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ABSTRACT* * * This study examines the detention patterns of the insanity defendant who is successful with the plea and hospitalized, or unsuccessful and incarcerated. Further comparisons are made with felony defendants who never entered a plea of not guilty by reason of insanity (NGRI). From existing data it is unclear to what extent detention may vary if the plea is successful as compared to if it is not successful. Of all defendants who entered a plea of NGRI in Erie County, New York (Buffalo) between 1970 and 1980, 128 were institutionalized as a result of their disposition. Sociodemographic, institutionalization histories, arrest, and disposition information were collected and analyzed for all 128 individuals. The research evaluates differences in the likelihood and length of either institutionalization or incarceration and in the rates of release between successful NGRI defendants, those who entered the plea unsuccessfully, and those who did not plead NGRI. From the findings reported here the authors conclude that pleading NGRI in Eric County may not be quite as advantageous for a defendant as commonly is believed.

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The authors present data on all insanity pleas (N = 202) in Erie County, New York, between 1970 and 1980. No demographic, criminal history, current offense, or history of mental hospitalization factor was associated with acquittal. Of the variables studied, only the recommendation of the forensic examiner was associated with the court's decision to acquit by reason of insanity. When an insanity acquittal was recommended in the examination report, conviction ensued in only 17% of the cases. The proportion of pleas that were successful varied considerably over the 10 years studied. The authors discuss the critical need for more research on the plea stage of insanity defense proceedings.

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The NYS Office of Mental Health invests significant staff resources in documenting, investigating, and reviewing minor incidents. This process generates an enormous amount of paperwork. A study by the NYS Commission on Quality of Care revealed that this investment, in fact, compromised the intended positive outcomes. A major flaw they cited was the requirement for identical reporting procedures for both major and minor incidents. A logging system for reporting minor incidents was developed and pilot tested in three OMH psychiatric hospitals. The study revealed that utilization of a log system for the reporting of minor incidents greatly reduced paperwork and staff time, and that these reductions were accomplished without detriment to the quality of care. In fact, the quality of patient care may have improved. More incidents were being reported, a stable record was available on wards for clinical review, staff were enthusiastic about the log system, perhaps improving their morale, and direct care staff had more time available to spend with patients. This type of logging system for the reporting of minor incidents would appear applicable to practically all inpatient psychiatric settings, and, if employed as intended, could be expected to contribute to an improved quality of patient care.