National attention has focused on criminal defendants who plead not guilty by reason of insanity, but the insanity defense is rarely successful. A far larger number of criminal defendants, estimated at 9,000 annually, are admitted for forensic and civil hospitals because they are found incompetent to stand trial. Once hospitalized, many of these defendants face the likelihood of indefinite commitment. This paper discusses issues related to he concept of incompetency to stand trial and presents an approach to treatment planning and programming designed to restore patients to competency.