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Restore, Revert, Repeat: Examining the Decompensation Cycle and the Due Process Limitations on the Treatment of Incompetent Defendants

Posted by on Thursday, January 18, 2018 in Notes, Volume 71, Volume 71, Number 1.

Restore, Revert, Repeat


Though correctional facilities are one of the largest providers of mental health care in the country, the treatment provided often fails to address the needs of many mentally ill inmates. Indeed, after receiving treatment at a state mental health facility, many pretrial detainees who have been recently restored to competency revert to an incompetent state—or decompensate—upon their return to jail, at which point they must return to the state treatment facility to be restored to competency once again. This Note is the first to explore this “decompensation cycle,” highlighting the significance of the problem and demonstrating how mental health treatment provided by correctional facilities, or the lack thereof, can lead to decompensation. Ultimately, this Note argues that the decompensation cycle and inadequate mental health treatment provided to recently restored pretrial detainees violates the Due Process Clause. Therefore, courts must step in and require jails to maintain the treatment regimen recommended by the state competency treatment facility. Furthermore, this Note advocates for the use of telemedicine in correctional facilities as one way to improve treatment and end the decompensation cycle.


Margaret Wilkinson Smith
J.D. Candidate, 2018, Vanderbilt University Law School; B.A., 2012, Duke University.