Stiavetti v. Ahlin (State Hospital Suit)

The ACLU Foundation of Northern California, along with Sullivan & Cromwell, won a lawsuit to protect the constitutional rights of defendants with psychiatric and intellectual disabilities in California.

In 2015, the ACLU and Sullivan & Cromwell represented family members of Californians with severe mental illness and developmental disabilities in bringing a legal challenge to California’s Department of State Hospitals (DSH) and Department of Developmental Services (DDS) for allowing their loved ones to languish in jails for months before receiving any treatment after being deemed “incompetent to stand trial” (IST). The lawsuit demanded that the state reduce the lengthy delays that these individuals face in being transferred from county jails to treatment.

At the time of filing, hundreds of people were languishing in county jails for extended periods of time, waiting to be transferred to treatment. In 2015, the average length of time an IST defendant spent waiting for transfer was 75 days.

California courts recognized that California violates the constitutional rights of individuals by leaving them in jail without access to treatment, and with their criminal proceedings stalled. In 2019, the trial court ruled in favor of the Stiavetti plaintiffs and ordered DSH to “commence substantive services” for people declared IST “within 28 days.” In June 2021, the California Court of Appeal upheld the trial court’s order, finding that DSH had “systematically failed to provide due process” to IST defendants and recognizing the “undisputed harms these defendants suffer due to prolonged incarceration in county jails.” A month later, the California Supreme Court denied the State’s request for review of the Court of Appeal ruling. This means the trial court’s ruling is final and binding. The case is now in the enforcement phase.

California's failure to provide prompt treatment for IST defendants continued for years into the litigation. According to DSH data from June 2022, over 1700 people declared IST were awaiting transfer to a state hospital or other medical facility. The average wait time for transfer was at the time 141 days—nearly double the wait time of when the case was filed.

The state long resisted judicial oversight, and sought extensions to delay the implementation of the court’s deadlines for compliance with the trial court ruling.

California ultimately responded to the call for an end to the warehousing of mentally ill people in the state’s jails with increased resources and political commitment. Propelled by this litigation and advocacy from the ACLU and others—including Disability Rights California and the California Public Defenders Association—there have been critical reforms to how people deemed IST are treated in California.

• There are now more opportunities for treatment and diversion, rather than warehousing in jails, especially for lower-level offenses.

• Judges are required to evaluate whether it is in the public interest to seek to restore individuals to competency for prosecution, and this is no longer an option for the lowest-level offenses.

• Los Angeles led the way with a visionary community-based treatment program, the Office of Diversion and Re-entry, which has grown considerably and shown tremendous results, including especially in producing very low recidivism rates.

The State also took some steps which raise concerns and deserve continued public oversight. In particular, the state created an “Early Access to Stabilization Services” (EASS) program as a short-term jail-based stabilization program for people deemed IST. While individuals certainly benefit from increased services, any effort by the State to assert that EASS programming on its own constitutes constitutionally compliant treatment would degrade the definition of competency-restoration treatment and the State's constitutional obligations.

On September 21, 2026, more than eleven years after the case was filed, the trial court terminated judicial oversight, finding DSH "in substantial compliance" with the court's order. The other defendant in the lawsuit, the California Department of Developmental Services (DDS), was found to be in substantial compliance with the judgment in October 2025.

The trial court, in ending supervision of DSH, acknowledged that a full examination of the EASS program was not before the court. The plaintiffs in Stiavetti did not challenge EASS because, at the time DSH requested an end to court supervision, individuals deemed IST were not enrolled in EASS for extended periods of time and DSH affirmed in sworn testimony that it was treating the court order as requiring it to admit IST defendants to an inpatient or outpatient program, or provide some other non-EASS outcome, within 28 days even for EASS-enrolled individuals.

A decade after the case was filed, people deemed IST no longer expect to be warehoused in jails for months pretrial before accessing treatment. This is an extraordinary success. ACLU NorCal continues to monitor the state’s compliance with its constitutional obligations with regard to this vulnerable population.

Learn more

'You can't get out': Mentally ill languish in California jails without trial or treatment (Los Angeles Times, September 14, 2022)

California Supreme Court Rules that the State Must Address the Prolonged Detention in County Jails of Defendants Deemed Incompetent to Stand Trial (Press Release, August 25, 2021)

California Court Rejects the State's Prolonged Detention of People with Psychiatric and Intellectual Disabilities in County Jails (Press Release, June 16, 2021)

Court Rules State Violating Due Process Rights of Defendants with Psychiatric and Intellectual Disabilities (Press Release, March 26, 2019)

ACLU Sues State Hospital System for Failing Criminal Defendants with Psychiatric & Intellectual Disabilities (Press Release, July 29, 2015)