A Jail-Based Competency Restoration Unit as a Component of a Continuum of Restoration Services

J Am Acad Psychiatry Law. 2020 Mar;48(1):43-51. doi: 10.29158/JAAPL.003893-20. Epub 2019 Nov 21.


This study reports on restoration outcomes of a sample of pretrial defendants (n = 877, 69% male) who were found incompetent to stand trial and underwent restoration services in a large urban county. Each male defendant was initially assigned to restoration in one of four settings on a continuum of services of varying intensity (ie, outpatient, jail general population, dedicated jail-based restoration unit, or forensic hospital inpatient unit) based on the defendant's assessed clinical need. Of those who received services on the jail-based restoration unit (n = 398), 40 percent were restored to competency, 31 percent were diverted out of the criminal justice system, and 29 percent were referred for more intensive inpatient services, primarily because of refusal of medication (i.e., the jail would not allow involuntary medication, even if court-ordered). Advantages of restoration on the jail unit compared with inpatient hospitalization included more rapid institution of restoration services and higher rates of diversion out of the criminal justice system at one-third of the cost of inpatient restoration services. A continuum of restoration services that allows the type of restoration service to be matched to the needs of the individual incompetent defendant has significant advantages over routine transfer to a forensic hospital for restoration.

MeSH terms

  • Adult
  • Correctional Facilities / organization & administration*
  • Female
  • Georgia
  • Hospitalization
  • Humans
  • Male
  • Mental Competency / legislation & jurisprudence
  • Mental Competency / psychology*
  • Mental Disorders / rehabilitation*
  • Mental Health Services / organization & administration*
  • Outcome and Process Assessment, Health Care
  • Program Evaluation