Pennsylvania Department of Human Services

The challenge

Criminal defendants in Pennsylvania routinely waited months, sometimes years, in county prisons before being transferred to state psychiatric hospitals for treatment to restore them to competency. Under the terms of a legal settlement with the American Civil Liberties Union, the Commonwealth was required to improve how it managed the transfer and treatment of these individuals, and in 2018 it contracted with IdeaCrew to create an operational improvement plan.

The approach

IdeaCrew delivered the plan in two phases within three months, focusing on the treatment of patients sent to state hospitals for competency evaluation and restoration. We:

• Conducted stakeholder sessions to gather input on definitions and recommendations and build consensus ahead of working groups convened across the Commonwealth
• Worked with the courts and clinical staff to develop shared definitions and procedures for restoring individuals to competency in a timely manner
• Developed Commonwealth-wide standards and policies for jail-based competency restoration
• Delivered recommendations on Commonwealth-wide standards and policies for community-based outpatient competency restoration
• Facilitated affinity groups spanning courts, the defense and prosecution bars, mental health professionals, law enforcement and corrections officials, and state and local government leaders for their review and comment
• Synthesized feedback from more than 300 participants to reach consensus

The outcome

IdeaCrew created a Competency Evaluation and Treatment Guide that is now widely circulated throughout the Commonwealth for use locally and in the state hospitals. Our work with the Commonwealth significantly reduced the wait for criminal defendants in county prisons being transferred to state psychiatric hospitals for competency treatment.