Gothamist, Samantha Max, Charles Lane, Apr 7, 2025

Judges are finding a growing number of criminal defendants in New York City’s state courts mentally unfit to stand trial, meaning their charges must either be dropped or they must be held in hospitals, not in jail, according to city health data obtained by Gothamist.

But the hospitals where the defendants are supposed to go for treatment can’t keep up with the increasing demand, mental health officials, researchers and legal experts said. Instead, the defendants are being held on Rikers Island, which faces the threat of a federal takeover amid high rates of violence. Five people have died in city custody — or just after their release — so far this year.

When hospitals don’t have space for criminal defendants with mental illness, it can slow down their court cases, delaying justice for everyone involved. Mental health experts said crowding jails with people with severe and untreated mental illness overwhelms staff and makes it more difficult for everyone to get the care they need.

“They should be as quickly as possible removed from a prison setting and sent into treatment,” said Douglas Stern, a lawyer and professor who specializes in mental health.

While it’s impossible to pinpoint all the reasons why more defendants are being found mentally unfit to stand trial, experts on the intersection of the mental health and criminal justice systems said the psychological toll of COVID-19 and disruptions to treatment during the pandemic likely contributed to the increase. They also cited a rise in arrests in recent years.

Elected officials have vowed to fund more psychiatric beds to alleviate the shortage, but some advocates and mental health professionals said more are still needed. Others said the state should rely less on hospitals to address the surge in demand for treatment.

A process ripe for delays

New York state law allows judges to order psychiatric examinations for criminal defendants when the judges believe defendants can’t understand the proceedings against them because of mental illness.

An order for a psychiatric exam sets off a multi-step process — one that presents numerous opportunities for delays, according to attorneys and observers of the court system. First, psychiatrists have to evaluate the defendant and write a report for the judge explaining whether they think the person is fit to stand trial. A recent report from the Independent Rikers Commission found this part of the process alone takes an average of 43 calendar days to complete. In the meantime, defendants are either detained or await results outside of jail, depending on their pretrial release conditions.

Prosecutors and defense attorneys can either agree with the psychiatrists’ findings or challenge them. Then, a judge decides whether the person is mentally fit to stand trial. If they are, the case moves forward normally.

But if the judge finds that the defendant is mentally unfit, then there are two possible outcomes, depending on the seriousness of the charges. A person charged with a misdemeanor might be observed for a few weeks, but then the cases is usually dismissed, according to legal experts. For a felony, the case is typically put on pause while the defendant goes to the hospital for treatment and education courses about the legal system. The case resumes after the defendant is “restored to competency,” meaning that the person’s mental state is stable enough to understand what’s happening and participate in their own defense.

New York City defendants who are mentally unable to stand trial typically go to one of two state-run hospitals: Kirby Forensic Psychiatric Center on Wards Island or Mid-Hudson Forensic Psychiatric Center in Orange County. The number of beds is low, and so is the turnover rate, which means defendants who have been found unfit to stand trial wait on Rikers for weeks or even months to go to hospitals. The average wait time was 79 days as of last fall, according to the Independent Rikers Commission report.

“It certainly increases the likelihood of their illnesses becoming even more entrenched and resistant to treatment,” Stern said. “The longer somebody is disconnected from treatment, the harder it is to treat that individual.”

The number of court-ordered psychiatric exams has climbed in recent years, as has the number of people found unfit to stand trial, which has further strained the system.

Data from the city agency that provides medical care on Rikers, Correctional Health Services, shows the number of people found mentally unfit more than doubled citywide between 2020 and 2024, from 372 to 898. But the number of beds available to restore people across the state to competency has only risen by less than 10% over the same period, according to state data.

Read More: Gothamist