Treatment of Incompetent to Stand Trial Patients

Patients committed to a state hospital because they cannot understand they are on trial and are unable to assist their attorney in their own defense. Their treatment will first get them into a stable state and then prepare them for what is coming through mock trial exercises. We offer this treatment both in our hospitals and also through program within jails themselves.

Jail-Based Competency Treatment (JBCT)

The Jail-Based Competency Treatment program (JBCT) is designed to provide treatment to patients who are accused of a felony and lack the mental competency to assist in their own legal defense. Declared by a judge to be Incompetent to Stand Trial (IST) pursuant to CA Penal Code Section 1370, these patients would otherwise be treated at a state hospital in an effort to restore their competency and enable them to face the charges against them. Because of limited hospital beds for treating ISTs, however, DSH has added capacity through the JBCT as part of its continuum of care.

DSH launched the first JBCT in 2010 at the San Bernardino County jail. Since then, similar programs have been established at the jails in Riverside and Sacramento counties. In addition, these programs are now serving ISTs from other counties. Efforts continue to expand JBCT services to new counties..

Trial Competency Program

The trial competency program has four steps.

First is the competency testing step. The patient is given a test to determine if they can understand what is going on around them. If they can communicate and can interact with someone. This test is administered by the admissions unit. The process is pass or fail.

Second is the mock trial. It is actually more of a mock competency hearing rather than a whole trial. The room is set up to resemble a court room. There is a raised area for the judge and a witness stand, a lower place for the defense and the prosecution. The patient’s treatment team play the roles of Judge, District Attorney, Public Defender and Bailiff. Only the person in the judge’s role wears a costume (a black robe). The patient is taken through the process of a competency hearing. This includes reading the charges (the actual charges are used) and a script of what is typically used in this process.

The patient is judged on several factors when they are in the mock court. Is the patient paying attention? Are they blurting out and responding to internal stimulation? Are they agitated? Are they talking out of turn?

The typical mock trial takes about 10 minutes.

This process is also graded as pass or fail by the treatment team. The pass rate on this step is about 80 percent, this is because it is a second step in the process and most of the failures are weeded out in the first step.

The third step in the process is to go back with the treatment team and work with them more in depth. Patient work on exploring their delusions and identifying them. If they were delusional at the time of the crime, that is explored also.

Fourth step is forensic evaluation. This is a one-on-one interview with the patient and a forensic psychiatrist. The social worker said this is actually a fairly recent step. He has been around long enough to remember when there was no forensic evaluation at the end and many of the patients had higher recidivism rates. He sees it as a checks and balance system with the forensic evaluator playing a role of independent evaluation.