When a criminal court finds a criminal defendant incompetent to stand trial, the court usually orders competence restoration services to provide treatment until the defendant can meaningfully understand proceedings, assist counsel, and make decisions necessary for criminal adjudication. Thus, competence restoration is a form of public mental health treatment ordered by the criminal justice system. The vast majority of criminal defendants ordered to competence restoration are, indeed, ultimately ‘restored’ to competence – usually within six to twelve months – and able to participate in proceedings. A small minority are found ‘unrestorable’ – usually those with severe intellectual deficits or psychiatric symptoms that are unresponsive to treatment. As more criminal defendants are referred for competence evaluations and found incompetent, the public mental health system – particularly state psychiatric hospitals – struggles to meet increasing demands for competence restoration services, and must increasingly explore new strategies to provide competence restoration. These new strategies include a shift towards community-based and jail-based restoration services rather than sole reliance on traditional inpatient psychiatric hospitalisation for restoration.