Outpatient Competency Restoration Programs: An Overview

Outpatient Competency Restoration (OCR) pilots served their first clients in the spring of 2008 and were fully operational by September of the same year.  The goal of these pilots is to allow individuals with serious mental illness and co-occurring psychiatric and substance use disorders(COPSD) diagnoses, who have committed a crime, to receive competency restoration services in their communities, rather, than in a more restrictive setting such as a state mental health facility. Participants must have a serious mental illness and/or COPSD diagnoses, be found incompetent to stand trial, and willing to comply with treatment.  Psychosocial assessment and risk of violence tools are used to determine whether participants may pose a significant risk of harm to self or others. Outpatient Competency Restoration programs work to erode stigma by collaborating with court staff, law enforcement, mental health treatment providers, and communities. An ultimate goal is to allow people with mental illness and COPSD issues, who have committed a crime, back into the community to participate in an appropriate degree of treatment that will keep them stable over a lifetime. 


Outpatient Competency Restoration: Facts  


  • Outpatient Competency Restoration program staff continue to build and enhance relationships between Local Mental Health Authorities, Managed Care Organizations, and the criminal justice system. These partnerships have worked to enhance jail diversion initiatives in communities with OCR sites.
  • Outpatient Competency Restoration program staff have targeted key services needed to rapidly restore individuals to competency.
  • Texas OCR programs have provided services to a number of clients with mental health and/or co-occurring COPSD diagnoses that has exceeded the number of clients served in comparable programs in other states. These services have contributed to a reduction of bed utilization in state mental health facilities, as well as, provided costs-savings benefits.


  • From 2008 through August 2013, over 1,061 individuals have been served by OCR programs, 42% of which have been restored to competency. During this same timeframe, 16% of clients had their charges dismissed.
  • In Fiscal Year 2013, the average cost of treatment per day in a state hospital was $415, compared to the average cost of treatment per day in an OCR program at $229.


  • Outpatient Competency Restoration programs began with 4 pilot programs. As of August 2013, there are a total of 12 programs.
  • Outpatient Competency Restoration programs utilize competency education curriculums that have been utilized in state mental health facilities and modified to suit the needs of clients being served.
  • Aside from the competency restoration treatment, OCR clients receive the core psychiatric care and services afforded other people served through Local Mental Health Authorities, or, Managed Care Organizations under the Texas Resilience and Recovery Management Guidelines.


For More Information Contact: Dr. Courtney Heard at courtney.heard@dshs.state.tx.us


Last updated July 17, 2014