Decision‐Making in Post‐acquittal Hospital Release: How Do Forensic Evaluators Make Their Decisions?

Abstract

A large number of individuals are acquitted of criminal charges after being found "not guilty by reason of insanity." Most of these individuals are hospitalized and later seek hospital discharge under a court-ordered provision called conditional release ("CR"). Courts rely on opinions from forensic evaluators to determine acquittees' readiness for CR. However, how evaluators make these decisions are unknown. Eighty-nine CR readiness evaluators from nine states were surveyed to understand which factors evaluators prioritize and to understand evaluators' assessment methodologies and their beliefs about the CR process itself. Little uniformity was found among evaluators on any aspect of the decision-making process. Evaluators utilized a wide variety of methodologies when making their decisions on readiness for CR. Moreover, evaluators' conceptualizations of the CR process itself varied widely. The results highlight the difficulty and confusion evaluators face when conducting CR readiness evaluations, and demonstrate the need for enhanced training, statutory guidance, and standardized evaluation protocols for these evaluations.

Reconviction and revocation rates in Flanders after medium security treatment

“…How evaluators decide to release NGRI patients conditionally or unconditionally is largely unknown. The study by Gowensmith, Bryant, and Vitacco (2014) investigated the procedures used by 89 forensic evaluators from nine states of the United States in conditional release readiness evaluations. The study showed that not only was there a lack of uniformity on any aspect of the decision making processes, evaluators de-emphasized important factors that have been empirically proven to be related to recidivism.…”

Methodological development of the Hoeven Outcome Monitor (HOM): A first step towards a more evidence based medicine in forensic mental health

“…For example, it was shown that the historical HCR-20 scale , living arrangement (Marshall et al, 2014;Novosad et al, 2014), financial resources, personality disorder, substance use disorder and number of incidents in the CR programme, were related to revocation of CR (Manguno-Mire et al, 2014). As highlighted by several scholars (Crocker et al, 2014;Gowensmith et al, 2014;Green et al, 2014;Manguno-Mire et al, 2014), more research into empirically validated CR related risk and protective factors is needed to provide the clinical and legal practice with an empirical basis to standardize the decision-making process into CR and to develop successful CR programmes. The HOM meso-measurements can provide for this much needed evidence based working model to research empirically validated factors to augment our empirical understanding of CR patients as to enhance CR risk assessment and management programmes.…”

“…Yet, recidivism as a measure of effectiveness is often complicated due to methodological issues and incommensurable programmes, indications and groups. Methodological differences between studies in observation period, data source, recidivism definitions and criteria, complicate a wellconsidered comparison of recidivism rates which renders comparative studies across different offender groups and treatments invalid (Chambers et al, 2009;Falshaw, Bates, Patel, Corbett & Friendship, 2003;Hodgins, 2001;Liem, 2013;Lloyd, Mair & Hough, 1994;Maltz, 2001;Payne, 2007;Wartna, 2009). To acquire a comprehensive view on the outcome of penal interventions, a sound standardized methodological basis is a prerequisite (Payne, 2007;Wartna, 2009).…”

“…This need to research different types of discharge by means of empirically supported methods to provide for a more efficient and effective treatment, is more readily stressed in a recent special issue of Behavioral Sciences and Law (32 (5), 2014) into the practices and outcomes of conditional release (CR) of criminal offenders with mental illness (Vitacco, Green & Felthous, 2014). To complement the lack of consensus in the clinical and legal practice of CR readiness risk assessment and management, these studies focused on (1) assessing risk and improving methodologies for evaluating CR readiness (Crocker, Nicholls, Charette & Seto, 2014;Douglas, 2014;Gowensmith, Bryant & Vitacco, 2014;Green et al, 2014) and (2) success and failure of CR (Manguno-Mire, Coffman, DeLand, Thompson & Myers, 2014;Marshall, Vitacco, Read & Harway, 2014;Novosad, Follansbee, Banfe & Bloom, 2014), to explore and validate empirically based CR related risk and protective factors for the development of standardized assessment protocols. Overall, these studies showed that a number of static and dynamic risk and protective factors were associated with failure and success of CR.…”

New Frontiers for Conditional Release: Applying Lessons Learned from Other Offenders with Mental Illness

“…Empirical studies regarding insanity acquittees are relatively sparse. There has been a surge of studies in the literature in the past decade regarding conditional release of insanity acquittees – specifically, which factors are most predictive of success or failure for persons placed on conditional release (Green et al, ; Vitacco et al, ; Vitacco, Vauter, Erickson, & Ragatz, ) as well as which factors are typically considered by courts and evaluators in determining an insanity acquittees' readiness for conditional release (Gowensmith, Bryant, & Vitacco, ; Manguno‐Mire et al, ; McDermott et al, ). However, despite this increase in research attention, the volume of research on conditional release remains fairly slight.…”