Competence to Stand Trial Scroll to learn more about PRA’s competence work

What Is Competence to Stand Trial?

Competence to stand trial (CST) is raised when individuals who are justice involved and are within the trial process exhibit signs or symptoms of conditions that can impair their ability to competently proceed. These individuals may have a serious mental illness, intellectual and developmental disabilities, or other conditions that can affect their thinking and courtroom behavior. Within the Sequential Intercept Model, CST takes place within Intercepts 2 (Initial Detention/Initial Court Hearings) and 3 (Jails/Courts), after arraignment, and before case adjudication and sentencing. When a defendant’s CST is raised, they are usually routed through forensic evaluations and systems. These defendants are rarely considered for diversion, even though diversion would be a safer alternative in many cases.

CST Flowchart. Available for download in the PRA Resource Library!

The CST Flowchart identifies decision points in the CST/competence restoration (CR) process where justice and behavioral health professionals can consider and create diversion opportunities for these defendants, making it a valuable resource for community-based organizations. Intercepts 2 and 3 provide a wide range of options to divert individuals for whom CST is raised, who have been adjudicated incompetent to stand trial with the potential for restoration, or even for those adjudicated not restorable. Icons for each possible decision point denote possible outcomes and referable services for individuals for whom CST is raised.

Quick Fixes for Effectively Dealing With Persons Found Incompetent to Stand Trial

CST is a constitutionally required mandate. It requires defendants to be able to understand their charges and to assist their attorney in preparation of their defense. When the issue of competence is raised by any of the parties involved, a competence examination can be ordered by the court. The requirements of competence proceedings have overburdened the mental health system recently in many states. In practice, competence examinations in most states require two licensed psychiatrists or psychologists. In many communities, this is not an option because of funding issues or an insufficient pool of qualified professionals to perform these examinations. Also, competence examinations must frequently be performed in forensic psychiatric hospitals that are costly and often unavailable.

Reducing the Pennsylvania Incompetency to Stand Trial Restoration Waitlist: More Than Just Beds

In 2017, PRA worked with the Commonwealth of Pennsylvania and the American Civil Liberties Union to implement a settlement agreement to reduce the jail waitlists for competence to stand trial evaluation and restoration. Based on an analysis of data on all CST/CR orders across Pennsylvania and interviews with key stakeholders, PRA made 11 recommendations to reduce waitlists and improve services to defendants in the competence system.


Evaluation and Restoration of Competence to Stand Trial: Intercepting the Forensic System Using the Sequential Intercept Model

Pinals, D. A., & Callahan, L. (2020). Evaluation and restoration of competence to stand trial: Intercepting the forensic system using the Sequential Intercept Model. Psychiatric Services, 71(7), 698–705. https://doi.org/10.1176/appi.ps.201900484

Challenges to Reforming the Competence to Stand Trial and Competence Restoration System

Callahan, L., & Pinals, D. A. (2020). Challenges to reforming the competence to stand trial and competence restoration system. Psychiatric Services, 71(7), 691–697. https://doi.org/10.1176/appi.ps.201900483

Trueblood: Diversion in Washington State

Over the past 2 years, PRA has provided technical assistance to 15 diversion services programs funded by the Trueblood settlement. Trueblood is a class-action lawsuit in Washington State that enforces a person’s constitutional right to timely competence evaluation and restoration services. The purposes of the diversion services programs are the following:

  1. To prevent deeper class member involvement in and recidivism in the criminal justice system;
  2. To reduce demand for competency services;
  3. To minimize harm inflicted on class members by reducing criminal justice involvement and long-term incarceration rates; and
  4. To serve class members in the least restrictive environment.

Policy Research Associates has partnered with the Trueblood Court Monitor’s Office, Seattle Foundation, Disability Rights Washington, and the Washington State Department of Social and Health Services to provide technical assistance to the diversion programs.

Trueblood Diversion Services Summit

The Trueblood Diversion Services Summit was held on September 11-12, 2019, at the Cedarbrook Lodge in Seattle, Washington. The Summit was planned and executed by Policy Research Associates in consultation with Judge Marsha Pechman, Dr. Danna Mauch (Court Monitor), Ms. Kim Mosolf (Disability Rights Washington), and Dr. Tom Kinlen (Washington State Department of Social and Health Services). The PRA team consisted of Dr. Lisa Callahan, Mr. Dan Abreu, Ms. Ashley Krider, Mr. Rocco Farano (videographer), and Ms. Kelly Abbruzzese (logistics).

The purpose of the Summit was to assist with the implementation of the state’s Diversion Services Plan to expand jail diversion programs state-wide. The agenda, which included plenary speakers, panel presentations, and topical breakout sessions, was developed to provide a national perspective on diversion of individuals with mental illness, to learn about diversion programs underway throughout the state, and to provide ample opportunity for cross-community networking and dialogue.

Trueblood Diversion Services Summit Videos

To share the lessons learned, promising practices, and recommendations stemming from the September 2019 Trueblood Diversion Services Summit, PRA created a suite of seven videos. The videos cover the following topics:

  • Trueblood Diversion Services Summit: 2019 Recap—An overview of the subject-matter experts, presenters, themes, and programs highlighted at the summit.
  • Implementing Community-Based Restoration—A plenary presentation by Debra Pinals, Ph.D., that examines the competence to stand trial/competence restoration system and possible methods for diversion to community-based services across all intercepts of the Sequential Intercept Model.
  • Peers & Class Members Panel Discussion—During this panel discussion, Trueblood peers and class members provided their perspective on the competence restoration system, their personal experiences with the criminal justice and treatment systems, and recommendations to the assembled diversion programs.
  • Peer Interviews (shortened and long-form versions)—These two videos, one shortened, one full-length, provide an inside look at the valuable role peer specialists play in assisting individuals experiencing a behavioral health crisis.
  • Class Member Interviews (shortened and long-form versions)—In these two videos, one shortened, one full-length, Trueblood class members share the importance of collaboration between the criminal justice system and the community to assist individuals with behavioral health needs effectively.

Watch Videos From The Summit:

Recommendations for Trueblood Sites

In working with the 15 diversion services programs funded through the Trueblood settlement, PRA developed a set of nine recommendations for communities interested in enhancing their competence evaluation, restoration, and jail diversion and reentry processes. PRA released these recommendations a two-page fact sheet. This tool outlines each of the recommendations and provides suggested guidance for implementing them.

About Policy Research Associates, Inc.

Policy Research Associates, Inc. was founded in 1987 with the stated mission of “creating positive social change for people and communities through technical assistance, research and training.”

Beginning with one research project, we have grown in size and project diversity while maintaining our expertise in technical assistance, research, and behavioral health. PRA is composed of approximately 50 talented employees, dedicated to bettering the lives of underserved populations.


Created with images by Kaitlyn Baker - "untitled image" • You X Ventures - "untitled image" • Sebastian Pichler - "untitled image" • AbsolutVision - "Business newspaper pages"