Competency restoration often best performed on outpatient basis

Dallas County is experimenting with outpatient competency restoration for some mentally ill people charged with misdemeanors, rather than hold them all in the county jail until space opens up at the state hospital. Reports Jennifer Emily at the Dallas News ("Program for mentally ill offenders offers compassion in court," April 12):

Nonviolent mentally ill defendants can now seek treatment to regain competency – the ability to help their attorneys with their defense – on an outpatient basis instead of waiting four to six months in the Dallas County Jail for a bed at a state hospital where they are stabilized enough to assist in their cases. ...

Last year the pilot program saved the county $300,000 by not housing the defendants in jail, Skemp said. He said it provides resources and treatment while those charged with crimes get healthy enough to face the justice system.

The judge, standing in the role of stern and concerned father, holds what he calls the carrot and the hammer over defendants. The carrot is the promise of treatment in the real world with the hope of getting better. The hammer is jail.

"You've got to have a hammer and a carrot," Skemp said, sitting in his office. "If you don't have a carrot, the hammer won't work."

Skemp began overseeing all the misdemeanor cases of defendants working to regain competency in 2007. Last year there were fewer than 50 defendants in the misdemeanor program. In the felony court, the cases are dispersed among the 17 felony court judges. But soon those cases could all be handled by a single judge, too – State District Judge Jennifer Balido.

There are currently about 35 cases pending in misdemeanor court and 30 in felony court.

The program matches each defendant with a caseworker who will bring them to court. The social workers oversee whether defendants are taking medication and attending classes that range from substance abuse treatment to anger management to life skills. Many live in a halfway house.

Supposedly a pilot outpatient competency restoration program was established in the Dallas area a year and a half ago in cooperation with the North Texas Behavioral Health Authority, but until now I'd not heard how it was working out there. See this flyer [pdf] describing the pilot programs from the Department of State Health Services.

In misdemeanor cases, it's not uncommon for defendants to wait longer in jail for a hospital bed to be declared competent than their sentence would be if convicted. Often people who will ultimately receive probation wait weeks or months in jail simply because they've been declared incompetent. Jail does nothing to help their mental illness, so for all but actually dangerous offenders, doing competency restoration on an outpatient basis makes an extraordinary amount of good sense - that's how IMO most such cases should be handled, especially on the misdemeanor side.