Dartmouth researchers outline options for Vermont competency restoration program

Dartmouth researchers presented findings to the Vermont House Judiciary Committee on May 20, 2025, laying out options for how the state might address competency to stand trial and restore defendants' capacity to participate in legal proceedings.

The presentation, delivered by JJ Daigle, Emily Liang and Sling Choi from Dartmouth's Rockefeller Center for Public Policy and the Social Sciences, summarized five New England case studies and proposed six nonexclusive policy pathways ranging from a fully funded formal restoration program to enhanced diversion, treatment courts and community-based services.

The proposal matters because most of the policy choices affect both public safety and individual rights. "We've spent the last eight months studying competency restoration programs," said JJ Daigle, explaining the team's methods and noting that their final brief will be published and circulated shortly. The researchers told the committee that, based on interviews with state officials, "around 80 percent of court cases in Vermont involve individuals who have been diagnosed with mental health or substance use disorders." That figure came from the Department of Corrections, the presenters said.

The research summarized four goals for restoration programs: enable legal proceedings to continue; address underlying mental-health needs; balance public safety with due process; and reduce repeated entry into the criminal justice system. The team compared Connecticut and Rhode Island, which have formal competency restoration programs, with New Hampshire and Massachusetts, which rely on informal or court-clinician models.

Connecticut's model, the researchers said, focuses on restoring legal competency and operates under the state Department of Mental Health and Addiction Services with multi‑disciplinary teams and inpatient facilities such as Connecticut Valley Hospital and a forensic hospital the presenters named in their notes. Rhode Island's centralized model requires that individuals be both incompetent and high risk or violent to enter its restoration pathway and uses a three‑part evaluation: clinical evaluation, competency evaluation and psychiatric risk assessment. New Hampshire and Massachusetts rely more on individualized clinical evaluations, risk assessments and local treatment or diversion options rather than a centralized restoration program.

The Dartmouth team walked the committee through a five‑step flowchart they devised for a formal program: competency raised; competency evaluation; determination; restoration programming (legal education and clinical treatment, inpatient or outpatient); and post‑restoration processes including reentry planning, possible return to the Department of Corrections, diversion to specialty courts, or dismissal where applicable. Emily Liang emphasized Vermont's existing constraints: "Vermont is one of the very few states to have had a state general hospital; it permanently closed in 2011 after Tropical Storm Irene," she said, noting that Vermont now relies on seven inpatient hospitals that admit patients under Medicaid criteria.

Researchers highlighted implementation hurdles for a formal program: staffing shortages that have forced Vermont to outsource forensic evaluations out of state, substantial start‑up and operating costs, and limited data sharing between treatment providers and legal teams. One stakeholder the presenters cited warned that a three‑year contract to implement a formal program could cost "triple the cost of a public system," though the presenters emphasized cost estimates vary by design. During questions, a committee member referenced a November report estimating about $4.5 million to get a program running.

As alternatives to a statewide formal program, the researchers proposed five informal pathways: incentivizing local crisis outreach and response teams; strengthening community‑based mental‑health and substance‑use services; expanding statewide treatment dockets; enhancing parole and probation supervision with mental‑health training; and broadening diversion programs at multiple intercept points in the criminal‑justice process. The researchers said these informal options can reduce the number of low‑level cases that would otherwise enter competency evaluations and can be implemented with community partners such as Vermont Community Justice Centers, Pathways Vermont and Vermont Care Partners.

The researchers also noted pending legislation: H.251, described at the time as a short form act related to establishing a competency restoration program, and H.405, described as adding statutory language on dismissal of cases for defendants who remain incompetent past the statute of limitations. They also referenced prior work by a Judiciary Commission on Mental Health created after a Vermont Supreme Court action and legislative activity including a bill labeled S.91. The presenters cautioned that statutory design—time limits for restoration, eligibility by offense type, and whether restoration focuses on legal education or on clinical treatment—would shape outcomes and costs.

Committee members asked detailed questions about psychotropic medication definitions, whether jurisdictions order treatment for defendants found incompetent but not dangerous, differences in time frames across states, and measures of program success such as restored competency versus long‑term recidivism. The presenters told the committee that formal restoration programs nationally often report high restoration rates (they cited studies showing roughly three‑quarters or higher) but that data collection and sharing are uneven and sustainable outcome tracking (for example, recidivism after restoration) is limited.

The presenters concluded by offering the research brief as a resource and said they would publish the full report. Committee Chair Martin Malone closed the session with procedural notes about other committee business and follow‑up on S.109. Several members commented that any Vermont shift toward a formal program would likely be multi‑year and budget‑intensive.

The Dartmouth brief and the committee exchange highlighted choices Vermont faces: build a centralized competency restoration system with clinical and legal services, or invest more broadly in community treatment and diversion that may reduce demand for direct restoration services. The researchers left committee members with design tradeoffs, cost concerns, and a menu of potential steps the legislature and agencies could pursue next.