An overview of jail-based competency restoration

Abstract

Forensic populations in the United States are increasing, driven largely by a rise in individuals determined to be Incompetent to Stand Trial (IST). Across most states, including California, the number of mentally ill inmates awaiting competency restoration has increased dramatically in recent years. Traditionally, competency restoration has taken place in state hospitals, but incompetent inmates often experience a significant wait for state hospital beds because of the rising demand for beds in such facilities. The resulting waitlists, which range from days to months, have led to states being held in contempt of court for violating limits placed on how long incompetent defendants can be held in jail. Therefore, alternatives to state hospitalization for IST patients have been developed, including jail-based competency (JBCT) restoration programs. JBCT programs provide restoration services in county jails, rather than in psychiatric hospitals. The following article will review the nature of JBCT programs and will emphasize the structure and evolution of such programs within California.

Jail‐based competency treatment comes of age: Multi‐site outcomes and challenges to the implementation of an evidence‐based forensic continuum

“…Finally, and specific to this article, critics point to the continuing lack of empirical support for the JBCT model (Danzer et al, 2019;Kirkorsky et al, 2019;Wik, 2018). Despite the proliferation of JBCT programs, the variability in its implementation across multiple states and counties has been a challenge to building a necessary evidence base, in two respects.…”

“…The growth of the JBCT model has been fueled by multiple perceived advantages, including accelerated access to more timely restoration and mental health services, reduction in prolonged incarceration for individuals waiting for limited hospital beds, reduction in the cost of restoration compared with hospitalization, removal of incentives for malingering, and improved proximity to local attorneys and family support (Ash et al., 2020; Danzer et al., 2019; Jennings & Bell, 2012; Kirkorsky, Gable, & Warburton, 2019; California Legislative Analyst’s Office, 2012, 2017; Rice & Jennings, 2014; Wik, 2018).…”

“…Other criticisms have focused on the ethical, legal and clinical problems of involuntary medication (IM) in correctional settings (Bloom & Kirkorsky, 2019; Danzer et al., 2019; Douglas, 2019; Felthous & Bloom, 2018; Kirkorsky et al., 2019). Moreover, if a JBCT program is prohibited from administering IM, the advantage of accelerated access to restoration services can disappear, because the attempt to restore with lower‐intensity JBCT services can delay the initiation of hospital restoration, where forced medication is available (Ash et al., 2020).…”

Jail-Based Competency Restoration Services in the United States: The Need, the Controversy, the Impact of COVID-19, and Implications for Future Treatment Delivery

“… Pinals and Fuller (2020) reported that the number of forensic psychiatric beds in state hospitals is insufficient and remains a nationwide concern. Accordingly, several jurisdictions have been involved in litigation regarding delayed waiting periods ( Fuller et al, 2017 ; Kirkorsky et al, 2020 ).…”

Technological Innovations in Forensic and Correctional Mental Health: An Introduction to the Special Issue

“…In the United States, jail-based competency restoration services have emerged as a way to help address the national shortage of forensic psychiatric hospital beds (Ash et al, 2020). However, research on the efficacy of these relatively novel services is scarce, and there has been criticism that jails do not provide a sufficiently therapeutic milieu (Kirkorsky et al, 2020). In their study, the authors compared the restoration rate of justice-involved individuals at a jail-based competency restoration unit in georgia, depending on whether they received in-person services (pre-pandemic) or telehealth services (during the pandemic).…”