Academic journal article Vanderbilt Law Review

Restore, Revert, Repeat: Examining the Decompensation Cycle and the Due Process Limitations on the Treatment of Incompetent Defendants

Academic journal article Vanderbilt Law Review

Restore, Revert, Repeat: Examining the Decompensation Cycle and the Due Process Limitations on the Treatment of Incompetent Defendants

Article excerpt

INTRODUCTION

The number of mentally ill individuals in the criminal justice system is staggering. The current population of jail or prison inmates with a mental illness surpasses the populations of cities like Cleveland, New Orleans, and St. Louis.1 And each year, two million people with mental illnesses are booked into jails.2 Indeed, the Bureau of Justice Statistics reported that fifty-six percent of state prisoners, forty-five percent of federal prisoners, and sixty-four percent of jail inmates suffer from a mental health problem.3 As a comparison, the rate of mental illness in the general population is estimated to be around eighteen percent.4 Moreover, between seven5 and fifteen percent of male inmates and thirty percent of female inmates suffer from a serious mental illness,6 compared to just four percent of adults in the general population.7

The prevalence of mental illness within the criminal justice system continues to grow over time8 due to a variety of factors, including the deinstitutionalization of state mental health facilities, lack of community health treatment, and aggressive prosecution for drug-related offenses.9 As a result, the largest correctional facilities now house more mentally ill individuals than many inpatient psychiatric facilities.10 However, the mental health treatment available in correctional facilities is ineffective in addressing inmates' mental health needs.11 Numerous studies have demonstrated that inadequate treatment in correctional facilities exacerbates already-existing mental illnesses and symptoms and contributes to the emergence of new psychiatric concerns.12

This is particularly problematic for individuals deemed incompetent to stand trial. Legal incompetence is distinct from, and considerably narrower than, mental illness. Mental illness is defined as a "disorder[ ] generally characterized by dysregulation of mood, thought, and/or behavior as recognized by the . . . American Psychiatric Association."13 Mentally ill individuals are legally incompetent only when they do not have the ability to either consult with their lawyer or understand the proceedings against them.14 Defendants who meet the standard of incompetency receive restoration treatment-typically at an inpatient state mental health facility-that is designed to restore their mental status so that they can both understand and participate in their own trial.15 On average, individuals are restored to competency within ninety days.16 Prior to, and after receiving competency treatment, these individuals are often detained in jail to await treatment or trial, despite the fact that they have not been found guilty of any crime.17 Due to the inadequate mental health treatment provided at jails, however, many of these recently restored pretrial detainees revert back to an incompetent or delusional state before the trial begins, a phenomenon referred to as "decompensation."18 At this point, the defendants must go back to the treatment facility to once again be restored to competency, before returning to jail again to wait for trial, creating a cycle of decompensation that can persist for years. As an example, in one notorious Florida case, the defendant, Bobby Lane McGee, bounced between competency restoration treatment and jail six times, resulting in a seventeen-year delay in his trial and ultimate conviction-costing the state $1.3 million.19

Though scholars have been unable to quantify the prevalence or severity of the decompensation cycle thus far, it is clear that McGee's story is not unique. Indeed, in Florida alone, approximately two hundred pretrial detainees are sent back to the state's mental health facility within twelve months of returning to jail after restoration.20 And yet, the decompensation cycle remains a relatively unexplored phenomenon within the criminal justice system and legal literature. This Note remedies that by illuminating the source and significance of the decompensation cycle, ultimately arguing that the decompensation cycle violates pretrial detainees' constitutional rights. …

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