Competency restoration alternatives

When a court determines that a defendant is not competent to stand trial, it often directs the defendant to inpatient treatment at the state hospital until competency is restored and they can return to the court. This is not always an efficient use of resources, and the process may take years due to long waitlists at state hospitals, which may result in jail holds until a slot opens up. Competency diversion programs provide alternative delivery of competency restoration services for people who may not require the intensive level of services offered by state hospitals.

Local Examples

Miami-Dade County, FL Forensic Hospital Diversion, Miami-Dade Forensic Alternative Center (MD-FAC)

• People who are found not competent to stand trial can be diverted from the state hospital to the MD-FAC for residential treatment and reentry services.
• Eligible participants have been charged with second- or third-degree felonies, do not have a significant record of violent felony offenses, and are not likely to face incarceration if convicted of the alleged offenses.
• Unlike individuals admitted to state hospitals, people served by MD-FAC are not returned to jail upon competency restoration. Instead, people served by MD-FAC receive ongoing case management services for 12 months upon reentry to the community from residential treatment, and many are enrolled in the Felony Jail Diversion Program for continued support and monitoring.
• The success of the MD-FAC program is built on active collaboration among community stakeholders from the criminal justice, mental health care, and public health systems.
• Key partners include Jackson Behavioral Health Hospital, which administers the program and is affiliated with the public safety net health care system; Thriving Mind South Florida, a local nonprofit-managing entity that coordinates, funds, and oversees behavioral health prevention and treatment services in the community; and the Eleventh Judicial Circuit Criminal Mental Health Project, a court-based program established to divert people with serious mental illnesses from the criminal justice system into community-based treatment and support services.

For more information on this example, see these resources:

• Program Description – Eleventh Judicial Circuit Criminal Mental Health Project (CMHP)
• Mental Health and Criminal Justice Case Study: Miami-Dade County

Lubbock County, TX Lubbock County Sheriff’s Office and StarCare

• The Jail-Based Competency Restoration Program is a behavioral health services program implemented by the Health and Human Services Commission to implement the Mental Health Grant Program for Justice-Involved Individuals, as directed by Senate Bill (S.B.) 292, 85th Texas Legislature, Regular Session, 2017.
• People who have been found not competent to stand trial are court-ordered to complete competency restoration in this jail setting and are screened to ensure that they are able to be treated in the least restrictive environment. The purposes of this program are to (1) reduce the length of stay, (2) increase connection to treatment, and (3) reduce rates of recidivism, arrests, and incarceration among people with mental illnesses, in addition to reducing wait times for people with mental illnesses who are placed on forensic commitment to a state hospital.

For more information on this example, see this resource:

• Texas Health and Human Services Website

Marin County, CA Marin County Behavioral Health and Recovery Services

• A diversion program provides screening, evaluation, treatment, planning, and wraparound services for individuals who have been charged with a felony, have been determined not to be competent to stand trial, and do not require the inpatient level of services offered by state hospitals. (Note that California state law no longer allows competency restoration for individuals facing misdemeanor charges.)
• Public defenders or private defense counsel provide referrals.
• The program consists of four phases: reentry supports; intensive services; ongoing services; and transition planning.
• Once clients successfully complete the diversion program, charges are dropped.