Hostname: page-component-84b7d79bbc-x5cpj Total loading time: 0 Render date: 2024-07-28T17:58:35.693Z Has data issue: false hasContentIssue false
  • English
  • Français

A longitudinal description of incompetent to stand trial admissions to a state hospital

Published online by Cambridge University Press:  02 October 2019

Barbara E. McDermott Open the ORCID record for Barbara E. McDermott [Opens in a new window] ,
Katherine Warburton Open the ORCID record for Katherine Warburton [Opens in a new window]  and
Chloe Auletta-Young
Barbara E. McDermott*
Affiliation:
Department of Psychiatry University of California, Davis, Sacramento, California, USA
Katherine Warburton
Affiliation:
California Department of State Hospitals, Sacramento, California, USA
Chloe Auletta-Young
Affiliation:
Department of Psychiatry University of California, Davis, Sacramento, California, USA
*
*Address correspondence to: Barbara E. McDermott, PhD, Department of Psychiatry, Division of Psychiatry and the Law, UC Davis School of Medicine, 2230 Stockton Blvd., Sacramento, CA95817, USA. (Email: bemcdermott@ucdavis.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Evidence is clear that the nation is experiencing an increasing number of incompetent to stand trial (IST) admissions to state hospitals. As a result, defendants in need of treatment can wait in jail for weeks for admission for restoration. This study was conducted to better understand this growing population and to inform hospital administration about the characteristics of IST admissions.

Methods.

The study was conducted at the Department of State Hospitals (DSH) facility in Napa (DSH-Napa), a 1200-bed primarily forensic inpatient psychiatric facility located in northern California. The records of patients found IST and admitted to DSH-Napa for restoration of competence between the dates of 1/1/2009 and 12/31/2016 were eligible for inclusion in the study.

Results.

There were a total of 3158 unduplicated IST admissions available during the specified time period. Our data indicate that the number of admissions with more than 15 prior arrests increased significantly, from 17.7% in 2009 to 46.4% in 2016. In contrast, the percent of patients reporting prior inpatient psychiatric hospitalization evidenced a consistent decrease over time from over 76% in 2009 to less than 50% in 2016.

Conclusion.

Our data add to the body of literature on the potential causes of the nationwide increase in competency referrals. The literature is clear that jails and prisons are now the primary provider of the nation’s mental health care. Our data suggest that another system has assumed this role: state hospitals and other providers charged with restoring individuals to competence.

Keywords

Incompetent to stand trialdeinstitutionalizationcriminalizationmajor mental disordercompetence restoration.
Type
Original Research
Information
CNS Spectrums , Volume 25 , Issue 2 , April 2020 , pp. 223 - 236
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.)

Footnotes

The findings and conclusions in “A longitudinal description of incompetent to stand trial admissions to a state hospital” are those of the authors and do not necessarily represent the views or opinions of the Department of State Hospitals or the California Health and Human Services Agency.

References

References:

Dusky v. United States, 362 402, 1960.Google Scholar
Bonnie, R, Grisso, T. Adjudicative competency and youthful offenders. In: Grisso, T, Schwartz, R, eds. Youth on Trial: A Developmental Perspective on Juvenile Justice. Chicago, IL: University of Chicago Press; 2000:73–103.Google Scholar
Vitacco, MJ, Rogers, R, Gabel, J. An investigation of the ECST-R in male pretrial patients: evaluating the effects of feigning on competency evaluations. Assessment. 2009;16(3):249–257.CrossRefGoogle ScholarPubMed
Melton, G, Petrila, J, Poythress, N, Slobogin, C. Psychological Evaluation for the Courts: A Handbook for Mental Health Professionals. 3rd ed. New York: Guilford; 2007.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. https://www.detroitnews.com/story/news/local/michigan/2017/06/16/competency-exams-detroitcourts-mental-evaluations/102938466/. Accessed August 11, 2019.Google Scholar
Sewell, A. LA County supervisors order report on unexplained surge in mental competency cases. Los Angeles Times. March 8, 2016, 2016. https://www.denverpost.com/2018/06/14/colorado-competency-backlog/. Accessed August 11, 2019.Google Scholar
Gowensmith, WN, Frost, LE, Speelman, DW, Therson, DE. Lookin’ for beds in all the wrong places: outpatient competency restoration as a promising approach to modern challenges. Psychol Public Policy Law. 2016;22(3):293–305.CrossRefGoogle Scholar
Hinkley , JA. Despite improvements, hundreds of criminal mental health evaluations still take too long. Lansing State J. 2018. https://www.lansingstatejournal.com/story/news/local/watchdog/2018/02/22/short-staffed-michiganpsychiatric-hospitals-delay-criminal-cases/323504002/. Accessed August 11, 2019.Google Scholar
Brand-Williams , O. Competency exam increase strains system in Detroit area. The Detroit News. June 16, 2017. https://www.latimes.com/local/lanow/la-me-lnmental-competency-cases-20160308-story.html. Accessed August 11, 2019.Google Scholar
Lowder, J. Personal communication, 2017.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
McDermott, BE, Newman, WJ, Meyer, J, Scott, CL, Warburton, K. The utility of an admission screening procedure for patients committed to a state hospital as incompetent to stand trial. Int J Forensic Mental Health. 2017;16(4):281–292.CrossRefGoogle Scholar
Wik, A, Hollen, V, Fisher, WH. Forensic Patients in State Psychiatric Hospitals: 1999-2016. Alexandria, VA: National Association of State Mental Health Program Directors; 2017.Google Scholar
Miller, RD. Hospitalization of criminal defendants for evaluation of competence to stand trial or for restoration of competence: clinical and legal issues. Behav Sci Law. 2003;21(3):369–391.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
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. Arlington County, VA: Treatment Advocacy Center; 2010.Google 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
Bondurant, SR, Lindo, JM, Swenson, ID. Substance abuse treatment centers and local crime. J Urban Econ. 2018;104:124–133.CrossRefGoogle Scholar
Stafford, K, Sellbom, M. Assessment of competence to stand trial. In: Weiner, I, Otto, R, eds. Forensic Psychology. Hoboken, NJ: John Wiley and Sons, Inc; 2012:412–439. Handbook of Psychology ; vol 11.Google Scholar
Sewell, A. Report on increase in mental competency cases leaves many unanswered questions. LA Times. May 25, 2016. https://www.latimes.com/local/lanow/la-me-ln-mental-competency-cases-20160525-snap-story.html. Accessed August 11, 2019.Google Scholar
Vitacco, MJ, Rogers, R, Gabel, J, Munizza, J. An evaluation of malingering screens with competency to stand trial patients: a known-groups comparison. Law Hum Behav. 2007;31(3):249–260.CrossRefGoogle ScholarPubMed
Homsy, S, McDermott, BE, Woofter, C. Competence to Stand Trial Reports Conducted by Community Psychiatrists and Psychologists: Does Quality Matter? Seattle, Washington: American Psychology and Law Society; 2017.Google Scholar
Cooper, VG, Zapf, PA. Predictor variables in competency to stand trial decisions. Law Hum Behav. 2003;27(4):423–436.10.1023/A:1024089117535CrossRefGoogle ScholarPubMed
Frierson, RL, Shea, SJ, Shea, ME. Competence-to-stand-trial evaluations of geriatric defendants. J Am Acad Psychiatry Law. 2002;30(2):252–256.Google ScholarPubMed
Hubbard, KL, Zapf, PA, Ronan, KA. Competency restoration: an examination of the differences between defendants predicted restorable and not restorable to competency. Law Hum Behav. 2003;27(2):127–139.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
Kois, L, Pearson, J, Chauhan, P, Goni, M, Saraydarian, L. Competency to stand trial among female inpatients. Law Hum Behav. 2013;37(4):231–240.CrossRefGoogle ScholarPubMed
Pinals, DA, Packer, IK, Fisher, W, Roy-Bujnowski , K. Relationship between race and ethnicity and forensic clinical triage dispositions. Psychiatr Serv. 2004;55(8):873–878.CrossRefGoogle ScholarPubMed
Caldwell, RM, Mandracchia, SA, Ross, SA, Silver, NC. Competency to stand trial and criminal responsibility: an examination of racial and gender differences among African American and Caucasian pretrial defendants. Am J Forensic Psychol. 2003;21(3):5–19.Google Scholar
Minsky, S, Vega, W, Miskimen, T, Gara, M, Escobar, J. Diagnostic patterns in Latino, African American, and European American psychiatric patients. Arch Gen Psychiatry. 2003;60(6):637–644.10.1001/archpsyc.60.6.637CrossRefGoogle ScholarPubMed
Viljoen, JL, Zapf, PA. Fitness to stand trial evaluations: A comparison of referred and non-referred defendants. Int J Forensic Mental Health. 2002;1(2):127–138.10.1080/14999013.2002.10471168CrossRefGoogle Scholar
Gay, J, Vitacco, M, Ragatz, L. Mental health symptoms predict competency to stand trial and competency restoration success. Legal Criminol Psychol. 2017;22:288–301.CrossRefGoogle Scholar
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
Lewis, CF, Fields, C, Rainey, E. A study of geriatric forensic evaluees: who are the violent elderly? J Am Acad Psychiatry Law. 2006;34(3):324–332.Google ScholarPubMed
Mossman, D. Predicting restorability of incompetent criminal defendants. J Am Acad Psychiatry Law. 2007;35(1):34–43.Google ScholarPubMed
Morris, DR, Parker, GF. Effects of advanced age and dementia on restoration of competence to stand trial. Int J Law Psychiatry. 2009;32(3):156–160.CrossRefGoogle ScholarPubMed
Colwell, LH, Gianesini, J. Demographic, criminogenic, and psychiatric factors that predict competency restoration. J Am Acad Psychiatry Law. 2011;39(3):297–306.Google ScholarPubMed
Morris, DR, DeYoung, NJ. Psycholegal abilities and restoration of competence to stand trial. Behav Sci Law. 2012;30(6):710–728.CrossRefGoogle ScholarPubMed
Anderson, SD, Hewitt, J. The effect of competency restoration training on defendants with mental retardation found not competent to proceed. Law Hum Behav. 2002;26(3):343–351.CrossRefGoogle Scholar
Advokat, CD, Guidry, D, Burnett, DMR, Manguno-Mire , G, Thompson, JW Jr. Competency restoration treatment: differences between defendants declared competent or incompetent to stand trial. J Am Acad Psychiatry Law. 2012;40(1):89–97.Google ScholarPubMed
Rosenfeld, B, Ritchie, K. Competence to stand trial: clinician reliability and the role of offense severity. J Forensic Sci. 1998;43(1):151–157.CrossRefGoogle ScholarPubMed
Warren, JI, Rosenfeld, B, Fitch, WL, Hawk, G. Forensic mental health clinical evaluation: an analysis of interstate and intersystemic differences. Law Hum Behav. 1997;21(4):377–390.CrossRefGoogle ScholarPubMed
Miller, HA. Miller Forensic Assessment of Symptoms Test professional manual. Odessa, FL: Psychologial Assessment Resources; 2001.Google Scholar
Overall, JE, Gorham, DR. The brief psychiatric rating scale. Psychol Rep. 1962;10:799–812.CrossRefGoogle Scholar
Johnson , WG, Mullett, N. Georgia court competency test In: Dictionary of Behavioral Assessment Techniques. New York: Pergamon Press; 1988.Google Scholar
Becker’s Hospital Review. https://www.beckershospitalreview.com/patient-flow/amid-shortage-number-of-psychiatric-beds-in-us-down-13-from-2010.html. Accessed June 17, 2019.Google Scholar
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
Torrey, EF. Jails and prisons–America’s new mental hospitals. Am J Public Health. 1995;85(12):1611–1613.CrossRefGoogle ScholarPubMed
Belcher, JR. Are jails replacing the mental health system for the homeless mentally ill? Community Ment Health J. 1988;24(3):185– 195.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.CrossRefGoogle 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
Ford , M. America’s largest mental hospital is a jail. In: The Atlantic; 2015. https://www.theatlantic.com/politics/archive/2015/06/americas-largestmental-hospital-is-a-jail/395012/. Accessed August 11, 2019.Google Scholar
Markowitz, FE. Psychiatric hospital capacity, homelessness, and crime and arrest rates. Criminology: An Interdisciplinary Journal. 2006;44(1):45–72.CrossRefGoogle 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
Roy, L, Crocker, AG, Nicholls, TL, Latimer, EA, Ayllon, AR. Criminal behavior and victimization among homeless individuals with severe mental illness: a systematic review. Psychiatr Serv. 2014;65(6):739–750.CrossRefGoogle ScholarPubMed
Koegel, P, Burnam, MA, Farr, RK. The prevalence of specific psychiatric disorders among homeless individuals in the inner city of Los Angeles. Arch Gen Psychiatry. 1988;45(12):1085–1092.CrossRefGoogle ScholarPubMed
Iglehart, JK. Decriminalizing mental illness–the Miami model. N Engl J Med. 2016;374(18):1701–1703.CrossRefGoogle ScholarPubMed
Carson, E. Prisoners in 2014. Washington DC: Bureau of Justice Statistics; 2015.Google Scholar
Teplin, LA, Abram, KM, McClelland, GM. Prevalence of psychiatric disorders among incarcerated women. I. Pretrial jail detainees. Arch Gen Psychiatry. 1996;53(6):505–512.CrossRefGoogle Scholar
Peralta, V, Cuesta, MJ. Delusional disorder and schizophrenia: a comparative study across multiple domains. Psychol Med. 2016;46(13):2829–2839.CrossRefGoogle ScholarPubMed
Hui, CL, Lee, EH, Chang, WC, et al. Delusional disorder and schizophrenia: a comparison of the neurocognitive and clinical characteristics in first-episode patients. Psychol Med. 2015;45(14):3085–3095.CrossRefGoogle ScholarPubMed
Marneros, A, Pillmann, F, Wustmann, T. Delusional disorders–are they simply paranoid schizophrenia? Schizophr Bull. 2012;38(3):561–568.CrossRefGoogle ScholarPubMed
Herbel, BL, Stelmach, H. Involuntary medication treatment for competency restoration of 22 defendants with delusional disorder. J Am Acad Psychiatry Law. 2007;35(1):47-59.Google ScholarPubMed
Harrison, PJ, Cipriani, A, Harmer, CJ, et al. Innovative approaches to bipolar disorder and its treatment. Ann N Y Acad Sci. 2016;1366(1):76-89.CrossRefGoogle ScholarPubMed
McKetin, R, Gardner, J, Baker, AL, et al. Correlates of transient versus persistent psychotic symptoms among dependent methamphetamine users. Psychiatry Res. 2016;238:166–171.CrossRefGoogle ScholarPubMed
McKetin, R, Dawe, S, Burns, RA, et al. The profile of psychiatric symptoms exacerbated by methamphetamine use. Drug Alcohol Depend. 2016;161:104–109.CrossRefGoogle ScholarPubMed
De Luca, SM, Blosnich, JR, Hentschel, EAW, King, E, Amen, S. Mental health care utilization: how race, ethnicity and veteran status are associated with seeking help. Community Mental Health J. 2016;52(2):174–179.CrossRefGoogle ScholarPubMed
Fusaro, VA, Levy, HG, Shaefer, HL. Racial and Ethnic Disparities in the Lifetime Prevalence of Homelessness in the United States. Demography. 2018;55(6):2119–2128.CrossRefGoogle ScholarPubMed
Scott, CL, McDermott, BE, Kile, S. Intoxication and insanity: A study of 500 NGRI Acquittees. San AntonioTX: American Academy of Psychiatry and the Law; 2003.Google Scholar
Hides, L, Dawe, S, McKetin, R, et al. Primary and substance-induced psychotic disorders in methamphetamine users. Psychiatry Res. 2015;226(1):91–96.CrossRefGoogle ScholarPubMed
McKetin, R, Baker, AL, Dawe, S, Voce, A, Lubman, DI. Differences in the symptom profile of methamphetamine-related psychosis and primary psychotic disorders. Psychiatry Res. 2017;251:349– 354.CrossRefGoogle ScholarPubMed
Fraser, S, Hides, L, Philips, L, Proctor, D, Lubman, DI. Differentiating first episode substance induced and primary psychotic disorders with concurrent substance use in young people. Schizophr Res. 2012;136(1–3):110–115.CrossRefGoogle ScholarPubMed