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A survey obtained standardized data to provide a dr of the approaches used in the 50 states and the District of Columbia for obtaining court-ordered competence to stand trial and criminal responsibility evaluations. Respondents were forensic mental health administrators and forensic mental health professionals. Data were obtained for variables describing the organizational characteristics of the states' pretrial forensic evaluation systems. A typology of the states' systems was developed, based on their predominant reliance on inpatient versus outpatient approaches and on service providers with court referral catchment areas that were statewide, regional, or local. Five types allowed classification of 43 states. The types are described on the major organizational and functional variables employed in the survey. The traditional practice of obtaining most court-ordered evaluations from a central inpatient facility has been replaced by a number of outpatient models in all but a minority of states. These models are more complex than past descriptions would suggest.Every state provides criminal courts with pretrial mental health evaluations of defendants, when their mental status raises legal questions of competence to stand trial or criminal responsibility. Nevertheless, little is known about the specific * This study was supported by a research grant from the National Institute of Mental Health (ROI-MH-44623). The authors gratefully acknowledge the National Association of State Forensic Mental Health Program Directors for its consultation in the planning phases of the study, as well as Paul Appelbaum for comments on an earlier draft. Reprints may be obtained from

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Jail diversion programs have been proposed for use with persons with mental illnesses.While much support exists for these programs in theory, little is known about their characteristics, the individuals they divert, or their effectiveness. The current study focuses on identifying the characteristics of persons diverted through a court-based program in one midwestern city and their outcomes during the first 2 months after diversion. Information on participants (n = 80) was gathered through detainee interviews, staff interviews, and record abstracts. Two factors appear to be important in diversion: (1) community risk and ( 2) availability of specialized programs for diverted offenders. Demographic, clinical, and social context variables appear to influence diversion decisions. Overall, the diverted and nondiverted groups did approximately the same upon release, but one third of the nondiverted group never got released during the follow-up.

The ACCESS demonstration was successful in terms of project-centered integration but not overall system integration.

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