NEW REPORT LIVE NOW! Fractured: Oklahoma's System of Competency Leaves Hundreds Languishing in Jail

People who have been charged with a crime have to be mentally competent to stand trial or enter a plea. Competency means being able to understand the charges against you and being able to assist in your own defense.

When someone is found incompetent to stand trial or enter a plea, they are ordered to competency restoration. This requires transport from the jail to Oklahoma Forensic Center where they are stabilized and given proper medications in hopes they will raise their competency standard to be able to participate in their case. Here is a diagram of the process.

The Oklahoma Statutes allow for two years to attain competency. This means someone could be attempting to attain competency for two years after they are transferred to Oklahoma Forensic Center. 

Currently the competency waitlist is over 200 people in Oklahoma. All of those people are waiting for services while in jail.

Studies estimate that in-hospital restoration costs from $401-$834 per defendant per day.

If they are not a danger to society and don't have a history of treatment noncompliance they are discharged. If there is a history of dangerousness and they cannot attain competency, the defendant is civilly committed.

The Treatment Advocacy Center recommends 50 mental health beds per 100,000 people. Oklahoma is approaching a population of 4 million people, which means we should have around 2,000 mental health beds available. Currently we have a little over 500 beds, some of which are still under construction.

Oklahoma has a dire shortage of Ph.D.s who provide mental health care. There are 10.3 psychiatrists per 100,000 in the state and 13.4 psychologists in the state to serve the entire population. Data also shows Oklahoma underpays public psychologists by about $10,000 compared to the national average.

Programs like Florida's     

Eleventh Judicial Circuit Criminal Mental Health Project (CMHP) sort defendants by seriousness and funnel those who are not likely to go  to prison into mental health services. Their low-level charges are dismissed.  General arrests fell from 118,000 to 53,000 in 2021. This reduction has led to a savings of 300 years of jail days and a cost avoidance of over $29 million. 

Many other states, like Colorado, have developed outpatient competency restoration services for clients who are well indicated to receiving these services in the community.

In states where litigation on this issue has taken place, courts have found a 14-day period to receive a competency assessment after being ordered by the court falls in line with constitutional requirements.

In states where litigation on this issue has taken place, courts have found a 7-day period to be transported to services after a finding of incompetence to stand trial falls in line with constitutional requirements.

Currently, Oklahoma law requires people to continue getting competency restoration services for up to two years, even if the doctors think it's unlikely the patient can regain competency. Research shows if competency cannot be reached within one year, it is unlikely it will be attained.

Passed by Oklahoma voters in 2016, a fund for mental health and substance use services at the county level has never been funded by the Oklahoma legislature. Recent reforms have saved between $10 and $20 Million per year since 2017 which could go toward services like out patient restoration and other needed services. 

Washington's settlement agreement on this issue required the state to hire forensic navigators to work in the system to find cases that would benefit from out-patient services, and which would track cases. through the competency process.

Lawyers, judges, police, corrections officers, and counselors need additional training for handling serious mental illness in the context of criminal law.

Sometimes people return from having competency restored and they are not kept on the same regimen that was used to stabilize them. When medications are changed, people can decompensate and have to start the process all over again. The state should require jails to keep medications the same upon return from competency services.

A contributing factor to long wait lists is the trial-and-error practices of prescribing medications. Trying different medications can take months to find the right doses etc. Many governmental bodies have begun genetic mouth swab testing to equip patients with information about which medications are contra-indicated or poorly metabolized.