Crisis in the treatment of incompetence to proceed to trial: harbinger of a systemic illness.

Across the nation, a growing number of defendants judged incompetent to proceed (ITP) to trial are unable to access needed mental health care because of critical shortages of state hospital psychiatric beds and funding. Many of these patients languish in jails and prisons that lack the resources to provide adequate care during their prolonged wait for treatment. The crisis is yielding results that are medically, legally, and ethically unacceptable. The problem is presented as the latest symptom of an overwhelmed mental health system. Deficits across multiple domains are responsible for the current ITP logjam, creating an emergency that has been receiving increasing attention by medical and legal professionals, the media, and the public. Achieving meaningful and long-term solutions will necessitate recognizing the deficiencies in mental health capabilities within jails and prisons, courts of law, and communities, and addressing the dire need for the integration of these sectors.