PROBLEMS and SOLUTIONS

Problems Competency is a complex issue Defendants are often referred for competency when other concerns represent the real questions Restoration of competence Disposition is a more complex issue Providing treatment for the consenting MI defendant Mandating treatment for the involuntary MI defendant

The Real Question Assessment of risk Complex assessment requiring social hx and rechecks Mandated recommendations Inpatient commitment Outpatient commitment Mandated conditions of bond or probation. Who track this?

Offenders/defendants with substance abuse MISA defendants/defendants Sexual offenders Difficulties with placement Problems with mandated reporting Offenders/defendants with substance abuse Mandated SA treatment MISA defendants/defendants Mandated dual dx treatment

The community nuisance offender Often the chronically and/or severely MI offender How much can be mandated when there is no risk of harm? Sometimes incompetence provides an avenue for mandated treatment

Restoration of competence 402 commitment Certain defendants are not restorable. The defendant who is diagnosed with ID or brain trauma Certain defendants require 24/7 evaluation (malingering/ sovereign citizen defense) Certain defendants do not require inpatient restoration Wait for transfer 90 days v 1 year in eastern part of state JRS treatment plan and recheck JRS and/or caseworker education and recheck

Treatment plan For the high risk MI defendant For the nuisance MI defendant For the hard to place defendant. Sexual offender or defendant with history of arson or assault The traveling MI defendant Encompasses many factors including dual dx needs, housing, medication compliance

SOLUTIONS

Restoration of competnce In jail competency restoration Accreditation Staff Psychiatrists Nurse/nurse practitioners or PA Mental health worker Social workers Program Assessment Testing Treatment Competency education groups

Competency restoration clinics Again considerations for accreditation, staff, and program Address the MI defendant who can be treated as an outpatient. Will require monitoring for compliance and abstinence Address the ID defendant with competency education Least restrictive Take the burden off the state hospital/ decrease the wait time Lowers the cost

Disposition Enhancement of existing programs Facilitate community inpatient treatment Protocol for involuntary commitment (302/303) Mandated condition for bond or probation Voluntary commitment (201) Cooperate with all treatment recommendations Cannot sign out Mediation compliance Comply with after care plan

Forensic clinics Bond stipulation Conditions for probation Clinicians understand defendant’s/offender’s charges and legal status Defendants/offenders can be tracted Clinical status communicated to court address only Defendant’s/offender’s attendance Defendant’s/offender’s treatment compliance

THOUGHTS?