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J Am Acad Psychiatry Law 35:3:357-363 (2007)
Copyright © 2007 by the American Academy of Psychiatry and the Law.
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ANALYSIS AND COMMENTARY

Crisis in the Treatment of Incompetence to Proceed to Trial: Harbinger of a Systemic Illness

Hal Wortzel, MD, Ingrid A. Binswanger, MD, MPH, Richard Martinez, MD, MH, Christopher M. Filley, MD and C. Alan Anderson, MD

Dr. Wortzel is Instructor-Fellow with the Veterans Integrated Service Network (VISN) 19 Mental Illness Research, Education, and Clinical Center (MIRECC), Denver VA, and the Department of Psychiatry, University of Colorado, Denver, CO. Dr. Binswanger is Assistant Professor, Division of General Internal Medicine, University of Colorado, Denver, CO. Dr. Martinez is Director, Program in Forensic Psychiatry, University of Colorado, and Director of Psychiatric Emergency and Forensic Services, Denver Health Medical Center, Denver, CO. Dr. Filley and Dr. Anderson are Associate Professors, Departments of Neurology and Psychiatry, University of Colorado and Denver VA, Denver, CO. Address correspondence to: Hal Wortzel, MD, Department of Psychiatry, CPH Room 2508, 4200 East 9th Avenue, C268-25, Denver, CO 80262. E-mail: hal.wortzel{at}uchsc.edu

Across the nation, a growing number of defendants judged incompetent to proceed (ITP) to trial are unable to access needed mental health care because of critical shortages of state hospital psychiatric beds and funding. Many of these patients languish in jails and prisons that lack the resources to provide adequate care during their prolonged wait for treatment. The crisis is yielding results that are medically, legally, and ethically unacceptable. The problem is presented as the latest symptom of an overwhelmed mental health system. Deficits across multiple domains are responsible for the current ITP logjam, creating an emergency that has been receiving increasing attention by medical and legal professionals, the media, and the public. Achieving meaningful and long-term solutions will necessitate recognizing the deficiencies in mental health capabilities within jails and prisons, courts of law, and communities, and addressing the dire need for the integration of these sectors.






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Copyright © 2007 by the American Academy of Psychiatry and the Law.