Every year, many Pennsylvanians remain in jail due to mental health issues that prevent them from standing trial. This often worsens their condition and traps them deeper in the criminal justice system.
In response, Allegheny County has introduced the state’s first mobile competency restoration clinic. The program will assess and treat individuals charged with crimes who are unable to aid in their defense due to mental or behavioral health challenges.
Historically, competency restoration treatment has been limited to just two state hospitals. This new initiative aims to expand access to necessary care, offering an alternative for those currently facing long waits in jail. Advocates hope this model will inspire other counties, where people often wait months for a bed in a treatment facility.
The county is also working to improve how local courts handle cases involving competency issues. This change aims to ensure that people, particularly those facing minor crimes, do not get lost in the system.
These efforts follow a 2023 investigation by Spotlight PA, which uncovered significant problems within Pennsylvania’s competency system. The report found that the legal process meant to help individuals instead often leaves them languishing in jail, where their mental health can deteriorate further.
The investigation spotlighted Rachel Bridgeman, a woman trapped in Allegheny County Jail for weeks due to her mental health issues, despite facing only minor, nonviolent charges.
County officials believe the new clinic will prevent situations like Bridgeman’s, ensuring that individuals in need of competency restoration are not detained simply because of their mental health needs. Competency restoration is a specific type of therapy designed to help individuals understand their legal situation.
“We have a lot of agreement on the need for this kind of approach,” said Erin Dalton, director of Allegheny County’s Department of Human Services. “It’s clear that this system doesn’t benefit anyone.”
The county’s public defenders and other advocates for criminal defendants see this program as a step in the right direction. However, some remain cautious, highlighting concerns over the county’s ongoing practice of holding individuals in jail while their competency is being evaluated. They also worry that the program might be used for individuals who cannot regain competency.
“I think we’re cautiously optimistic,” said Sarah Linder Marx, deputy director at the Allegheny County Public Defender’s Office. “But we’re approaching this with a healthy level of skepticism.”
Outside of Allegheny County, only two state hospitals—Torrance and Norristown—offer the specialized therapy needed to both treat mental health issues and help individuals understand their legal standing. Both hospitals have limited capacity, leading to long waits for treatment. On average, Allegheny County has 125 people waiting for competency restoration annually, yet Torrance has only 100 beds available for all of Western Pennsylvania.
A 2023 Spotlight PA analysis found that most individuals waiting for competency restoration were charged with misdemeanors linked to mental health issues, often involving public behavior.
“We don’t want people with minor offenses, who we believe can be safely supported in the community, to remain in jail,” Dalton said. “This new program provides an alternative that hasn’t existed before.”
Centurion, a private health care provider, has signed a $1.9 million contract with the county to deliver competency restoration services both in the county jail and in community settings. The program is mobile, meaning treatment can be delivered outside the jail in various community locations, depending on need.
“We want to provide services in the least restrictive setting possible,” said Jenn Batterton, a county official overseeing collaboration between the justice system and human services. “Our goal is to serve individuals without resorting to jail or Torrance if possible.”
For now, the program will serve only Allegheny County, but other counties like Bucks and Delaware are looking to implement similar programs. In addition to the mobile clinic, Allegheny County will introduce a new court docket next month specifically dedicated to competency cases. This new docket is designed to expedite proceedings and ensure timely access to treatment.
Samantha Sridaran, head of the mental health team at the Allegheny County Public Defender’s Office, is hopeful about these new changes. “I’ve had several discussions with the mobile team,” she said. “They have great ideas on how to truly help our clients in the long term.”
Despite the optimism, advocates remain wary of potential negative outcomes. If the program doesn’t work as intended, individuals could remain trapped in the criminal justice system.
Linder Marx expressed concerns that people with irreversible conditions, such as intellectual disabilities or brain injuries, may be wrongly referred for competency restoration. She also pointed out that Allegheny County’s practice of imposing “behavioral holds” on individuals suspected of being incompetent to stand trial has resulted in delays. This practice, according to the public defender’s office, is illegal.
Ideally, individuals suspected of incompetency should be evaluated within 48 to 72 hours. However, delays are common, with individuals often waiting weeks. Spotlight PA’s 2023 investigation found that Bridgeman waited two weeks before her case was addressed.
“We don’t believe anyone should be incarcerated simply because they are deemed incompetent,” said Linder Marx. “That goes against the intent of our laws.”
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