The Competency Crisis: Why the System Is Buckling—and How We Can Fix It

Across the United States, competency to stand trial evaluations have shifted from a routine procedural safeguard to one of the most pressing bottlenecks in the criminal legal system. Courts are overwhelmed, jails are overcrowded, defendants are waiting months for restoration services, and states are facing lawsuits alleging violations of constitutional rights.

The crisis is real. But it is not unmanageable. With the right reforms, it’s possible to restore efficiency, fairness, and humanity to a system that was never designed to carry this much weight.

Why Competency to Stand Trial Matters

Competency determinations exist for a fundamental reason: a person cannot be tried if they cannot understand the legal process or meaningfully assist in their own defense. This standard comes from the U.S. Supreme Court case Dusky v. United States, and nearly every state mirrors its framework.

Competency is not about guilt.

It is not about diagnosis.

It is not about dangerousness.

It is about whether someone can meaningfully participate in their own defense today. And today, we have more people than ever entering the criminal system who cannot.

How We Got Here: The Roots of the Crisis

The surge in competency cases is not random. Instead, it is the predictable result of overlapping systemic failures.

1. The Mental Health System Collapsed Into the Criminal System

Decades of underfunding community mental health services have left jails functioning as America’s largest psychiatric institutions.

2. Increased Complexity of Cases

More defendants are presenting with co-occurring conditions, such as trauma histories, intellectual disabilities, neurodevelopmental disorders, substance-induced cognitive impairment, and chronic psychosis.

3. Limited Restoration Bed Capacity

State hospitals cannot keep pace with the growing number of court-ordered admissions, and court orders now routinely exceed available beds, leaving defendants waiting weeks or months for a placement that the law presumes should be timely.

4. Legal Mandates Create Bottlenecks

Courts often order inpatient restoration even when outpatient care would suffice, clogging the pipeline with people who don’t need the most restrictive level of service.

The result? Months-long delays, lawsuits, skyrocketing system costs, and defendants deteriorating while they wait.

What Has Worked: Successful Interventions in Some States

Some states have already begun piloting meaningful solutions.

1. Outpatient Restoration Programs

States like Texas, Colorado, and Oregon have demonstrated that many individuals can successfully be restored in the community, with dramatically lower cost and shorter wait times.

2. Jail-Based Restoration Units

While not ideal as a long-term model, these programs have reduced backlogs when used selectively and with clinical oversight.

3. Specialized Competency Dockets

Courts in Washington, Arizona, and Ohio have developed streamlined judicial pathways focused on treatment, accountability, and efficiency rather than procedural stagnation.

4. Early Screening and Diversion

Fast-track mental health diversion has prevented unnecessary competency referrals, especially in low-level or nonviolent cases.

These solutions prove that change is possible, but they are not being implemented fast enough.

Where We Go Next: Modern Solutions for a Modern Problem

Incremental adjustments are no longer enough. The volume of competency cases is increasing faster than restorations can be completed.

A new model must include:

1. A Tiered Competency Pathway

Not all cases require the same level of evaluation or treatment. A structured triage system could include:

• Fast-track screening for clear cases

• Outpatient restoration as the default

• Inpatient restoration reserved for severe impairment only

This reduces unnecessary hospitalization and preserves high-level resources for those who truly need them.

2. Competency Restoration in Community Mental Health Centers

Rather than waiting for a bed in a state hospital, restoration should occur in local clinics with judicial oversight, mirroring successful Assisted Outpatient Treatment models.

3. Telehealth and Hybrid Restoration Services

Tele-restoration models have already succeeded in rural jurisdictions. Expanding them statewide, or nationally, would close service gaps without expensive construction or staffing expansions.

4. A National or State Certification Standard for Evaluators

Competency evaluations vary widely by jurisdiction and provider training. A standardized evaluator credential would increase reliability and reduce legal disputes.

5. Automatic Post-Evaluation Case Review

If someone is unlikely to regain competency, continued prosecution may be neither ethical nor legally appropriate. Courts should be required to review alternatives sooner, including civil commitment, guardianship, and dismissal with structured supervision.

A Blueprint for Implementation

A realistic, phased rollout could look like this:

Phase 1: Stabilize

• Implement triage evaluations

• Convert existing treatment settings into outpatient restoration hubs

• Expand evaluator workforce through certification incentives

Phase 2: Expand

• Launch statewide tele-restoration networks

• Incentivize diversion and mental health court partnerships

• Require restoration feasibility opinions prior to inpatient admission

Phase 3: Sustain

• Establish long-term funding streams tied to outcomes rather than volume

• Track data nationally or statewide to guide policy and resource allocation

• Require periodic external audits to ensure accountability, transparency, and ongoing system improvement

This is not just reform—it’s restructuring.

Why Reform Is Urgent

It is increasingly clear that delaying reform carries substantial financial, constitutional, and human costs.

Defendants suffer.

Attorneys wait.

Judges grow frustrated.

Communities pay for a system stuck in limbo.

Competency exists to safeguard the fairness and integrity of the justice process, not to prolong proceedings beyond what is truly necessary for a just and humane resolution.

Conclusion: A System Worth Fixing

The competency-to-stand-trial process embodies one of the justice system’s core values: fairness. Yet when thousands wait months for evaluation or treatment, that promise of fairness is no longer truly being fulfilled. With strategic restructuring, competency restoration can become faster, more humane, and more effective. The solutions already exist, the urgency is clear, and the moment for action is now.

A sustainable solution to the competency crisis does not begin in the courtroom or inside state hospitals—it begins in the community. When individuals with mental illness receive timely treatment, stable housing, care coordination, and wrap-around supports, they are far less likely to decompensate to the point where the court must intervene. Strengthening outpatient services, ensuring consistent access to medication, expanding crisis response systems, and supporting families and providers reduces the likelihood that a person will enter the legal system unable to understand or participate in their own defense.

If states invest in comprehensive community mental health care, the pipeline feeding the competency backlog will shrink. Fewer people will enter court in crisis, fewer evaluations will be needed, and fewer restoration beds will be required. The most effective way to resolve the competency-to-stand-trial emergency is to prevent it.