Community-Based Competency Restoration

Where We Stand

NAMI believes in minimizing justice system response to people with mental illness, while ensuring that any interactions preserve health, well-being and dignity. NAMI supports public policies and laws that expand and promote the use of community-based competency restoration services.

Why We Care

In the U.S., every person facing criminal charges has the constitutional right to a fair trial. The 1960 U.S. Supreme Court Case, Dusky v. United States, recognized that part of this right includes being competent to stand trial (CST). The case set the standard that a defendant must be able to understand the charges against them and be able to participate in their own defense. A judge might question if someone experiencing certain symptoms of a mental illness are CST and order a competency evaluation before the criminal case can proceed.

Unfortunately, many states’ competency restoration systems are overwhelmed and face significant backlogs, with some defendants waiting weeks or months for assessment and restoration services to become available. Many who have been charged with low-level misdemeanor crimes can spend more time incarcerated, waiting for competency restoration services, than what they would have served if they had been convicted of the crime for which they are accused. For people with mental illness, these unnecessary and lengthy stays can result in mental health symptoms worsening due to the inadequate access to mental health care in jails. Furthermore, state psychiatric hospitals are struggling to meet the increased demand for forensic beds for those requiring hospital-level care.

Community-based competency restoration is a promising practice that allows some defendants, who may not require hospital level care, to receive competency restoration services while living in the community, instead of an institutional setting like a jail or hospital. This model has shown to be less expensive than traditional competency restoration services and has favorable restoration rates. More importantly, it allows some defendants to remain in the community where they can continue to receive support from friends and family and connect with community mental health services to support long-term recovery. By allowing those who do not require hospital level care to stay in their community, these programs also help to reserve institutional based care for people with the most significant needs.

Many states allow community-based competency restoration — 16 states have formal community-based competency restoration programs and 35 state mental health agencies report that they pay for these services. Unfortunately, institutional-based competency restoration remains the norm in many places.

Expanding community-based competency restoration services is a key strategy to prevent prolonged and unnecessary incarceration, and an alternative to more restrictive institutional based services. By incorporating practices such forensic navigators, community-based competency restoration can help individuals involved in the criminal justice system to focus on fostering recovery and community connections.

How We Talk About It

• People with mental illness deserve help, not handcuffs.
• Unfortunately, people with mental health conditions are overrepresented in our nation’s jails and prisons — often as a result of low-level misdemeanors that may stem from symptoms of their condition.
• When a person faces criminal charges, they have a right to a fair trial, including being competent to stand trial, which means they are able to understand the charges against them and contribute to their defense.
• Many states’ competency restoration systems are overwhelmed and face significant backlogs, which means that some defendants can wait weeks or months for assessment and restoration services to become available.
• When competency restoration delays happen, the defendant’s trial cannot proceed, and they are kept in jail until the process is complete — where there is poor mental health care available.
• Many who have been charged with low level misdemeanor crimes can spend more time incarcerated waiting for these services than if they were convicted of the initial crime.
• People with mental illness deserve equal protection under the law, including access to a speedy trial and not be subject to unnecessary incarceration.
• Timely access to restoration services and supports is key to preventing long and unnecessary incarceration.
• Community-based competency restoration is a critical to reduce the backlog by allowing some individuals to receive competency restoration services in the community, instead of an institutional setting like a jail or state hospital.
• Expanding access to community-based competency evaluation and restoration services is less expensive. But more importantly, it can help prevent people with mental health conditions from experiencing unnecessary incarceration, while allowing them to focus on recovery and community connections.

What We Have Done:

• NAMI position on Medicaid IMD Exclusion
• NAMI position on Mental Health Care While Incarcerated
• NAMI position on Mental Health Courts
• NAMI position on Criminalization of People with Mental Illness