This study explores the effectiveness of antipsychotic medications in restoring competency to stand trial in individuals with severe mental illness, particularly psychotic disorders. While antipsychotic medications are known for reducing symptoms of psychosis, this research focuses on their ability to improve functional outcomes necessary for competency to stand trial (CST). Among over 3,000 patients in California’s forensic state hospital system, 86.5% were successfully restored to competency, with 98.8% discharged on antipsychotic medications. Patients on antipsychotic monotherapy demonstrated higher restoration rates compared to those requiring additional mood stabilizers, suggesting that more complex cases demand more intensive treatment. Delusional disorder, traditionally seen as more resistant to treatment, showed a high restoration rate of 93.8% with antipsychotic use.

Our findings emphasize the pivotal role of antipsychotics in not only reducing symptoms but also in restoring critical functional abilities for participation in legal proceedings. The functional improvements they enable extend beyond the courtroom. Incorporation of antipsychotic medication as an integral evidence-based mechanism in facilitating community reintegration for individuals with severe mental illness supports the broader goal of transitioning individuals from the legal system back into society, consistent with the ultimate promise of deinstitutionalization.

Despite significant scholarship, research, and funding dedicated to implementing criminal diversion programs over the past two decades, persons with serious mental illness and substance use disorders remain substantially overrepresented in United States jails and prisons. Why are so many U.S. adults with behavioral health problems incarcerated instead of receiving treatment and other support to recover in the community? In this paper, we explore this persistent problem within the context of “relentless unmet need” in U.S. behavioral health (Alegría et al., 2021).

This essay explores four key dimensions of political science literature on the U.S. criminal legal system, by way of introducing articles in the special issue on criminal justice featured in the Journal of Racial and Ethnic Politics. We situate police as an institution of social control, rather than providing safety for people vulnerable to crime. The vast array of policy tools to surveil, track, and detain citizens, which lack commensurate restraints on their application, amount to a finely tuned carceral machine that can be deployed against groups newly identified as deviant. We therefore turn attention to this dynamic with our second theme: the criminalization of immigrants, the expansion of interior immigration enforcement, and the consequent targeting of Latinx people. We likewise discuss lessons for reform that can be drawn from research on representation and the political socialization that occurs as a consequence of involuntary contact with the system. We conclude with a brief discussion of directions for future research. The criminal legal system is a key force for persistent racial and class inequality. By turning attention to the politics of the criminal legal system, we forward a critical and understudied facet of American political life that intersects with all corners of the discipline.