Pennsylvania’s competency system is in crisis, according to a recent state-backed study.
The state’s competency restoration system is part of the criminal justice process.
If someone is charged with a crime, but because of a serious mental illness or other cognitive issue cannot understand their legal situation enough to aid in their own defense, a judge may find them “incompetent” to stand trial. These people must undergo competency restoration treatment before their case can proceed.
But despite decades of scrutiny, Pennsylvania’s latest review found the process still sweeps up people facing low-level offenses, overrelies on state hospitals to treat them, and leaves them there far longer than necessary.
The Department of Human Services, which oversees much of the competency system, commissioned the report “to identify ways to enhance access to community-based competency restoration services and improve the timeliness of state hospital-based restoration services,” said spokesperson Brandon Cwalina.
Technology firm CAI reviewed the system last year, between August and December, and finished the report in April. Of the four people who conducted the review, three were former state officials. The Department of Human Services posted their findings publicly in July.
The study echoes prior state-commissioned studies as well as a Spotlight PA and Pittsburgh Institute for Nonprofit Journalism investigation published in 2023. All found the system disjointed, inefficient, and lacking comprehensive data that would allow for better oversight.
“There are still too many individuals with mental illness engaging with the criminal justice system for relatively minor offenses,” the CAI review found. It was also critical of the numbers of people referred to state hospitals for competency restoration treatment, and those who remain despite no longer needing services.
The Spotlight PA and PINJ investigation found no one government agency assesses, determines, and restores a person’s competency. Instead, a patchwork of state and local agencies with little oversight facilitate the detention, treatment, and trial of someone found incompetent.
The newsrooms also found there is no standardized system for documenting competency assessments and hearings, and no easy way to identify people who may be stuck in jail and getting worse.
In its review, CAI found similar limitations.
While Pennsylvania uses different datasets to track the movement of people into and out of state hospitals and certain state-funded mental health services, the state does not know how many competency evaluations have occurred, how many people have been court ordered to competency restoration services, or where those are occurring if not in a state hospital.
“These limitations preclude a thorough understanding of what is occurring in the competency restoration system,” the report found.
Once a person is found incompetent, they are typically referred to Torrance or Norristown State Hospitals. The inpatient state facilities both provide competency restoration treatment. Though 11 counties have their own outpatient competency restoration programs, CAI found the vast majority still rely on these two hospitals to treat people ordered incompetent, leading to significant wait times for beds.
“Those programs often have available capacity and have been slow to be accepted as viable alternatives by the judicial system,” the researchers wrote of the county projects.
The firm also found as of Jan. 1, 2025 that about 25% of patients residing in the two hospitals did not need to be there. These patients were either already found competent and awaiting trial, found non-restorable and in need of discharge, or were long-term residents that could also likely rejoin the community.
“If individuals determined non-restorable, competent, and under long-term commitments were moved from the [forensic state hospitals] to more appropriate services, sufficient beds would be available to serve the active waitlist,” the report reads.
Additional findings include:
- About 21% of people on the waitlist for competency restoration at a state hospital faced a misdemeanor as a maximum charge.
- Despite receiving additional spending in recent years, state funding for counties to develop community mental health programs isn’t keeping up with need.
- Long-term residence programs for people with significant mental health issues, while a good alternative to incarceration and institutionalization in state hospitals, are not spread evenly across the state. There are 42 of these programs in Pennsylvania, but they are concentrated near Philadelphia and Pittsburgh, with a few additional programs in-between. So beds are not always available, as some counties reserve theirs for their residents.
- The state published standards for conducting competency assessments, but they are not applied uniformly, leading to disagreements among evaluators on whether a person has been restored.
The report makes a number of recommendations to the state to improve the system. It calls for the creation of a centralized data system to manage and monitor the competency system. The report also urges the state to continue the development of community-based mental health resources and create more opportunities for people to avoid the justice system entirely due to mental health issues.
The CAI report, completed in April and posted publicly to a DHS website over the summer, is the latest in several reviews finding worrisome issues with Pennsylvania’s system for assessing and treating competency issues.
Former Gov. Milton Shapp ordered a study of the system in 1975 that led to a 1977 report that recommended many of the same measures in the 2025 study — notably, the creation of outpatient services and a centralized information system.
In 2015, the ACLU of Pennsylvania sued the state over lengthy wait times for Norristown and Torrance. As part of settlement with the civil rights firm, the state paid for a 2017 study that recommended discharging people who did not need to be in state hospitals and creating standardized definitions and procedures for competency assessments and restoration among other things.
The 2025 review, noting some of the same findings as both the 1977 and 2017 publications, concludes with a call to action.
“There is no singular solution, and some solutions lie outside the scope of influence or investment that [the state mental health office] alone can provide,” it reads.
The department is working to adopt the report’s recommendations, Cwalina said, to continue making progress on reducing wait times for competency restoration treatment.
The department is also updating regulations for crisis services and assessing strategies to maintain close partnerships with counties, Cwalina said.