Competency Restoration: Is it Effective

Abstract

The number of individuals with a serious mental illness (SMI) found incompetent to stand trial (IST) and court-ordered to competency restoration is high in the United States. Defendants referred to competency restoration programs have poorer psychological, physical, social, and economic outcomes compared to others involved in the criminal justice system. Current competency restoration research focuses on forensic evaluations and the interpretation of statutes, few studies evaluate competency restoration programs and no studies evaluate rural programs. This dissertation investigates attainment outcomes in outpatient competency restoration programs in three studies. First, a systematic literature review was conducted to identify determinants of competency, elements of competency restoration programs, and restoration outcomes. The findings from the review found that competency restoration programs were effective; and programs with high restoration rates continuously assessed clients and provided specialized holistic treatments addressing the client’s strengths and needs. Second, outpatient competency restoration programs in Texas were assessed for efficacy. Results showed OCR programs in Texas were effective. Furthermore, defendants with a diagnosis of Schizophrenia were less likely to be restored to competency compared to other clients and tailor intensive services led to higher rates of competency attainment. Third, an analysis was conducted on rural outpatient competency restoration programs in Texas. Rural OCR programs were not different from programs in urban areas in competency restoration rates. The findings suggest rural areas were effective in restoring individuals and clients benefited from specialized services. Future research needs to focus on the evaluation competency restoration programs and should also incorporate rural areas. More research is needed in order to expand treatment in outpatient settings, create standards for treatment, and to develop effective policy. Researchers need to prioritize competency restoration research as this is a public health concern and a legal issue impacting the mental health system.