Skip to main content Accessibility help
Hostname: page-component-cd4964975-xtmlv Total loading time: 0 Render date: 2023-03-31T17:13:32.815Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true

Chapter 36 - Length of Stay for Inpatient Incompetent to Stand Trial (IST) Patients: Importance of Clinical and Demographic Variables

from Part V - Criminal Justice and Social Considerations

Published online by Cambridge University Press:  19 October 2021

Katherine Warburton
University of California, Davis
Stephen M. Stahl
University of California, San Diego
Get access


State psychiatric hospitals face increasing referrals for the evaluation and restoration of individuals whose mental health symptoms render them incompetent to stand trial (IST). As referrals can overwhelm capacity for admission, state hospitals at times are unable to admit IST patients in a timely fashion. The resulting use of “waitlists” have the undesirable consequence of forcing symptomatic individuals to endure long waits (while jailed) for admission to a psychiatric hospital. These long wait times have been determined to be unconstitutional, resulting in litigation against the responsible state mental health authorities. Unfortunately, available options to expedite hospital admission of these IST patients can have significant clinical and economic consequences.

Publisher: Cambridge University Press
Print publication year: 2021

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.)


National Association of State Mental Health Program Directors. Assessment #10: Forensic Patients in State Psychiatric Hospitals: 1999–2016. 2017. (accessed June 2020).
Bellisle, M. After paying $83 million in fines, Washington settles jail mental-health lawsuit. Seattle Times. December 12, 2018.
Pirelli, G, Gottdiener, WH, Zapf, PA. A meta-analytic review of competency to stand trial research. Psychol Public Policy Law. 2011; 17(1): 153.
Gay, JG, Vitacco, MJ, Ragatz, L. Mental health symptoms predict competency to stand trial and competency restoration success. Legal Criminol Psychol. 2017; 22(2): 288301.
Morris, DR, DeYoung, NJ. Long-term competence restoration. J Am Acad Psychiatry Law. 2014; 42(1): 8190.
Morris, DR, Parker, GF. Effects of advanced age and dementia on restoration of competence to stand trial. Int J Law Psychiatry. 2009; 32(3): 156160.
Grossi, LM, Green, D, Schneider, M, et al. Personality, psychiatric, and cognitive predictors of length of time for competency to stand trial restoration. Int J Forensic Ment Health. 2018; 17(2): 167180.
Colwell, LH, Gianesini, J. Demographic, criminogenic, and psychiatric factors that predict competency restoration. J Am Acad Psychiatry Law. 2011; 39(3): 297306.
Toofanian Ross, P, Padula, CB, Nitch, SR, et al. Cognition and competency restoration: using the RBANS to predict length of stay for patients deemed incompetent to stand trial. Clin Neuropsychol. 2015; 29(1): 150165.
Nicholson, RA, Barnard, GW, Robbins, L, et al. Predicting treatment outcome for incompetent defendants. Bull Am Acad Psychiatry Law. 1994; 22(3): 367–377.
Mossman, D. Predicting restorability of incompetent criminal defendants. J Am Acad Psychiatry Law. 2007; 35(1): 34–43.
Morris, DR, Parker, GF. Jackson’s Indiana: state hospital competence restoration in Indiana. J Am Acad Psychiatry Law. 2008; 36(4): 522534.
Renner, M, Newark, C, Bartos, BJ, McCleary, R, Scurich, N. Length of stay for 25,791 California patients found incompetent to stand trial. J Forens Legal Med. 2017; 51: 2226.
Department of State Hospitals. Violence Report DSH 2010–2017. 2019.–2017.pdf (accessed January 2020).
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Text Revision (DSM-IV-TR®). Washington, DC: American Psychiatric Association Publishing; 2000.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th edn. (DSM-5®). Washington, DC: American Psychiatric Association Publishing; 2013.
Broderick, C, Azizian, A, Kornbluh, R, et al. Prevalence of physical violence in a forensic psychiatric hospital system during 2011–2013: patient assaults, staff assaults, and repeatedly violent patients. CNS Spectr. 2015; 20(3): 319330.
Monrad, AIH. Global Assessment of Functioning (GAF) properties and frontier of current knowledge. Ann Gen Psychiatry. 2010; 9(1): 20.
R Core Team. R: a language and environment for statistical computing. R Foundation for Statistical Computing; 2018. (accessed June 2020).
Harrell, FE. Regression Modeling Strategies: With Applications to Linear Models, Logistic and Ordinal Regression, and Survival Analysis. New York and Switzerland: Springer International Publishing; 2015.
Carroll, KJ. On the use and utility of the Weibull model in the analysis of survival data. Controlled Clin Trials. 2003; 24(6): 682701.
Hilbe, JM. Logistic Regression Models. Boca Raton, FL: CRC Press; 2009.
Kinon, BJ. The group of Treatment-Resistant Schizophrenias: heterogeneity in Treatment-Resistant Schizophrenia (TRS). Front Psychiatry. 2018; 9(9): 757.
Bak, N, Ebdrup, BH, Oranje, B, et al. Two subgroups of antipsychotic-naive, first-episode schizophrenia patients identified with a Gaussian mixture model on cognition and electrophysiology. Transl Psychiatry. 2017; 7(4): e1087.
Chang, WC, Ho, RWH, Tang, JYM, et al. Early-stage negative symptom trajectories and relationships with 13-year outcomes in first-episode nonaffective psychosis. Schizophr Bull. 2019; 45(3): 610619.
Elvevag, B, Goldberg, TE. Cognitive impairment in schizophrenia is the core of the disorder. Crit Rev Neurobiol. 2000; 14(1): 121.
Green, MF. Cognitive impairment and functional outcome in schizophrenia and bipolar disorder. J Clin Psychiatry. 2006; 67(9): 38; discussion 36–42.
MacCabe, JH. Population-based cohort studies on premorbid cognitive function in schizophrenia. Epidemiol Rev. 2008; 30: 7783.
Schwalbe, E, Medalia, A. Cognitive dysfunction and competency restoration: using cognitive remediation to help restore the unrestorable. J Am Acad Psychiatry Law. 2007; 35(4): 518525.
Palmer, BW, Loughran, CI, Meeks, TW. Cognitive impairment among older adults with late-life schizophrenia or bipolar disorder. Continuum (Minneap Minn). 2010; 16(2): 135152.
Reichenberg, A, Weiser, M, Rabinowitz, J, et al. A population-based cohort study of premorbid intellectual, language, and behavioral functioning in patients with schizophrenia, schizoaffective disorder, and nonpsychotic bipolar disorder. Am J Psychiatry. 2002; 159(12): 20272035.
Lewandowski, KE, Whitton, AE, Pizzagalli, DA, et al. Reward learning, neurocognition, social cognition, and symptomatology in psychosis. Front Psychiatry. 2016; 7: 100.
Fagiolini, A, Goracci, A. The effects of undertreated chronic medical illnesses in patients with severe mental disorders. J Clin Psychiatry. 2009; 70(3): 2229.
Scurich, N. Personal communication requesting clarification of table dated November 14, 2017. ed.

Save book to Kindle

To save this book to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats