A legal quagmire: the need for a public health approach to the competency crisis

Competency to stand trial is a legal construct in the United States whereby an individual’s capacity to meaningfully and knowingly function in a legal proceeding, typically for those with mental or developmental disabilities or dementia, is questioned. The competency determination and restoration process often leads to unnecessary and excessive incarceration of those with disabilities without treatment for the underlying cause of competency concerns, often worsening health and leading to repeated incarceration. Yet, this crisis is rarely considered from a public health lens. Further, the number of individuals entangled in this legal process has risen dramatically in recent years, with 130,000 competency evaluations being conducted annually. We review what is known about this topic from legal studies, provide case studies of individuals failed by this process, and outline the responses that criminal legal systems and local and state governments have had to this crisis (e.g., increase in jails’ competency beds, diversion programs). We conclude that the competency process is a public health crisis which merits both study by public health researchers and a public health response.

Duke Scholars

Author Zaire Cullins