After seven days of deliberations, a jury in Plymouth, Massachusetts, failed to reach a unanimous verdict in Lindsay Clancy’s trial, leading the judge to declare a mistrial. Clancy admitted strangling her three young children in 2023. Her lawyers argued that postpartum psychosis left her not criminally responsible.
The deadlock came at the end of a five-week trial that had divided the public over the degree to which mental illness should mitigate responsibility for a crime. Hundreds of women rallied for Clancy outside the courthouse, but her support base online was far larger. Clancy-related communities on social-media platforms number in the tens of thousands. Pro-Clancy posts, often portraying her as a victim of a failed mental-health system, have drawn tens of thousands of upvotes. Others see that sympathy as badly misplaced, given that her actions left three children dead.
Finally, a reason to check your email.
Sign up for our free newsletter today.
The controversy reflects a broader cultural shift toward casting offenders themselves as victims of mental illness or trauma. Progressive reformers argue that courts should divert offenders with mental-health conditions into treatment instead of jail or prison. Over the past decade, the growing popularity of this approach has reshaped the mental-health system.
Tewksbury Hospital, where Clancy has been confined for the past three years, stands itself at the center of a larger crisis. State psychiatric hospitals have become a new battleground over where mentally ill offenders belong.
Tewksbury is a state psychiatric hospital intended to serve patients admitted voluntarily or through civil commitment. Today, a large share of its psychiatric population comes through the criminal-justice system. According to the Massachusetts Nurses Association, which represents nurses at Tewksbury, 112 of roughly 160 recent psychiatric patients came from corrections. The union says Tewksbury has effectively become a mental-health correctional facility without the staffing, infrastructure, or security practices needed to operate safely.
Hospital workers say the growing court-involved population has brought persistent violence and security problems. Tewksbury’s public-safety department responded to 478 assaults in 2025. Nurses and other employees have reported being punched, threatened, groped, and attacked by patients, while civil psychiatric patients have told staff that they avoid therapeutic groups because they feel unsafe.
The hospital has also struggled with escapes. Police recorded 39 unauthorized departures between 2018 and 2023, and in May 2024, officers had to track down a court-committed patient with a history of sexual assault, setting fires, and attacks on elderly people after he escaped for the fourth time. The Massachusetts Nurses Association attributes this “epic epidemic of violence” to the state’s failure to manage the influx of court-involved patients.
Yet Massachusetts officials have responded as if the greater danger were making the hospital feel too much like a correctional institution. This spring, the hospital barred Tewksbury security officers from using pepper gel, batons, and handcuffs against patients. Tewksbury’s CEO stressed that the hospital is a “place of healing” and that its security policies should reflect its “therapeutic mission.” Less than a week later, police charged a patient with assaulting an employee. More violent incidents followed, and the hospital partially reversed the policy after protests from workers and local officials.
Tewksbury is part of a national trend afflicting an already-strained psychiatric system, where state-hospital beds are scarce and waits for inpatient care can last weeks or months. In 2023, forensic patients—those sent to state hospitals through the criminal courts—occupied 52 percent of all state psychiatric-hospital beds. That share rose 18 percentage points since 2010. The share of forensic patients in Texas state hospitals went from 28 percent in 2006 to 71 percent today. In some states, they now occupy virtually the entire state-hospital system.
Much of the recent growth in forensic patients has come through competency restoration. Competency concerns a defendant’s ability to stand trial, not whether he was responsible for the crime itself. Someone too impaired to understand the proceedings or to assist his lawyer cannot be prosecuted until his condition improves. Once a judge finds him incompetent, the criminal case is suspended while clinicians attempt to “restore” his competency, typically through psychiatric treatment and instruction designed to help him understand and participate in the court process. In many states, these defendants are sent to state psychiatric hospitals for restoration.
Across 30 states, the number of patients hospitalized for competency restoration increased 33 percent between 2022 and 2024 alone. A national survey found that 82 percent of states were seeing increases in competency evaluations, and 78 percent increases in referrals for restoration of competency. The Texas State Auditor found that the competency-restoration waitlist had risen 247 percent between 2018 and the end of 2023. In North Carolina, defendants found unfit to stand trial accounted for just over 1 percent of state-hospital admissions in 2005 but 36 percent last year. DeCarlos Brown Jr., accused of fatally stabbing 23-year-old Iryna Zarutska on a Charlotte train, is among the defendants recently found incompetent there.
For defendants, hospitalization can carry significant advantages over remaining in jail. Psychiatric hospitals generally offer more freedom and privileges than correctional facilities. In many states, time spent confined for competency treatment can count toward an eventual sentence; Massachusetts is one of them. If the defendant is never restored to competence, the state may eventually dismiss the charges. Oregon researchers examined 2,499 people who had undergone hospital restoration and found 38 percent ultimately had all charges dismissed. Some defendants are released, while others are converted to civil commitment and cease to appear in statistics counting the forensic population.
These incentives are well known to forensic psychiatrists. “Malingering” refers to deliberately faking or exaggerating psychiatric symptoms for an external benefit, including avoiding incarceration or prosecution. A 2025 study in the Journal of the American Academy of Psychiatry and the Law cited studies reporting malingering rates as high as 38 percent among defendants facing serious charges such as murder and robbery.
A finding of incompetence also creates a formal court record that the defendant was considered too mentally impaired to stand trial, which defense attorneys can later cite when arguing for reduced criminal responsibility. The National Association of Criminal Defense Lawyers is devoting its national fall seminar this year to mental and behavioral health, which it describes as “underutilized” in criminal litigation. The training covers competency and criminal responsibility as well as the use of mental illness to seek leniency at sentencing. One session teaches a diversion model intended to “Decriminalize Mental Illness.”
The influx of criminal defendants is pushing state hospitals beyond what they were designed to handle. Recent state reports and local investigations have documented problems associated with growing forensic populations in Massachusetts, Virginia, Hawaii, Florida, Oregon, Pennsylvania, Washington, Ohio, California, Maine, Illinois, North Carolina, Maryland, Indiana, Texas, Arkansas, South Carolina, and Vermont. These problems include assaults, deaths, escapes, security failures, and the loss of beds for civil psychiatric patients.
Violence and difficult working conditions can make it harder for hospitals to retain enough staff to keep existing beds open. Virginia found that forensic patients remain hospitalized about three times longer than civil patients and have “substantially reduced” the capacity available for civil admissions. In North Carolina, staffing shortages have left roughly one-third of state-hospital beds offline, while criminal defendants now occupy about one-third of the beds that remain. Civil psychiatric patients spend weeks or months waiting in emergency departments or local hospitals for admission.
Forensic patient populations aren’t growing only because there are more defendants with psychiatric problems. There has also been an organized movement to shift mentally ill defendants out of jails and into treatment. Many civil-rights, disability, and mental-health advocacy organizations describe their goal as “decriminalizing mental illness” or “decarceration,” pressing for diversion from prosecution and incarceration, including for defendants found incompetent to stand trial.
One can see this strategy at work in competency litigation across the country. By 2023, at least 16 states had faced lawsuits over delays in competency restoration. New cases have been filed since then. ACLU affiliates, disability-rights groups, and public defenders have sought strict deadlines for moving defendants out of jail and into treatment. States that fail to comply can face contempt findings and substantial financial penalties, creating powerful pressure to reserve scarce hospital capacity for criminal defendants.
States should take a different approach. Manhattan Institute senior fellow Stephen Eide argues that they should invest in psychiatric care inside jails rather than continually moving offenders into state hospitals. Jails already have legal obligations to provide health care, and competency restoration often consists of psychiatric stabilization along with teaching defendants enough about the legal process to participate in their cases. States can fund specialized restoration programs within secure correctional settings while reserving hospital transfer for defendants whose conditions actually require hospital-level treatment. The ACLU has opposed this approach, calling jail-based competency treatment “inhumane” and arguing that defendants should instead receive restoration in a therapeutic setting.
Eide’s proposal recognizes that treatment and criminal accountability can coexist. A defendant can suffer from serious mental illness and still belong within the criminal-justice system. Improving psychiatric care in jails would allow states to provide treatment without turning ordinary psychiatric hospitals into de facto correctional facilities. It would also preserve scarce civil beds and reduce the burden on staff and patients when hospitals are asked to manage forensic populations they were not designed to house.
The debate over Lindsay Clancy reflects the same tendency to treat compassion for the offender as incompatible with criminal accountability. Much of the public response has centered on her suffering rather than on the three children she killed. The same priorities appear in policy when the needs of offenders take precedence over crime victims, hospital workers, and psychiatric patients who committed no crime.