Treatment for restoration of competence to stand trial: Critical analysis and policy recommendations.

Heilbrun, Kirk; Giallella, Christy; Wright, Helen; DeMatteo, David; Griffin, Patricia A.; Locklair, Benjamin; Desai, Alisha

doi:10.1037/law0000210

Cited by 24 publications

(33 citation statements)

References 30 publications

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“…In contrast to the relatively steady number of referrals for outpatient evaluations, the number of inpatient evaluations across the state has been increasing every year since 2013, with the number of evaluations in 2019 exceeding the previous 18-year average by 15% (TDMHSAS, 2019). This finding is consistent with research documenting unprecedented rises in competency referral rates across the United States (Gowensmith, 2019; Heilbrun et al, 2019).…”

Section: The Present Studysupporting

confidence: 90%

“…Increasing referral rates for CST evaluations have spurred a national crisis resulting in popular media attention, legislative changes, government intervention, and creative solutions to address overburdened systems with few available resources (Gowensmith, 2019; Heilbrun et al, 2019). The present study was designed to analyze the characteristics of, and re-arrest outcomes for, defendants charged with misdemeanors ordered to undergo CST evaluations in a large metropolitan area.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, there has been an unprecedented rise in rates of referrals across the United States, with some jurisdictions reporting that rates of referrals have increased over 200% within 5- and 10-year timeframes (see Gowensmith, 2019, for a review). This widespread increase in rates of individuals referred for CST evaluations has created a national crisis, and multiple states are facing legislation/lawsuits pursuant to lengthy waiting lists for evaluations and associated competence restoration services (Heilbrun et al, 2019). One major concern is that the referral rate increase and excessive wait lists reflect, at least partially, inadequate community mental health services leading to reliance on the criminal justice system as an alternative treatment facility, consistent with the criminalization hypothesis (Gowensmith, 2019; Lamb & Weinberger, 2017).…”

Section: Diversion Strategies For Mentally Ill Defendantsmentioning

confidence: 99%

See 2 more Smart Citations

Characteristics and outcomes for defendants charged with misdemeanors referred for court-ordered competency evaluations.

Tansey¹,

Brown²

2022

Psychological Services

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Recent research has suggested nationwide increases in the rates of referral for competence to stand trial (CST) evaluations across the United States. Many of these evaluations are for defendants charged only with misdemeanor offenses and for whom diversion programs are most appropriate. The present study was designed to analyze the characteristics of, and re-arrest outcomes for, defendants charged with misdemeanors ordered to undergo CST evaluations in a large metropolitan area. Overall, there was a high base rate of incompetent to stand trial (IST) opinions (over 70% of defendants) in this sample, with the greatest impairments in rational understanding and ability to assist counsel. Defendants opined IST were more likely to have a psychotic disorder, a history of psychiatric hospitalization, and greater abnormalities in thought content relative to their competent counterparts. Of concern, defendants opined IST, and especially those referred for crisis evaluations upon dismissal of the charges, were significantly more likely to be re-arrested than their counterparts. These data support the criminalization hypothesis, suggesting that criminal justice involvement for this subset of defendants inappropriately reflects psychiatric instability, supporting the need for more options for inpatient and outpatient treatment to effectively intervene in this process. Impact StatementDefendants who are charged with low-level offenses and evaluated for competency to stand trial are among the most psychiatrically unstable and severely mentally ill defendants. The increased rates of incompetency findings, higher re-arrest rates for repeat low-level offenses, and recommendations for crisis evaluations provide support for the criminalization of mental illness.

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Section: The Present Studysupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Diversion Strategies For Mentally Ill Defendantsmentioning

confidence: 99%

See 1 more Smart Citation

Characteristics and outcomes for defendants charged with misdemeanors referred for court-ordered competency evaluations.

Tansey¹,

Brown²

2022

Psychological Services

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“…The hierarchy of interventions recommended in this review offers some basis for planning with the smaller group of individuals who are not restored within 6 months. At the six-month point, a combination of specialized interventions individualized to the defendant's clinical needs and functional-legal capacities is recommended by Heilbrun et al (2019), with results carefully documented, providing evidence of attempted interventions that are comprehensive and reasonable under the circumstances.…”

Section: Theoretical and Scientific Evidence On Unrestorabilitymentioning

confidence: 99%

Jackson-based restorability to competence to stand trial: Critical analysis and recommendations.

Heilbrun¹,

Giallella²,

Wright³

et al. 2021

Psychology, Public Policy, and Law

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It is a well-established principle of U.S. law that criminal proceedings may not be held against a defendant who is not competent to participate in them. Although the vast majority of defendants who are adjudicated incompetent to stand trial (IST) will subsequently regain sufficient capacities to be adjudicated competent to stand trial (CST), there is a subgroup of defendants who do not show sufficient improvement in clinical functioning and functional-legal capacities to regain CST. The present article focuses on individuals who are unrestorably IST. We critically analyze the available scientific evidence on defendants who are unrestorably IST. The great majority of this research is focused on restoration to CST and thus has limited applicability to predicting unrestorability. Nonetheless, as a review of relevant U.S. state statutes demonstrates, evaluators are often asked to make such predictions when addressing CST. Statutes also reflect a wide range of allowable durations prior to a legal decision on the question of IST unrestorability. Three important implications for law, research, policy and practice can be drawn: (a) the empirical literature presently provides very minimal research guidance for the accurate prediction of IST unrestorability; (b) such research guidance could be substantially improved by modifications in the design and application of relevant studies; and (c) improved legal decision-making and greater recognition of defendants' liberty interests could result from observing and documenting the results of restoration interventions over a period of 12 to 18 months, as described in the Revised Criminal Justice Standards on Mental Health (American Bar Association, 2016), rather than using the longer periods set forth in 30 U.S. state statutes and the federal jurisdiction.

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“…In the second article, Heilbrun et al. (2019) reviewed and compared outcomes for restoration programs in multiple settings, including 10 state/forensic hospitals, three prison psychiatric units, eight community‐based settings, eight jail‐based settings, and three others. Acknowledging the potential of jail‐based and community‐based alternatives to traditional hospital‐based restoration, the Heilbrun group proposed a “system‐level decision tree” for determining the best restoration service option for IST patients.…”

Section: Introductionmentioning

confidence: 99%

Jail‐based competency treatment comes of age: Multi‐site outcomes and challenges to the implementation of an evidence‐based forensic continuum

Jennings

Rice

Baglio

2021

Behavioral Sci & The Law

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The jail‐based competency treatment (JBCT) model has become an established forensic practice across the country. From the perspective of implementation science and the three core elements of the Promoting Action on Research Implementation in Health Service (PARiHS) framework, the JBCT model is a remarkable example of how context (an unrelenting and overwhelmingly strong demand for forensic beds) has driven multiple state governments to facilitate implementation of a methodology in the absence of empirical evidence supporting its efficacy. This 7‐year study of outcomes from four JBCT program sites provides this much‐needed evidence by showing that JBCT restored 56% of 1553 male and 336 female patients over an average of 48.7 days. At the same time, the study highlights how variations in JBCT models, methods, and preadmission stabilization time present challenges to planned and effective implementation of evidence‐based practice at the statewide system level. By identifying differential responsiveness to JBCT treatment by diagnosis and other factors, the study suggests preliminary implementation ideas for what types of patients are well served by the JBCT model as part of a continuum of restoration options that includes inpatient, outpatient and diversion. Significant findings showed that JBCT patients were restored at a higher rate and in a shorter time if they were female, < 20 years old (highest restoration rate; those < 60 years old also significantly better rates), free of co‐occurring intellectual and cognitive deficits, and malingering. Of the major diagnoses, schizoaffective disorder required a significantly longer length of JBCT treatment for restoration, and lower restoration rates than schizophrenia and bipolar disorder, although this was moderated by a significant interaction with abuse of amphetamines.

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Treatment for restoration of competence to stand trial: Critical analysis and policy recommendations.

Cited by 24 publications

References 30 publications

Characteristics and outcomes for defendants charged with misdemeanors referred for court-ordered competency evaluations.

Characteristics and outcomes for defendants charged with misdemeanors referred for court-ordered competency evaluations.

Jackson-based restorability to competence to stand trial: Critical analysis and recommendations.

Jail‐based competency treatment comes of age: Multi‐site outcomes and challenges to the implementation of an evidence‐based forensic continuum

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