The Colorado Department of Human Services (CDHS) has long been committed to jail-based competence restoration programming. In recent years, the nation experienced a dramatic increase in orders for competence restoration and a shortage of inpatient psychiatric hospital beds, and states began looking for alternative solutions. CDHS’s Office of Civil and Forensic Mental Health (OCFMH) and Forensic Services Division researched established programs and best practices to create a treatment environment within jails suitable for providing psychiatric services to meet the necessary level of care.
Competence restoration: Among individuals facing criminal charges deemed incompetent to stand trial, competence restoration is the treatment of the underlying mental health condition and instruction in the concepts and procedures of the trial process.
Restoring Individuals Safely and Effectively (RISE) opened in 2013 in the Arapahoe County Detention Center as a collaboration among CDHS, the Arapahoe County Sheriff’s Office, and Wellpath Recovery Solutions. Since then, jail-based restoration in Colorado has evolved across program locations and sizes, all steered by the fluid nature of the demand for these services. A second RISE program was established at the Boulder County Jail in 2019. Two years later, CDHS partnered with the Denver Sheriff Department and the Denver Health and Hospital Authority to open the Denver Restoration and Treatment Unit (DRTU), a multiple-bed unit maintained separately from Denver County Jail’s main housing.
Services
Male clients who are court ordered to CDHS inpatient custody to receive an initial evaluation of competence to stand trial or inpatient restoration treatment are eligible for the programs. RISE admits individuals statewide, and DRTU admits individuals from Denver County. To determine program admissions, state-employed clinicians assess treatment needs, including history with restoration treatment, medication, diagnoses, medical needs, and ability to engage in the program.
Ongoing assessment is part of a recovery-oriented and trauma-informed approach to whole-person intensive treatment that focuses on mental health, overall well-being, and competence restoration and education. Specific treatment for competence restoration is based on Colorado statute and a required educational manual. Clinical treatment groups, however, vary based on program participant needs and staff expertise. Examples of their focuses include cognitive behavior therapy, dialectical behavior therapy, coping skills, social skills, anger management, cognitive remediation, and substance use treatment.
Staffing
Individualized treatment requires trained staff who creatively meet a variety of needs and mental health presentations. Programs are staffed with multidisciplinary team members, including psychiatric providers and psychologists, as well as a combination of social workers, reentry specialists/case managers, recreation or activity specialists, administrative support, and sheriff deputy staffing.
The RISE program also employs peer support professionals, who provide participants with the insight of someone who has traveled a similar path, can relate in a more personal way, and can offer connections to communities and support. This relationship cultivates a sense of being understood and supported, positively influencing engagement and ongoing care and stability.
Significant statutory changes in Colorado have required flexible program responses. For example, while previous participants were typically discharged from these programs once the individuals were considered restored to competence, statute changes and other program expansions now generate a significant number of people transitioning into the community to continue their treatment. As such, program staff now focus heavily on connecting individuals to the support services they may need in preparation for possible release. This includes close collaboration with courts and community partners to support community treatment needs, housing, and transportation.
Outcomes
Since the inception of jail-based restoration programming in Colorado, more than 2,000 individuals court-ordered to custody and care for competence evaluation and restoration have been served. The average duration of treatment typically ranges from 98 to 116 days, with most individuals discharged after being found restored to competence. These programs allow Coloradans to access competence restoration and mental health services more quickly, resulting in less backlog in the court systems and less prolonged treatment and court processes for those the programs serve.
Moreover, in response to an increase in individuals being deemed eligible by the court to receive treatment in the community and a less restrictive environment, CDHS offers outpatient restoration treatment through contracted community providers and partnerships with community mental health centers. Securing longer-term housing options has become a high priority as it is a primary need for this population and a contributing factor to health and well-being.
The success of Colorado’s jail-based restoration programming is attributed to evidence-based and scientifically supported services tailored to meet individual needs and delivered by strong multidisciplinary treatment teams. No less critical, strong partnerships with sheriff’s departments include cross-partnership policy alignment supporting the treatment program and persons within it. Clear policies help alleviate implementation and operational challenges, addressing who can admit to a program, what items they may have access to, how treatment milieus are managed, how mental health and medical emergencies are navigated, and what is required in treatment.
“We are passionate about providing high-quality care to individuals with mental health needs, some of whom happen to be involved in the criminal justice system,” comments Ashley Gunterman, PsyD, deputy director of the OCFMH Forensic Services Division. “DRTU and RISE allow us to facilitate access to immediate care—assessment, psychiatric and medical consultation, group and individual programming—during competence restoration and to long-term care upon departure from the criminal justice system.
For more information about Denver’s jail-based restoration programming, visit CDHS’s Forensic Services page or contact Ashley Gunterman at Ashley.gunterman@state.co.us.