NaphCare Perspective: Combating the Competency Crisis in Jails to Reduce the Burden on State Hospitals

by Amber H. Simpler, Ph.D., ABPP, Chief Psychologist, NaphCare
March 10, 2020

On any given day around the nation, the competency of thousands of individuals with severe mental illness (SMI) who have been accused of crimes is questioned. When concerns arise as to whether defendants understand their legal situation and/or can assist in their defense, justice is immediately stalled, as prosecuting an incompetent defendant is unfair and does not embody the core tenets of judicial processes.

Then the waiting begins – to undergo competency evaluation, to initiate restoration treatment, and to eventually return to court. Some individuals may end up waiting in jail for months and even years, as more than 70% of state hospitals have lengthy waiting lists for admission. Consequently, advocacy groups are forcing state and county government agencies to address the competency crisis through litigation – though often to no avail, as agencies frequently cannot meet the dictates of consent decrees due to lack of resources, such as funding and personnel.

With over 30 years of experience in correctional healthcare, NaphCare witnessed the increasing impact of the competency crisis and resolved to help our patients, our partners and our communities navigate this critical situation.

NaphCare’s Jail-Based Competency Treatment (JBCT) Program

Partnering with county and state agencies, NaphCare offers Jail-Based Competency Treatment (JBCT), a program that provides competency restoration treatment within the jail to defendants charged with criminal offenses who have been deemed by the court to be incompetent to stand trial due to a mental disorder. In most jurisdictions, restoration treatment occurs in state psychiatric hospitals, but bed availability is severely diminished, requiring patients to wait in jails for lengthy periods of time before they can begin treatment.

In light of high demand for restoration treatment services – coupled with limited state hospital-bed availability – our JBCT program is an alternative treatment option that serves to relieve pressure on state hospital resources, provide timely treatment to efficiently restore defendants to competency, and deter excessive delays of the judicial process.

Because we also recognize the limited number of forensic professionals available to perform the necessary work for competency restoration, NaphCare connects defendants in rural areas to specialized providers (e.g., psychiatrists, forensic psychologists) via telehealth. When combined with our proprietary software solution, we are able to streamline the process of restoring adjudicative competence, promoting an expedient return to court.

In the first year offering JBCT with our partners at the Mendocino County Jail in California, 83% of participants completed the program, meaning defendants received treatment in jail and bypassed admission to the state hospital. Of those who completed the program, 80% were successfully restored to competency. The average length of stay in the program was approximately 40 days. We believe the JBCT model holds promise for an alternative solution to the competency crisis by reducing the burden on state hospitals, initiating timely treatment and operating more efficiently through technology solutions.

As NaphCare’s Chief Psychologist, Dr. Simpler collaborates with mental health providers to improve clinical and operational processes within correctional settings and evaluates sites to assist with new initiatives such as mental health crisis stabilization units and jail based competency restoration programs.