The CMHS National GAINS Center for Systemic Change
for Justice Involved Persons with Mental Illness
Some Quick Fixes for Backlogged Incompetency to Stand Trial Systems
Net/Teleconference
Thursday, June 7, 2007
2:00-3:30 pm Eastern Time
Joel A. Dvoskin, Ph.D.
University of Arizona
Russell Kurth
Defense Attorney
Seattle Municipal Mental Health Court
What is Incompetence
- The most ironic right
- It is not supposed to be a back door into treatment
- It is not supposed to be a defense strategy
- Its only purpose is to vindicate the rights to trial and counsel
Who is Incompetent?
- The stereotype: Cognitive limitations and ignorance
- Reality: Acute psychosis
- What Do Incompetent People Need?
- Stereotype: Education about courts and trials
- Reality: Alleviation of psychosis
If a tree falls in the forest….?
- People committed to state forensic hospital
- People found incompetent and waiting for a bed
- People waiting for an evaluation
- People who are floridly psychotic but not yet identified for competency evaluation
Prevalence
- Why are there so many incompetent people?
The Real Conversation
- Inadequate treatment for people with SMI in the community
- Arrest rates
- Inadequate treatment of acute psychoses in jail
Commitments for Hospital-Based Restoration of Competency?
- The greatest sin is waste
- Careful use of beds
- What predicts length of stay?
- LOS: As long as they need and not a day longer
- Ought there to be such a thing as competency restoration?
Where should restoration occur?
- Hospital?
- Jail?
- Community?
- New models?
Is There a Better Way
- A Not So Modest Proposal: The ADA Model
- Judge as Gatekeeper of Justice
- What would it take to give this person a fair trial?
There Is A Better Way
- Quick Fixes—working within your current competency evaluation system
- Not So Quick Fixes—changing your system
Quick Fixes
Switch Evaluations From Hospital to Jail
- Eliminates Transport Delay
- 2003—116 evaluations at hospital, average transport delay 10 days*
- 2006—14 evaluations at hospital
- Savings—10 x 100 x $200** = $200,000
Seattle Municipal’s Mental Health Court (MHC)
$200 per day in jail
Orders to Show Cause
- Evaluations not completed on time
- 2004—WSH* granted funding for five more evaluators
- 2007—WSH satellite office opened blocks from the jail
WSH – Western State Hospital
Waive Statutory Requirement of Two Evaluators
- Enables hospital to more efficiently utilize resources
- Defense can request second opinion
Only Order Competency
- Not insanity or diminished capacity
- Improves hospital and court efficiency
Get The Hospital The Documents!
- Police reports, court orders
- Two day average in Seattle Municipal MHC
Advance The Court Date
- When evaluation is completed prior to scheduled court date
- Increases likelihood of evaluation’s accuracy
Immunity Agreement
- From time competency is ordered until court rules, client’s statements won’t be used against him/her if found competent
- Exception—perjury
Help Me Help You
- Provide evaluator the reasons you requested the evaluation
- Comply with your local ethics rules
Quarterly Systems Collaboration Meetings
- Who—court, prosecution, defense, mental health professionals, hospital, jail, police, politicians
- Why—separate silos
It Works!!!
- Seattle Municipal’s MHC orders 450 competency evaluations a year
- 2003—20 day average
- 2007—10 day average
- Savings—450 x 10 x $200 = $900,000
Just Say No
- Don’t order new evaluations on frequent fliers
- Seattle’s MHC—50 times in 2006
- Savings—50 x 10 x $200 = $100,000
- Savings—50 x $800* = $40,000
Cost of competency evaluation
Out of Custody Evaluations
- For clients connected with housing and services
- Seattle’s MHC—30 in 2006
- Savings—30 x 10 x $200 = $60,000
Results For Everyone
- Transport delay--$200,000
- Faster evaluations--$900,000
- No evaluation--$140,000
- Out of custody--$60,000
- Total Savings: $1.3 million!
Not So Quick Fixes
Competency Court
- Seattle Municipal’s MHC operates as both a competency and a therapeutic court
- Spotting the issue—170 evaluations in 1999, 450 by 2003
- Accuracy—65% vs. 3%
- Flag system
- Process 15-20 cases per calendar
Rewrite Your Competency Laws
- Washington’s Competency Law Revision Task Force
- You need the right players to win
Sequential Intercept Model
- King County, Washington is currently implementing
- GAINS provides literature and consultation
- Goal: identifying and helping those in crisis before they enter the criminal system
Crisis Intervention Teams
- Trained police officers who better respond to people in crisis
- Officers work closely with the MHC
- Case study
