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In an effort to identify modifiable risk factors for suicide in New York State prisons, the authors reviewed available statistical data and also examined a series of 40 psychological autopsies conducted on suicides of inmates who had received mental health services during their incarceration. Factors associated with suicide included substance abuse, history of prior suicide attempts, mental health treatment prior to incarceration, recent "bad news," recent disciplinary action, and manifestation of agitation and/or anxiety. This review led to changes in certain clinical policies and procedures, environmental modifications and hazard reduction in observation cells, and an improved process for quality assurance reviews of suicides.

Non-secure state operated psychiatric centers and community based providers of mental health services have witnessed an increase in their caseloads of defendants adjudicated not responsible for criminal activity as a result of mental disease or defect (NGRIs). NGRIs receiving services in these traditionally non-forensic settings are subject to continued court supervision by virtue of Court Orders of Conditions that are designed to assure that NGRIs receive services in a manner that is consistent with the public safety. Several characteristics of the current service delivery system often impede the ability to fulfill statutory mandates and the effective delivery of services to NGRIs. The authors provide an overview of the statutory provisions governing the care of NGRIs, discuss obstacles to the implementation of integrated services to NGRIs and propose a model for the development of an effective community based monitoring and treatment program.

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