No abstract

In response to consistently increasing numbers of individuals found incompetent to stand trial, some states have identified community-based or "outpatient" competency restoration programs (OCRPs) as a viable alternative to inpatient restoration. This study used a multistep approach to capture information about OCRPs nationwide. We reviewed states' competency statutes to determine which states have provisions that allow for outpatient competency restoration, and we then corroborated this review with a brief preliminary survey that was disseminated to each representative of the Forensic Division of the National Association of State Mental Health Program Directors. We received responses from 48 of 51 U.S. jurisdictions (47 states and the District of Columbia). We conducted in-depth interviews with forensic representatives in those 16 states that identified having operational OCRPS. The current study presents our analysis of state statutes and then compares and contrasts current OCRPs. In summary, OCRPs are a recent but rapidly developing alternative to traditional inpatient restoration. Through a comparison of existing OCRPs, we believe OCRPs show preliminary but promising outcomes in terms of high restoration rates, low program failure rates, and substantial cost savings.

No abstract

Many jail releasees have persistent physical and mental health needs that are frequently unaddressed, leading to high rearrest rates and return to jail. This article details the potential benefits and challenges of integrated health services during transition planning and return to the community and details lessons learned from a pilot program in Houston, Texas. It examines how patient-centered medical homes, a modality supported by policy changes at the federal level, provide one means of effective transition from jail to the community that integrates behavioral health services with primary care. Evidence from the pilot program suggests that effective integrated health services for jail releasees can help divert individuals from a cycle of recidivism.