Outpatient competency restoration programs for adults with serious mental illness

Due to increasing referrals, long waits for forensic beds, insufficient resources available in hospital- and jail-based settings, and the imperative to deliver competency restoration in the least restrictive setting possible, there is increased need for, and interest in, the creation of more outpatient competency restoration programs (OCRPs) across the United States. Jurisdictions wishing to implement OCRPs require guidance to do so. This scoping review serves as an updated and comprehensive resource to inform these efforts, summarizing academic and gray literature on OCRPs and highlighting key features of program implementation and operation and, when available, indices of effectiveness. A total of 19 OCRPs currently in operation and/or previously studied were identified. Data on these programs were largely descriptive, and available evaluations are limited in size, scope, and methodological rigor. Findings suggest OCRPs are heterogeneously implemented across jurisdictions but are cost-effective and yield restoration to competency rates similar to those observed in forensic and jail settings. Recommendations for future research are provided. (PsycInfo Database Record (c) 2026 APA, all rights reserved).