SPECIAL MASTER REPORT to JUDGE WANG 

February 28, 2024 

CENTER FOR LEGAL ADVOCACY, d/b/a 

DISABILITY LAW COLORADO, 

Plaintiff, 

v.

MICHELLE BARNES, 

in her official capacity as Executive Director of the Colorado Department 

of Human Services, and

JILL MARSHALL, 

in her official capacity as Chief Executive Officer of the Colorado Mental 

Health Institute at Pueblo, Defendants.

 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 1 of 51
Page 2

February 27, 2023

Re: Civil Action No. 11-cv-02285-NYW 

The Honorable Judge Nina Wang

United States Magistrate Judge

District of Colorado

Alfred A. Arraj United States Courthouse

901 19th Street

Denver, CO 80294

Judge Wang, 

This report serves as our February 2024 quarterly status report mandated by the Consent Decree 

that was filed March 15, 2019 pursuant to Case No. 1:11-cv-02285-NYW. As you know, the 

Consent Decree requires us to monitor progress and provide recommendations to the Colorado 

Department of Human Services (CDHS; hereafter the Department) as they attempt to improve 

competency-related services for criminal defendants with psychiatric illness. Specifically, the 

Consent Decree (p. 24) indicates, 

(i) As part of the duties, the Special Master shall provide the Court and the Parties with status 

reports every other month for the first six months, and then quarterly thereafter. The Special 

Master’s status report was submitted on January 28, 2019. Dkt. 146. The next report shall be 

submitted to the Court and the Parties on March 28, 2019, and then May 28, 2019, and then 

quarterly thereafter. Such reports shall address the Department’s compliance with the 

timeframe requirements of the Consent Decree concerning Competency Services and shall 

provide a detailed summary of information and recommendations the Special Master believes 

the Court and Parties should consider relating to the Department’s compliance with the 

Consent Decree timeframes concerning Competency Services. 

(ii) The Special Master’s report shall include, but is not limited to, reporting on the number of 

Pretrial Detainees ordered to receive Competency Services, an assessment of the 

Department’s operations, systems, and admissions practices and policies relating to the 

Department’s ability to comply with the Consent Decree timeframes, and guidance to the 

Department for improvement and increasing efficiencies in these areas. 

The Consent Decree prescribed a variety of steps the Department must take to improve the 

competency assessment and restoration system in Colorado, and to comply with time frames 

and deadlines mandated in the Consent Decree. The Department initiated these steps and 

demonstrated meaningful progress. Both the wait list, and the time detainees spent waiting, 

were decreasing throughout the first year the Consent Decree was in effect. 

Exactly one year later, in the spring of 2020, the COVID-19 pandemic brought the Department 

unforeseeable challenges and their progress stalled. COVID-related complications slowed 

progress on most metrics, and put simply, all metrics moved in the wrong direction. Even after 

the pandemic relented, many setbacks remained. In particular, the Department faced 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 2 of 51
Page 3

tremendous difficulties staffing their facilities, which left unused hospital units, and less capacity 

to serve the people in jail awaiting transfer and treatment in those units. Similar difficulties have 

been common across the country, and states vary in the timing and degree to which they have 

begun to improve. 

Last quarter featured the first sustained pause in many of these negative trends, and this quarter 

revealed further progress. As staffing began to improve during the prior quarters, most hospital 

units have reopened, moving more people from the waitlist to inpatient beds. After years of 

steady increases in the demand for competence services, there has been more of a plateau. The 

number of people awaiting inpatient restoration at the end of last quarter (n = 374) is lower than 

last quarter’s average (n = 433) and the prior quarter’s average (n = 456). In short, the waitlist is 

slowly decreasing. Last quarter, the Department’s budget requests to the Governor’s office were 

granted; these will sustain the available beds and provide additional beds (as described later). 

New Mental Health Transitional Living homes (MHTLs) are beginning to provide a crucial level of 

care that has long been lacking in Colorado. This quarter had more Tier 1s detainees admitted 

than any other quarter this year. There are now nearly 100 fewer people on the waitlist than 

there were seven months ago.1 More than at any other point since the pandemic, there is reason 

to anticipate steady (though not immediate) improvement.

While we see more reason for optimism, we see no reason for decreased efforts. Even with the 

Department’s progress in opening inpatient beds, it remains clear that Colorado’s “competency 

crisis,” is not something the Department can solve alone. They must continue efforts with other 

stakeholders to enact legislation and strategies that decrease orders for competence evaluation 

and restoration, instead prioritizing mental health treatment over competence restoration. 

This Quarterly Report, like all prior reports, will review key metrics as required, and provide other 

updates on the functions prescribed in the Consent Decree. 

 

1 As of February 24, 2024, the waitlist has decreased to 343 people (compared to 464 at the end of May, 

2023).

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 3 of 51
Page 4

 

TABLE OF CONTENTS 

 

CONTEXT for QUARTERLY METRICS................................................................................................5

KEY METRICS FOR PROGRESS: ........................................................................................................9

COMPLIANCE WITH TIME FRAME REQUIREMENTS........................................................................9

KEY METRIC: COMPETENCE EVALUATION TIME FRAMES ......................................................................10

KEY METRIC: TIME FRAMES FOR ADMISSION TO COMPETENCE RESTORATION ...................................12

KEY METRIC: THE WAITLIST FOR COMPETENCE RESTORATION SERVICES.............................................15

CONSENT DECREE SECTION VI UPDATES......................................................................................18

ADMISSION OF PRETRIAL DETAINEES FOR INPATIENT COMPETENCY EVALUATIONS AND RESTORATION 

TREATMENT ...........................................................................................................................................18

Wait Times for Inpatient Evaluation..................................................................................................19

Wait Times for Inpatient Restoration ................................................................................................21

INTERIM JAIL MENTAL HEALTH TREATMENT.........................................................................................25

RELEASE OF PRETRIAL DETAINEES FOR COMMUNITY-BASED RESTORATION TREATMENT...................27

TRANSPORTATION OF PRETRIAL DETAINEES .........................................................................................29

NOTIFICATION OF NON-COMPLIANCE WITH TIME FRAMES..................................................................30

DECREE SECTION VII UPDATES .....................................................................................................34

CIVIL BED FREEZE ...................................................................................................................................34

COMPREHENSIVE AND COHESIVE PLAN ................................................................................................36

INCREASE COMMUNITY RESTORATION SERVICES .................................................................................39

CONCLUSION................................................................................................................................42

APPENDIX 1 ..................................................................................................................................43

APPENDIX 2 ..................................................................................................................................44

APPENDIX 3 ............................................................................................................................................. 46

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 4 of 51
Page 5

CONTEXT for QUARTERLY METRICS 

Historic Context: 

As all parties understand, longstanding vulnerabilities in Colorado’s public mental health system 

set the stage for the current “competency crisis.” For many years preceding the Consent Decree 

and the pandemic, Colorado had far too little inpatient hospital capacity for a state of its size, 

and it struggled to staff the largest inpatient hospital it did have. Colorado also had an unusual 

community mental health system that—unlike most other states—was able to operate 

selectively, routinely declining services to those involved in the criminal legal system. Finally, 

Colorado could anticipate that orders for competence evaluation and restoration would rise, just 

as they were rising across the United States. Put simply, longstanding structural and contextual 

factors left Colorado with a precarious mental health system, vulnerable to any further strain.

Amid these longstanding vulnerabilities and escalating referrals for competence services, the 

parties (i.e., Disability Law Colorado and the Department) engaged in years of litigation to 

address the increasing number of detainees waiting for competency services, and the increasing 

time these detainees spent waiting. The litigation culminated in the 2019 Consent Decree that

prescribed many steps the Department must take, and the timelines it must meet, to improve 

competency services in Colorado. The Department initiated these steps in ways that were 

faithful to the details and the spirit of the Consent Decree. As you know, we tend to summarize 

the overall spirit and provisions of the Consent Decree in three goals: 

a) Reducing the number of people on the waitlist for competence restoration services, 

b) Reducing the wait times for people on the waitlist, particularly people with the most 

acute psychiatric illness, and 

c) Reducing harm (by providing care) to people on the waitlist. 

Progress on the first goal was significant until the COVID-19 pandemic began in March 2020. The

number of detainees on the waitlist had finally dropped below 100. But as the pandemic 

persisted, the waitlist grew as the Department could not keep pace with court orders for 

competency services. At the Colorado Mental Health Hospital in Pueblo (CMHHiP) where 

inpatient restoration services occur, quarantine procedures slowed or stopped admissions, and 

the waitlist grew dramatically. Furthermore, CMHHiP became so short-staffed that it could not 

operate at full capacity, which further slowed admissions. For almost two years, over 80 beds2 at 

CMHHiP remained unused because there were not sufficient staff to operate the units. The

waitlist peaked at 464 people.3

2 This figure varied a bit, but for over one year, over 80 beds remained unusable. 

3 For example, the waitlist appeared to peak at 464 people at the end of May 2023, and was still 459 at 

the end of July 2023. But by the end of October 2023, the Department reported a waitlist of 427 people, 

and by February 24, 2024 it had decreased to 343.

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 5 of 51
Page 6

The Department made great efforts to address this crisis. For example, they established 

contracts with private hospitals to accept Pretrial Detainees. In early 2022, Governor Polis (at the 

Department’s urging) and the Joint Budget Commission approved approximately $30 million in 

emergency funding to secure 64 additional private psychiatric beds to temporarily address the 

record demand for restoration services. More recent legislation devoted $60 million to fund 

another 96 beds through 2023. The Department continued to pay a premium for emergency 

treatment beds, while some of their own CMHHiP treatment beds remained unused because 

they lacked staff. But over the past several years, the Department opened new units at CMHHiFL

and reopened other units (at CMHHiP) that were closed for over one year.

Progress on the second goal was also clear in the first year following the Consent Decree. 

Defendants with most severe treatment needs (i.e., “Tier 1”) were consistently admitted within 

the prescribed 7-day timeline, though delays remained for those with less acute needs (“Tier 2”). 

But COVID-19 created new sources of delay, even for those with most urgent needs. Staffing 

shortages (exacerbated by COVID-19) even further limited CMHHiP admissions. Therefore, 

almost all competency-involved Pretrial Detainees—whether designated Tier 1 or Tier 2—faced 

wait times that far exceeded those permitted by the Consent Decree. 

Progress towards the third goal—providing care for those waiting—continued even amid 

significant barriers. The Department’s Forensic Support Team (FST) works to monitor detainees 

and provide care while these detainees await hospitalization. The FST has also worked to 

transition many of the less acutely ill detainees to restoration services in the community when 

judges allow bond. Still, amid slow admissions, many Detainees experience serious and severe 

distress in jails that are ill-prepared to treat severe psychiatric illness. 

Recent Context: 

Over the past few years, the Department worked with stakeholders to pass legislation and 

secure funds from the American Rescue Plan Act (ARPA). Although passed many months ago 

(and addressed in prior Quarterly Reports), many of initiatives have begun providing services. 

Indeed, the first Mental Health Transitional Living home (MHTL) has already altered the waitlist. 

Initiatives: Action: 

 

$65 million in ARPA funding to launch 125 

beds in group homes and an additional 16 

beds at CMHHIFL. 

The Department reviewed proposals for 

group homes and awarded all contracts. The 

first group home, operated by Department, 

has now opened to patients (and accepted

many who had been hard to discharge from 

the hospital).

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 6 of 51
Page 7

$62 million to support grants for early 

intervention, deflection, and redirection from 

the criminal justice system among those with 

psychiatric illness.

The Department has reviewed proposals and 

awarded grants. None of these programs 

have begun operating to the degree that it 

would be possible to gauge their impact.

$61 million to improve Colorado’s clinical 

workforce, particularly addressing the 

shortage of nurses. 

The Department has adjusted salaries and 

bonuses to enhance recruitment and 

retention. These strategies have clearly 

improved staffing, with far more applicants 

and hires.

New legislation to limit inpatient restoration, 

among those with only misdemeanor charges, 

to those who meet emergency hospitalization 

criteria (those who do not must be ordered to 

outpatient restoration). 

CRS 16-8.5-111 allows for the dismissal of a 

misdemeanor charge and civil commitment 

among ITP defendants. Other legislation 

(HB22-1386) requires outpatient restoration 

as the default approach for defendants with 

only misdemeanor charges unless they meet 

commitment criteria.

 

All these developments reflect movement towards the broader and more comprehensive steps 

that Colorado needs to take across the continuum of competency services: from diversion and 

deflection at the entry points to more restoration beds at the later points. 

The Department has continued to cultivate collaborations with other stakeholders, because all 

parties agree that the Department cannot solve the competency crisis alone. Although certain 

key services (e.g., evaluation quality, inpatient beds) are solely within the Department’s control, 

many causes of the competency crisis—such as the arrests of unhoused people with mental 

illness—are well outside of Department control. The Department has continued to:

• Convene the Judicial Taskforce with judges eager to help solve the competency crisis.

• Convene the multidisciplinary “Consent Decree Steering Committee” to meet with all 

parties (Department, DLC, and Special Master, as well as a national consultant) every 

other month, and address potential collaborative solutions.

• Support the Denver Competency Docket, led by two judges who are knowledgeable and 

motivated regarding competency matters.

• Pursue strategies to divert people with serious mental illness into community (civil) 

treatment rather than defaulting to the competency mechanism for forensic treatment.

Unfortunately, many of these strategies require a more robust community mental health system 

that, as we’ve emphasized before, is an historic weakness for Colorado. The Department 

anticipates a transition towards a Behavioral Health Administration system, a new cabinet-level 

agency, housed within the Department of Human Services, designed to be the single entity 

responsible for coordination and collaboration across state agencies to address behavioral 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 7 of 51
Page 8

health needs. This transition includes many promises relevant to the competency population: a 

true “safety net” to ensure mental health services for all who need them, decreasing 

opportunities to deny services to certain populations. Indeed, this requirement has now gone 

into effect. A BHA should benefit the competency population, and even ultimately reduce the 

number of people entering competency services, if the BHS indeed creates significantly more 

access and availability of community mental health resources. But, at best, the impact of these 

changes is nearly two years away. Worse, this year has featured many delays and struggles

within the BHA, which will almost certainly delay any potential reforms even further. 

This Quarter 

This quarter follows two prior quarters of increasing bed capacity (e.g., re-opening 39 beds at 

CMHHiP, opening the second new 22-bed unit at CMHHiFL, expanding the Restoration 

Treatment Unit in the Denver Jail (DRTU) from 12 to 18 beds). They also began to transition 

some long-term patients into a new Mental Health Transitional Living (MHTL) home. 

Consequently, the Department has continued admitting more detainees than in previous 

quarters, and the overall number of persons on the waitlist has generally declined for six

consecutive months – the first time this has occurred since the beginning of the pandemic.4 

 

Recent Budget Approvals Support Inpatient Capacity 

 

The Department’s recent (November 2023) budget request to the Governor’s office—mentioned 

in our last quarterly report—was granted. They received $58 million supplemental for FY 2023-

24, $75 million and 3.4 FTE in FY 2024-25, and $70 million and 3.4 FTE in FY 2025-26. The 

Department reported the funding will allow them to make a total of 162 inpatient beds available 

by increasing restoration beds at private hospitals and opening three additional forensic units 

with 82 beds at the Mental Health Hospitals (MHHs) that had been closed or delayed because of 

understaffing. For FY 2023-24 this includes: maintaining the 61 beds at private hospitals and 

adding 19 more beds before the end of the fiscal year; staffing and maintaining 82 beds in 

certain forensic units at CMHHIP, then staffing and opening the new F3 forensic unit at 

CMHHIFL. Indeed, some of these have been opened already. The request also increases staffing.

All parties agree that inpatient beds are certainly not the only strategy needed, but they are an 

essential part of the solution. The Department’s recent budget approvals supports the largest 

increase to inpatient capacity in recent history, addressing the tremendous needs we have 

described over the past few years. 

 

With this broad history and recent developments in mind, this Quarterly Report will review the 

key metrics that the Consent Decree requires us to monitor and report.

4 As of today (February 24, 2024), the waitlist has decreased to 343, the lowest point in the past 4 years. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 8 of 51
Page 9

KEY METRICS FOR PROGRESS: 

COMPLIANCE WITH TIME FRAME REQUIREMENTS 

As prescribed in the Consent Decree, a primary focus of our quarterly reports must be the 

Department’s compliance with time frame requirements:

(i) As part of the duties, the Special Master shall provide the Court and the Parties with status 

reports ... Such reports shall address the Department’s compliance with the timeframe 

requirements of the Consent Decree concerning Competency Services and shall provide a 

detailed summary of information and recommendations the Special Master believes the Court 

and Parties should consider relating to the Department’s compliance with the Consent Decree 

timeframes concerning Competency Services. (Consent Decree p. 24)

(ii) The Special Master’s report shall include, but is not limited to, reporting on the number of 

Pretrial Detainees ordered to receive Competency Services, an assessment of the 

Department’s operations, systems, and admissions practices and policies relating to the 

Department’s ability to comply with the Consent Decree timeframes, and guidance to the 

Department for improvement and increasing efficiencies in these areas. 

Therefore, a primary focus of our review is the Department’s progress in meeting the time 

frames delineated in the Consent Decree. This includes both time frames for competence 

evaluation and for competence restoration. These will be the key metrics to gauge progress, so 

they are our starting point in the report, as well as a primary focus. Of course, performance in 

meeting these time frames depends greatly on enacting the other steps prescribed in the 

Consent Decree, so subsequent sections of the report review those steps in greater detail.

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 9 of 51
Page 10

KEY METRIC: COMPETENCE EVALUATION TIME FRAMES 

Historically, the Department met evaluation time frames, even before the 2019 Consent Decree 

and even through most of the pandemic. After staffing shortages caused delays during some of 

2020, the Department returned to almost perfect compliance with evaluation time frames. Court 

orders for jail-based competence evaluations had dropped to an all-time monthly low during the 

Spring of 2020 (e.g., 56 people in April 2020), with the onset of the COVID-19 pandemic. But 

arrests and orders for jail-based evaluations resumed dramatically peaking at an all-time monthly 

high two years after the pandemic began (i.e., 178 in March of 2022). Orders for evaluation have 

held steady the past two quarters, averaging 132 per month for the past six months. 

Average waiting time (in days) for a competence evaluation5

 

Aug 23 - 

Oct 23 

Nov 

2023 

Dec 

2023 

Jan 

2024 

Requirement 

Jail-based 

Competency 

Evaluations 

 12.3* 10.9 12.1 11.1 21 days

 

Inpatient 

Competency 

Evaluations 

 

 125.5** n/a 37*** 15** 14 days

* = at least one defendant waited longer than the maximum time frame for the evaluation

** = most defendants waited longer than the maximum time frame for the evaluation

*** = all defendants waited longer than the maximum time frame for the evaluation

Even with a high volume of court orders the Department’s Court Services unit has generally 

remained responsive and efficient, maintaining near-perfect compliance with timelines for most 

of the past year. This quarter, they maintained perfect performance; no detainee waited more 

than 21 days for an evaluation in jail.

Regarding inpatient evaluations, performance appeared to improve for the first time in years. 

There remain very few orders for inpatient competence evaluations (i.e., only 6 this quarter). 

However, five were admitted for evaluation. For the past several years, almost all such orders 

were resolved in ways other than hospital admission and often after lengthy delays. This quarter, 

however, five detainees were admitted for inpatient evaluation, and waiting times decreased 

(though still exceeded prescribed timelines). Again, orders for inpatient evaluation remain rare 

(evaluations should usually be completed in jail) and often reflect severely ill detainees. This 

5 Information retrieved from the Department’s Special Master Compliance Plan report for January 2024, 

submitted February 15, 2024, pp. 25, 37. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 10 of 51
Page 11

quarter’s tendency to admit these detainees for inpatient evaluation reflects marked 

improvement in the Department’s ability to admit to the hospitals. 

Orders for jail-based evaluations held steady. Court Services continues to keep pace amid the 

challenges and completed all jailed-based evaluations within the 21-day time limit. For the few 

detainees ordered to inpatient evaluation, the Department has shown striking improvement:

admitting them to hospitals rather than resolving the matter in other ways, with less wait time 

for the detainees. 

 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 11 of 51
Page 12

KEY METRIC: TIME FRAMES FOR ADMISSION TO COMPETENCE RESTORATION 

Historical context: Historically, the Department failed to provide timely restoration services, 

prompting the litigation that led to the Consent Decree. In the months preceding the Triage 

system, defendants who were admitted for inpatient restoration treatment at CMHHiP or RISE 

waited, on average, 71 days.6 This figure included all defendants referred for restoration, 

without distinguishing those with more, versus less, acute needs. Then the Department launched 

on June 1, 2019 the Consent Decree-mandated triage system,7 designed to prioritize the 

defendants with the most acute clinical needs (“Tier 1”) over those with less acute clinical needs 

(“Tier 2”). Tier 1 defendants must receive services within 7 days of the restoration order; Tier 2 

defendants must receive services within 28 days. Upon initiating the Triage system, the 

Department initially maintained excellent adherence to the 7-day deadline for Tier 1 for several 

months. The wait times for Tier 2 defendants also improved, though still exceeding the time 

frames prescribed in the Consent Decree. Wait times and the number on the waitlist were 

decreasing until the onset of the COVID-19 pandemic, but greatly increased thereafter. Those 

wait times have continued to remain far out of compliance even after the pandemic relented. 

But the past six months have revealed some improvement. 

This quarter, both Tier 1 and Tier 2 wait times for inpatient restoration again remained far 

beyond mandated time frames. Of those admitted, Tier 1 defendants waited an average of 92 

days prior to admission while Tier 2 defendants waited 130 days, as reflected below:

 

Average Wait Times for Inpatient Competence Restoration Services8 

 

Aug 2023 - 

Oct 2023 

Nov 2023 Dec 2023 Jan 2024 July 2021 

Requirement 

 

Tier 1 

 

122.7*** 50.5*** 113.6*** 95.4** 7 days

Tier 2 138.3** 135.9** 125.4** 126.6** 28 days

** = most defendants waited longer than maximum time frame for restoration services

*** = ALL defendants waited longer than maximum time frame for restoration services

6 Average waiting period November 2018 - April 2019, as calculated from data provided by the 

Department (see p. 7 of their April monthly report filed May 7, 2019).

7 See Consent Decree paragraph 43.

8 Information retrieved from the Department’s Special Master Compliance Plan report for January 2024, 

submitted February 15, 2024, p. 12. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 12 of 51
Page 13

Pretrial Detainees are all still waiting far longer than Consent-Decree time frames allow:

• Tier 1 detainees wait more than 13 times longer than allowed by the Consent Decree 

(i.e., 92 days on average between November 2023 – January 2024, rather than 7 days).

• Tier 2 Detainees wait more than 4 times longer than allowed by the Consent Decree (i.e., 

130 days on average between November 2023 – January 2024, rather than 28 days). 

Despite these long wait times, there is some reason for cautious optimism. The average Tier 1 

wait times above reflect the shortest time frames for any quarter in nearly a year; further, the 

quarterly average wait time for Tier 2 admissions was the shortest in more than one year. Also, 

for the first time in 8 months, some Tier 1 detainees were admitted within 7 days. We see many 

Tier 1 detainees now being admitted in a matter of days to weeks, rather than in weeks to 

months. All of these improved metrics follow steadily improving metrics over the past several 

months, after the reopening of inpatient hospital units along with steadily expanding community 

placement options. 

The following table illustrates how wait times for inpatient restoration have remained far out of 

compliance for the past year, with this quarter revealing recent improvement:

 

Average Wait (in days) for Inpatient Competence Restoration Services9 

 

 

Feb – Apr 23 May – Jul 23 Aug – Oct 23 Nov 23 – Jan 24 

Tier 1 

 

84.2 109.1 128.3 92.0

Tier 2 

 

140.2 131.5 138 129.7

The Department remained mostly out of compliance regarding restoration time frames. Between 

November 2023 – January 2024, the Department was noncompliant with the 7-day time frame 

for all but two Tier 1 Detainees admitted. Of the 270 Tier 2 Detainees admitted in that same 

period, 240 were admitted beyond their time frame of 28 days. Overall, this reflects only a 8.9% 

compliance rate – like last month’s 6.9% compliance rate, and still far from compliance.

10

9 Information retrieved from the Department’s Special Master Compliance Plan report for January 2024, 

submitted February 15, 2024, p. 12. 

10 To be clear, some detainees originally designated as Tier 2 decompensate into severe illness, such that 

FST urges them for priority admission. Conversely, a few detainees originally designated as Tier 1 may 

stabilize, and need admission less urgently than originally anticipated, and less urgently than some Tier 2 

detainees. In this regard, tier designations are an imperfect (though generally helpful) proxy for the actual 

need for urgent admission. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 13 of 51
Page 14

In later report sections, we recommend systemic strategies such as diversion, deflection, and 

increased civil capacity for long-term compliance with time frames. Such solutions go beyond 

simply increasing inpatient hospital capacity to reduce the waitlist and will improve the 

likelihood of sustainable compliance. Still, the impact of reopening restoration beds is evident

even within this one quarter. It remains to be seen if decreases in wait times continue without 

the addition of substantially more inpatient beds next quarter (19 private hospital restoration 

beds may be opened this quarter); we are eager to monitor trends over the next quarter. 

The number of people awaiting restoration, and their wait times, remain unacceptable this 

quarter. On average, pretrial detainees now wait four to thirteen times longer than Consent 

Decree time frames allow. Further, only 9% were admitted within Consent Decree time frames. 

Inpatient admissions must continue to occur at a rapid pace to decrease the time detainees 

spend on the waitlist. However, progress is evident: wait times are decreasing, admissions of Tier 

1 Detainees occurred at a record volume and within days to weeks, and inpatient restoration 

capacity finally approximates pre-pandemic levels. We will carefully monitor progress over the 

next quarter. We estimate that progress will continue, though likely at a more modest pace, 

given that hospital capacity is expected to plateau over the next quarter. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 14 of 51
Page 15

KEY METRIC: THE WAITLIST FOR COMPETENCE RESTORATION SERVICES 

Historical context: One key metric for gauging the Department’s progress is the waitlist for 

competence restoration services. The Consent Decree aims not only to reduce wait times for 

defendants, but also to reduce the number of defendants waiting at all. In the months before

launch of the Triage system, the waitlist averaged around 150 to 180 defendants. By June 2020, 

the number on the waitlist dropped below 100. The Department projected that the waitlist 

would be minimal by December 2020, but the pandemic changed all projections. In summer of 

2023, the waitlist peaked at 464 Detainees. The number has steadily decreased since then. 

Current realities: Court orders for competency restoration have remained generally stable for 

the past year. The past 12 months averaged 124 orders for inpatient restoration per month, with 

this past quarter averaging 117 per month. However, the number of people awaiting inpatient 

restoration at the end of this quarter (n=374) is lower than the previous quarter’s average 

(n=427). This shift is remarkable; the waitlist trended downward for six months. 

 

Number of Defendants Waiting for Inpatient Restoration11 

 March 2019 Aug – Oct 23 Nov 2023 Dec 2023 Jan 2024 

Combined 157 433 411 366 374

Tier 1 N/A 42 39 31 23

Tier 2 N/A 391 372 335 351

Figures reflect the number of persons waiting for restoration services on the last day of the respective month. 

Prior to the summer of 2023, the wait list had grown steadily for more than one year, reaching

an all-time peak of 464 in May 2023. But this quarter, the Department was able to reopen a 21-

bed admissions unit at CMHHiP, and they continued to transition some long-term patients into 

the newly opened Mental Health Transitional Living (MHTL) homes. This increased capacity 

follows a 39-bed unit reopening at CMHHiP and a 22-bed unit opening at CMHHiFL in previous 

recent quarters. Consequently, the Department was able to admit many more detainees than in 

previous quarters, and the overall number of persons on the waitlist has mostly declined for six

consecutive months – the first time this has occurred since the beginning of the pandemic. This 

represents crucial progress and an apparent turning point. The number of Tier 1 Detainees 

waiting at the end of January (n = 24) was the lowest since July 2021 (and has further decreased 

to 17 as of February 24, 2024). Further, the total number of all Detainees waiting reflects the 

lowest quarterly average overall in the past year, and it was lower than the Department’s 

11 According to the Department’s Special Master Compliance Plan report for January 2024, submitted 

February 15, 2024, p. 9. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 15 of 51
Page 16

projections. In addition, 26 Tier 1 Detainees had waits ended in January 2024, which was the 

highest monthly number since the beginning of the consent decree. This quarter also had more 

Tier 1s admitted than any other quarter this year. In short, there are more than 100 fewer people 

on the waitlist than there were eight months ago, with Tier 1 Detainees once again prioritized for

more prompt admission. 

 

Number of Detainees Waiting for 

Inpatient Competence Restoration Services 

at the end of the month12 

January 2023

February 2023

March 2023

April 2023

439

464

439

448

May 2023 464

June 2023 445

July 2023 459

August 2023 442

September 2023 431

November 2023 411

December 2023

January 2024

366

374

Qualitative review and extraordinary cases: Of course, the waitlist is not simply a number. It is a 

group of people with psychiatric illness awaiting critical treatment. Each week, we review the 

documented updates on each person in jail who has been waiting for inpatient restoration

12 According to the Department’s Special Master Compliance Plan report for January 2024, submitted 

February 15, 2024, p. 9. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 16 of 51
Page 17

longer than their time frames allow. In that review, we see dozens of acutely ill people remaining

in jails awaiting admission who might otherwise meet criteria for an involuntary mental health 

hold due to grave disability (living in cells soiled with urine or feces, neglecting hygiene, not 

eating, experiencing serious medical problems, and so on) or who languish with acute symptoms 

of inadequately managed psychosis. One man we described in the last quarterly report – briefly 

taken to a local medical hospital with legs so deteriorated and infected that amputation was 

considered – still remains in a jail cell awaiting a state hospital bed. Several Detainees received 

new criminal charges while on the waitlist for behaviors that likely reflect symptoms of their 

illness. Although the Department typically prioritizes the most acutely ill individuals for 

admission, most admissions still occur far beyond mandated time frames. 

The number of people waiting in jails for restoration services decreased this quarter, down from 

an all-time high last summer. The total number of people on the waitlist declined over six

months, which has not occurred for more than two years. A record number of Tier 1 Detainees 

were admitted to hospitals in January 2024, and the number of Tier 1 Detainees on the waitlist is 

now half the number during most of 2023. This suggests promising progress. While we affirm 

these improvements, we also recognize the waitlist is still roughly twice as long as it was at the 

start of the Consent Decree, wait times are still far out of compliance for most Detainees, and 

the waitlist includes many people in acute psychiatric crisis and vulnerable to self-harm, injury, 

violence, or suicide. There can be no decrease in effort amid the promising progress. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 17 of 51
Page 18

CONSENT DECREE SECTION VI UPDATES 

ADMISSION OF PRETRIAL DETAINEES13 FOR INPATIENT COMPETENCY 

EVALUATIONS AND RESTORATION TREATMENT 

33. (a) Admission of Pretrial Detainees for Inpatient Competency Evaluations and Restoration 

Treatment. The Department shall Offer Admission to Pretrial Detainees to the Hospital for Inpatient 

Restoration Treatment or Inpatient Competency Evaluations pursuant to the attached table (Table 1). 

Compliance with this measure shall be calculated based on the number of Days Waiting for each 

Pretrial Detainee. 

The Consent Decree prescribed the following time frames for admitting defendants to inpatient 

competence restoration and for performing competence evaluations.

14 Admission time frames 

were longer at the start of the Consent Decree (June 1, 2019), but shortened every six months, 

with the final reduction in July 2021, establishing the current and ongoing time frames. 

 

 

Deadlines 

Tier 1: Maximum 

Time to Offer 

Admission for 

Inpatient 

Restoration 

Tier 2: Maximum 

Time to Offer 

Admission for 

Inpatient 

Restoration 

Maximum Time to 

Offer Admission for 

Inpatient 

Competency 

Evaluations 

Maximum time to 

Complete Jail 

Competency 

Evaluations 

June 1, 2019 7 days 56 days 21 days 28 days

January 1, 2020 7 days 49 days 21 days 28 days

July 1, 2020 7 days 42 days 14 days 21 days

January 1, 2021 7 days 35 days 14 days 21 days

July 1, 2021 

and onward 

 

7 days 28 days 14 days 21 days 

 

 

13 “Pretrial Detainee” means a person who is being held in the custody of a County Jail and whom a court 

has ordered to undergo competence-related services (i.e., competence evaluation or restoration 

treatment). Persons serving a sentence in the Department of Corrections and juveniles are excluded from 

this Consent Decree.

14 Fine amounts are tied to delays beyond each of the time frames listed. However, these fines are not 

applied for Pretrial Detainees designated ISC. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 18 of 51
Page 19

Wait Times for Inpatient Evaluation 

Inpatient evaluations have always been quite rare compared to the common practice of 

evaluating a defendant in jail. Historically, judges typically ordered inpatient evaluations only 

when defendants appeared severely ill and in need of urgent admission (rather than waiting for 

an evaluation to determine whether they need admitted for restoration). The Department was 

generally successful in timely admission for inpatient competence evaluations before the 

pandemic, but they have exceeded timeframes since the pandemic began. The number of 

people ordered for an inpatient competence evaluation has remained quite low, and the number 

subsequently admitted upon order is even lower (often none), because the Department resolves 

such orders in other ways. Unlike prior quarters, however, five detainees were admitted to a 

hospital for inpatient evaluation this quarter. 

 

Recent Wait Times for Inpatient Evaluations15 

 

Month People “admitted or 

ended” for inpatient 

evaluation16 

Average days 

waited before 

“admitted or 

ended” 

 

People who waited more 

than 14 days before 

“admitted or ended” 

Nov 2023 0 (0 admitted) n/a n/a

Dec 2023 2 (2 admitted) 37 2***

Jan 2024 3 (3 admitted) 15 2**

Aug 23 - Nov 2023

 

8 (3 admitted) 125.6 7

March 2019 total 18 16.4 1

* = at least one defendant waited longer than maximum time frame for inpatient evaluation services

*** = ALL defendants waited longer than maximum time frame for restoration services

“Admitted or ended” is the language used in the Department’s reports to designate all ways these orders are 

resolved. In recent years, most orders for inpatient evaluation were not resolved with an actual inpatient evaluation, 

but through other means (such as dropped charges, ending or converting the order, etc.).

15 According to the Department’s Special Master Compliance Plan report for January 2024, submitted 

February 15, 2024, (p. 25).

16 This column reflects the number of Pretrial Detainees admitted to either CMHHIP or RISE for an 

inpatient competency evaluation, bonded out, or had their cases dismissed. Unlike most previous months

in 2023, most waits are now ended with an admission to a CDHS facility.

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 19 of 51
Page 20

This quarter revealed remarkable change relative to recent history. For the first time since 

August 2021, most waits were ended by admission to a CDHS facility rather than “other 

reasons.” Indeed, all “waits ended” this quarter were due to an admission. This is also the first 

time since November 2022 that at least one detainee was admitted for an inpatient evaluation 

within 14 days. While others still waited for unacceptably long times, this quarter revealed 

remarkable progress with respect to admissions for inpatient evaluations. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 20 of 51
Page 21

Wait Times for Inpatient Restoration 

Regarding wait times for inpatient restoration at CMHHiP, the Consent Decree established a twotier triage system. Defendants with the most urgent clinical needs (Tier 1) have an admission 

deadline of 7 days, while those with less urgent needs (Tier 2) have a deadline of 28 days. 

 

Recent Wait Times for Inpatient Restoration for Pretrial Detainees17 

Month Number 

“admitted or 

ended” for 

inpatient 

restoration 

Average days waited 

before “admitted or 

ended” on inpatient 

restoration order 

Number waiting more 

than the maximum days 

for admission to CMHHiP 

inpatient restoration 

 

Tier 1 Tier 2 Tier 1 Tier 2 Tier 1 Tier 2

Nov 2023 11 103 50.5 135.9 11*** 91** 

Dec 2023 17 96 113.6 125.4 17*** 84** 

Jan 2024 26 71 95.4 126.6 24*** 65**

Aug 23 – Oct 23

(average)

 15 92.3 128 138.3 15** 80.7**

March 2019

(before tiers)

44 58.2 31

* = at least one defendant waited longer than maximum time frame for inpatient evaluation services

** = most defendants waited longer than maximum time frame for inpatient evaluation services

*** = ALL defendants waited longer than maximum time frame for restoration services

The total number of people admitted to inpatient restoration this quarter (n=270) was similar to 

last quarter (n=277). Both of these quarters represented a larger quarterly total than any other 

quarter since the beginning of the Consent Decree. In addition, a record number of Tier 1 

Detainees were admitted to inpatient restoration in January 2024, and average wait times for 

both Tier 1 and Tier 2 Detainees decreased this quarter. 

However, wait times remain exceedingly long, reaching four to thirteen times the prescribed

17 According to the Department’s Special Master Compliance Plan report for January 2024, submitted 

February 15, 2024, p. 12.

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 21 of 51
Page 22

Consent Decree time frames, as described in the earlier “Key Metrics” section.

18 Although the 

number of people waiting in jail for inpatient restoration decreased during the past quarter, wait 

times for admission remain far beyond mandated time frames. Approximately 91% of Detainees 

who were admitted exceeded their maximum allowable wait times in jail. 

Average wait times to admission far exceed the time frames mandated in the Consent Decree. 

The number of people waiting for restoration services—and the time they spend waiting—

remain unacceptable. But this quarter has shown a sustained decrease in the number of 

Detainees waiting, as well as shorter average time frames waiting as compared to recent 

quarters, revealing sustained progress. The Department must continue efforts to fully staff 

CMHHiP to lower the length of stay and maximize occupancy rates, continue robust jail-based 

restoration programs and privately contracted hospital restoration, and fill community MHTL 

housing beds.

18 Recall that wait times are ended upon admission to CMHHiP or RISE, or when ended for other reasons

(i.e., a case is dismissed or the court changes an order for inpatient restoration to an order for outpatient 

restoration when on-bond in the community). For example, among 270 “admitted or ended” between 

November 2023 and January 2024, only 212 defendants were actually admitted to an inpatient facility. 

The other 58 people were either dismissed, vacated, or released on bond. Still, the percentage of cases 

“admitted or ended” because of hospital admission is the highest since the onset of the pandemic. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 22 of 51
Page 23

PERFORMANCE OF JAIL-BASED COMPETENCY EVALUATIONS 

33. (b) Performance of Jail Competency Evaluations. The Department shall complete all Jail 

Competency Evaluations of a Pretrial Detainee pursuant to the attached table (Table 1), after the 

Department’s receipt of a Court Order directing the evaluation and receipt of Collateral Materials. 

This timeframe requirement shall apply to the following counties: Adams, Alamosa, Arapahoe, 

Boulder, Broomfield, Crowley, Custer, Denver, Douglas, El Paso, Elbert, Fremont, Huerfano, 

Jefferson, Larimer, Mesa, Otero, Pueblo, Teller, and Weld. Counties not specifically identified are 

counties that use the “Hold and Wait” court ordered process. Counties utilizing the Hold and Wait 

Evaluation process will be offered a meeting date within 30 days of the Department’s receipt of the 

Court Order and Collateral Materials, and the evaluation will be completed within 30 days of the 

meeting. Beginning January 1, 2020, counties utilizing the Hold and Wait Evaluation process will be 

offered a meeting date within 30 days of the Department’s receipt of the Court Order and Collateral 

Materials, and the evaluation will be completed within 14 days of the meeting. 

Historical context: Timely competence evaluations were a relative strength of the Department

until around November 2019, when performance deteriorated substantially. Many jail-based 

evaluations then exceeded the 28-day time frame—reaching peak delays in January 2020 (46%

delayed). Even through much of Spring 2020, roughly 30% of jail-based evaluations exceeded the 

28-day time frame. During the summer of 2020, referrals for jail-based evaluations again began 

to increase towards prior levels. At the same time, the Department improved Court Services. 

They hired new leaders, evaluators, and contractors; they increased compensation and 

prioritized jail-based evaluations. In short, Court Services underwent dramatic improvements 

sufficient to handle the increasing court orders and challenges they have faced. 

Recent history: As Court Services improved, far fewer Pretrial Detainees waited for evaluations 

beyond the required timeline. For roughly two years, the Department completed nearly all in-jail 

evaluations within the required time frames. Court Services leadership appeared to continually 

monitor challenges and adjust procedures accordingly, often in creative ways. Although court 

orders for jail-based evaluations peaked at an all-time high in March 2023, they have otherwise 

held fairly steady at high, but just-manageable, levels.

July 2023 featured the first significant failures to meet evaluation time frames, as the

Department encountered budget constraints and paused their use of contracted forensic 

evaluators. However, with the new fiscal year, the Department resumed use of contractors, and 

quickly resumed their pattern of timely evaluations for defendants waiting in jail. 

This quarter, court orders for evaluations held steady (almost identical to the prior quarter), and 

Court Services was timely in all respects. All jail-based evaluations occurred within 21 days, as 

required. Their reliability was particularly remarkable amid internal challenges. The unit has lost 

several full-time evaluators in recent months and has had several open positions. This has made 

their compliance with time frames more difficult—and perhaps more tenuous these past two 

quarters—but they nevertheless met these time frames. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 23 of 51
Page 24

For the past few years, Court Services has managed to meet timelines for jail-based evaluations, 

even amid substantial challenges, with only one brief period of significant noncompliance. Court 

services maintained perfect compliance with timelines this quarter, following near-perfect 

compliance last quarter. Their ongoing challenge will be filling open positions sufficient to 

maintain an adequate team of evaluators. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 24 of 51
Page 25

INTERIM JAIL MENTAL HEALTH TREATMENT19 

34. Interim Jail Mental Health Treatment. If the court does not release the Pretrial Detainee to 

Community-Based Restoration Treatment and the Pretrial Detainee is awaiting receipt of Inpatient 

Restoration Treatment, the Department shall work with the County Jails to develop a program to 

assist in the provision of coordinated services for individuals in accordance with C.R.S. §§ 27-60-105 

et seq. to screen, treat, assess, and monitor for triage purposes Pretrial Detainees in the least 

restrictive setting possible. This paragraph does not toll or otherwise modify the Department’s 

obligation to Offer Admission to the Pretrial Detainees for Inpatient Restoration Treatment. Interim 

Jail Mental Health Treatment shall not replace or be used as a substitute for Inpatient Restoration 

Treatment but does not preclude the Department from providing Restoration Treatment. A member of 

the Forensic Support Team shall report to the Court Liaison every 10 days concerning the clinical 

status and progress towards competency of the Pretrial Detainee. 

Historical context: The Department is required to partner with county jails to develop a program 

of coordinated services for competency-involved detainees. The Department utilizes Jail-Based 

Behavioral Services (JBBS) as a hub for coordinating these subcontracted services across 

Colorado. These providers are tasked with providing adequate mental health services to inmates 

involved in competency matters until their transfer to competency restoration services. 

Current realities: The JBBS teams provide critical services across the state. They remain the

primary frontline mental health workforce for Pretrial Detainees, and Competency Enhancement 

Team (CET) staff are dedicated to enhancing services for Pretrial Detainees awaiting restoration. 

However, services, staffing, and quality vary greatly across Colorado jails. 

OCFMH’s mobile competency enhancement service contracts with a part-time forensic 

psychiatrist to meet with specific Detainees and treatment providers to discuss and encourage 

medication administration and management. In fiscal year 2023, this psychiatrist provided 42

consultations and held three stakeholder trainings; we see in our weekly review several 

instances of Detainees benefitting from these additional psychiatric services. 

The Department has also offered a statewide “Jail-Based Pre-Restoration Educator Program,” in 

which several pre-restoration educators provide selected Detainees with education and services 

to “jumpstart” restoration. This is not a jail-based substitute for inpatient restoration; rather it is 

intended to provide some services (medication and education) that may accelerate the 

restoration process. In January 2024, a total of 37 Detainees were participating in the program. 

To date, 8% of JBPEP participants have been found competent while on the waitlist, 4% have had 

their cases dismissed, and 36% have been re-directed to outpatient restoration. These numbers 

19 “Interim Jail Mental Health Treatment” means mental health treatment of a Pretrial Detainee that is 

performed in the County Jail where the Pretrial Detainee is held while the Pretrial Detainee awaits 

Community-Based or Inpatient Restoration Treatment per Court Order consistent with the time frames in 

the Consent Decree. It is not a substitute for competency restoration services. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 25 of 51
Page 26

have remained steady for several months. This one-year pilot program has ended, with the end 

of the fiscal year. However, the Department will continue to fund the part-time forensic 

psychiatrist who meets with certain Detainees and treatment providers to discuss and encourage 

medication.

We still encourage the Department to vigorously explore using involuntary medication orders 

(IMOs) when appropriate. Like many advocates, we are concerned that overreliance on IMOs 

could shift treatment to jails that should occur in the hospitals. We also understand many jails 

have inadequate staff or conditions to appropriately provide IMOs and monitor their effects 

immediately after administration. On the other hand, we see the dramatic improvements 

medications can bring to those suffering in jails. We have seen the benefits of more assertive 

IMO policies on waitlisted Detainees in several other states, and we believe similar benefits are 

feasible in Colorado if suitable legal and clinical safeguards, conditions, and policies are 

implemented. Of course, such approaches would be feasible only in certain well-resourced jails 

with appropriate clinical expertise. 

We continue to suggest that IMOs, assertive community treatment, and broader criteria for 

involuntary evaluation and treatment could address unmet mental health needs among persons 

who lack the capacity to make informed choices about their care and who simultaneously are at 

risk for criminal justice involvement or worsening physical or mental health status. Such 

initiatives should only occur after all other options have been exhausted; collaboration and 

voluntary care should be prioritized in all cases before involuntary treatment is pursued. 

Additionally, these sorts of programs rely most heavily on the presence of a functional, 

accessible civil mental health system. Developing this type of robust, community (civil) mental 

health system is not solely within the Department’s control. We affirm their decision to pursue 

conversations with leadership from other stakeholders (law enforcement, corrections, private 

mental health, judges, and persons with lived experience). 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 26 of 51
Page 27

RELEASE OF PRETRIAL DETAINEES FOR COMMUNITY-BASED RESTORATION 

TREATMENT20 

 

35. Release of Pretrial Detainees for Community-Based Restoration Treatment. If the court releases 

the Pretrial Detainee on bond to commence Community-Based Restoration Treatment, the 

Department shall coordinate with the Court Liaison to develop a discharge plan (in a format approved 

by the Special Master) within seven days of the order to all parties involved in the Community-Based 

Services Recipient’s case, and the Court Liaison and community-based provider. 

The Department has continued to meet the requirement to develop discharge plans for people

identified as appropriate for Outpatient Competence Restoration programming (OCRP). Indeed, 

the waitlist would likely be double its size were not for the persistent efforts to shift so many 

detainees into the Department’s robust outpatient competency restoration program and related 

community supports. The Department continued their efforts in two broad areas:

Housing: The Forensic Support Team (FST) Navigators continue to facilitate transitions from jail 

to community housing across the state. Most community housing options are in the Denver and 

Colorado Springs metro areas, and they are funded through the Fines Committee. The total 

number of housing placements and beds funded by the Fines Committee remains high. Most of 

these housing options offer additional treatment and supportive services. The launch of the 

Mental Health Transition Living homes has created a critical new level of community housing and 

services as well.21 Please see Appendix 3 for a description of these programs. 

Forensic Support Team (FST): The FST expanded and filled most of their open positions; as of 

January 2024, only two vacant positions out of 34 remain. Despite persistent vacancies and time 

required to recruit new personnel, FST Navigators continued to monitor clinical status and 

restoration progress for those in jails awaiting transfer to CMHHiP at a remarkable rate. In 

January 2024, FST Navigators were assigned to 716 persons and coordinated care for a total of 

980 people in county jails waiting for inpatient restoration services. For individuals awaiting 

restoration services this quarter, Navigators logged an average monthly total of 617 face-to-face 

20 “Community-Based Restoration Treatment” means Restoration Treatment of a Community-Based 

Recipient that is ordered to be performed out of custody and in conjunction with a community-based 

mental health center or community organization.

21 Unfortunately, this quarter saw the unexpected closing of an organization that utilized fines-funded 

housing and clinical services (Integrated Insights in Delta, described later in this report). The closing 

followed allegations of financial impropriety, among other issues. Although only a few OCRP clients were 

housed there, the decreased capacity for clinical care and outpatient restoration in a rural location is 

significant. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 27 of 51
Page 28

contacts with defendants in jail and 1,591 contacts with care teams or stakeholders.22 For 

persons awaiting evaluations in jail, the FST recorded an average monthly total of 171 face-toface contacts and 451 contacts with care teams or other stakeholders during the past quarter. 

These numbers are similar to the past quarter and represent tremendous time and effort 

devoted to Detainees. To date, several thousand CMHHiP bed days have been “saved” since 

January 2020 through these combined efforts. 

The core responsibilities of the FST are identifying and mitigating acute mental health crises of 

Pretrial Detainees. This quarter, 127 Pretrial Detainees were identified as “high acuity,” similar to

last quarter (122). As you know, because so few acutely ill detainees are admitted promptly, 

statewide monitoring of these vulnerable Detainees is critical; the FST performs this task well.

The FST also facilitates community transitions for those Detainees who no longer warrant 

hospital-level restoration. They continue to facilitate discharges and community transitions for 

many people on the waitlist. FST actions include changing the restoration setting from CMHHiP 

or CMHHiFL to the community, placing appropriate Detainees into community-based specialty 

programs, working with competency dockets to facilitate quicker hearings and community 

restoration options, advocating for the dismissal of charges or resolution of competency for 

those who have stabilized, and more. 

For example, the “Momentum” Program provides dedicated case management, medication 

assistance, and peer support to persons transitioning from jails to community settings. Since 

early 2020, the FST has referred 544 people to the Momentum Program, resulting in 345 active 

current clients—people who would have otherwise remained in jails or a state hospital. In 

addition, the FST works to secure additional releases and community supports for veteran 

Detainees: 44 clients have been linked with V.A. services to date. 

Finally, Navigators work closely with many specialized judicial programs, such as the Larimer 

County Competency Court, the Aurora Judiciary’s “Sustained” program, the Denver Competency 

Diversion program, the REACH docket in Denver County, and day reporting services in El Paso 

and Pueblo counties. Each of these is discussed in the “Notification of Non-compliance with Time 

Frames” section and Appendix 3. The FST is also partnering with many new competency dockets 

(see Appendix 2). We affirm the Navigators collaborations with these innovative programs. 

Overall, the FST continues to be a strength within the Department as they collect information 

from JBBS providers, Competency Enhancement Teams, deputies, and others in the jails. 

Outcomes from the FST are again strong this past quarter, despite difficult conditions and 

overwhelming demand for their services. 

22 According to the Department’s Special Master Compliance Plan report for January 2024, submitted 

February 15, 2024, pp. 44-48. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 28 of 51
Page 29

TRANSPORTATION OF PRETRIAL DETAINEES 

 

36. Transportation of Pretrial Detainees. If a Pretrial Detainee is transported to the Hospital for an 

Inpatient Competency Evaluation and the Department or a medical professional opines that the 

Pretrial Detainee is incompetent and the provisions of C.R.S. § 27-65-125 have been met, the 

Department shall not transport the Pretrial Detainee back to his/her originating jail. 

Five defendants were admitted to inpatient facilities for inpatient competence evaluations this 

past quarter.

23 This is the most Detainees admitted to an inpatient facility for competence 

evaluation since 2021. Indeed, there were only 3 other admissions for inpatient evaluation 

throughout the rest of 2023. 

The Department has not reported any other delays or barriers to transportation with jails around 

Colorado. 

 

23 According to the Department’s Special Master Compliance Plan report for January 2024, submitted 

February 15, 2024, pp. 25.

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 29 of 51
Page 30

NOTIFICATION OF NON-COMPLIANCE WITH TIME FRAMES 

38. Notification of Non-Compliance with Timeframes. The Department shall notify the Special 

Master and DLC weekly regarding any non-compliance with timeframes. 

(a) Only one notice per Pretrial Detainee shall be provided and should include: (i) The name of the 

Pretrial Detainee; (ii) The Pretrial Detainee’s location; (iii) The Pretrial Detainee’s charges based on 

information available to the Department; (iv) The Pretrial Detainee’s bond amount based on 

information available to the Department; (v) Whether a forensic assessment has been made on 

whether restoration in the community is appropriate; (vi) Whether the Pretrial Detainee has 

previously been found incompetent; (vii) What efforts are being made to provide timely Competency 

Services to the Pretrial Detainee, including communications with the court, Court Liaisons, and 

community mental health providers; 

(b) The Department shall accompany its Monthly Data Report (see Paragraph 52) with a separate 

“Fines Report” which will include the names of the Pretrial Detainees for whom the Department has 

accrued a fine during the preceding month, the number of days each Pretrial Detainee waited in the 

County Jails past the timeframes for compliance, and the total fines owed by the Department for the 

preceding month. 

(c) The Department shall pay the total fines owed on the date the Fines Report is submitted to the 

Special Master to be deposited in a trust account created for the purpose of funding non-Department 

mental health services. The account will be managed by a court-appointed administrator. Decisions 

concerning payments out of the account will be made by a committee consisting of a representative 

from the Plaintiff, a representative from the Department, and the Special Master. Any disputes 

regarding the fines shall be handled through the dispute resolution process identified in Paragraph 59. 

Historical context for calculating fines: The funds from fines should benefit the population served 

by the competency system. A small committee comprising Department administration, a DLC 

representative, and the Special Master meet regularly to address use of these fines. This 

committee has also added a team of two auditors (to review and support fines-funded 

programs), and a program-developer (to consult with potential programs submitting proposals). 

The broad goal is to use the funds in ways that help those involved in the mental health and 

criminal justice systems (i.e., those who are, or are likely to become, involved in competencyrelated services), and to address Colorado’s “competency crisis,” by providing new services or 

interventions that do not already fall within the Department’s responsibilities. In other words, 

funds from the fines should supplement, but not supplant, existing services. The Department has 

provided reliable notification of non-compliance of time frames on a weekly basis, as required by 

the Consent Decree since June 1, 2019. 

Current realities: Throughout the past four years that fines have accrued, the Department has 

routinely completed the “Fines Report,” as prescribed by the Consent Decree. Also, as prescribed 

by the Consent Decree, the Department continues to pay these fines into a trust account 

(managed by Cordes & Company, LLP), which is used to support additional special projects that 

complement the broad goals of the Consent Decree. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 30 of 51
Page 31

Projects funded by the Fines Committee

Currently, the top priorities for the fines committee are projects that address housing, diversion 

from the competency system, and specialized competency judicial programs (competency 

dockets and calendars). 

Housing is a priority because the lack of housing is a persistent barrier to community restoration; 

judges often remark that they would release a detainee for outpatient restoration if only the 

detainee had stable housing. Therefore, the Fines Committee continues to fund a variety of 

community-housing for those involved in outpatient restoration. The fines-funded Restoration 

Housing initiative continues to provide community placement options for some Pretrial 

Detainees. These individuals have shown clinical improvements and minimal public safety risk, 

making them appropriate for transition from jails or CMHHiP to Outpatient Competence 

Restoration programming (OCRP) with housing contracted through the Colorado Coalition for 

the Homeless (CCH). At the time of this writing, the Forensic Support Team has coordinated 241

completed referrals and placed 82 individuals in CCH housing units. To date, 40 people have had 

their cases either dismissed or resolved after moving into CCH Housing.24 These figures have 

held steady for months, because those admitted to CCH Housing have remained there, 

consistent with CCH’s priority on sustainable, permanent housing.

Since the initial housing projects through CCH, the Fines Committee has increasingly funded new 

housing such options, such as Ananeo’s supportive and sober housing, which serves roughly 20 

individuals at any time. Likewise, the Embark program provides sober-living housing and dayreporting center, while Monarch provides sober-living housing and wraparound services. Please 

see Appendix 3 for all the fines-funded housing projects.

This quarter featured a significant loss in fines-funded projects. We had funded Integrated 

Insights, near Delta Colorado, to provide supportive housing to those in the competency system. 

They were compliant with all reporting, received very positive reviews from local stakeholders 

(judges, prosecutors, defense attorneys, law enforcement, and even consumers of their 

resources), and all parties were impressed with them during our direct site visits. However, this 

quarter, credible allegations of fraud and other maleficence emerged. The agency is now under 

investigation by regulatory agencies. Thus, the Fines Committee has already suspended future 

funding allocations. No fines-funded clients are at this program as the investigations move 

forward. The Committee is terminating its agreement in light of these serious allegations, and it 

has ensured the competency-involved clients are receiving services elsewhere. In addition, the 

Committee has also secured a contract with Cordes and Company to provide external financial 

auditing on an as-needed basis; some of the larger projects will received routine audits, while 

smaller ones may be reviewed at longer intervals or upon any concern. 

24 According to the Department’s Special Master Compliance Plan report for January 2024, submitted 

February 15, 2024, pp. 46-47. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 31 of 51
Page 32

Significant New Programming:

This quarter also featured the largest addition to the fines portfolio of projects: The Fines 

Committee has supported Embrave with $8,902,175 to develop the Valor Program, which will 

support individuals needing a level of care that does not currently exist in Colorado. Specifically, 

the Valor Program will provide residential care to people who need intensive support and 

stabilization, including medication, which will address the gap between inpatient hospitalization 

and supportive and/or recovery housing. The 72-bed facility will offer 24/7 care for individuals 

with moderately to highly acute psychiatric symptoms, who are not a danger to themselves or 

others but need 3 to 6 months of care to stabilize symptoms, receive case management, 

restoration education, peer support, and connect to the services and resources that will support 

their successful reintegration into their community. The Valor Program will serve any individual 

in Colorado who is in or at risk of being in the competency system, accepting referrals from the 

justice system and the community to support not only decreasing the waitlist but to also deflect 

and divert individuals from the justice and competency system. This large-scale service is 

scheduled to launch in June, 2024.

Diversion programs of course, divert people out of the competency system and into treatment, 

which can be provided outside the slow competence restoration system. Therefore, the Fines 

Committee has funded court-based diversion programs in Denver and Aurora counties. For 

example, the Denver “Competency Diversion Docket” diverts into community treatment 

defendants with less serious charges who would likely otherwise enter the competency system; 

if they successfully complete community treatment their charges are dropped. 

Competency Dockets and related efforts provide greater efficiency and better service to 

detainees because they centralize expertise among court personnel. The Fines Committee has 

funded specialized competency judicial programs including the competency court in Larimer 

County and the Denver competency docket. Indeed, there are several “competency dockets” 

emerging across Colorado as more jurisdictions recognize the strengths of this model; Colorado’s 

Court Services is beginning to study and support these, even aside from Department efforts. This 

quarter, an average of 336 people were actively participating in one of the 9 competency 

dockets statewide at any one point in time. 

A full info-graphic summary of fines-funded projects comprises Appendix 3. 

 

Finally, the fines support three professionals who provide support and oversight to the many 

fines-funded projects. As you know, we rely on a program auditor (a team of two experienced 

program supervisors), who regularly monitor the fines-funded programs, helping them track 

their outcomes and improve services. These consultants also help monitor the overall finesproject “portfolio,” i.e., the group of funded projects, their funding period, and remaining funds. 

Information from these reports is integrated into this quarterly report (see Appendix 3). We also 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 32 of 51
Page 33

rely on a community-based program-development specialist who now works with jurisdictions or 

localities to cultivate or formalize some of their promising local approaches. While the 

Department works on broader (often state-wide) efforts, we increasingly see the value of smaller

projects developed among local partners. When funding appears to be a barrier, our specialist 

helps the projects pursue funding from the fines committee or other sources. Our communitybased program-development specialist—who has extensive experience developing and 

overseeing innovative programs—now helps them cultivate strong programs and links them with 

other programs or experts across the state, to help foster success. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 33 of 51
Page 34

DECREE SECTION VII UPDATES 

CIVIL BED FREEZE 

39. Civil Bed Freeze. The Department’s 2018 Plan included an effort to freeze civil admissions to its 

beds to devote Hospital beds to perform Inpatient Restoration Treatment services. On February 7, 

2019, the Department agreed to stop this practice. The Department will continue to leave the state’s 

civil and juvenile beds allocated as of the execution of this Consent Decree for civil and juvenile 

psychiatric admissions and will not freeze or convert those beds to provide competency services for 

Pretrial Detainees, unless the Department receives prior agreement from the Special Master to use 

unutilized beds for such purposes. This strategy to facilitate compliance with the Consent Decree 

shall only be re-implemented in the future upon agreement of the Special Master. 

The Department removed the “civil bed freeze” as mandated by the Consent Decree. That is, 

they have not re-purposed the civil beds at CMHHiFL for competence restoration, as they had 

proposed in 2018. Indeed, since the Consent Decree, the Department has largely protected civil 

beds, even amid forensic pressures, and the Department recognizes that increasing civil capacity 

is one key to solving the competency crisis. However, the Department has renovated two 

previously closed civil units into units for competence restoration. As of their most recent report, 

the CMHHiFL population included a total of 88 civil patients and 41 restoration patients.

25 

In January 2024, the Department was able to reopen a previously closed 21-bed admissions unit 

at CMHHiP, which allows for more individuals to be admitted to the hospital. 

Of course, civil inpatient capacity remains precariously low throughout Colorado. As we have 

continually emphasized, the Department must also increase civil bed capacity. No amount of 

diversion, community programs, or other outpatient alternatives will ever meet the needs of all

Colorado’s mentally ill population. Additional inpatient civil and forensic beds are critical to 

supplement Colorado’s creative outpatient efforts. The few states with reasonable wait times for 

forensic services all have strong civil capacity, both inpatient and in the community. We reiterate 

that any successful long-term solution to Colorado’s competency crisis will require a strong civil 

system that can manage the mental health needs of people with minor charges, reserving the 

criminal court competency system for defendants with serious charges. This broad strategy 

aligns with our other long-standing recommendations: diversion and deflection programs, longacting injectable medications, assisted outpatient treatment, peer supports, robust case 

management, judicial supervision and monitoring, and involuntary medication orders. Without a 

strong civil system (inpatient and outpatient), competency remains the most accessible (albeit 

least efficient) route to mental health treatment among people without housing or resources—

ultimately increasing the numbers of people ordered to the competency services system. We 

25 According to the Department’s Special Master Compliance Plan report for January 2024, submitted 

February 15, 2024, p. 27.

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 34 of 51
Page 35

continue to encourage the Department to strongly pursue both civil and forensic funding and 

statutory changes that support both systems. We support the Department’s current short-term 

push to reduce the waitlist by prioritizing inpatient beds for competence restoration, but we 

continue to emphasize that any long-term sustainable solution must shift inpatient priority from 

forensic to civil beds. 

Responsive to these needs, this quarter expanded the number of open Mental Health 

Transitional Living (MHTL) homes, which serve as a critically important addition to Colorado’s 

civil service array. The Department funded 125 MHTL beds allocated to various providers around 

the state, with 24 beds across three homes operated by CDHS and the others (96 beds across 

five homes) by private contractors. Remarkably, the Department estimates that the initial 

funding for the 125 homes will actually allow for nearly 150 beds to be funded, due to cost 

savings across the system. To date, three of the contracted homes are open, with a total of 24 

people either residing, enrolled, or pending admission in the homes. These homes provide stepdown interim housing opportunities for people who have spent more time than necessary at the 

state hospital (perhaps due to difficulties finding an appropriate place to discharge) or who are 

at substantial risk for entering inpatient competence restoration. We view these homes as one 

of the most critical components of a full civil service system, and we affirm the Department for

addressing this long-standing gap in service and housing. We also believe more transitional

housing is critical. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 35 of 51
Page 36

COMPREHENSIVE AND COHESIVE PLAN 

40. Comprehensive and Cohesive Plan. The Special Master’s first recommendation was to revise the 

Department’s 2018 Plan into a more comprehensive and cohesive plan. Dkt. 146. By or about January 

2020, the Department will produce an initial plan resulting from a long-term visioning process with 

DLC, the Special Master, and stakeholders that will consolidate disparate pieces of the Department’s 

current plan, along with legislative initiatives, in a cohesive package for courts, administrators, 

service providers, and legislators to consider. As referenced in the Special Master’s Recommendation 

Number 7, the 2020 Plan will highlight the methods to prioritize quality amid quantity and time 

pressures. Dkt. 146 at 42. On an annual basis thereafter, the Department will review and revise the 

plan as appropriate based upon data provided by the Department. 

The Department first submitted a comprehensive, cohesive plan on February 27, 2020, as 

mandated by the Consent Decree. Given the unexpected challenges of the pandemic, they 

submitted subsequent plans in March 2021 and September 2021. The latter report reviewed 

much of the progress the Department made and identified some broader vision of adjacent and 

“upstream” strategies that can reduce the competency-involved population. 

As the pandemic continued, and as the competency crisis grew more dire, we increasingly 

advised the Department that emergency, crisis-management strategies, though necessary, were 

not sufficient. Rather, as we encouraged “a Comprehensive Plan for the competency system 

should include broad planning that diverts many people with mental illness away from the 

competency system before they enter it.” The Department made significant progress in this type 

of comprehensive approach. In April of 2022, the Department pushed forward new legislation, 

ultimately passing several bills designed to divert people from the competency system or limit 

their time in the competency system. Much of their progress involved securing millions of dollars 

in ARPA [American Rescue Plan Act] emergency funding to sustain existing services and support 

new resources. 

In the Fall of 2022, the Department submitted another Comprehensive Plan, which addressed 

these substantial developments in legislation and funding, along with other key plans. The

Department organized their efforts according to six key strategies or “levers:”

1. Number of inpatient beds;

2. Inpatient bed utilization (reducing waste);

3. Right sizing inpatient restoration beds;

4. Reduce the number of individual inpatient court orders;

5. Securing more beds in the community; and

6. Providing more services in the community. 

We agreed with the Department that these are the primary variables influencing the waitlist and 

wait times. But we also appreciated the efforts to expand the scope of their focus to beds and 

services in the community, for a much more comprehensive approach to the crisis. Indeed, 

addressing the first several (inpatient) variables will be crucial to decrease the current waitlist, 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 36 of 51
Page 37

but vigorously addressing the last few (community) variables will be crucial for minimizing future 

additions to the waitlist. 

During the 2023 legislative session, the Department supported two competency bills. Though the 

first primarily addresses juvenile proceedings, the second (effective July 2024), HB 23-1138, 

improves the path to civil treatment for those involved in the competency system. However, this 

is tightly tied to the anticipated (but delayed) BHA system.

2023 Comprehensive Plan and Budget Requests:

During the prior quarter, the Department submitted their latest Comprehensive Plan (September 

2023). The Department memorialized their efforts over the past year, including much greater 

collaboration with other stakeholders across various workgroups. The Department also 

memorialized their plans to: 

• Expand their use of community (private) hospital beds for the restoration population,

• Continue to reduce the proportion of misdemeanor charges that lead to inpatient 

restoration

• Better use existing inpatient beds, with increasing efficiencies, re-evaluations, and related 

measures

In line with the goals detailed in this Comprehensive Plan, the Department requested from the 

Governor’s office: “$57,967,379 supplemental for FY 2023-24, $75,245,671 and 3.4 FTE in FY 

2024-25, and $70,143,328 and 3.4 FTE in FY 2025-26.” The Department’s reasoned that,

“Providing this funding will allow the Office to make a total of 162 additional beds available in 

FY 2023-24, FY 2024-25, and FY 2025-26 which includes increasing inpatient restoration beds 

at private hospitals, opening three additional forensic units with 82 beds at the Mental Health 

Hospitals (MHHs) that have been closed or delayed because of understaffing, and complying 

with staffing levels recommended by Chartis [external consultants]...”

Specifically, the requested $57,967,379 in supplemental funds for FY 2023-24 will, according to 

the Department, serve to:

1. Maintain the 61 beds at private hospitals and add 19 more beds before the end of the 

fiscal year;

2. Staff and re-open 82 beds at the E2 and RNRU forensic units at CMHHIP, and staff and 

open the new F3 forensic unit at CMHHIFL by the end of 2023;

3. Add 6.8 temporary RNs and 17.2 temporary MHCs to ensure adequate staffing of the F2 

and F3 forensic units at CMHHIFL, open F3 in December 2023, and comply with Chartis’ 

recommendations; and

4. Fill direct care FTE vacancies by 12.5% at the MHHs while reducing agency direct care staff by 

12.5%. (p.8)

This quarter, the Governor granted this budget request. As we emphasized in the prior quarterly 

report, there is much to affirm in the budget request and the underlying plan. Much is consistent 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 37 of 51
Page 38

with our strategic discussions over the past few years, and much should meaningfully improve 

the services addressed in the Consent Decree. Indeed, the decreased waitlist we describe 

throughout this report is largely attributable to increasing beds. These inpatient beds are 

absolutely necessary. The Department has long had far too few inpatient beds, relative to the 

state population and need. Likewise, more staffing is essential. Without decreasing these 

compensation gaps, it will be impossible to adequately staff CMHHiP or CMHHiFL. 

Along with our affirmation and enthusiasm for these ambitious budget requests, we have also 

offered the Department several suggestions. First, over the coming months and years, inpatient 

beds should also prioritize civil, not just forensic, treatment. The Department recognizes the 

challenging hydraulics of public mental health treatment: the cycle of increasing forensic 

demand continues until there is adequate community and civil psychiatric treatment available. 

Second, inpatient beds are necessary, but not sufficient, to resolve the current crisis. 

OCFMH recognizes the need for broad, collaborative solutions across the continuum of care. 

These strategies remain crucial no matter how many inpatient beds open. Many defendants do 

not require this inpatient treatment and can be adequately served through Colorado’s 

outpatient restoration program. Others only require inpatient treatment until they can “step 

down” to other types of facilities or housing (such as the recently emerging Mental Health 

Transitional Living Homes). Thus, increases in inpatient beds should occur alongside

improvements across the continuum of care. We are pleased to see the Department continue 

pursuing these other strategies, including collaboration with other stakeholders.

For the second consecutive quarter, there is more reason for cautious optimism. The 

Department has opened more beds, prompting the first sustained decrease in waitlist since the 

pandemic. Recent budget gains will create more available beds. This is likely to further decrease 

the waitlist, addressing a dire need. At the same time, we continue to encourage the broad and 

comprehensive changes—e.g., more diversion from the competence system, greater use of civil 

psychiatric treatment, etc.—that are crucial to help sustain any decrease in the waitlist. As the 

Department knows, this multi-causal, complex crisis requires multiple strategies for solution. 

Prior quarters revealed substantial progress for the Department in collaborating with others and 

securing significant funding to prioritize more comprehensive, long-term, and “upstream” 

approaches to the competency crisis. More recent efforts are targeting the pressing needs for 

staff and additional inpatient beds. We affirm all these efforts, which are necessary to address 

such a daunting challenge. The state certainly needs more inpatient beds, along with coordinated 

efforts that steer people with mental illness away from jails and forensic hospitals, and into 

regular community treatment. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 38 of 51
Page 39

INCREASE COMMUNITY RESTORATION SERVICES 

41. (a) Implement a coordinated wide-scale outpatient (community-based) competency restoration 

(OCR) system. This system shall be integrated and submitted with the “Comprehensive and Cohesive 

Plan” referenced in Paragraph 40 herein. This plan shall be approved by the Special Master. 

The Department’s formal competency restoration program (OCRP) began in March of 2018, and 

has grown steadily since then. Referrals for outpatient restoration were steady this quarter, 

ranging from 74 to 77 defendants per month, similar to other quarters this year.

26 More than 

600 individuals participate in Colorado OCRP, and there still is no waitlist for OCRP services. We 

continue to affirm the Department’s success in building the largest, most robust statewide OCRP 

program in the country (only one other state offers statewide OCR). Of course, high OCR capacity 

ultimately reduces the restoration service demand on Colorado’s two state hospitals. In the past 

quarter, 227 people were placed in OCR. 

OCRP outcomes 

Data from November 2023 – January 2024 reveals a 33.6% restoration rate in the OCRP reevaluation reports that the Department reviewed (51 of 152 total opinions). An additional 28.9% 

were opined as unrestorable (44 out of 152). The remaining 37.5% were opined as remaining 

incompetent. This reflects a slightly lower but still reasonably steady OCRP restoration rate, 

which was 39% and 41% the past two quarters. Data from the same period shows that courts 

found 47.7% of defendants restored to competence (72 of 152 total adjudications), similar to 

last quarter’s 47.7% rate. The court dismissed charges and/or otherwise terminated restoration 

services in an additional 34.2% of these re-evaluation cases. The Department reported that 

positive outcomes may be declining due to enrolling a more acutely ill population; at the onset of 

the OCRP, about 20% were defined as having “high needs,” but this quarter showed a “high 

needs” rate of 35%. 

41. (b) The Department may utilize private hospital beds to meet the needs of Pretrial Detainees 

meeting C.R.S. § 27-65-105(a) civil commitment criteria and with prioritization to Pretrial Detainees 

already residing within the same geographic location. The Department shall create a plan to 

implement this subsection (b) to be approved by the Special Master. 

The Department continues to contract with local hospitals to provide inpatient beds for shortterm competency-related services. We provide a summary of these beds and programs as an 

appendix to this report (see Appendix 1). Currently, the Department contracts with Denver 

Health Hospital for 15 beds, and Peakview Hospital for 54 beds; beds were filled to more than 

90% capacity over the past quarter. A pending contract with Aurora Medical Center should allow 

for the opening of 19 more beds. These overflow beds have proven critical amid the pauses in 

admission to CMHHiP, and we encourage the Department to maintain this capacity at least until

CMHHiP reopens all their previously closed units. Additionally, while we affirm the Department 

26 All data in this section retrieved from the Department’s Special Master Compliance Plan report for 

January 2024, submitted February 15, 2024, pp. 49-56. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 39 of 51
Page 40

securing these inpatient restoration beds, we reiterate that civil inpatient capacity remains too 

meager. The Department must prioritize civil inpatient capacity in addition to building its forensic 

capacity; this will help sustain the improvements in the waitlist as individuals receive civil (rather 

than forensic) treatment. We encourage the Department to continue to devote reopening beds 

to civil patients, diversion programs, or similar programs designed to provide inpatient mental 

health services in lieu of restoration services. See Appendix 2 for more details on these privately 

contracted beds. 

41. (c) The Department currently estimates that 10-20% of Pretrial Detainees admitted for inpatient 

restoration do not need hospital-level care. Dkt. 146 at 29. The Department will make best efforts to 

reduce inpatient restoration hospitalizations by 10% and increase community restorations by 10% in 

six-month increments beginning June 1, 2019. The baseline for the preceding sentence will be 

determined by the Special Master by June 1, 2019, utilizing data provided by the Department. On 

June 1, 2020, the Special Master will establish a modification of this guideline based upon a survey of 

the data collection and implementation of the Department’s Plan.

OCRP baselines 

As prescribed in the Consent Decree, we established a baseline for improvement by calculating a 

six-month period (i.e., Nov 2018 - April 2019) prior to the June 1, 2019 deadline. We identified 

40% as an optimal proportion of defendants referred for outpatient (versus inpatient) 

restoration and we report progress towards that 40% OCR rate in the following table. 

 

Inpatient Restorations 

 

 

Outpatient Restorations 

 

Initial baseline Nov 2018 – April 2019: 69% Nov 2018 – April 2019: 31%

November 1, 2021 goal 60% maximum 40% minimum

Recent progress (past 6 months) May 1, 2023 – Oct 1, 2023:

62.1%

May 1, 2023 – Oct 1, 2023:

37.9%

For the past six months (July 2023 through January 2024), a total of 37.9% of all restoration 

orders were to outpatient restoration. This rate has remained at compliance or very near 

compliance for the past several quarters. Directing such a large portion of defendants towards 

outpatient restoration is a tremendous strength of the Colorado system, and a crucial protection 

against an even greater “competence crisis.”

We also monitor the numbers of persons found ITP in jails who are referred to OCRP (i.e., 

excluding those referred to OCRP after on-bond evaluations), because this is the population that 

the Consent Decree specifically addresses. Based on a similar historic review, we calculated a 

baseline of 20% and expected an increase of 10% for each subsequent 6-month period. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 40 of 51
Page 41

This metric decreased substantially over the past six months as compared to the previous sixmonth period. The current figure, reflecting six months’ worth of data between July 2023 —

January 2024 (a lag in data is unavoidable, as restoration orders are not always received within 

the month that the restoration hearing occurs), indicates a 19% OCR referral rate among all 

evaluations conducted in jails. Monthly averages dipped as low as 12% in July 2023, and 

exceeded the 20% threshold only once. The 19% rate is higher than the earlier six-month figures

of 13% (2023) and 13% (2022-23). The December 2023 rate of 37.2% is clearly an exceptional 

outlier; without it, the average for the other five months over the past two quarters was 15.3%. 

While this 15.3% rate still represents an increase over the figures from the previous year, it also 

still remains below the ideal rate. 

Still, given the combination of persons ordered to OCRP overall (37.9% of all persons adjudicated 

as ITP) and the proportion of persons ordered to OCRP after an in-custody evaluation (15.3% or 

19%, depending on the inclusion of December 2023’s incredibly high rate), we continue to affirm 

the tremendous impact that OCRP has on the waitlist. A total of 227 individuals were placed in 

OCRP this past quarter, many of whom would have otherwise been placed on the waitlist. 

Although benchmarks remained unmet this quarter, the OCRP continues to be a critical 

component in Colorado’s competence services system. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 41 of 51
Page 42

CONCLUSION 

Like every quarter for the past two years, this quarter revealed wait times that far exceed the 

required timelines. However, the waitlist has decreased for the second consecutive quarter. With 

new units opened at the hospitals, there have been more admissions this quarter than any in 

recent history. Of course, the backlog is extreme, and detainees continue to wait too long. But 

for the second consecutive quarter, several key metrics trended in the right direction, for the 

first time in two years, revealing the best progress we have seen since the pandemic.

As always, we appreciate the opportunity to serve the Court, and the state of Colorado, in these 

important efforts.

 

Neil Gowensmith, Ph.D. Daniel Murrie, Ph.D.

President, Groundswell Services Inc. Special Master, Civil Case 11-cv-02285-NYW

Special Master, Civil Case 11-cv-02285-NYW

 

 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 42 of 51
Page 43

APPENDIX 1 

 

Summary of Inpatient Restoration Service Capacity 

 

 

Summary of Inpatient Restoration Service Capacity 

 

 

Setting Total currently 

active restoration 

beds 

Total future 

restoration beds 

through 12/24 

Total future 

restoration beds 

(anticipated full 

capacity) 

Funding Source 

CMHHiP* 218 218 218 CDHS

CMHHiFL* 44 44 44 CDHS

Arapahoe RISE 60 60 60 CDHS

Boulder RISE 18 0 0 CDHS

Denver County 

Restoration

Treatment Unit 

(DRTU)

18 18 18 CDHS 

Denver Health 15 15 15 CDHS / Emergency

Peakview Hospital 54 54 54 CDHS / Emergency

Medical Center of 

Aurora

0 19 19 Emergency

Total 427 428 428 

* All restoration beds at CMHHiP are now available. The Department has received preliminary approval for funding 

to maintain these beds throughout the next two fiscal years, continue privately contracted beds, and acquire 19 

new contracted beds in the next fiscal year. Boulder RISE is expected to end their contract on June 30, and 

Arapahoe RISE is considering expanding their program to accommodate those extra beds. We have not included 

those 18 potential Arapahoe RISE beds here. 

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 43 of 51
Page 44

APPENDIX 2 

 

Summary of Colorado’s Competency Dockets 

(compiled by the Department’s Forensic Support Team) 

 

Judicial District

Judicial 

Office 

Assigned Population Served Comments Schedule Navigator

1st Judicial 

District

Judge 

Klein & 

Judge 

Miloud Low-level felony

Operational in January 

2024 EO Wednesday Taciana

2nd Judicial 

District

Judge Lisa 

Arnolds 

(1H)

F6-F4 Cases (and 

higher w/ DA 

approval)

Also incorporates a precomp “screener”Tuesdays 

starting at 9AM

Denver County 

Court Comp 

Docket 

(Misdemeanor 

Charges)

Judge 

Cherry

Misdemeanor 

Cases Only

March 2024 Launch / 

Diversion Oriented

4th Judicial 

District - El 

Paso

Magistrate 

Gurney

F5&F6 Non-VRA 

cases (and case-bycase approval from 

DDA)

Staffing Every 

Tuesday 9AM, 

Hearing every 

Thursday 9AM

Charity, 

Sunset

5th Judicial 

District

Judge 

Shamis

Will eventually take 

all competency 

cases in the district

Launched in November 

2023

Friday afternoon 

2x/mo

1x in Eagle

1x in 

Breckenridge

8th Judicial 

District -

Larimer

Judge 

Blanco

Low-Level Felony 

and Misdemeanor

Thursday 

mornings at 9AM Denise

10th Judicial 

District - Pueblo

Judge 

Ernst

<F3 non-violent, 

judges make 

"referrals"

Focuses on clients that 

need support for reentry/transition

EOWednesday

staffing at 2, 

hearing at 3 Kimberly

12th Judicial 

District -

Alamosa Only

Judge 

CortezRodriguez>F2 clients that 

need “support”

Launching February 

2024 1x/month Charlie

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 44 of 51
Page 45

16th - Otero, 

Bent, Crowley

Magistrate 

Fouracre 

(Otero)

Low Level Charges 

(in-custody cases)

Virtual appearances 

approved for Bent & 

Crowley cases (either 

jail or courthouse).

3rd Friday of the 

Month Kimberly

17th Judicial 

District - Adams

Judge 

Jimenez TBD

CJCC taking over 

Comp Docket Planning 

Meetings

18th Judicial 

District Court -

Arapahoe Judge Volz

No crimes of 

violence,(assault vs 

peace officer case 

by case), both in 

and out of custody 

(capped at 10)

Pre-ITP Referral from 

Division 302 

(preliminary division), 

100% will have Bridges 

Liaison assigned.

Monthly on 3rd 

Thursday at 1 

(staffing at 1, 

hearing at 2)

Nick, 

Brittany

19th Judicial 

District - Weld TBD TBD Launch Spring 2024? Staci

Other

2nd Judicial 

District (PreComp MiniScreener)

Judge 

Arnolds Pre-Comp Cases

Pre-ITP cases 

screened for initial 

direction (need full eval, 

likely competent, etc.)

EOTuesday 1:30 

in Division 1H n/a

Denver County 

Competency 

Diversion 

Program

Jail 

Magistrate 

(rotating)

Pre-Comp Clients in 

Denver

Denver County Court's 

Competency Diversion 

- they serve felony and 

misdemeanor cases. 

Magistrate Beckman 

has presided over 

courtroom 2300 (DDC) 

where most of the 

action takes place but 

that may be changing 

with rotation. PRN n/a

Case No. 1:11-cv-02285-NYW Document 284 filed 03/01/24 USDC Colorado pg 45 of 51
The Competency Waitlist Fines

Fund was created by a federal

court consent decree in litigation

addressing Colorado's

Competency to Stand Trial

system. The Fines Committee

was established to oversee the

Fines Fund; its purpose is to

support programs that have

potential to reduce the State's

competency restoration waitlist.

Colorado Coalition for

the Homeless (CCH)

Larimer County

Competency Docket

SummitStone

Competency Hub

Aurora Municipal

Court Sustained

Denver Competency

Diversion & WellPower

$4,964,964 - Providing modified

Assertive Community Treatment level

services to clients who are referred

through the Office of Behavioral

Health’s Forensic Support Team as

appropriate for Outpatient

Restoration. Additionally, start-up

funding was provided in 2019 to

enable the program to purchase a

182-unit housing facility, out of which

this, and other Colorado Coalition for

the Homeless programs are

operated.

$533,242 - Diverting individuals

involved in the competency process

from custody while coordinating

necessary care in the community. The

Fines Committee funds a competency

services case manager and a

competency services team lead. 

$3,029,283 - Increasing psychiatric

services in the Larimer County Jail and

establishing a community-based

competency hub that enables clients'

medication management and

provision of services.

$719,284 - Screening individuals

booked in the municipal jail and

assessing appropriate individuals for

competency. The program connects

clients to treatment out of custody

and works toward prosecutorial

diversion. The Fines Committee funds

a program administrator, pays for

competency evaluations, and

provides cell phones for clients.

$2,159,208 - Diverting from

prosecution those defendants who

are likely to be found incompetent to

proceed. The Fines Committee funds a

program administrator, behavioral

health navigators, and salaries for

prosecutors and public defenders who

work with clients in the program.

Funding also provides for direct

wraparound client services, including

emergency and temporary housing,

transportation assistance, mobile

phone, hygiene items, clothing, and

nutritional assistance.

University of Denver's

Denver FIRST Program

$948,729 - Identifying and assessing

clients ordered to outpatient

competency restoration programs for

traumatic brain injury and acquired

brain injury, to enhance appropriate

interventions for those identified

clients, and to provide training to jail

staff and providers.

Fidelity Behavioral

Health

$1,272,559 - Providing housing,

treatment, wraparound services, and

outpatient restoration to competencyinvolved individuals and those at risk of

becoming competency-involved in

Adams, Jefferson, Arapahoe, Douglas,

and Weld Counties for three years.
Ananeo Competency

Housing

$1,847,630 - Providing housing and

services associated with supportive

monitored sober housing. Forty

dedicated beds are reserved for

individuals, suitable for diversion from

confinement, who are receiving

outpatient competency restoration and

treatment, referred by the Forensic

Support Team or Bridges.

g

$953,074 - Providing sober-living

housing and supportive wraparound

services . Twenty-four dedicated beds

are reserved for clients deemed

appropriate to be released from

custody for the restoration process and

referred by the Forensic Support Team

or Bridges.

SAFER Opportunities

Colorado

$2,007,500 - Offering safe, continuous

hotel sheltering in Arapahoe County

with a continuum of community-based,

client-centered safety net services. The

Fines Committee funds numerous

positions and wraparound services.

AllHealth Network

Bridges to Care

$134,000 - Supporting the

implementation of an Arapahoe

County Competency Docket by

doubling the capacity of the existing

State Court Bridges Program which is

providing client case management and

treatment support.

$313,762 - Providing five beds in a

sober-living facility to serve individuals

referred for out-of-custody competency

restoration in the 12th Judicial District.

This program will also connect clients to

medically-assisted recovery treatment

and other services to support

competency recovery.

San Luis Valley

Recovery Housing

Injectables Program

$360,000 - Providing in-custody clients

with long-acting injectable

medications to support mental health

outcomes for those returning from the

State hospital following competency

restoration, and for newly booked

inmates for whom the intervention is

medically indicated.

2nd Judicial District

REACH Docket

$220,000 - Establishing a Docket

Coordinator position for two years to

support the 2nd Judicial District

Competency Docket (REACH).

$262,000 - Establishing a dedicated

Senior Public Defender position for

two years to support the Larimer

County Competency Docket.

Larimer County

Public Defender's

Office
Sheriff's Office

$130,000 - Providing in-custody clients

with long-acting injectables to support

mental health for those returning from

the State hospital following restoration,

and for newly-booked inmates, as well

as supporting clients transitioning to

the community through temporary

housing and ancillary items.

Gateway to Success

Day Reporting Center

$275,000 - Establishing a Day Reporting

Center with treatment, medication

management, daily classes, peer

support, and case management in a

warm and welcoming space to

individuals receiving out-of-custody

competency evaluation and restoration.

Docket Analyst

$222,664 - Creating an analyst position

to support judicial districts operating

special programs in the competency

system; the analyst provides training,

awareness of resources, data collection,

and evaluation support for competency

dockets and judicial programs.

United Way of Weld

County

$1,421,440 - Transitioning competencyinvolved individuals from the Weld

County Jail to the community by

providing rapid rehousing and

emergency housing services, case

management, assistance with benefit

acquisition, and wraparound services.

1st Judicial District

Competency Docket

$220,000 - Establishing a docket

coordinator position to support the 1st

Judicial District Competency Docket.

Second Chance Center

in the City

$488,125 - Providing onsite case

management, peer mentoring,

employment services, housing

navigation, mental health services, and

substance misuse services to

individuals in or at risk of being in the

competency system. The Fines

Committee funds a care manager,

behavioral health navigator, and partial

salaries for the director and assistant

director, as well as costs directly

related to clients' basic needs,

emergency housing, community

navigation, and leasing an office space.

City of Greeley

Homeless Solutions

$111,835 - Serving individuals in Weld

County who are competency-involved

by providing benefit acquisition,

employment support, permanent

housing vouchers, bridge housing, and

wraparound services; funding also

supports a .25 FTE case manager and

.25 FTE peer specialist.

Pulse Line

Collaborative Training

$1,058,270 - Providing training and

resources to law enforcement, first

responders, and caregivers to reduce

unwarranted use of force incidences

and the number of individuals with

behavioral health disorders and

disabilities being arrested and confined.
National Alliance on

Mental Illness (NAMI)

Colorado

$91,030 - Providing evidence-based

peer programming for patients and

staff of the Colorado Mental Health

Hospitals in Pueblo and Fort Logan

qppp

12th Judicial District

Competency Docket

$69,555 - Establishing a Docket

Coordinator position to support the

12th Judicial District Competency

Docket.

Embark Assisted

Living - Renaissance

$380,820 - Providing eight licensed

transitional assisted living beds, called

Renaissance, in El Paso County to

competency-involved individuals. 24-

hour staffing supervision and

programming geared toward

participants' health optimization,

reinteigration into the community, and

assistance with long-term placement

will also be provided.

Boulder County

Community Justice

Services

$505,842 - Supporting aspects of the

State Court Bridges Program, including

the provision of access to services to

enable the release from custody for

competency clients.
programming focused on competency

restoration, general mental health

needs, and enhancing life skills.

Mesa County Pretrial

Community

Alternative Placement

$27,900 - Diverted individuals, deemed

likely to be found incompetent to

proceed, from confinement to

supportive community-based

treatment. The Fines Committee

funded inpatient treatment for clients

in the PreCAP program.

Colorado Mental

Health Institute

$669,850 - Purchased and provided

cellular phones, access (minutes), and

transportation for competencyinvolved individuals during the

pandemic, as well as laptops and

related expenses for providers and

local jails to allow pandemic-era

competency services to continue.

$440,800 - Provided psychiatric beds

for out-of-custody competency clients

on an emergency basis.

Peak View Behavioral

Health

REACH Docket

Competency Screener

$17,850 - Provided additional

screening and evaluation capacity to

the 2nd Judicial District REACH Docket.

clients on an emergency basis.

IMPACT Integrated

Insight Therapy

$1,178,000 - Diverted 22 individuals

on whom competency was raised by

providing dedicated program housing

with treatment and wraparound

services. The Fines Committee funded

case managers, house managers, peer

support professionals, monitoring

services, and houses in rural

Colorado. Community Based

Enhanced Restoration

$400,000 - Provided Assertive

Community Treatment to individuals so

that they could be released on bond

and restored to competency out-ofcustody. The Fines Committee also

funded housing options for clients who

would otherwise be homeless.
$1,847,630

$822,000

$719,284

$505,842

$130,000

$265,814

$111,835

$1,500,000

$3,464,964

$669,850

$400,000

$2,159,208

$3,270,000

$663,114

$683,300

$380,820

$641,700

$1,272,559

$275,000

$1,178,000

$533,242

$262,000

$360,000

$27,900

$286,745

$953,074

$91,030

$440,800

$1,058,270

$17,850

$2,007,500

$313,762

$222,664

$488,125

$600,000

$3,029,283

$1,421,440

$948,729

$18,628

$594,156

$158,213

$512,659

$146,519

$56,242

$0

$7,382

$1,500,000

$3,464,964

$669,850

$400,000

$903,793

$3,270,000

$663,114

$0

$303,227

$262,420

$0

$192,419

$564,079

$387,374

$262,000

$64,882

$27,900

$104,090

$533,250

$0

$440,800

$0

$17,850

$750,000

$0

$17,091

$115,511

$0

$614,740

$77,892

$195,323

Allocated Spent

Ananeo Housing

Assisted Living of Aurora

Aurora Sustained

Boulder County Justice Services

Boulder County Sheriff's Offi

BTS Forensic Day Reporting

City of Greeley Homeless Solutions

Colorado CCH (CREST)

Colorado CCH (Restoration Housing)

Colorado Mental Health Institute

Community Based Enhanced Restoration

Denver Comp. Diversion & WellPower

Denver Health

Denver Sheriff Department

Douglas County Sheriff's Offi

Embark Assisted Living - Renaissance

Embark Recovery Residences

Fidelity Behavioral Health

Gateway to Success-Pueblo

IMPACT Integrated Insight Therapy

Larimer County Competency Docket

Larimer County Public Defender's Offi

Mesa County LAI Program

Mesa County Pretrial CAP

Mile High Behavioral Healthcare

Monarch Competency Housing

NAMI Colorado

Peak View Behavioral Health

Pulse Line Collaborative Training

REACH Docket Competency Screener

SAFER Opportunities

San Luis Valley Recovery Housing

SCAO Competency Docket Analyst

Second Chance Center in the City

Solange Assisted Living

SummitStone Competency Hub

United Way of Weld County

University of Denver's Denver FIRST

0 500000 1000000 1500000 2000000 2500000 3000000 3500000 4...

This document is updated quarterly; as such, it does not reflect up-to-the-minute expenditures and funded projects.