Indiana officials say the state's push to ensure criminal defendants are competent before trial has reached a breaking point, and it leaves little room for other patients who need psychiatric care.
That determination happens through a competency evaluation — a court-ordered assessment of whether a defendant can understand the charges against them and assist in their own defense.
It's that finding of incompetence that triggers a restoration order in the first place.
State officials are calling it a crisis as the demand for competency restoration has grown rapidly. According to the Indiana Family and Social Services Administration, referrals for competency restoration increased by 477% between 2013 and 2025. By the end of 2025, more than 709 people were under competency restoration orders, and state officials projected that number would surpass 800 in 2026.
Sarah Sailors, who oversees FSSA’s Division of Mental Health and Addiction within Indiana, told a council of executive, legislative, and judicial branch members that so many beds in Indiana's psychiatric hospitals are occupied by criminal defendants ordered into competency restoration that there's little room left for other patients.
"There will be no treatment available for people who have serious mental illness, who are dangerous to our communities,” said FSSA’s general counsel Jordan Stover, who joined Sailors at the April meeting of the Justice Reinvestment Advisory Council.
Those would include people who could be under a civil commitment, or forced by the courts to undergo treatment if judges find they are mentally ill and dangerous or gravely disabled.
State officials said about 70% of patients currently in Indiana's state psychiatric hospitals are patients in the criminal justice system, known as forensic patients, while 30% are civil commitments. New admissions are even more heavily weighted toward forensic patients: 86% are competency restoration or other forensic admissions, compared with 13% civil commitments, officials said. Officials warned that if current trends continue, the state hospital system could eventually serve almost exclusively forensic patients.
FSSA did not respond to WFYI's follow-up questions about the current hospital wait times, bed capacity and the agency's plans to address the growing demand. The agency also did not respond to similar questions about wait times and bed capacity for WFYI's April 2025 investigation into the competency system.
Indiana Supreme Court Justice Christopher Goff, who chairs the state’s Justice Reinvestment Advisory Council, said other systems are stretched thin, too.
"You're always operating in scarcity," Goff said, describing shortages that stretch from county jails to community mental health services and state psychiatric hospitals.
Judge Amy Jones, who presides over the Marion County Superior Court's Mental Health Alternative Problem Solving Courts, said the vast majority of people referred for competency evaluations are charged with misdemeanors or low-level felonies, such as Level 6.
Jones said those cases often take so long to move through competency restoration that, by the time defendants return to court, they have already spent nearly as much time in custody as they could have received if convicted.
For level 6 felonies, the maximum could be over two years. Most plead guilty in exchange for time served and are released.
Because misdemeanor and Level 6 felony cases make up most competency restoration referrals, Jones said defendants accused of more serious crimes are often forced to wait for a hospital bed.
"The people that have the greatest public interest in pursuing charges for public safety purposes, they're having to wait for their turn because the system is clogged up with people who, more than likely, because they aren't stable, are going to just come right out," Jones said. "This is the revolving door.”
Since 2024, state lawmakers have passed legislation aimed at speeding up the competency process, but officials say reforms haven’t kept up with demand.
House Bill 1238, which passed in 2024, made several significant changes to the competency process — including requiring only one competency evaluation for a low-level felony charge instead of two and allowing Advanced Practice Registered Nurses with a certification in psychiatric nursing and physician assistants specializing in psychiatry and mental health to perform the evaluations.
The bill also allowed courts to dismiss certain criminal cases without prejudice when a defendant has been diagnosed with dementia, Alzheimer’s disease, or a traumatic brain injury, and the diagnoses substantially impact the person's ability to understand the case and how to assist in their defense. The courts confirmed no one is tracking how often that happens.
But even with those changes, a statewide competency workgroup, made up of Jones and three circuit court judges, concluded additional reforms are needed. In the inaugural Behavioral Health Committee Report that came out in April of 2026, the competency work group recommended several changes to make the process more efficient and divert people to other resources.
Those include restricting which cases are referred for competency, creating a directory of available competency evaluators, and organizing and collecting more data about what programs are currently in place and what changes are happening over time.
Brittany Kelly, the state court behavioral health administrator in the Office of Judicial Administration at the Indiana Supreme Court, has been leading the state’s push to track data around how competency is handled throughout the state.
While there are options for how to make the competency system better, Kelly said it’s going to take everyone at the table.
“The momentum is strong,” Kelly said. “We have a lot of interest from across all three branches of government and lots of different stakeholders that are invested in finding solutions.”
Farrah Anderson is WFYI's investigative health reporter. You can follow her on X at @farrahsoa or by email at fanderson@wfyi.org
