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Research ArticleRegular Article

A Jail-Based Competency Restoration Unit as a Component of a Continuum of Restoration Services

Peter Ash, Victoria C. Roberts, Glenn J. Egan, Kelly L. Coffman, Tomina J. Schwenke and Karen Bailey
Journal of the American Academy of Psychiatry and the Law Online November 2019, JAAPL.003893-20; DOI: https://doi.org/10.29158/JAAPL.003893-20
Peter Ash
Dr. Ash is Professor and Director, Psychiatry and Law Service, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia. Ms. Roberts is Court Liaison Director, Psychiatry and Law Service, Emory University School of Medicine, Atlanta, Georgia. Dr. Egan is Assistant Professor, Emory University School of Medicine, Atlanta, Georgia. Dr. Coffman is Assistant Professor and Medical Director, Fulton County Jail Competency Restoration Unit, Emory University School of Medicine, Atlanta, Georgia. Dr. Schwenke is Assistant Professor and Program Director, Fulton County Jail Competency Restoration Unit, Emory University School of Medicine, Atlanta, Georgia. Dr. Bailey is Director of Forensic Services, Georgia Department of Behavioral Health and Developmental Disabilities, Atlanta, Georgia.
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Victoria C. Roberts
Dr. Ash is Professor and Director, Psychiatry and Law Service, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia. Ms. Roberts is Court Liaison Director, Psychiatry and Law Service, Emory University School of Medicine, Atlanta, Georgia. Dr. Egan is Assistant Professor, Emory University School of Medicine, Atlanta, Georgia. Dr. Coffman is Assistant Professor and Medical Director, Fulton County Jail Competency Restoration Unit, Emory University School of Medicine, Atlanta, Georgia. Dr. Schwenke is Assistant Professor and Program Director, Fulton County Jail Competency Restoration Unit, Emory University School of Medicine, Atlanta, Georgia. Dr. Bailey is Director of Forensic Services, Georgia Department of Behavioral Health and Developmental Disabilities, Atlanta, Georgia.
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Glenn J. Egan
Dr. Ash is Professor and Director, Psychiatry and Law Service, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia. Ms. Roberts is Court Liaison Director, Psychiatry and Law Service, Emory University School of Medicine, Atlanta, Georgia. Dr. Egan is Assistant Professor, Emory University School of Medicine, Atlanta, Georgia. Dr. Coffman is Assistant Professor and Medical Director, Fulton County Jail Competency Restoration Unit, Emory University School of Medicine, Atlanta, Georgia. Dr. Schwenke is Assistant Professor and Program Director, Fulton County Jail Competency Restoration Unit, Emory University School of Medicine, Atlanta, Georgia. Dr. Bailey is Director of Forensic Services, Georgia Department of Behavioral Health and Developmental Disabilities, Atlanta, Georgia.
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Kelly L. Coffman
Dr. Ash is Professor and Director, Psychiatry and Law Service, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia. Ms. Roberts is Court Liaison Director, Psychiatry and Law Service, Emory University School of Medicine, Atlanta, Georgia. Dr. Egan is Assistant Professor, Emory University School of Medicine, Atlanta, Georgia. Dr. Coffman is Assistant Professor and Medical Director, Fulton County Jail Competency Restoration Unit, Emory University School of Medicine, Atlanta, Georgia. Dr. Schwenke is Assistant Professor and Program Director, Fulton County Jail Competency Restoration Unit, Emory University School of Medicine, Atlanta, Georgia. Dr. Bailey is Director of Forensic Services, Georgia Department of Behavioral Health and Developmental Disabilities, Atlanta, Georgia.
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Tomina J. Schwenke
Dr. Ash is Professor and Director, Psychiatry and Law Service, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia. Ms. Roberts is Court Liaison Director, Psychiatry and Law Service, Emory University School of Medicine, Atlanta, Georgia. Dr. Egan is Assistant Professor, Emory University School of Medicine, Atlanta, Georgia. Dr. Coffman is Assistant Professor and Medical Director, Fulton County Jail Competency Restoration Unit, Emory University School of Medicine, Atlanta, Georgia. Dr. Schwenke is Assistant Professor and Program Director, Fulton County Jail Competency Restoration Unit, Emory University School of Medicine, Atlanta, Georgia. Dr. Bailey is Director of Forensic Services, Georgia Department of Behavioral Health and Developmental Disabilities, Atlanta, Georgia.
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Karen Bailey
Dr. Ash is Professor and Director, Psychiatry and Law Service, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia. Ms. Roberts is Court Liaison Director, Psychiatry and Law Service, Emory University School of Medicine, Atlanta, Georgia. Dr. Egan is Assistant Professor, Emory University School of Medicine, Atlanta, Georgia. Dr. Coffman is Assistant Professor and Medical Director, Fulton County Jail Competency Restoration Unit, Emory University School of Medicine, Atlanta, Georgia. Dr. Schwenke is Assistant Professor and Program Director, Fulton County Jail Competency Restoration Unit, Emory University School of Medicine, Atlanta, Georgia. Dr. Bailey is Director of Forensic Services, Georgia Department of Behavioral Health and Developmental Disabilities, Atlanta, Georgia.
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    Figure 1.

    A continuum of services.

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    Figure 2.

    Outcomes by restoration intervention (percentages given are within intervention group).

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    Table 1

    Outcomes of CRU Admissions by Type of Impairment and Medication Compliancea

    ImpairmentMedication CompliancenOutcome, %
    DivertedRestoredInpatient
    PsychosisNo prescription9563311
    Refuses111241066
    Takes163394714
    Subtotal283
    Cognitive deficitsNo prescription1145550
    Refuses367330
    Takes28216811
    Subtotal42
    Psychosis and cognitive deficitsNo prescription250500
    Refuses6331750
    Takes38424216
    Subtotal46
    • N = 348 subjects

    • ↵a Does not include 48 admissions of those whose impairments did not fit in this classification, such as suspected malingering (later confirmed) or substance abuse-related.

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    Table 2

    Restoration Outcomes of Those Admitted to Forensic Inpatient Hospital Unit

    Referred From:Medication ComplianceanFinal Competency Status
    CompetentNot, Not, NotbNot, Not, Committedc
    General populationUnknown2387%9%4%
    Competency restoration unitNot prescribed1100%0%0%
    Poor/refuses6080%12%8%
    Compliant2259%32%14%
    Inpatient directUnknown8691%2%7%
    WomenUnknown9082%2%16%
    • ↵a Medication compliance on jail unit.

    • ↵b Not competent, not restorable, not committable.

    • ↵c Not competent, not restorable, committable.

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Journal of the American Academy of Psychiatry and the Law Online: 53 (1)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 53, Issue 1
1 Mar 2025
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A Jail-Based Competency Restoration Unit as a Component of a Continuum of Restoration Services
Peter Ash, Victoria C. Roberts, Glenn J. Egan, Kelly L. Coffman, Tomina J. Schwenke, Karen Bailey
Journal of the American Academy of Psychiatry and the Law Online Nov 2019, JAAPL.003893-20; DOI: 10.29158/JAAPL.003893-20

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A Jail-Based Competency Restoration Unit as a Component of a Continuum of Restoration Services
Peter Ash, Victoria C. Roberts, Glenn J. Egan, Kelly L. Coffman, Tomina J. Schwenke, Karen Bailey
Journal of the American Academy of Psychiatry and the Law Online Nov 2019, JAAPL.003893-20; DOI: 10.29158/JAAPL.003893-20
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