Table of Contents
ACKNOWLEDGEMENTS..............................................................................1
INTRODUCTION...........................................................................................2
PART 1- OVERVIEW OF INTELLECTUAL AND DEVELOPMENTAL
DISABILITIES AND MENTAL ILLNESS.........................................................3
What is Disability?................................................................................4
What are Developmental Disabilities?..................................................5
Types of Developmental Disabilities.....................................................5
Intellectual Disability ......................................................................... 5
Autism Spectrum Disorder ............................................................... 6
Fetal Alcohol Spectrum Disorder (FASD) ......................................... 6
What is Mental Illness?.........................................................................6
Types of Mental Illnesses.....................................................................7
Major depressive disorder ................................................................ 7
Bipolar disorder ................................................................................ 7
Schizophrenia .................................................................................. 7
Anxiety disorders .............................................................................. 7
Co-Occurring Conditions......................................................................9
Diagnosis and Recovery......................................................................9
Antipsychotics .................................................................................10
Antidepressants ..............................................................................10
Anti-anxiety medication ...................................................................10
Mood stabilizers ..............................................................................10
Access and Functional Needs............................................................11
Legal Rights of Those with I/DD or Mental Illness.............................11
PART 2 – PROSECUTOR APPROACHES FOR WORKING WITH PEOPLE
WITH I/DD OR MENTAL ILLNESS..............................................................14
Introduction..................................................................................................15
Victims and Witnesses with I/DD or Mental Illness............................16
Misconceptions and Discomfort.........................................................16
Interviewing Victims and Witnesses with I/DD or Mental Illness and
Trial Considerations...........................................................................16
Preparing for the Interview ............................................................17
Medical and Psychiatric Records ...................................................17
Conducting the Interview ................................................................19
Preparing the Victim or Witness for Trial ........................................ 21
Special Considerations for Defendants with I/DD or Mental Illness...22
Competency ...................................................................................22
Customized Dispositions ................................................................23
Diversion to Mental Health Court ...................................................24
PART 3 – PROSECUTOR-INVOLVED INITIATIVES.................................26
Intellectual and Developmental Disabilities Alternative to Incarcera-
tion Program - Rockland County District Attorney’s Oce,
New York............................................................................................27
Program Stakeholders ...................................................................27
Case Management .......................................................................28
Qualifying for the Program .............................................................28
Length of Program .........................................................................29
Individualized Service Plans ..........................................................30
Family Involvement ........................................................................31
Number of People in the Program ..................................................31
New York State Attorney General’s Oce Training on I/DD, Mental
Illness and Police Mental Health Collaborations...............................32
Mental Health and Intellectual and Developmental Disabilities (Pre-
sented by NAMI New York and The Arc of the United States) .......32
Police Mental Health Collaborations – Best Practices ..................33
Prosecutor’s Perspective (Presented by prosecutors) ................... 33
CONCLUSION.............................................................................................34
RESOURCES..............................................................................................35
I/DD and Disability Resources...........................................................35
Mental Health Court Resources.........................................................35
Resource on Competency..................................................................36
1
ACKNOWLEDGEMENTS
e article is written by Kristine Hamann - Executive Director of Prosecutors’
Center for Excellence, Ariel Simms – Senior Program Manager and Attorney for
Criminal Justice Initiatives, e Arc of the United States, and Shannon Scully –
Manager, Criminal Justice & Advocacy, NAMI. e authors would like to thank
the following people for their excellent assistance, advice and contributions to
this paper: Leah Pope, Senior Research Fellow and Melissa Reuland, Senior Ad-
visor, both from the Vera Institute of Justice, Assistant District Attorney Patricia
Bailey of the New York County District Attorney’s Oce (NY), Assistant Dis-
trict Attorney Guy Arcidiacono of the Suolk County District Attorney’s Oce
(NY), Judy Rosenthal, Executive Director of Fiscal and Program Operations at
the Rockland County District Attorney’s Oce (NY), Wanda Perez Maldona-
do, Chief of the Special Investigations & Prosecution Unit and Gail Heatherly,
Counsel to the Special Investigations & Prosecution Unit both of the New York
State Attorney General’s Oce.
is project was supported by Grant No. 2017-NT-BX-K001 awarded by the Bureau of Justice
Assistance. e Bureau of Justice Assistance is a component of the Department of Justice’s
Oce of Justice Programs, which also includes the Bureau of Justice Statistics, the National
Institute of Justice, the Oce of Juvenile Justice and Delinquency Prevention, the Oce for
Victims of Crime, and the SMART Oce. Points of view or opinions in this document are
those of the author and do not necessarily represent the ocial position or policies of the U.S.
Department of Justice.
2
Victims, Witnesses, and Defendants
with Mental Illness or Intellectual and
Developmental Disabilities
A Guide for Prosecutors
INTRODUCTION
People with intellectual and developmental disabilities (I/DD) or mental illness
are overrepresented in the criminal justice system, as victims, witnesses, sus-
pects, and defendants. e purpose of this guide is to increase understanding
and generate discussion about these conditions or disabilities and their potential
impact on resolving cases. is guide provides prosecutors with a synopsis of
useful information that can provide strategies that will assist them in their work
with those who have I/DD or mental illness.
e goal of this paper is to introduce a series of complex issues and concepts; it
is not intended to be a comprehensive, in-depth review of the many practical,
medical, and legal issues that are associated with the intersection of the criminal
justice system and those with mental illness or I/DD.
e paper proceeds in three parts. Part 1 oers an overview of I/DD and mental
illness and the legal obligations involved when interacting with people with I/
DD or mental illness. Part 2 gives practical approaches for prosecutors to more
eectively work with these populations, as victims, witnesses, or defendants. Part
3 gives examples of programs that prosecutors have either created or partici-
pated in that address the involvement of persons with I/DD or mental illness in
the criminal justice system. Additional resources that oer further information
about these topics are provided at the end of the paper.
3
PART 1- OVERVIEW OF INTELLECTUAL AND
DEVELOPMENTAL DISABILITIES AND MENTAL ILLNESS
4
What is Disability?
“Disability” can be dened in various ways. According to the Americans with
Disabilities Act (ADA), disability is a “physical or mental impairment that sub-
stantially limits one or more major life activities.”
1
is denition of disability
focuses on an actual or perceived impairment and assumes that an impairment
is what keeps an individual from fully participating in society.
However, people with disabilities do not necessarily dene themselves by a med-
ical diagnosis or impairment. In contrast to the more functional denition of
disability, international human rights law denes disability as “long-term physi-
cal, mental, intellectual or sensory impairments, which in interaction with var-
ious barriers may hinder...full and eective participation in society on an equal
basis with others.”
2
Unlike the ADA’s denition, this one emphasizes the impact
of barriers on an individual’s ability to fully participate in society as part of the
“social model” of disability.
3
Developmental and mental health disabilities are two categories of disabilities.
ere are many other types of disabilities, such as physical disabilities, sensory
disabilities, and age-related disabilities. Individuals with one type of disability
frequently also have others. Regardless of the particular diagnoses or labels, ev-
ery individual’s experience with disability is unique.
In some ways, mental health and developmental disabilities may manifest simi-
larly in interactions with justice professionals, and there can be signicant over-
lap between these disability communities. However, these disabilities will oen
require dierent services and supports, so it is important for justice professionals
to have a better understanding of both types of disabilities.
1 Americans with Disabilities Act, §12102 (1990).
2 United Nations Convention on the Rights of Persons with Disabilities, Article 1 (2008). e United States has
signed, but not yet ratied, the Convention, which has been ratied by 177 other countries to date.
3 “e Social Model vs e Medical Model of Disability,” Disability Nottinghamshire (2019). Retrieved from http://
www.disabilitynottinghamshire.org.uk/about/social-model-vs-medical-model-of-disability/.
5
What are Developmental Disabilities?
Developmental disabilities are life-long disabilities that start before age 22,
during a person’s developmental period, and must substantially aect at least
three of the following areas: the ability to care for oneself, learn, communicate,
move, live independently, work, or make decisions.
4
Some examples of devel-
opmental disabilities include intellectual disability, Down syndrome, autism,
cerebral palsy, and Fetal Alcohol Spectrum Disorder.
5
ese disabilities can be
dicult for justice professionals to identify, as individuals with these disabilities
might not have any obvious physical traits or outward characteristics. is is one
of the reasons these disabilities oen go unrecognized in the criminal justice
system.
Types of Developmental Disabilities
ere are many types of developmental disabilities, but the most common in-
clude:
Intellectual Disability
Intellectual disability is characterized by limitations in intellectual functioning
and adaptive behaviors, including practical, social, and cognitive skills. e on-
set of these limitations must be before the age of 18, even if a person is not iden-
tied as having this disability until later in life.
4 American Association on Intellectual and Developmental Disabilities, Intellectual Disability:
Denitions, Classication, and Systems of Supports (11th ed.) (2010).
5 Id.
6
Autism Spectrum Disorder
Autism is a pattern of neurodiversity that can be characterized by diculties
with social interaction, processing sensory information, and communication.
Some people with autism engage in repetitive, self-stimulation behaviors, such as
hand-apping, which are more colloquially known as “stimming.”
Fetal Alcohol Spectrum Disorder (FASD)
FASD is a developmental disability that is caused by the consumption of alcohol
during a pregnancy. FASD can lead to challenges with impulsivity, judgment,
and decision-making, though many with FASD have high expressive language
skills.
6
People with developmental disabilities may have more than one type of disabil-
ity, including multiple developmental disabilities, or co-occurring physical or
mental health disabilities. When a person has both a developmental and men-
tal health disability, this is sometimes referred to as “dual diagnosis,” though in
many elds, dual diagnosis refers to someone with a mental health disability and
co-occurring substance use.
What is Mental Illness?
Mental illnesses are medical conditions that can disrupt a person’s thinking,
feeling, mood, daily functioning, and ability to relate to others. ey include
many dierent conditions that can vary in degree of severity ranging from mild
to moderate to severe.
7
Neither the person or the person’s family is to blame for the mental illness and
mental illness does not develop because of a person’s character or intelligence.
Mental illness can aect anyone regardless of their gender, geography, income,
social status, race/ethnicity, religion/spirituality, sexual orientation, background,
or other aspects of cultural identity. While it also can occur at any age, three-
fourths of all mental illness begins by age 24.
6 Id.
7 National Institute of Mental Health (2019). “Mental Illness”. Retrieved from: https://www.nimh.nih.gov/health/
statistics/mental-illness.shtml
7
Mental illness is common. In a given year:
• 18.9 percent of U.S. adults experience some form of mental illness
8
• 4.5 percent have a serious mental illness
9
• Among the 46.6 million adults with any mental illness, 19.8 million
(42.6 percent) received mental health services in the last year.
10
Types of Mental Illnesses
ere are many types of mental illnesses, but the most common include:
Major depressive disorder
A mood disorder that causes persistent feelings of sadness and loss of interest.
It aects how you feel, think, and behave and can lead to a variety of emotional
and physical problems.
Bipolar disorder
Bipolar disorder is a disorder that causes extreme shis in mood, energy, and
activity levels. It includes both manic and depressive symptoms which may last
days to months.
Schizophrenia
e most common of all psychotic disorders that typically emerges in early
adulthood and aects about 1 percent of people worldwide. Symptoms include
delusions and hallucinations, disoriented thinking, which can include a rapid
switching from one topic to another, and unpredictable agitation.
Anxiety disorders
We all experience anxiety at some point in our lives, but for those who develop
an anxiety disorder, the symptoms can be overwhelming and develop physically.
Anxiety disorders develop as a result of genetics or life events. For example, Post
8 Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health indi-
cators in the United States: Results from the 2017 National Survey on Drug Use and Health (HHS Publication No.
SMA 18-5068, NSDUH Series H-53). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance
Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
9 Id. SAMHSA (2018).
10 Id. SAMHSA (2018).
8
Traumatic Stress Disorder (PTSD – a type of anxiety disorder) oen develops in
veterans who have served in war zones.
Regardless of the diagnosis, symptoms can be similar and can overlap. e fol-
lowing are some examples of symptoms:
• Feeling sad or down
• Confused thinking or reduced ability to concentrate
• Excessive fears or worries, or extreme feelings of guilt
• Extreme mood changes of highs and lows
• Withdrawal from friends and activities
• Signicant tiredness, low energy, or problems sleeping
• Detachment from reality (delusions, paranoia, or hallucinations)
• Inability to cope with daily problems or stress
• Trouble understanding and relating to situations and to people
• Major changes in eating habits
• Excessive anger, hostility
• Suicidal thinking.
It’s important to be aware that the presence of one or more of these symptoms
is not evidence that a mental illness is present. ey may be a typical reaction
to stress, or they may be the result of an underlying medical condition. In fact,
one of the most important parts of an initial psychiatric evaluation is a physical
work-up to rule out underlying physical illnesses. is is especially true when
symptoms develop rapidly. If someone is exhibiting symptoms, they should seek
the assistance of their doctor or a mental health professional.
9
Co-Occurring Conditions
Oen mental illness is not the only thing going on in a person’s life. Other con-
ditions may also be present that further complicate the diculties created by
mental illness. is is referred to as co-occurring, co-morbid conditions, or dual
diagnosis which means that there is more than one condition causing the di-
culties. It is estimated that 3.4 percent of adults have co-occurring mental health
and substance use disorder.
11
Substance use is the most common co-occurring condition. Even if a person
does not have a formal diagnosis of substance use disorder, alcohol and other
drugs are frequently involved in times of mental health crises. Many also use
drugs and alcohol to self-medicate when their treatment plan is not eective.
In addition to complicating the symptoms of mental health conditions, alcohol
and other drugs can also interfere with medications that may be used to treat the
conditions.
Diagnosis and Recovery
Diagnoses are based on clinical observations, self-reported information, and
reports from those close to the person about someone’s behavior or thinking.
Symptoms vary from one person to another, and each person responds dier-
ently. However, working towards identifying an accurate diagnosis can mean a
greater chance for someone to identify a treatment and recovery plan that works
for them. Dening symptoms for each mental illness are detailed in the Diag-
nostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).
For many people, recovery is a mix of services and supports that manage the
symptoms of their mental illness. is can include medication, therapy, and psy-
chosocial services (i.e., psychiatric rehabilitation), housing, employment or ed-
ucation, and peer supports. is combination of services and supports will vary
from person to person. Even people with the same diagnosis will have dierent
experiences, needs, goals, and objectives; there is no “one size ts all” approach.
11 Id. SAMHSA (2018).
10
ere are generally four categories of medication used to treat mental illness,
and each come with side eects that can be a barrier to people engaging in med-
ication as part of their recovery.
Antipsychotics
A category of medication used to treat symptoms of psychosis, such as delusions
and hallucinations. ey play a vital role in treating schizophrenia and schizoaf-
fective disorder but can also treat certain types of bi-polar disorder and treat-
ment-resistant depression. Side eects oen include weight gain, which can lead
to health complications, such as metabolic syndrome or a condition known as:
tardive dyskinesia; where an individual can experience random, uncontrollable
muscle movements or tics.
Antidepressants
Generally used to treat depression. Side eects can include nausea, reduction in
sexual desire, weight gain, dry mouth, vomiting, insomnia, drowsiness, agita-
tion, or restlessness.
Anti-anxiety medication
Used to reduce the emotional and physical symptoms associated with anxiety.
Side eects can include low blood pressure, decreased sex drive, nausea, lack of
coordination, depression, unusual emotional dysfunction, including anger and
violence, memory loss, and diculty thinking.
Mood stabilizers
ese medications commonly treat mood swings associated with bipolar dis-
order, including manic or hypomanic episodes and depression. Side eects can
include excessive thirst, frequent urination, tremor of the hands, nausea and
vomiting, slurred speech, blackouts, change in vision, seizures, hallucinations,
loss of coordination, and irregular or pounding heartbeat.
While innovations in the range of treatment and recovery services have in-
creased, the reality is that many people with mental illness struggle to get con-
nected to treatment providers and supportive services.
11
Every community in the United States experiences a mental health provider
shortage.
12
Approximately 12.2 percent (over 5.3 million) of adults with mental
illness are uninsured,
13
and 44.6 percent of adults with mental illness report that
they were not able to receive the treatment they needed because of costs.
14
Access and Functional Needs
Instead of relying on diagnostic labels, it is oen more helpful to think about
disability from a standpoint of access and functional needs, an approach that is
common in the elds of emergency and disaster response.
15
Instead of focusing
on someone’s diagnosis, or more commonly, a list of diagnoses, the idea is to
focus instead on what someone may need to have access or fully participate. For
example, if a person is struggling to read a form, it would be helpful to know
what the person might need to make that form accessible, such as larger print or
to have the form read/explained aloud. In this situation, a diagnosis would not
necessarily provide the most helpful information.
Legal Rights of ose with I/DD or Mental Illness
In the United States, the rights of persons with disabilities are protected by a va-
riety of statutes, at both the state and federal levels, including the Rehabilitation
Act of 1973 and the Americans with Disabilities Act (“ADA”) of 1990. Together
with state law, these statutes protect the civil rights of persons with disabilities
and outlaw discrimination in many forms by many types of actors.
Under Title II of the ADA, many criminal justice actors, including prosecutors,
cannot discriminate in the provision of services or access to programs on the
basis of disability.
16
is general obligation not to discriminate translates into
12 Mental Health America (2018) e State of Mental Health in America. https://www.mentalhealthamerica.net/
issues/state-mental-health-america-2018
13 Id. SAMHSA (2018).
14 Id. SAMHSA (2018).
15 See, e.g., Federal Emergency Management Agency’s (FEMA) Functional Needs Support Services Guidance,
https://www.phe.gov/Preparedness/planning/abc/Pages/functional-needs.aspx.
16 Title II, Americans with Disabilities Act (1990).
12
two, armative obligations for prosecutor oces: (1) providing access and (2)
ensuring eective communication.
Individuals with disabilities have the right to access prosecutorial services and
activities on the same basis as those without disabilities. On the access front, this
may mean that a prosecutor has to modify an existing program, policy, or proce-
dure to ensure full participation by someone with a disability. An example could
be modifying standard provisions of a plea agreement, such as deleting a require-
ment to pursue education for someone with intellectual disability. On the com-
munication front, this may mean providing auxiliary aids and services, such as
live captioning, interpreters, assistive listening devices, or a notetaker. An exam-
ple could be contracting with an agency to provide real-time captioning services
during interviews or court proceedings for someone with an auditory processing
disability.
ese rights do not create a
special advantage for persons
with disabilities; instead, they
help level the playing eld to
allow a person with disabili-
ties to access a complex and
dicult and, at times, inac-
cessible system for many peo-
ple. One additional require-
ment of the Americans with
Disabilities Act is that any
public entity with 50 or more
employees must have a designated “ADA Coordinator,” someone who is familiar
with the various requirements of disability rights laws and can help their agen-
cy stay in compliance.
17
Many prosecutor ocers have fewer than 50 employees;
in that case, an ADA Coordinator would most likely be found within the larger
court system or a dierent state or local government agency. If there is not an
ADA Coordinator in their own oce, prosecutors can look for one in the courts
17 Department of Justice, Nondiscrimination on the Basis of State and Local Government Services Regulations, 28
C.F.R. pt. 35, § 35.107(a) (2005).
13
in their jurisdiction – this information can oen be found online or through the
Court Clerk’s Oce. Building a relationship with the ADA Coordinator helps
to ensure compliance, and maintains a process that is informed and current. A
pre-existing relationship will prove to be quite fruitful once a matter does arise
involving a person with a disability.
Prosecutors also have resources in the community that may be helpful in prepar-
ing for and providing reasonable accommodations and supports to individuals
with disabilities, including state and local disability organizations, such as chap-
ters of e Arc. In every U.S. state and territory, there is also a designated Pro-
tection and Advocacy (“P&A”) agency, an organization that is federally funded to
provide advocacy services to individuals with all types of disabilities. P&As can
also be a resource for prosecutors on disability compliance, training, and techni-
cal assistance.
14
PART 2 – PROSECUTOR APPROACHES FOR WORKING
WITH PEOPLE WITH I/DD OR MENTAL ILLNESS
15
Introducon
It may not be commonplace for prosecutor training to include information about
how to work with those who have mental illness or I/DD. However, meeting
compliance laws and improving case outcomes, has put an emphasis on the need
for such training. Even when prosecutors have encountered the issue, it may only
be in the context of attempting to defeat a defense claim that the defendant is
not responsible for the crime due to I/DD or mental illness. is paper does not
address how to defeat such defenses, but instead, it provides general guidance to
prosecutors who will interact with victims, witnesses, or defendants with I/DD
and/or mental illness. e rst section addresses issues related to working with
victims and witnesses with I/DD or mental illness. e second section provides
special considerations that arise when a defendant has I/DD or mental illness.
16
Victims and Witnesses with I/DD or Mental Illness
Interviewing and working with victims and witnesses with I/DD and mental
illness can pose various challenges for a prosecutor – some pertain to the prose-
cutor’s own perceptions and others involve making necessary accommodations
for the person.
Misconceptions and Discomfort
It is not uncommon for people to have a level of discomfort regarding interac-
tions or behaviors that are not well understood. So, prosecutors, as many others,
may have pre-existing misconceptions about people with I/DD and mental ill-
ness, or they may be uncomfortable when speaking with a person with I/DD or
mental illness. Prosecutors may worry that a case may be weak or unprovable if it
is based on the testimony of a victim or witness who has I/DD or mental illness.
However, with a better understanding of I/DD and mental illness and some en-
hanced tools for interviewing these victims and witnesses, a viable criminal case
can be built. As previously noted, the American Disabilities Act requires that
victims and witnesses with I/DD or mental illness are entitled to equal access to
justice, the same access as those without disabilities.
e misconceptions and discomfort can be addressed by prosecutors in a variety
of ways:
• Acknowledge the misconceptions, bias, and discomfort
• Learn more about I/DD or mental illness, including outreach to
these communities
• Practice empathy, e.g., how would you like to be treated?
• Obtain advice from friends, colleagues, and advocates who have
experience working with people with I/DD or mental illness
• If unsure of what to do or what language to use, ask the person or
the I/DD or mental illness community for guidance
Interviewing Victims and Witnesses with I/DD or Mental Ill-
ness and Trial Considerations
e general rule for speaking with victims or witnesses with I/DD or mental ill-
ness is to approach the case like any other. In other words:
17
• Assess credibility
• Evaluate the evidence
• Look for corroboration.
However, some additional preparation may be needed in order to maximize the
communication and understanding between the victim or witness and the prose-
cutor.
Preparing for the Interview
Where possible in advance of the interview, the prosecutor should determine the
nature of the disability and potential accommodations. e prosecutor can learn
more about the victim or witness from the victim or witness themselves, family
members, service providers, police, or others. Questions to ask may include:
• What supports may be helpful to the victim or witness during the
rst interview?
• Does the disability or mental health symptoms interfere with the
ability to perceive, communicate or recall events?
• If yes, what supports could be provided to assist the victim or wit-
ness with these functions?
• What is the best way to communicate with the victim or witness?
• Are any reasonable accommodations needed?
• Would the victim or witness like to have a support person present?
• What would make the person most comfortable?
• What is the victim or witness’ relationship to the other people in-
volved in the case?
• How can the interview be made less frightening or confusing?
• Does the victim or witness need services? If so, can the services be
provided by the prosecutor’s oce or community-based providers?
Medical and Psychiatric Records
In some instances, it may be necessary to obtain the victim or witness’s medical,
psychiatric, or other types of service records.
An example of when the records will be needed is when the person may have
been symptomatic at the time of the incident, for example, if there is a concern
18
that the victim or witness was experiencing delusions or hallucinations at the
time of the crime. ese factors should not preclude the prosecutor from moving
forward, but it may be important to know if, and to what extent, those symptoms
aected the witness’s ability to perceive, recall, and communicate.
Consider the sensitivity around medical, psychiatric, or other types of service
records and what the larger impact might be for the victim or witness. Exposing
this personal information could be a deterrent for a victim or witness to partici-
pate in the court process or report future victimization. Prosecutors should start
by considering what information they need and whether there is a way to nar-
row the scope of requested records. Next, prosecutors should inform the victim
or witness that they may need to obtain these records, address any questions or
concerns, and seek the individual’s permission to retrieve them. roughout the
process, it is important to:
• Explain to the impacted individual what information is needed and
why;
• Discuss under what circumstances the defense or other court per-
sonnel would gain access to the individual’s information; and
• Ask the person directly to consent to sharing that information.
Records may have to be
obtained, even if the victim
or witness does not consent.
Records can be obtained by
serving a subpoena on the
service provider or seeking
a waiver of HIPAA from the
victim or witness. HIPAA is
the Health Insurance Porta-
bility and Accountability Act
of 1996 and is legislation that
provides data privacy and
security provisions for safeguarding medical information. A subpoena in con-
nection with a criminal investigation should override HIPAA constraints. How-
ever, understandably, service providers are extremely protective of these types of
records. As a result, they may ignore a subpoena unless it has been ordered by a
19
court. Even then, some providers may refuse to honor subpoenas, inaccurately
believing that HIPAA rules prevent the disclosure. In such cases, contacting the
provider’s Risk Management Oce can resolve the issue. Finally, if the provider
continues to refuse to provide the information, the prosecutor can consider ling
a motion to compel the production of the records or seek contempt proceedings.
Once records are obtained, they may be discoverable as Brady/Giglio material.
Given the sensitive nature of the records, the prosecutor should seek an in cam-
era ruling from the judge on whether the documents have to be disclosed, and if
so, to what extent and how.
Another approach is to seek a HIPAA waiver from the victim or witness to ob-
tain the records. If so, the best course of action is for the prosecutor to explain
to the victim or witness why the records are needed and to advise the person
about if, when and how the records may be disclosed to the defendant. Some
victims or witnesses may be quite willing to waive, while others may be less so. It
is important that the victims or witnesses understand that they have the option
to waive or not waive and that the investigation will proceed regardless of their
decision.
Conducting the Interview
As with any other victim or witness, the prosecutor should start by listening
and being objective; the prosecutor should not assume the person is incapable
of being a witness simply because of a disability. ere is oen a misperception
that individuals with disabilities are not credible; and unfortunately, this may
lead to under-prosecution in cases involving someone from these communi-
ties. As in all cases, the victim or
witness’s testimony will have to
be assessed in light of the other
facts and circumstances of the
case to determine if the person is
ultimately worthy of belief. It is
always important to listen to the
victim or witness’s experiences
and demonstrate respect.
ere are some helpful strategies
for speaking with a victim or
20
witness with I/DD or mental illness. Be exible in determining which approaches
are needed and which ones are not. ese strategies include:
• Introduce yourself clearly, explain the role of the prosecutor, and
outline the process of a criminal case.
• Speak slowly and clearly.
• Use layperson’s language and not technical legal terms or jargon.
• Be prepared to repeat yourself.
• Ask the victim or witness to introduce themselves and share why
they have come to the proscutor’s oce.
• Allow the victim or witness to share their story or experience in
their own way. It is possible that the victim or witness may not recall
events in a logical or chronological fashion. Strategic questions may
be needed to get a sense of the whole story and obtain crucial de-
tails.
• Accommodate the victim or witness’s needs. ese accommodations
could include:
• Taking extra breaks
• Explaining things more than once
• Providing written instructions
• Using visual or other forms of communication aids
• Adjusting the physical space
• Being mindful of the impact of trauma
• Be respectful, but set boundaries regarding personal space, time,
issues outside of the court case.
• Build a rapport with the victim or witness.
• Consider allowing others to sit with the victim or witness during the
interview, if requested by the person. However, be aware of the per-
son’s right to condentiality and the possible tainting of evidence.
• Look for areas where the victim or witness’s statements can be cor-
roborated by other evidence.
• In addition to asking the victim or witness what happened at the
time of the incident, also ask what happened before and aer the
incident.
21
Preparing the Victim or Witness for Trial
If the case goes to trial, a victim or witness with I/DD or mental illness, like any
other witness, will have to be prepared for that process. is preparation can
include:
• Explain what a trial is and how the person will participate in that
trial.
• Describe the dierent people and their roles in the courtroom: the
judge, defense attorney, court ocers, spectators. If the prosecu-
tor will be asking the victim or witness to identify the defendant in
court, the witness should not be told where the defendant will be
sitting.
• Visit the courtroom with the victim or witness and have them sit on
the witness stand.
• Make sure that the courtroom has the necessary accommodations
for the victim or witness. Work with the Court’s Americans with
Disabilities Act Coordinator to help ensure the appropriate supports
are provided and understood by all parties. As noted above, the
Americans with Disabilities Act requires any public entity with 50
or more employees to have a designated ADA Coordinator.
• Let the judge and defense counsel know if you are requesting rea-
sonable accommodations.
• Ask the victim or witness if they would like an advocate or support
animal to accompany them to and from the courtroom or stay in
the courtroom during the testimony.
Disability Rights and Resources: Be aware of disability rights and resources
throughout the process. As described above, a victim or witness with I/DD or
mental illness has legal rights to eective communication and access. If an ADA
Coordinator is not available, state or local disability groups and advocates may be
able to assist with determining the appropriate accommodations and nding the
right tools and services to support the victim or witness.
Special Considerations for Defendants with I/DD or Mental
Illness
For defendants with I/DD or mental illness, the prosecutor’s role is to evaluate
22
the evidence, charge the defendant where appropriate, assess the defendant’s
competence, prove the case, and determine an appropriate disposition, with an
overall goal of preserving public safety. Prosecutors rarely speak with defendants
in a criminal matter, unless it is to evaluate the defendant’s eligibility for Mental
Health Court or other diversion program. However, prosecutors can help ensure
that defendants with disabilities receive the necessary accommodations during
the process, for example, by sharing contact information for the ADA Coordina-
tor or other potential resources with defense counsel.
Competency
In some instances, the defendant’s I/DD or mental illness renders the defendant
unt to participate in the criminal proceedings. e defendant has a consti-
tutional right to assist in his own defense and to understand the nature of the
charges against him. If the defendant is incompetent to participate in this way,
the case cannot proceed against him.
18
is paper does not provide a detailed
discussion of the issues involved in defendant competency; however, some stan-
dard questions to determine competency include:
• Is the defendant oriented as to time and place?
• Is the defendant able to perceive, recall, and relate?
• Does the defendant understand the process of the trial and the roles
of judge, jury, prosecutor, and defense attorney?
• Can the defendant establish a working relationship with the defen-
dant’s attorney?
• Does the defendant have the ability to listen to the advice of counsel
and, based on that advice, appreciate (without necessarily adopting)
the fact that one course of conduct may be more benecial than
another?
• Can the defendant withstand the trauma and stresses of the trial
without lasting eects?
19
18 Pate v. Robinson, 383 U.S. 375, 378 (1966); Medina v. California, 112 S.Ct. 2572 (1992).
19 People v. Picozzi, 106 A.D.2d 413 (1984).
23
ough the specics of determining whether a defendant is competent varies
from state to state, a few factors are worth noting:
• A defendant can have I/DD or mental illness and still be competent
to participate in the criminal proceedings.
• A defendant may be feigning I/DD or mental illness to avoid re-
sponsibility for a criminal act. is is commonly referred to as ma-
lingering.
• A defendant may come in and out of competence.
• e defendant must be competent at each stage of the criminal pro-
ceedings from the time of initial charging through sentencing.
• Even if a defendant is found competent to stand trial, lack of compe-
tence can be used as a defense to a crime.
• e defendant can be held in custody, even if the defendant is found
incompetent.
Customized Dispositions
Assuming the defendant is deemed competent to participate in the proceedings,
the prosecutor will be involved in determining the proper outcome for a defen-
dant with I/DD or mental illness. An appropriate disposition can be craed for
the defendant at various stages of the case ranging at any time from before a case
is charged through a verdict at trial. If the disposition does not involve incarcer-
ation, but instead a diversionary program, the disposition is likely to require a
customized plan that is tailored to the defendant’s specic needs. To recommend
an appropriate disposition, the prosecutor should consider the following factors:
• What are the public safety implications of a diversionary disposi-
tion?
• What are the defendant’s needs?
24
• Does the defendant have access to appropriate disability or men-
tal health services? What barriers may prevent the defendant from
accessing services?
• What will keep the defendant from engaging in criminal behavior in
the future? Has a risk assessment been conducted?
• Would education be appropriate, such as education on healthy rela-
tionships and sexuality?
• What are the available resources for alternative dispositions to in-
carceration?
• Is the defendant eligible for diversionary programs? If not, should
and can creative alternatives be craed? If yes, what modications
may be needed to better ensure the defendant’s access to the pro-
gram?
• How should compliance with a diversionary program be monitored?
• How can the defense attorney assist with developing an appropriate
disposition?
• How can state and local disability advocacy organizations and/or
service providers assist with developing an appropriate disposition?
Diversion to Mental Health Court
Among the various options for craing an appropriate disposition for a person
with mental illness is referral to a Mental Health Court. ough developing and
running a Mental Health Court is not the focus of this paper, the following are
some considerations to assist a prosecutor to decide whether a defendant is eligi-
ble for Mental Health Court:
• Does the Mental Health Court provide the services needed for the
defendant? For example, Mental Health Courts are unlikely to be
appropriate for those with I/DD or those with both I/DD and a
mental health condition. is is because a Mental Health Court
does not have the services typically provided for someone with I/
DD. As discussed below, the Rockland County District Attorney
Oce’s Intellectual and Developmental Disabilities Alternative to
Incarceration (IDDATI) Program was developed to provide an alter-
native to a Mental Health Court tailoring available services tailored
for the needs of defendants with I/DD.
25
• What is the defendant’s criminal history, and does the defendant
pose a risk to public safety? It is important to note that mental ill-
ness alone is not a predictor of future violence.
20
• What are the facts of the current case and prior cases? Has the
defendant exhibited violent behavior, and if so, to what degree and
under what circumstances?
• Is the defendant competent to proceed in the case?
• What is the defendant’s medical and psychiatric history? Has the
defendant been compliant with medication and therapy in the past?
• What is the defendant’s daily routine, for example, where and with
whom does the defendant live, what are the living conditions, is the
defendant employed, is the defendant connected with services?
• What information can be obtained about the defendant from the
defendant, family members, or others?
• Does the defendant have any substance use history and, if so, has
the defendant received any services?
• What are the expectations of the defendant and the defense attor-
ney regarding participation in the Mental Health Court program?
• What advice or services can state and local disability advocacy or-
ganizations and service providers oer?
If a defendant agrees to participate in a Mental Health Court, the terms of the
participation and any plea agreement should be in writing, clarifying expecta-
tions regarding the service plan, the terms of the plea, and the various outcomes
of the case, depending on whether the defendant succeeds or fails the program.
Any Mental Health Court should continually assess the barriers and challenges a
defendant may experience in accessing services and successfully completing the
program’s requirements.
Resource materials for developing and running a Mental Health Court can be
found in the Resources section of this paper.
20 See, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686644/ (last viewed 8/16/19)
26
PART 3 – PROSECUTOR-INVOLVED INITIATIVES
27
Intellectual and Developmental Disabilities Alternative to
Incarceration Program - Rockland County District Attorney’s
Oce, New York
e Intellectual and Developmental Disabilities Alternative to Incarceration
(IDDATI) Program is a new problem-solving program developed and led by the
Rockland County District Attorney’s Oce (RCDAO). e need for an alterna-
tive to incarceration program for defendants with an intellectual or developmen-
tal disability was identied in 2015, following the completion of a county-wide
assessment on behavioral health. In addition, there were participants in the
Mental Health Alternative to Incarceration (MHATI) program who were unsuc-
cessful as they were later identied as having an I/DD.
Unlike Drug Courts, Mental Health Courts, and Veterans Courts, IDDATI is
not a treatment court. Since a person with I/DD or signicant brain injury (TBI)
cannot ‘recover’, the format of this court program is dierent from traditional
treatment courts in that its focus is on helping people with I/DD or TBI to reach
their potential rather providing treatment. e strength of the IDDATI para-
digm is that it includes stakeholder collaboration, individualized programing,
exibility, and family involvement.
Program Stakeholders
Identifying the need for the IDDATI program, the RCDAO reached out to local
service providers, behavioral health organizations, educational support agen-
cies, governmental agencies, and policy makers to seek their support. Given the
overwhelming support for the concept, the RCDAO convened an executive-level
stakeholder group to develop and run the program. e stakeholders include:
• Rockland County Department of Mental Health (RCDMH). RCDMH
also oversees the Behavioral Health Unit of the local jail.
• New York State Oce for People with Developmental Disabilities (OP-
WDD). ey are a direct service provider.
• Rockland Board of Cooperative Education Services (BOCES), funded
through the State Department of Education. ey provide support-
ive educational services for youth with I/DD within local schools and
within their own school settings. BOCES also has adult literacy and
vocational training programs. e BOCES representative provides the
28
educational/vocational perspective that is an integral piece of the ID-
DATI program.
• Local disability rights advocates
• A local victim advocacy rights group
• e Arc of the United States’ National Center on Criminal Justice and
Disability
• Local service providers.
e monthly Stakeholders Meeting are chaired by the District Attorney’s Oce
with assistance from the IDDATI Case Manager. rough the stakeholder meet-
ings, a policy and procedure manual was developed and updates on the IDDATI
participants are given. e stakeholders provide recommendations, guidance,
and assistance with issues raised. Between meetings, the IDDATI Case Manager
reaches out to stakeholders when necessary for assistance, referral to services, or
to problem-solve systemic issues when they arise.
Case Management
e RCDAO contracted with BRiDGES, a community-based organization that
“helps people with disabilities to self-determine their own lives and works to
overcome barriers, stigma, indierence, and the quiet prejudice of low expec-
tations.”
21
A BRiDGES caseworker refers participants to the services identied
during the intake and throughout the IDDATI program. Case management ses-
sions are held weekly in the beginning of the program and can be reduced on an
individualized basis. e Case Manager provides support and coordinates the
services with which the participant is involved. ese can include skills develop-
ment, mental health or substance use treatment, housing, educational or voca-
tional programs, social services, etc. If there is a need for an intervention with the
participant, the Case Manager coordinates the attendees and location. e Case
Manager also works with the Program Director from the RCDAO when partici-
pants make requests for travel. e Case Manager is supervised by a clinician at
BRiDGES as well as the Program Director.
21 See, Bridges website: https://www.bridgesrc.org/ (last viewed July 5, 2019)
29
Qualifying for the Program
A defendant may be referred by a prosecutor, defense counsel, behavioral health
unit of the jail, service providers, or others. All participants must be Rockland
County residents. Once a referral is received, the defendant is vetted for issues in
their criminal history or current legal involvement to determine if the defendant
qualies for the program. e defendant’s admission into the program is ap-
proved by an RCDAO Assistant District Attorney, who balances the needs of the
defendant against public safety concerns. If the defendant poses a risk to public
safety, that will be a disqualier.
If accepted into the program, the defendant is evaluated for clinical eligibility by
the RCDAO’s contract psychologist and/or the IDDATI Case Manager. If there is
no available documentation to identify I/DD, the psychologist completes various
standard tests to determine approximate IQ and to identify adaptive behavior
challenges. If the defendant is found to be appropriate for the program by the psy-
chologist, the defendant and defense counsel will consider the merits of joining
the program. If found eligible, and the defendant is willing to join the program,
the defendant will plead guilty to the criminal charges. e date of the guilty plea
is considered the entry date for the IDDATI program. If the defendant successful-
ly completes the program, the charges will either be dismissed or reduced.
Following the plea, the defendant and Case Manager complete the intake, which
gathers information about the defendant’s medical issues, substance use, mental
health, family, education, employment, and convictions. Behaviors associated
with the participant’s arrest are also reviewed to identify services that may help
address these problem behaviors. Using both the information collected and the
interests of the participant, a service plan is developed. e service plan identies
goals that the Case Manager and participant have developed collaboratively. e
plan may be modied at any time by either the Case Manager or the participant
and agreed upon by both. e Case Manager then makes referrals to the appro-
priate service providers, which may include employment referrals, mental health
and/or substance use services as needed. e level of engagement is assessed by
the Case Manager through regular contact with the service providers and case
management meetings with the participant, sometimes including family members
or signicant others.
30
Length of Program
e IDDATI program is a minimum of 12 months for those charged with a mis-
demeanor and 18 months for those charged with a felony. ese timeframes are
similar to the timeframes for the Drug Courts and other alternative to incarcer-
ation programs. ere is no maximum length for the program, but most partic-
ipants are able to complete the program within the minimum timeframe. For
those who need more time, there is no limit on the time given to participants to
be successful.
Individualized Service Plans
Each participant is provided an individualized Service Plan developed collabo-
ratively with the IDDATI Case Manager. is Service Plan incorporates both the
needs and interests of the participant and is always open to revision. A revision
can result from the attainment of a goal, request by the participant, recommenda-
tion of the Case Manager, or through an intervention.
Individualization within the IDDATI program is best exemplied by the process
of incentives and sanctions, which are customized for each participant. In tradi-
tional problem-solving court programs, standard non-customizable forms of in-
centives and sanctions are commonplace. In contrast, the incentives and sanctions
of the IDDATI model are based upon the individual participant. Foremost is a
consideration of the internal motivators for each participant and what is person-
ally important to this individual. For example, one participant enjoyed riding the
bus. As an incentive, the participant was allowed to ride the bus more frequently.
Sanctioning of IDDATI participants is considered a last resort. Problematic be-
havior exhibited by an IDDATI participant is addressed by the Case Manager in
collaboration with service providers. e use of interventions, such as bringing
together the service providers and signicant others with the Case Manager, is the
process used for ‘non-compliant’ behavior. Multiple interventions may take place
before a collaborative decision to sanction a participant is made. If this decision is
made, the sanction is specic to the individual participant. ere are no standard-
ized sanctions in the IDDTI program. Jail sanctions are rarely used and only as a
last resort.
An example of IDDATI’s exible model is the approach to participants who use
31
marijuana. In Drug Court, the participant would be given four weeks to provide
a negative urine test result to demonstrate that marijuana is no longer being used.
In IDDATI, the participant is given a longer timeframe with additional supports
to help stop the marijuana use.
Completion of the IDDATI program is also an individualized process. e objec-
tive of engagement in the program is applied to each participant dierently, de-
pending upon the individual’s set of skills and abilities and the eort displayed by
the participant to meet their agreed upon goals. Aside from the minimum time
required and meeting the agreed upon goals, there are no specic standards for
successfully completing the program.
Family Involvement
e IDDATI program frequently incorporates family members or signicant
others, if available and willing. Many of the participants live with others who have
an active role in their life, some who have guardianship. It is essential to involve
those close to the participant in the IDDATI program as early as possible and
maintain routine communication throughout the program. Family members can
be very helpful with the intake process, particularly since they may have addition-
al information. Also, family members and signicant others are appreciative of
the added support.
roughout the IDDATI process, the Case Manager maintains contact with the
family member or signicant other. is collaboration provides better support
for the participant, informs the Case Manager about issues that may otherwise go
unrecognized, and helps the participant become more successful. Family involve-
ment is varied and ranges from providing transportation to working with the
participant on independent living skills.
ough family members or signicant others are important to the process, the
program is mindful that separate time with the participant is needed to ensure
privacy for issues that the participant may not want to share with others.
Number of People in the Program
e number of participants usually ranges from 10–12 at any given time. With a
full-time Case Manager, the program could expand to 15–20 participants.
32
New York State Attorney General’s Oce Training on I/DD,
Mental Illness and Police Mental Health Collaborations
On July 8, 2015, New York Governor Andrew Cuomo signed Executive Order
No. 147 (the “Executive Order”), appointing the Attorney General as special pros-
ecutor “to investigate, and if warranted, prosecute certain matters involving the
death of an unarmed civilian . . . caused by a law enforcement ocer.” e Execu-
tive Order also authorized the Attorney General to “investigate and prosecute in
such cases where, in his opinion, there is a signicant question as to whether the
civilian was armed and dangerous at the time of his or her death.” e Executive
Order includes the requirement that, where a matter is not presented to a grand
jury, or where no indictment is voted, the Attorney General provide the Governor
with a report explaining the conclusions in the case and “any recommendations
for systemic reform arising from the investigation.”
22
Nationwide, mental illness or I/DD has been acknowledged as a contributing
factor in some ocer-involved fatalities. us, the Attorney General requested a
training program that could provide an overview of issues relating to mental ill-
ness and I/DD and information about police mental health collaborations, includ-
ing specialized training for police on how best to respond to persons with mental
illness or I/DD, commonly referred to as Crisis Intervention Training (CIT).
e Serving Safely initiative—funded by the Bureau of Justice Assistance and
spearheaded by the Vera Institute of Justice in partnership with a consortium of
other organizations—developed a training program for the Attorney General’s
Oce that can be replicated by other prosecutors. e training agenda included
the following components:
Mental Health and Intellectual and Developmental Disabilities (Present-
ed by NAMI New York and The Arc of the United States)
• Mental health basics
• I/DD basics
• Overrepresentation as victims, suspects and defendants in the crimi-
nal justice system
22 New York State Executive Order 147, July 8, 2015
33
• Common myths and stereotypes
• Overview of relevant disability rights laws
Police Mental Health Collaborations – Best Practices
• Dierent models of police mental health collaborations (e.g., CIT,
co-responder teams), importance of the models, outcomes, and how
they are tailored to local considerations. (Presented by Vera)
• New York Police Department CIT training details (Presented by the
NYPD Assistant Chief in charge of CIT training)
• Behavioral health and best practices in collaborating with police and
treating justice-involved people with mental illness and I/DD (Pre-
sented by a representative from the New York City Department of
Health and Mental Hygiene)
• e Arc of the United States’ national training program focused on I/
DD, called Pathways to Justice®, was also briey discussed.
Prosecutor’s Perspective (Presented by prosecutors)
• Victims and Witnesses: How prosecutors can interview victims and
witnesses with mental illness or I/DD.
• Defendants: Eligibility for Mental Health Court; Issues of compe-
tence.
is training can be useful to prosecutors in oces of all sizes. Prosecutors have
to assess cases where victims, witnesses, and defendants have mental illness or
I/DD, and they have to evaluate the actions of police ocers who have contact
with this population. More cross training in model responses and approaches
are needed between prosecutors and law enforcement to understand the unique
needs and challenges of people with mental illness and I/DD. Local chapters of
NAMI and e Arc, as well as CIT trained police ocers, can be called upon to
provide important training for prosecutors.
34
CONCLUSION
ere is a growing understanding within the criminal justice system of the issues
raised by law enforcement interactions with victims, witness, suspects, and defen-
dants with I/DD, mental illness, or both. Many police departments are embracing
trainings and new initiatives informed by a deeper understanding of I/DD and
mental illness. Prosecutors must do the same. Enhanced knowledge and im-
proved processes within the prosecution sphere that take I/DD and mental illness
into account will benet both individuals with I/DD or mental illness and the
community at large.
35
RESOURCES
I/DD and Disability Resources:
State and Local Chapters of e Arc
e Arc has over 600 state and local chapters that may be able to assist on mat-
ters involving a person with I/DD. Chapters do not provide the same services, so
contact your local chapter to nd out if they may be able to assist in your unique
situation.
e Arc of the United States’ National Center on Criminal Justice & Disability®
(NCCJD®)
NCCJD serves as a bridge between the criminal justice and disability commu-
nities and pursues and promotes safety, fairness, and justice for people with I/
DD, especially those with marginalized identities, as victims, witnesses, suspects,
defendants, and incarcerated persons. NCCJD also provides training and tech-
nical assistance to criminal justice professionals. Email nccjdinfo@thearc.org or
complete a Request for Assistance.
Protection and Advocacy Agencies
For legal or technical assistance on disability-related issues, you can seek assis-
tance from your local Protection and Advocacy (P&A) agencies, federally-funded
organizations available in all states and U.S. territories.
Mental Health Court Resources
Some prosecutors around the country have embraced Mental Health Courts,
when resources are available. As described above in the summary on the Rock-
land County District Attorney’s IDDATI program, Mental Health Courts are of-
ten not appropriate for those with I/DD. ough this paper does not cover how to
develop and run a Mental Health Court, many excellent resources exist to guide
prosecutors who are either participating in a Mental Health Court or would like
36
to investigate the possibility of starting one. ese resources include:
• Publications on Mental Health Court, e Justice Center - Coun-
cil for State Governments, https://csgjusticecenter.org/publica-
tions-on-mental-health-courts/
• Mental Health Courts - Resource
Guide, National Center for State Courts,
https://www.ncsc.org/Topics/Alternative-Dockets/Problem-Solv-
ing-Courts/Mental-Health-Courts/Resource-Guide.aspx
• Mental Health Courts: A Guide to Research-Informed Pol-
icy and Practice, MacArthur Foundation and e Jus-
tice Center of the Council of State Governments (2009),
https://www.bja.gov/Publications/CSG_MHC_Research.pdf
• Practice Pro le – Adult Mental Health Courts, Crime S olutions.gov,
https://www.crimesolutions.gov/PracticeDetails.aspx?ID=34
• Developing a Mental Health Court: An Interdis-
ciplinary Curriculum, BJA and e Justice Cen-
ter of the Council of State Governments. (2015),
https://www.courtinnovation.org/sites/default/les/media/docu-
ment/2018/Developing%20a%20Mental%20Health%20Court_Hand-
book%20for%20Curriculum%20Facilitators.pdf
Resource on Competency
• Treatment Advocacy Center: Competency Restoration versus Psy-
chiatric Treatment, https://www.treatmentadvocacycenter.org/
xing-the-system/features-and-news/4126-the-distinction-be-
tween-competency-restoration-and-psychiatric-treatment
