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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)
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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

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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.

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