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Every year, hundreds of Pennsylvanians languish in jail because they're considered mentally unfit to stand trial, despite conditions that can worsen their state and plunge them deeper into the criminal justice system.
To avoid that scenario, Allegheny County has created the state's first mobile competency restoration clinic. The program will assess and treat people who have been charged with a crime, but can't aid in their own defense because of a mental or behavioral health issue.
The move expands access to this treatment, which is generally available only at two state hospitals. Supporters hope it can become a model for other counties, where as of now, people deemed “incompetent” to stand trial can wait months for a bed.
The county also plans to change how local courts handle cases involving competency issues, a move intended to prevent people from getting lost in the system, especially for low-level crimes.
These announcements come two years after a Spotlight PA investigation identified serious issues with Pennsylvania’s competency system.
The 2023 investigation found that the legal process meant to help people instead routinely traps them in jail, where they may deteriorate further.
The story highlighted one woman, Rachel Bridgeman, whose precarious mental health trapped her in the Allegheny County Jail while she awaited treatment, despite the minor, nonviolent charges she faced.
Allegheny County officials say the new clinic will ensure people like Bridgeman aren’t incarcerated just because they need competency restoration, a specific type of psychiatric therapy that helps them understand their legal situation.
“I think there's a lot of agreement where we don't always have a lot of agreement on these cases,” said Erin Dalton, director of the Allegheny County Department of Human Services.
“People see that this isn't good for anyone.”
The county’s public defense office and other advocates for criminal defendants see the program as a step forward.
But advocates said the changes could go further, citing the county’s ongoing practice of holding people in jail before their competency can be determined. They also expressed concern that the court will refer people to the program who are not able to regain their competency.
“I think we are cautiously optimistic that, if this is well-intentioned with the competency docket or mobile office restoration, that it will be employed legally,” said Sarah Linder Marx, a deputy director in the Allegheny County public defender’s office.
“But we are definitely approaching it with a healthy level of skepticism,” she said.
Outside Allegheny County, just two places — Torrance and Norristown State Hospitals — provide the specific therapy needed to both improve someone’s mental health and help that person understand their legal situation.
Both hospitals have a limited number of beds, which has created a backlog of people waiting for treatment. They often sit in jail.
On average, Allegheny County has about 125 people waiting for competency restoration annually, according to county officials. But Torrance has about 100 beds to serve all of Western Pennsylvania.
In 2023, a Spotlight PA analysis found most individuals undergoing competency assessments or waiting for restoration faced misdemeanors that could stem from experiencing mental health issues in public.
“We don't want people held on low-level offenses who we think are safe to be supported in the community,” Dalton said. “And now the district attorney and the judges and everyone have another option which they just haven't had before.”
Centurion, a private prison health care company, has signed a one-year, $1.9 million contract with Allegheny County to provide competency restoration therapy both within the county jail and in community settings.
The team is mobile, with no fixed home base, said Debbie Scovill, who oversees behavioral health care in the Allegheny County Jail.
“So, a lot of their services are done at the jail,” Scovill said. “They do have some partners in the community, like if they have a desire to run a group or to do meetings with patients, they can use spaces at those partnering agencies to do some boots on the ground in locations, but they are pretty much mobile.”
The itinerant design was intentional, said Jenn Batterton, who manages collaborations between the justice system and the county human services department.
People may be at different phases of involvement with the justice system, she said, “but the hope is that now more often, we'll be able to serve them in the least restrictive setting, so neither Torrence nor the jail, but in the community.”
The program will serve only Allegheny County for now, but others may soon follow suit. Both Bucks and Delaware Counties are pursuing similar programs.
In concert with the new effort, the Fifth Judicial District of Pennsylvania will next month debut a separate docket, or calendar of cases, dedicated to cases involving competency issues.
Gathering these cases in one place will help expedite them and ensure people get needed care sooner, Allegheny officials argued.
Both the mobile restoration team and the new competency-focused docket are promising, said Samantha Sridaran, who leads a team focused on cases involving mental health within the Allegheny County Office of the Public Defender.
“I’ve had several conversations with [the mobile competency restoration team],” Sridaran said. “I think they have really great ideas about how to really, actually, truly help our clients in the long term.”
But Sridaran, Linder Marx, and other advocates for criminal defendants told Spotlight PA they worry about unintended, criminal consequences of any court-ordered program.
“If things don't go well, we are still encapsulating people in the criminal legal system, and there's always potential things may escalate even further,” Linder Marx said. “I just don't want this to be employed as a weapon against individuals, if it were to not work as intended.”
Sridaran has also seen judges order competency restoration for people who cannot be restored: those who have unchangeable conditions such as intellectual disabilities, traumatic brain injuries, or cognitive impairment.
And Allegheny County has still not resolved an underlying issue that imposes a “behavioral hold” on individuals who are suspected to be incompetent to stand trial, effectively keeping them in jail while someone without a mental health condition may have walked free. The county public defender’s office has argued is illegal.
Ideally, these individuals would be evaluated within 48 or 72 hours by the court system’s behavioral assessment unit. But advocates said the delay can be longer; in the 2023 investigation, Spotlight PA found Bridgeman waited two weeks.
“The public defender's office's position is that no one should be incarcerated because they're incompetent,” Linder Marx said. “That's not in line with the spirit or intent of … our laws. That's not a reason to incarcerate somebody.”
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