Abstract:Introduction.In recent years mental health officials have reported a rise in the number of forensic patients present within their state psychiatric hospitals and the adverse impacts that these trends had on their hospitals. To date there have been no large-scale national studies conducted to determine if these trends are specific only to a few states or representative of a more global trend. The purpose of this study was to investigate these reported trends and their national prevalence.Methods.The forensic di… Show more
“…Colorado reported a 206% increase in the number of competence evaluations from 2005 to 2014 (Colorado Department of Human Services, ), and Los Angeles county reported a 273% increase from 2010 to 2015 (Sewall, ) (p. 2).The rapid rise in court orders for competence evaluation corresponds to what has been labeled the “criminalization of mental illness” (Abramson, ; for a review, see Lamb & Weinberger, ), the well recognized trend wherein public mental health treatment has become increasingly rare and difficult to access, such that criminal arrest (often followed by a competence evaluation) has become one of the only remaining mechanisms to link people with chronic mental illness to public mental health treatment. Consequently, the proportion of forensic (versus civil) patients in state psychiatric hospitals has increased dramatically in recent years, and most of these forensic patients are hospitalized for competence restoration services (Gowensmith, ; Wik, Hollen, & Fisher, ).…”
Competence to stand trial (CST) evaluations are a critical part of certain criminal proceedings, and competence‐related evaluation and treatment are an increasing part of public mental health services. Whereas more research describes the defendants undergoing competence evaluations, less research has examined the actual reports detailing those competence evaluations. This study reviewed 3,644 court‐ordered CST evaluation reports submitted by 126 evaluators in Virginia since Virginia initiated an oversight system allowing for comprehensive review. The base rate of incompetence opinions was 38.8%, but these rates varied significantly across evaluation type (initial versus post‐restoration efforts) and evaluators (ranging from 9.1% to 76.8% incompetence rate). Results suggest generally strong compliance with state statutes guiding CST evaluations, but also highlight marked variability in forensic conclusions and reveal a few areas in which some reports fell short of statutory requirements and practice guidelines.
“…Colorado reported a 206% increase in the number of competence evaluations from 2005 to 2014 (Colorado Department of Human Services, ), and Los Angeles county reported a 273% increase from 2010 to 2015 (Sewall, ) (p. 2).The rapid rise in court orders for competence evaluation corresponds to what has been labeled the “criminalization of mental illness” (Abramson, ; for a review, see Lamb & Weinberger, ), the well recognized trend wherein public mental health treatment has become increasingly rare and difficult to access, such that criminal arrest (often followed by a competence evaluation) has become one of the only remaining mechanisms to link people with chronic mental illness to public mental health treatment. Consequently, the proportion of forensic (versus civil) patients in state psychiatric hospitals has increased dramatically in recent years, and most of these forensic patients are hospitalized for competence restoration services (Gowensmith, ; Wik, Hollen, & Fisher, ).…”
Competence to stand trial (CST) evaluations are a critical part of certain criminal proceedings, and competence‐related evaluation and treatment are an increasing part of public mental health services. Whereas more research describes the defendants undergoing competence evaluations, less research has examined the actual reports detailing those competence evaluations. This study reviewed 3,644 court‐ordered CST evaluation reports submitted by 126 evaluators in Virginia since Virginia initiated an oversight system allowing for comprehensive review. The base rate of incompetence opinions was 38.8%, but these rates varied significantly across evaluation type (initial versus post‐restoration efforts) and evaluators (ranging from 9.1% to 76.8% incompetence rate). Results suggest generally strong compliance with state statutes guiding CST evaluations, but also highlight marked variability in forensic conclusions and reveal a few areas in which some reports fell short of statutory requirements and practice guidelines.
“…Space limitations do not permit a comprehensive review, but rather, we present an overview of the competency research as it pertains to criminalization with a focus on recent history and current trends. The interested reader is referred to the other articles in this special issue for more data and detail on related issues, and to other sources 1 – 4 …”
Section: Competence To Stand Trial and Criminalization: An Overview Omentioning
Beginning in the 1960s, a steady decline in the number of inpatient psychiatric beds has occurred across the United States, primarily as a result of stricter civil commitment criteria and a societal movement toward deinstitutionalization. Concomitant with this decrease in psychiatric beds has been a steady increase in the number of mentally ill individuals who are arrested and processed through the criminal justice system as defendants. One consequence of this has been an explosion in the number of defendants referred for evaluations of their present mental state—adjudicative competence—and subsequently found incompetent and ordered to complete a period of competency restoration. This has resulted in forensic mental health systems that are overwhelmed by the demand for services and that are unable to meet the needs of these defendants in a timely manner. In many states, lawsuits have been brought by defendants who have had their liberties restricted as a result of lengthy confinements in jail awaiting forensic services. The stress on state-wide forensic systems has become so widespread that this has reached the level of a near-national crisis. Many states and national organizations are currently attempting to study these issues and develop creative strategies for relieving this overburdening of forensic mental health systems nationwide. The purpose of this article is to review the current state of the research on competence to stand trial and to highlight those issues that might be relevant to the issue of criminalization of individuals with mental illness in the United States.
“…Recent information indicates that the number of forensic patients in state hospitals has been increasing, largely driven by an increase in patients referred as incompetent to stand trial (IST) 1 , 2 . The surge in referrals for the evaluation and restoration of patients found IST is taxing state hospital systems, as well as the jails that must care for these patients when state hospitals are unable to accommodate the increased referrals 3 , 4 .…”
Section: Introductionmentioning
confidence: 99%
“…Although this 2014 survey confirmed anecdotal reports and indirect data about increasing forensic admissions, it did not specifically address increases in IST patients within the larger forensic population. Recently, national data have emerged confirming that the number of forensic patients in state hospitals from 1999 to 2016 has increased by 76%, and IST patients are largely responsible for this trend 2 …”
Objective.Recent information indicates that the number of forensic patients in state hospitals has been increasing, largely driven by an increase in patients referred to state hospitals as incompetent to stand trial (IST). This survey was intended to broaden the understanding of IST population trends on a national level.Methods.The authors developed a 30-question survey to gather specific information on IST commitments in each state and the District of Columbia. The survey was administered to all 50 states and the District of Columbia via email. Specific individuals identified as primary administrators responsible for the care and evaluation of IST admissions in each state were contacted.Results.A total of 50 out of the 51 jurisdictions contacted completed the survey. Fully 82% of states indicated that referrals for competency evaluation were increasing. Additionally, 78% of respondents thought referrals for competency restoration were increasing. When asked to rank factors that led to an increase, the highest ranked response was inadequate general mental health services in the community. Inadequate crisis services were the second ranked reason. Inadequate number of inpatient psychiatric beds in the community was the third highest, with inadequate assertive community treatment services ranking fourth.Conclusions.Understanding the national trend and causes behind the recent surge in referrals for IST admissions will benefit states searching for ways to remedy this crisis. Our survey indicates most states are facing this issue, and that it is largely related to insufficient services in the community.
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