title: When Restoration Fails: One State's Answer to the Dilemma of Permanent Incompetence.
abstract: The landmark 1972 U.S. Supreme Court decision in Jackson v. Indiana prohibited the indefinite commitment of criminal defendants on grounds of incompetence to stand trial if there was no substantial probability of restoration to competency in the foreseeable future. Such defendants are still subject to ordinary civil commitment; however, not all will meet civil commitment criteria, given that the criteria for a finding of incompetency to stand trial do not map directly onto the general criteria for involuntary psychiatric hospitalization. If a person charged with a serious crime, such as murder, has no substantial probability of being restored to competency, but does not meet standard civil commitment criteria, compliance with Jackson would seem to require release into the community. This article describes a legislative response to this possibility that became law in California four decades ago, as well as the outcome of its main legal challenge a few years later. Although the law has received harsh criticism from some quarters, it has survived, and provides a legally straightforward, if ethically controversial, means of answering the question of what to do with a permanently incompetent defendant who is charged with a serious violent offense and does not meet traditional civil commitment criteria.
authors.affiliation: Dr. Simpson is Clinical Associate Professor, Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, California. jrsimpsonmd@gmail.com.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Simpson
mesh_terms: D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence*; D057237:Criminals / Q000523:psychology*; D016743:Mental Competency; D035521:Supreme Court Decisions; D014481:United States