Jail-based competency restoration

Abstract Jail-based competency restoration (JBCR) emerged from the need to reconcile growing numbers of defendants adjudicated incompetent to stand trial with a shortage of forensic hospital beds. JBCR offers a pathway in which competency restoration for defendants with mental illness is provided in a jail rather than a hospital; it is one option on a continuum of restoration services. JBCR offers a cost-saving alternative to hospital restoration and a potentially faster resolution of cases, reducing the overall incarceration time. Significant variation exists with regard to policies and procedures of JBCR programs. Restriction on prescribing involuntary medication is one key difference between treatment in a JBCR program and a hospital, and it creates additional considerations for management of defendants adjudicated incompetent to stand trial. The JBCR model is not without controversy, and further data are needed to elucidate the full range of benefits and limitations of this approach to restoration.