Competence to Stand Trial

updated behavioral health banners

Task Force Activities

In the fall of 2019 NCSC convened eight trial judges from around the country as a focus group to analyze the current competency process. Shortly thereafter the Council for State Governments brought together a broadly representative group of judges, psychiatrists, legislators, and other policy makers for the same purpose. Out of these gatherings emerged two policy papers, the NCSC brief Competence to Stand Trial, and CSG Justice Center’s Just and Well: Rethinking How States Approach Competency to Stand Trial. Recently CSG released an excellent short video on the topic, featuring Judge Steve Leifman, Dr. Sarah Vinson, and Dr. Michael Champion, all Task Force members. Stay tuned for recommendations from the Task Force to address the delays and deficiencies of the competency to stand trial systems.

Please remember to share the Behavioral Health Alerts widely and encourage your colleagues to sign up to receive the alerts twice a month. Sign up for Behavioral Health Alerts here.

Research and Resources

Welcome to The ARK – The Annals of Research and Knowledge (ARK) Combining the Risk Need Responsivity (RNR) model with the Sequential Intercept Model (SIM), the ARK is a searchable database containing information on evidence-based and promising programs for persons involved in the criminal justice system. Because no intervention works for everyone, programs are cataloged according to participants’ risk and need profiles and stage of processing in the justice system.

Medicaid Forward: Behavioral Health This comprehensive resource from the National Association of Medicaid Directors identifies opportunities for action to address immediate and long-term mental health and substance abuse challenges emerging from the COVID crisis across communities, including for children, older adults, those with mental health and addiction diagnosis, individuals transitioning from prison, and those living with developmental or intellectual disabilities. It offers options for state administrators to explore and determine what makes most sense for their state.

Adoption of Virtual Services in Judicially Led Diversion Programs The focus of this report is judicially led diversion programs, an umbrella term that encompasses drug courts, opioid courts, and recovery-oriented compliance dockets. The report highlights preliminary survey results from 500 respondents—including judges, court coordinators, treatment providers, case managers, and community supervision officers—from 298 unique court programs and provides a multi-state examination of how practices were modified in judicially led diversion programs in response to the pandemic.

Forensic e-Mental Health: Review, Research Priorities, and Policy Directions Forensic e-mental health is an area of psychology that is relatively underdeveloped considering technological advancements and the many mental health needs of justice-involved individuals. It includes the procurement, storage, sharing, and provision of forensic mental health information and services via electronic means and is associated with improved accessibility, efficiency, cost-savings, and safety. A “primer” covering the many aspects of technology-assisted forensic practice and research was overdue. To address this knowledge gap, we reviewed the e-mental health research base encompassing forensic evaluations and interventions.

Becoming Trauma Informed: A Core Element in Effective Services for Justice Settings The Bureau of Justice Assistance (BJA) leadership, in collaboration with the Comprehensive Opioid, Stimulant, and Substance Abuse Program (COSSAP) team and Advocates for Human Potential, invites you to this no-cost, three-part webinar: Becoming Trauma Informed: Understanding the ACE Study; Becoming Trauma Informed and Moving to Trauma Responsive; and Trauma-Specific Services: Programs That Work.

Implementing Specialized Caseloads to Reduce Recidivism for People with Co-Occurring Disorders Many criminal justice leaders are beginning to look to specialized caseloads as a tool for reducing recidivism among people who have mental illnesses and co-occurring substance use disorders. This brief presents five key practices for successful implementation of specialized caseloads for people with co-occurring disorders. It relies on a coordinated and collaborative approach and reinforces the need for probation officers to have the appropriate resources to connect people to individualized treatments and supports.

Get Out of Jail Free? Achieving Racial Equity in Pretrial Reform Most policy experts agree the bond system should be curtailed or abolished, but controversy surrounds what, if anything, should take its place. One approach is to perform standardized assessments of defendants’ risk for committing a new crime or fleeing prosecution and impose release conditions if warranted, such as drug and alcohol testing or mental health treatment. Although research is sparse, growing evidence suggests that using risk assessment instead of bond may reduce pretrial detention and racial disparities in release conditions.

NASMHPD Update Newsletter New announcements, policy updates, and other resources from the National Association of Mental Health Program Directors.

TAC Research Weekly: February Research Roundup Virtual visits for people with serious mental illness during the COVID-19 pandemic; Cancer rates and mortality among people with schizophrenia; and Preventing psychiatric hospital readmission through promoting health literacy.

Mitigating Trauma in the Courthouse by Understanding Changes to the Brain Substance misuse and trauma change brain architecture, leading to frustrating or unexpected behaviors. This webinar will discuss structural changes commonly found in the brains of people struggling with substance misuse and trauma, which will help us understand some of our participants’ frustrating behaviors.

Sozosei Foundation Hosts Inaugural Summit on Decriminalizing Mental Illness The Sozosei Foundation convened its Inaugural Summit on Decriminalizing Mental Illness from December 14-16, 2020. The Summit convened over 200 advocates, experts, and people with lived experience to share ideas, discuss best and emerging practices, and eliminate the inappropriate use of the justice system for the diagnosis, treatment, and care of mental illness. A video recording of the event is now available.

Evidence-based Treatment in Custody, Jail-based Mentor Site Initiative This new initiative offers jails interested in providing or enhancing their medication-assisted treatment services a unique opportunity to observe and learn from innovative programs that have worked successfully to meet the treatment needs of individuals with substance use disorders.

JCOIN Speaker Series: Medications for Opioid Use Disorder in Criminal Justice Settings This webinar will feature presentations from key researchers who will summarize the effectiveness of medications for addiction treatment (MAT) for individuals with a substance use disorder, and specifically those in jails and prisons.

Mental Health First Aid Monthly Newsletter This month, we’re sharing a variety of resources and educational tools to help frame the inequities in mental health care. We encourage you to explore all of the articles and resources shared to get a better picture of the current state of mental health for Black Americans so you can #BeTheDifference for everyone in your community.

Equity and Inclusion Training for Treatment Courts NDCI, in partnership with the White House Office of National Drug Control Policy, developed a training program based Standard II of the Adult Drug Court Best Practice Standards, equity and inclusion. This training program is for jurisdictions interested in addressing racial disparities and bias to ensure equivalent access, retention, treatment, incentives and sanctions and dispositions. This training is designed to provide attendees with skills and to improve outcomes for the treatment court program.

Innovations to Support Drug Treatment Court Programs during COVID-19: Spotlight on Technology to Improve Participant Experiences This webinar will present recent findings from the National Drug Court Institute’s survey of Bureau of Justice Assistance grantees on how drug treatment court programs across the country made changes and adopted innovations to minimize interruptions to programming during COVID-19, as well as lessons learned to date. Spotlights from a local drug treatment court program utilizing virtual platforms for streamlining services during the pandemic will highlight practical strategies for increasing program participation and improving participant experience through the use of technology.

Early Diversion Virtual Learning Community Part 1: Strategies for Addressing Treatment Engagement Challenges with Certain Individuals The Early Diversion Virtual Learning Community kicks off its five-part series on enhancing systems responses for people with mental and substance use disorders who are justice-involved or at risk for justice involvement. Join this webinar and interactive discussion group about strategies and tools for addressing common barriers to treatment engagement for people who cycle through homelessness, incarceration, and crisis services.

The Stepping Up Minute Welcome to the first issue of the Stepping Up Minute, a monthly newsletter designed to keep you informed of the latest news and resources from the Stepping Up network. Learn more about Set, Measure, Achieve—our latest call to action; COVID-19 resources; and free support opportunities for Stepping Up counties.

Transforming Dispatch and Crisis Response Services: Meeting Challenges with Innovation This webinar will feature four programs that have leveraged the training, policies, and procedures of 911 call-takers and dispatch when restructuring their community’s response to crisis incidents. Panelists will present the innovative approaches in crisis response implemented by their programs and discuss the challenges of ensuring appropriate services are dispatched to crisis incidents to best meet the needs of individuals.

‘The Center Collaborative’ Podcast will Discuss Intersection of Criminal Justice & Mental Health From the Oregon Center on Behavioral Health and Criminal Justice, this series shines a light on partnerships that are moving the dial, leading to better solutions and outcomes for people who may become involved with the justice system due to experiencing behavioral health, intellectual/developmental disabilities, or neurocognitive concerns. We talk with guests representing prominent voices from government, the judicial system, public safety, healthcare, and the broader community throughout metropolitan and rural parts of Oregon.

CSG Justice Center Justice Briefing Taking action to improve competency to stand trial; enhancing housing support for formerly incarcerated Californians; and reducing recidivism for people with co-occurring disorders.

BHive Newsletter – News, Resources and Learning Opportunities Addressing Medication Non-adherence in Times of Disaster, CCBHC resources, and a list of upcoming webinars.

SAMHSA Headlines Your one-stop source for the latest from SAMHSA, including webinars, funding opportunities, and other resources.

SAMHSA Grant Announcement: Screening, Brief Intervention and Referral to Treatment (SBIRT) Grants This program is designed to expand/enhance the continuum of care for substance use disorder (SUD) services and reduce alcohol and other drug (AOD) consumption and its negative health impact, increase abstinence, reduce costly health care utilization, and promote sustainability and the integration of behavioral health and primary care services through policy changes that increase treatment access in generalist and specialist practice.

SJI Funding Toolkit - Current Opportunities Find funding opportunities that are currently available. As the due date for submission of an application passes, these funding opportunities, and their companion resources, will be moved to the Past Funding Opportunities.  If you identify an opportunity of interest, please click on the link to access the solicitation and associated templates you may use to prepare your application.

Relationships for People with Mental Health Conditions Forming successful relationships, whether they be personal or professional, may pose particular challenges for those experiencing a mental health condition. This week, through this Brain Waves episode and an article we wrote for the Forbes website, we explore these challenges and provide ideas on how best to support relationship building and communication for those in the neurodiverse community. In addition, we also share our most recent book read recommendation of the month.

In the News

Medicaid’s IMD Exclusion: The Case for Repeal This report argues that the IMD Exclusion has outlived its usefulness and should be repealed. It discourages states from investing in inpatient care, hampering access to a necessary form of treatment for some seriously mentally ill individuals. As a result, these individuals end up repeatedly in the emergency departments of general hospitals, “boarded” for lack of access to available beds, and overrepresented among the homeless and incarcerated populations. More broadly, the exclusion discriminates, through fiscal policy, against the seriously mentally ill.

Will Eliminating Old Rule Return “Snake pit” Hospitals or Help Seriously Mentally Ill Americans Get Much Needed Long Term Care? The IMD exclusion, or 16 bed rule, was enacted, in part, to put an end to warehousing patients in huge state hospitals, and those who support keeping it fear that state hospitals, once again, will become giant “snake pits” if the rule is repealed.

Opinion: Connecticut sets example for the country with proposed racial justice reforms In a tumultuous year that brought racial justice to the fore, a task force of judges, lawyers and academics has put forth a list of recommendations that could substantially ameliorate the racial inequities of Connecticut’s judicial system. If adopted, the far-reaching proposals could provide a model for every state in the country, particularly in jury selection.

Mental health in the Black community: Q&A with former U.S. Surgeon General Dr. David Satcher “ I think we have not dealt with mental health the same way we’ve dealt with other health issues. We have to be very concerned about people who are being arrested because of how they are behaving on the street, and I think that we are now starting to talk about this issue. I think stigma has been a problem throughout our history.”

Tom Watkins: Hold hospitals accountable for treating severe mental illnesses COVID has exposed the inadequacies, inequities and flaws in our educational, public health and hospital system, pulling back the scab, too, on the failures of behavioral health in our state and nation.

The Lost Souls: More Minnesotans are falling into criminal justice system 'gap' than ever before It’s a system "gap" where hundreds of people end up in limbo; they are unable to stand trial but also cannot receive critical services to treat their mental illness. While gap cases have been recognized as a serious issue for years, a recent court study shows it is impacting people at a higher rate than ever before. Sixty percent of the defendants who are not competent enough to stand trial for their alleged crimes also cannot access inpatient mental health services, according to a 2019 report by the state court administration.

Ohio Senate bill would increase psychiatric hospital bed availability, improve access to mental health services A bill introduced in the state senate hopes to make more beds available for those who need them, as well as improve access to mental health services. The first component enters the state into the Psychology Interjurisdictional Compact (PSYPACT) which is an agreement that allows psychologists to practice temporary, in-person psychology and tele-psychology across participating states. The second part of the bill would allow nonviolent, misdemeanor offenders to get competency evaluations in outpatient settings, freeing up state psychiatric hospital beds for Ohioans suffering from serious mental illness.

State to add some emergency beds for children in psychiatric distress With the number of children and adults in need of psychiatric care being held in emergency rooms reaching historic numbers, the state announced Thursday it will temporarily transition ten beds at New Hampshire Hospital to care for children. The state has long struggled with a shortage of inpatient and community-based treatment options for people with mental health crises. In recent days, the number of children being held inside emergency rooms waiting to be transferred to a more appropriate facility has grown to 50.

State Supreme Court looking to set up 16 new intervention courts Mississippi currently has 44 intervention courts. There are 22 adult felony drug intervention court programs – one in each of the 22 circuit court districts. There are four approved adult misdemeanor intervention court programs, 15 juvenile intervention courts and three family intervention courts. The Supreme Court hopes to establish 16 new intervention courts. In 2019, the Legislature extended the definition of intervention courts to include veterans and mental health courts. In an effort to comply with this legislative directive, national best practices, standards, rules and policies of multi-state mental health and veteran intervention court were reviewed.

How the Biden-Harris Administration Can Advance Criminal Justice Reform Against the backdrop of a dire need for change, this document presents 13 recommendations for federal engagement and action. It draws on the experience and work of Fair and Just Prosecution, a nonprofit organization that brings together a network of reform-minded, elected prosecutors from across the country.

Local judges work to combat mental health issues in the court system “We as courts, jails, and prisons have become de facto mental health providers, and that’s a shame,” says Lucas County Common Pleas Judge Lindsay Navarre. In fact, 24% of Lucas County Jail inmates have screened positive for serious mental illness. To help combat the issue, Navarre began pursuing a dedicated mental health court but had to put it on hold due to a lack of resources. She’s now decided to work to strengthen the foundation in hopes of building the program.

Fourth Circuit sets mental health reform plan The Fourth Judicial Circuit Leadership Team on Mental Health and Criminal Justice announced last week that the Fourth Circuit was a recipient of a $50,000 Justice Reinvestment Initiative grant from the state. The award to the Fourth Circuit will fund three initiatives:

  • A 24/7 mental health counselor available to law enforcement officers during contacts with a person in crisis
  • The expansion of Alternative Treatment Court programs
  • Crisis intervention training for law enforcement

Lawmaker Seeks to Change Mental Health Treatment Behind Bars After reviewing the results of a study that showed vast numbers of inmates in the state’s prisons may need mental health treatment, Sen. Cathy Osten, D-Sprague, CT, is proposing a bill that would require a diagnosis. The findings revealed that 28% of inmates had mild to severe mental health disorders that may require a range of treatments from regular medication to specialized housing or 24-hour crisis care, the report said. Osten’s bill would require the DOC and the Department of Mental Health and Addiction Services to work together to establish protocols to accurately assess the mental health of inmates from the date of incarceration to the date they are released.

Collier officials approve plans to build $25M mental health facility Nancy Dauphinais, the Chief Operating Officer for David Lawrence Center said that they have seen record-breaking numbers in their crisis stabilization unit since the pandemic. “Unfortunately, we are having to transfer hundreds of individuals each year outside of Collier County to get emergency behavioral health care when they are in need,” Dauphinais said. The county is hoping the new facility will help people in the community.

The only way to make the subways safe: Bulk up mental health treatment There are many broken parts in the mental health system, but for the most desperate and dangerous cases, the system will not be fixed unless elected officials and the public come to terms with New York’s standard for involuntary commitment under the state’s Mental Hygiene Law. For people living with certain untreated serious mental illnesses, who can present real and immediate harm to themselves, loved ones, police and sometimes unsuspecting strangers, the current standard makes no sense.

Want to get the Behavioral Health Alerts newsletter automatically? Subscribe here.

Have comments or feedback about Behavioral Health Alerts? Contact Rick Schwermer at