Competence Corner: New Mexico and North Carolina’s Work to Improve Competence Restoration and Diversion

Developing a Strategic Action Plan

At the Policy Academy, the New Mexico state team developed a strategic action plan to reform the state’s approach to handling CST cases. The plan prioritizes improving access to behavioral health services and integrating community-based treatments for individuals involved in the criminal justice system. Trauma-informed care and diversion strategies are key components, aiming to reduce reliance on incarceration while addressing systemic issues. The plan also addresses service access for Indigenous and rural communities. The state is looking to achieve multiple goals through evidence-based approaches and collaboration with interested parties. First, they aim to improve outcomes for people impacted by CST proceedings. Second, they intend to implement practices that will reduce the burden on the criminal justice and behavioral health systems that results from CST cases by diverting individuals to community services and out of the criminal justice system.

Technical Assistance to Build Capacity

To support the implementation of its initiatives, New Mexico engaged in targeted technical assistance (TA) facilitated by the GAINS Center. A pivotal aspect of this support was a site visit to Minnesota’s 4th District Court. Hosted by Judge Julia Dayton Klein, this visit provided four members of the New Mexico team with comprehensive insights into Minnesota’s CST case-flow process. The agenda included a detailed examination of felony and misdemeanor CST case management, relevant statutory language, and the specific roles of judicial officers in the process. The team also engaged with the local district attorney’s office and public defender’s office to understand the application of Rule 20 of the Minnesota Rules of Criminal Procedure, which governs competency proceedings in criminal court, as well as the roles of attorneys and the use of local civil commitment mechanisms. The visit to the 4^th District Court in Minnesota further highlighted strategies for recruiting and retaining forensic psychologists and competence evaluators, led by the Minnesota Psychological Services Division. Additionally, the team explored the use of forensic peer navigators and learned from the community behavioral health team, which included representatives from Behavioral Health Services, Hennepin County Social Work Division, and Minnesota NAMI, about available resources for individuals navigating CST proceedings under Rule 20. These comprehensive discussions and observations informed New Mexico’s development of cross-system collaboration strategies tailored to the state’s needs.

In the year following the Policy Academy, the GAINS Center provided follow-on TA to New Mexico, focusing on practical applications of the knowledge gained. This included a tailored training session for court staff and others involved in the Competency Diversion Pilot Project, which began operating in 2024 and is a cornerstone of New Mexico’s reform efforts. The training clarified distinctions between CST and capacity to consent to treatment, legal mechanisms within CST processes, and the self-determination rights of individuals considering voluntary diversion programs. Additional TA addressed statutory language, with GAINS Center staff offering feedback and recommendations to refine legal frameworks supporting diversion and CST-related initiatives. Finally, New Mexico received a report analyzing jail diversion programming within a pilot county participating in the Competency Diversion Pilot Project. This report evaluated local resources and existing programs and proposed an integrated jail diversion system to enhance community-based alternatives for eligible individuals.

The Scope of the Competency Diversion Pilot Project

The Competency Diversion Pilot Project in New Mexico became operational in June last year, with the first of four courts beginning to accept participants. This program focuses on diverting individuals with SMI or IDD who are charged with misdemeanors and likely to enter CST proceedings. The project emphasizes reducing the justice system’s reliance on incarceration by connecting eligible participants with community-based services through trauma-informed and system redesign approaches. Participants are assessed for eligibility through two pathways: pre-screening based on prior interactions with the justice system and a formal screening using the Brief Jail Mental Health Screen. Once enrolled, participants engage with forensic navigators and behavioral health providers, who facilitate a clinical bio-psycho-social assessment to identify treatment needs. The program is designed to last between 90 days and 6 months, with an emphasis on creating individualized support plans that prioritize housing, employment, and behavioral health care.

Forensic navigators play a critical role in the success of the Competency Diversion Pilot Project by serving as liaisons between participants and the behavioral health and justice systems. They assist participants in accessing essential services, including housing, mental health and substance use treatment, and community-based case management. Navigators also help participants navigate court requirements and maintain communication with service providers. Navigators establish a navigation plan in collaboration with each participant, reflecting their unique strengths and needs. They provide consistent follow-up to support participants’ continued engagement with their services. This work occurs primarily in the community, including at service agencies, behavioral health provider locations, and other accessible public spaces, to reduce barriers for participants. In cases where participants lose contact or face challenges maintaining engagement, forensic navigators make meaningful attempts to re-establish communication, such as contacting support persons or checking with local shelters. This proactive approach helps minimize disruptions to participants’ progress and ensures they remain connected to critical resources. While challenges remain in operationalizing the pilot across four planned courts, New Mexico is actively collecting data to evaluate outcomes and refine program design for expansion across the state.

North Carolina’s Advances in Competence Restoration and Diversion

From 2019 to 2024, North Carolina has been actively engaged in initiatives to improve CST restoration and diversion for individuals involved in the criminal justice system. The state’s participation in the CST Learning Collaborative and subsequent Policy Academy has led to significant advancements in community-based competence restoration and systemic reforms.

Early Efforts and Learning Collaborative (2019–2022)

North Carolina’s work with the GAINS Center began in 2019 when the state joined the CST Learning Collaborative. During the first year, the focus was on identifying steps to develop community-based competence restoration in a pilot community. The state also explored alternative models for forensic evaluations and organized workgroups to achieve these goals. Parties with key expertise—including the attorney general’s office, sheriff’s offices, judges, district attorneys, health service providers, and local NAMI representatives—were involved in drafting guidelines for referrals for restoration and compiling relevant statutes for legislative revisions.

Building on these efforts, the third year of North Carolina’s involvement in the CST Learning Collaborative (2021–2022) saw the state planning pilot restoration programs in both community and jail settings. Efforts were made to gain buy-in from local sheriffs, significantly expanding competence restoration services statewide via jails. A subcommittee on competence evaluation was created to make legislative recommendations. A 1-day TA event, facilitated by the GAINS Center, helped develop a template for judges on ordering appropriate restoration treatment services. This event included presentations from experts and breakout sessions to ensure comprehensive understanding and collaboration among state teams.

Policy Academy and Technical Assistance (2022–2024)

In 2022–2023, North Carolina launched its first jail-based competence restoration program in Mecklenburg County with plans to expand to two additional counties in January 2025. Community-based restoration centers in Mecklenburg, Wake, and Cumberland Counties began operating in the summer of 2023. Inspired by the model in Miami-Dade County, Florida, there was also strong interest in post-arrest, pre-plea diversion for misdemeanor charges, with plans to pilot this program in resource-limited areas like New Hanover County.

The state’s goals included expanding capacity restoration settings, improving local evaluation systems through a quality improvement initiative, and considering regional restoration centers. Planned TA sessions aimed to establish program evaluation, integrate data from various sources, and gain buy-in from interested parties for diversion programs. Legislative proposals focused on defining capacity restoration, addressing funding issues, and educating judges and court partners.

Ongoing Technical Assistance and Future Plans (2023–2024)

In 2023, North Carolina identified a need for Forensic Assertive Community Treatment (FACT) teams. After reviewing approaches from other states, the team requested consultations and held productive meetings with GAINS Center consultants to refine their plans. These efforts are part of the ongoing TA following the Policy Academy, aimed at enhancing the state’s competence restoration and diversion programs.

Additional investments in upstream diversion and deflection, as well as post-release care coordination, continue to be supported in several counties throughout the state. These were identified as having an impact on the competency evaluation and restoration system and include such programs as Law Enforcement Assisted Diversion and SMI priority reentry, which is a program designed to assist incarcerated individuals with SMI who are being released and transitioning back to the community. North Carolina Department of Health and Human Services has supported the hiring of Care Coordinators to assist individuals with accessing needed services, such as helping them apply and enroll in Medicaid prior to release. There is also funding to assist with transition supports (e.g., housing, co-pays).

Piloting Restoration Programs

North Carolina is piloting jail-based and community-based restoration programs in three counties. Mecklenburg County is furthest along, with the jail-based program NC-RISE (Restoring Individuals Safely and Effectively) celebrating its second anniversary in December 2024. Community Capacity Restoration (CCR) programs in Mecklenburg, Wake, and Cumberland counties have been operational for about a year and a half. NC-RISE, initially a 10-bed program, is expanding to 25 beds and will become a regional restoration program serving surrounding counties. The CCR program has seen a gradual increase in referrals but faces challenges with compliance, stable housing, and reliable transportation for participants. Despite these issues, both programs have successfully reduced the backlog of individuals found not competent to stand trial on the state hospital waiting list, expedited case processing, and decreased the number of people facing charges with serious mental illness held in detention.

Reflections and Advice

The effort to improve CST systems in the state has not been without challenges. With the support of the GAINS Center Learning Collaborative, North Carolina has continuously adapted its competence evaluations and restoration services. Tracy Ginn, currently the operations manager in the Justice System Innovations Section of the Division of Mental Health, and Dr. Robert Cochrane, statewide director of forensic services, have been instrumental in these efforts. Their advice to other states is to engage court systems and law enforcement partners early in the process to address concerns and gain support. Having champions within the courts and sheriffs’ offices has been crucial for the success of pilot programs. North Carolina continues to work towards statutory changes to support these initiatives.

Through comprehensive efforts and collaboration, North Carolina is paving the way for a more effective approach to competence restoration and diversion in the criminal justice system.