Adminstrative issues in the follow-up treatment of insanity acquittees

Abstract

This paper discusses issues in the community-based management of forensic patients. Community acceptance and safety demand a careful system of follow-up treatment for insanity acquittees. Many studies have examined the recidivism of this population, but few have dealt with administrative strategies to manage their care as outpatients. In this paper, we discuss our experiences in developing systems for follow-up care of insanity acquittees in the state of Maryland. Central to this work is the balancing of clinical, judicial and community concerns. The decision for outpatient care or movement of the patient to a non-forensic (regional) hospital is a significant turning point in the forensic patient's care. One of the major challenges faced by forensic mental health services is to develop consistency of practice throughout a state. A centralized system is easier to manage, but costly. A system embedded in community mental health centers is less duplicative, but requires major and ongoing educational support. A private practice model is flexible, but administratively challenging. The authors believe Maryland possesses well-developed approaches for the evaluation, treatment and conditional release of insanity acquittees. The state continues to study and redesign its systems toward increased effectiveness and efficiency.

The New Orleans Forensic Aftercare Clinic: a seven year review of hospital discharged and jail diverted clients

“…Given the increasing involvement of persons with mental illnesses in the criminal justice system, the issue of ongoing community based treatment has assumed increasing importance (Lamb, Weinberger, & Gross, 1999). Numerous states and countries are currently addressing issues related to forensic aftercare and several researchers and clinicians have presented information about their specific state or country's forensic aftercare (Lamb, Weinberger, & Gross, 1988;Miraglia & Giglio, 1993;Rogers, Bloom, & Manson, 1982, 1986Muller-Isberner, 1996;Spodak, Silver, & Wright, 1984;Silver & Tellefsen, 1991). The state of Louisiana has reviewed and restructured the way forensic aftercare is addressed, and this process will be discussed in the article.…”

Evaluating conditional release in female insanity acquittees: A risk management perspective.

“…There has been a recent proliferation of research focusing on the conditional release of mentally disordered offenders to the community after a period of institutionalization (Fox, 2008; McDermott & Thompson, 2006; Monson, Gunnin, Fogel, & Kyle, 2001; Silver & Tellefsen, 1991; Soliman & Resnick, 2006). The goal of conditional release is to provide community-based treatment to mentally disordered offenders along with structured supervision, which in turn reduces their risk for violence and recidivism (Tellefsen, Cohen, Silver, & Dougherty, 1992).…”

New Frontiers for Conditional Release: Applying Lessons Learned from Other Offenders with Mental Illness

“…In the conditional‐release context, this may lead to an out‐of‐sight, out‐of‐mind mentality towards insanity acquittees who no longer regularly appear before the court. Community mental health providers may then be given nearly sole responsibility for the acquittee, often without the knowledge or resources to effectively communicate problems to the court (Silver, Cohen, & Spodak, ; Silver & Tellefsen, ).…”

“…Despite the amendments, however, Texas still experiences problems when it comes to supervising acquittees (Peters & Lex, in press). A large system of agencies, professionals, and supervision create conditions in which timely, nimble, idiographic actions are difficult (Silver & Tellefsen, ). Consequently, small transgressions snowball into larger violations of the conditional release, leading to revocations or rehospitalizations that could have been avoided with better communication and collaboration among treatment, judicial, and law providers.…”