Hostname: page-component-8448b6f56d-mp689 Total loading time: 0 Render date: 2024-04-18T02:15:22.976Z Has data issue: false hasContentIssue false
  • English
  • Français

A survey of national trends in psychiatric patients found incompetent to stand trial: reasons for the reinstitutionalization of people with serious mental illness in the United States

Published online by Cambridge University Press:  09 January 2020

Katherine Warburton Open the ORCID record for Katherine Warburton [Opens in a new window] ,
Barbara E. McDermott Open the ORCID record for Barbara E. McDermott [Opens in a new window] ,
Anthony Gale  and
Stephen M. Stahl
Katherine Warburton*
Affiliation:
California Department of State Hospitals, Sacramento, California, USA University of California Davis, Davis, California, USA
Barbara E. McDermott
Affiliation:
University of California Davis, Davis, California, USA
Stephen M. Stahl
Affiliation:
California Department of State Hospitals, Sacramento, California, USA University of California, San Diego, California, USA University of Cambridge, Cambridge, United Kingdom
*
*Address correspondence to: Katherine Warburton, California Department of State Hospitals, Sacramento, California, USA. (Email: katherine.warburton@dsh.ca.gov)
Get access Rights & Permissions [Opens in a new window]

Abstract

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.

Keywords

Incompetentstandtrialnationaltrendssurvey.
Type
Original Research
Information
CNS Spectrums , Volume 25 , Issue 2 , April 2020 , pp. 245 - 251
Copyright
© Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

References:

Fitch, WL. Forensic mental health services in the United States. National Association of State Mental Health Program Directors Policy Paper; 2014.Google Scholar
Wik, A, Hollen, V, Fisher, WH. Forensic patients in state psychiatric hospitals: 1999-2016. National Association of State Mental Health Program Directors Policy Paper; 2017.Google Scholar
Grissom , B. With state hospitals packed, mentally ill inmates wait in county jails that aren’t equipped for them. Dallas Morning News. 2016. https://www.dallasnews.com/news/politics/2016/04/21/with-state-hospitals-packed-mentally-ill-inmates-wait-in-county-jails-that-aren-t-equipped-for-them/.Google Scholar
Jail wait times are inhumane for the mentally ill. The Delaware County Daily Times. 2016. https://www.delcotimes.com/opinion/editorial-jail-wait-times-are-inhumane-for-the-mentally-ill/article_cb4244a5-7113-5f8f-96a4-ab1bb0228cc2.html.Google Scholar
Dusky v. United States, 362, 402 (1960).Google Scholar
Pirelli, G, Gottdiener, WH, Zapf, PA. A meta-analytic review of competency to stand trial research. Psychol Public Policy Law. 2011;17(1):1–53.CrossRefGoogle Scholar
Warren, JI, Murrie, DC, Stejskal, W, et al. Opinion formation in evaluating the adjudicative competence and restorability of criminal defendants: a review of 8,000 evaluations. Behav Sci Law. 2006;24(2):113–132.CrossRefGoogle ScholarPubMed
Bartos, BJ, Renner, M, Newark, C, McCleary, R, Scurich, N. Characteristics of forensic patients in California with dementia/Alzheimer’s disease. J Forensic Nurs. 2017;13(2):77–80.CrossRefGoogle ScholarPubMed
Cooper, VG, Zapf, PA. Predictor variables in competency to stand trial decisions. Law Hum Behav. 2003;27(4):423–436.CrossRefGoogle ScholarPubMed
Cochrane, RE, Grisso, T, Frederick, RI. The relationship between criminal charges, diagnoses, and psycholegal opinions among federal pretrial defendants. Behav Sci Law. 2001;19(4):565–582.CrossRefGoogle ScholarPubMed
Torrey, EF, Kennard, AD, Eslinger, D, Lamb, R, Pavle, J. More mentally ill persons are in jails and prisons than hospitals: a survey of the states. Treatment Advocacy Center Policy Paper; 2010.Google Scholar
Abramson, MF. The criminalization of mentally disordered behavior. Psychiatr Serv. 1972;23(4):101–105.CrossRefGoogle ScholarPubMed
Arvanites, TM. The impact of state mental hospital deinstitutionalization on commitments for incompetency to stand trial. Criminology. 1988;26(2):307–320.CrossRefGoogle Scholar
Torrey, EF. Jails and prisons—America’s new mental hospitals. Am J Public Health. 1995;85(12):1611–1613.CrossRefGoogle ScholarPubMed
Fields, G, Phillips, EE. The new asylums: jails swell with mentally ill. The Wall Street Journal, September 25, 2013.Google Scholar
Trueblood v. Washington State Department of Social and Health Services (United States Court of Appeals, Ninth Circuit); 2016.Google Scholar
Phillips, N. Lawyers take Colorado DHS back to court over mental competency exam backlog. The Denver Post. June 14, 2018.Google Scholar
Katz, MH. Examination of increase in mental competency cases. Report to LA County Supervisors; 2016 Google Scholar
Gowensmith, WN. Resolution or resignation: the role of forensic mental health professionals amidst the competency services crisis. Psychol Public Policy Law. 2019;25(1):1–14.10.1037/law0000190CrossRefGoogle Scholar
Lamb, HR, Weinberger, LE. The shift of psychiatric inpatient care from hospitals to jails and prisons. J Am Acad Psychiatry Law. 2005;33(4):529–534.Google ScholarPubMed
Lamb, HR, Weinberger, LE, Marsh, JS, Gross, BH. Treatment prospects for persons with severe mental illness in an urban county jail. Psychiatr Serv. 2007;58(6):782–786.CrossRefGoogle Scholar
Bondurant, SR, Lindo, JM, Swensen, ID, National Bureau of Economic Research. Substance abuse treatment centers and local crime; 2016.10.3386/w22610CrossRefGoogle Scholar
Toynbee, M. The Penrose hypothesis in the 21st century: revisiting the asylum. Evid Based Mental Health. 2015;18(3):76.CrossRefGoogle ScholarPubMed
Stafford, K, Sellbom, M. Assessment of competence to stand trial. In: Weiner, I, Otto, R, eds. Handbook of Psychology, Vol 11 Forensic Psychology. Hoboken, NJ: John Wiley and Sons, Inc.; 2012:412–439.Google Scholar
Honberg, R, Diehl, S, Kimball, A, Gruttadaro, D, Fitzpatrick, M. State mental health cuts: a national crisis. National Alliance on Mental Illness; March 2011.Google Scholar
Martell, DA, Rosner, R, Harmon, RB. Base-rate estimates of criminal behavior by homeless mentally ill persons in New York City. Psychiatr Serv. 1995;46(6):596–601.Google ScholarPubMed
Martell, DA, Rosner, R, Harmon, RB. Homeless mentally disordered defendants: competency to stand trial and mental status findings. Bull Am Acad Psychiatry Law. 1994;22(2):289–295.Google ScholarPubMed
Schreiber, J, Green, D, Kunz, M, Belfi, B, Pequeno, G. Offense characteristics of incompetent to stand trial defendants charged with violent offenses. Behav Sci Law. 2015;33(2-3):257–278.CrossRefGoogle ScholarPubMed
Bastiampillai, T, Sharfstein, SS, Allison, S. Increase in US suicide rates and the critical decline in psychiatric beds. JAMA. 2016;316(24):2591–2592.CrossRefGoogle ScholarPubMed
Sisti, DA, Sinclair, EA, Sharfstein, SS. Bedless psychiatry-rebuilding behavioral health service capacity. JAMA Psychiatry. 2018;75(5):417–418.CrossRefGoogle ScholarPubMed
California’s acute psychiatric bed loss. California Hospital Association; February 2019.Google Scholar
Green, TM. Police as frontline mental health workers. The decision to arrest or refer to mental health agencies. Int J Law Psychiatry. 1997;20(4):469–486.CrossRefGoogle ScholarPubMed
Sisti, DA, Segal, AG, Emanuel, EJ. Improving long-term psychiatric care: bring back the asylum. JAMA. 2015;313(3):243–244.CrossRefGoogle ScholarPubMed
Steadman, HJ, Osher, FC, Robbins, PC, Case, B, Samuels, S. Prevalence of serious mental illness among jail inmates. Psychiatr Serv. 2009;60(6):761–765.10.1176/ps.2009.60.6.761CrossRefGoogle ScholarPubMed
Trestman, RL, Ford, J, Zhang, W, Wiesbrock, V. Current and lifetime psychiatric illness among inmates not identified as acutely mentally ill at intake in Connecticut’s jails. J Am Acad Psychiatry Law. 2007;35(4):490–500.Google Scholar
Wilper, AP, Woolhandler, S, Boyd, JW, et al. The health and health care of US prisoners: results of a nationwide survey. Am J Public Health. 2009;99(4):666–672.CrossRefGoogle ScholarPubMed
Bellisle, M. After paying $83 million in fines, Washington settles jail mental-health lawsuit. The Seattle Times. 2018.Google Scholar
Supplementary material: File

Warburton et al. supplementary material

Warburton et al. supplementary material

Download Warburton et al. supplementary material(File)
File 33.9 KB