials said it is not often used. In this unit, sleeping rooms are limited to just two patients and all "stimuli" are muted: lights, colors, and sound all quieter than normal. As patients comply with treatment they are moved out and into other parts of the campus.
"I am confident we are not coddling anyone," Smith said before pivoting to his success rate when interviewed in 2016. "Roughly 85 percent (of our patients) are referred back to court and we're doing that in 95 days," he said at the time.
State records show "actively aggressive" patients take 494 days on average.
State statistics show the wait list has grown in recent years.
As of May 16, 2016, there are 228 Texas inmates waiting for restoration services at the North Texas State Hospital. The state turned over records since 2006. The wait list has never been this long. It's grown by seven percent in the last six weeks, and 20 percent in the last six months.
On the chart below, the Maximum Security Wait List (in red) is for defendants who are charged with a serious offense (capital murder, aggravated robbery) or with an offense involving use of a deadly weapon, or who is determined to be manifestly dangerous. Forensic patients are also waiting for competency restoration services to stand trial or those found not guilty by reason of insanity. The green line is the total of both categories.
Smith is confronted by the growing wait list every day telling abc13, "I feel a great responsibility not to let myself feel pressured or let my staff feel pressured into moving people out of this environment sooner than is appropriate."
His team of mental health providers cannot move patients out any faster, especially ones who need more treatment than in years past.
"State hospitals are seeing people who are sicker and more difficult to treat," he said.
There has not been any help on the way for years.
"Within the last 10 years, we technically added eight maximum security beds (statewide)," he said.
The treatment comes with a far higher cost than traditional jail stays.
According to the Texas Department of State Health Services, it costs $697 a day to treat a patient at North Texas State Hospital. A 2008 Harris County study suggests that same patient is housed and treated in the Harris County Jail for just $21.
The Harris County Jail does have an award-winning mental health unit, but does not offer the kind of court-mandated competency restoration available only at North Texas State Hospital.
A pilot program is exploring adding competency-restoration in county jails. No counties have yet been announced.
State Sen. Whitmire told abc13 he will push the state to add a facility near Houston, where 20 percent of Vernon's patients currently come from.
"I've already talked to lieutenant governor, this should become a priority," he said. "I talked to UT Health Science Center. They will come up with a proposal."
Whitmire said he was previously unaware of the wait, but that it is "on my radar now," adding that he wants to cut the wait list as soon as Texas can.
"I'm tough on crime, but when a judge says a man is sick and sends him to a hospital, I thought they meant it," he said.
NOTE: All statistics and proposals were current as of Nov. 2016.