Indiana’s competency restoration crisis demands a community-based answer

The right question is not, “Do we limit restoration or do we need more state hospitals?” The right question is, “How do we prevent people from needing competency restoration in the first place, and when necessary, can we provide it closer to home and connect it to existing and ongoing care?”

Fortunately, Indiana has partially implemented a model that can do both: the Certified Community Behavioral Health Clinic model. This federal initiative requires a transformation of the traditional service delivery model into one that provides and coordinates healthcare for the person — regardless of their ability to pay, diagnosis, age, or where they live — rather than asking them to navigate complicated and fragmented services. The goal is simple: Right care, Right time, Right place. That matters because behavioral health crises rarely begin with a criminal charge.

Indiana is currently demonstrating the model across eight community mental health centers with the goal of transforming the state’s traditional system. Initially supported by the Indiana Legislature through Sen. Michael Crider’s 2023 Senate Enrolled Act 1 and all nine of Indiana’s federal legislators, including then-U.S. Sen. Mike Braun, Indiana implemented CCBHC coverage across the eight centers in 35 counties in 2025. The results are encouraging. Participating centers have seen improvement in access and quality of care, along with reductions in hospitalizations and incarcerations. In other words, the program in Indiana is working exactly as it’s supposed to.

However, there are 57 counties still to go, and Indiana hasn’t finished the job.

Competency restoration, by definition, is a legal intervention. But the person sitting before a judge didn’t become mentally ill when they were declared incompetent. Often, they are struggling for months or years before a criminal arrest. Therefore, the opportunity to improve is to intervene earlier. When people have access to timely and high quality care in their own communities, they have better outcomes. Their symptoms are more quickly identified, crises prevented and mitigated, substance use addressed, and deterioration is reduced leading to fewer arrests and hospitalizations. Better access and better treatment leads to better outcomes across all systems. That’s the promise of CCBHC: the ability to address issues before they reach a courtroom or emergency department.

Of course, prevention will not completely eliminate the need for competency restoration. But needing restoration shouldn’t automatically mean placement in a state psychiatric hospital. Indiana could expand competency restoration to include jail-based and/or community-based restoration. Indiana’s own Behavioral Health Commission has already identified this as a possibility. A statewide, 92-county CCBHC infrastructure would provide a framework making that possible. They are designed to coordinate care across systems, something the current restoration process lacks. This makes CCBHCs particularly well suited to meeting the needs of people whose lives intersect with courts, jails, behavioral health providers, housing, hospitals, schools, social services, and other systems simultaneously.

Indiana’s community mental health centers already have the relationships and expertise to make this work. Many provide care in county jails and all provide community-based care. They are willing and ready to help, but without the sustainable funding unlocked by the CCBHC model, they cannot hire and pay the staff necessary to provide these services. With that infrastructure in place, a community behavioral health provider could begin working with an individual while the legal case is pending, provide competency restoration, and remain connected through their return to the community. This is not just a better way to restore competency, it’s a better way to take care of people, which is directly related to ensuring a safer community.

Indiana started this transformation. It’s time to finish it.

Every Hoosier should have access to behavioral healthcare close to home. Indiana should complete the work begun in 2023 and build out a 92-county CCBHC system that treats people before they reach a crisis, supports them when they do, and stays connected as they recover and reintegrate into their communities.

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