Predicting Voluntary and Involuntary Readmissions to Forensic Hospitals by Insanity Acquittees in Maryland

Abstract

The current study investigated factors associated with voluntary and involuntary readmissions to forensic hospitals 356 insanity acquittees on conditional release in the state of Maryland from 2007, 2008, and 2009 and monitored their community progress for a 3-year follow-up period. The results indicated that voluntarily readmitted insanity acquittees had fewer reported arrests on conditional release and fewer reported instances of non-compliance with treatment compared with insanity acquittees who were returned involuntarily to hospital. As expected, arrests and treatment non-compliance predicted involuntary readmission. A third group of insanity acquittees who were not readmitted on conditional release presented with numerous differences compared with voluntarily and involuntarily readmitted acquittees. These included a longer duration in the community prior to any psychiatric readmission and fewer community psychiatric admissions than both the voluntary and involuntary groups. Data from this study provide useful information on where community monitoring resources for insanity acquittees may best be allocated.

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

“…Additionally, evaluators did not routinely prioritize those factors that previous research has shown to be most predictive of success or failure on CR. Research has shown that substance abuse treatment, intensive case management, stable housing, and good continuity of care from hospital to community are important factors in differentiating those persons on CR who succeed from those who have their CRs revoked (Marshall et al, 2014; Salem et al, ; Vitacco et al, ). However, evaluators in this study consistently rated these predictive factors lower than most other factors.…”

“…Vitacco et al () recommend short‐term intensive hospitalizations to reduce rates of CR revocation based on their research with females on CR. Additionally, appropriate housing was found to be a significant predictor of success on CR in both Maryland (Marshall, Reed, & Vitacco, 2014) and Canada (Salem et al, ). Persons on CR who were supervised by officers with specialties in mental health were hospitalized for fewer days as compared with those persons on CR supervised by non‐mental health officers (Gowensmith, Skeem, & McNichols, ).…”

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

“…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. Moreover, in line with recommendations of Manguno-Mire et al (2014) and Marshall et al (2014), the HOM model provides for the comparable patient release groups (without follow-up), that are needed to further research the effectiveness of CR. Hence, the HOM meso-measurements provide for the empirical data to enhance and validate treatment effectiveness of CR programmes, to ultimately augment the public safety.…”

“…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.…”

“…Overall, these studies showed that a number of static and dynamic risk and protective factors were associated with failure and success of CR. 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.…”