Jail-based competency restoration

One of the most traditional, longstanding, and essential methods of providing the proper level of psychiatric treatment for severely disturbed jail inmates with serious mental illness has been hospital transfer. Transfer does not necessarily imply diversion from trial, but diversion from jail, at least while the detainee is in need of higher level care. Unfortunately, hospital transfer has become increasingly unavailable. Two responses to the unavailability of hospital care for pretrial detainees have been used as justification for maintaining this deficiency: the development of jail-based competency restoration programs and the acceptance of enforced medication of pretrial detainees in jail. The authors analyze each of these practices as inadequate responses to the state’s failure to provide timely pretrial hospitalization to detainees who have a serious mental illness and are in need of this level of service.