Cognition and Competency Restoration: Using the RBANS to Predict Length of Stay for Patients Deemed Incompetent to Stand Trial

ObjectiveWe investigated clinical and demographic variables to better understand their relationship to hospital length of stay for patients involuntarily committed to California state psychiatric hospitals under the state’s incompetent to stand trial (IST) statutes. Additionally, we determined the most important variables in the model that influenced patient length of stay.MethodsWe retrospectively studied all patients admitted as IST to California state psychiatric hospitals during the period January 1, 2010 through June 30, 2018 (N = 20 041). Primary diagnosis, total number of violent acts while hospitalized, age at admission, treating hospital, level of functioning at admission, ethnicity, sex, and having had a previous state hospital admission were evaluated using a parametric survival model.ResultsThe analysis showed that the most important variables related to length of stay were (1) diagnosis, (2) number of violent acts while hospitalized, and (3) age of admission. Specifically, longer length of stay was associated with (1) having a diagnosis of schizophrenia or neurocognitive disorder, (2) one or more violent acts, and (3) older age at admission. The other variables studied were also statistically significant, but not as influential in the model.ConclusionsWe found significant relations between length of stay and the variables studied, with the most important variables being (1) diagnosis, (2) number of physically violent acts, and (3) age at admission. These findings emphasize the need for treatments to target cognitive issues in the seriously mentally ill as well as treatment of violence and early identification of violence risk factors.

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An overview of jail-based competency restoration

CNS Spectrums ◽

10.1017/s1092852919001731 ◽

2019 ◽

Vol 25 (5) ◽

pp. 624-629

Author(s):

Scott E. Kirkorsky ◽

Mary Gable ◽

Katherine Warburton

Keyword(s):

United States ◽

State Hospital ◽

Mentally Ill ◽

Psychiatric Hospitals ◽

The United States ◽

Competency Restoration ◽

State Hospitals ◽

Hospital Beds ◽

Incompetent To Stand Trial ◽

County Jails

Forensic populations in the United States are increasing, driven largely by a rise in individuals determined to be Incompetent to Stand Trial (IST). Across most states, including California, the number of mentally ill inmates awaiting competency restoration has increased dramatically in recent years. Traditionally, competency restoration has taken place in state hospitals, but incompetent inmates often experience a significant wait for state hospital beds because of the rising demand for beds in such facilities. The resulting waitlists, which range from days to months, have led to states being held in contempt of court for violating limits placed on how long incompetent defendants can be held in jail. Therefore, alternatives to state hospitalization for IST patients have been developed, including jail-based competency (JBCT) restoration programs. JBCT programs provide restoration services in county jails, rather than in psychiatric hospitals. The following article will review the nature of JBCT programs and will emphasize the structure and evolution of such programs within California.

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Corrigendum to ‘Length of stay for 25,791 California patients found incompetent to stand trial’ [Journal of Forensic and Legal Medicine 51C (2017) 22–26]

Journal of Forensic and Legal Medicine ◽

10.1016/j.jflm.2018.02.023 ◽

2018 ◽

Vol 54 ◽

pp. 136

Author(s):

Matthew Renner ◽

Carol Newark ◽

Bradley J. Bartos ◽

Richard McCleary ◽

Nicholas Scurich

Keyword(s):

Length Of Stay ◽

Legal Medicine ◽

Incompetent To Stand Trial

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Length of stay for 25,791 California patients found incompetent to stand trial

Journal of Forensic and Legal Medicine ◽

10.1016/j.jflm.2017.07.006 ◽

2017 ◽

Vol 51 ◽

pp. 22-26 ◽

Cited By ~ 4

Author(s):

Matthew Renner ◽

Carol Newark ◽

Bradley J. Bartos ◽

Richard McCleary ◽

Nicholas Scurich

Keyword(s):

Length Of Stay ◽

Incompetent To Stand Trial

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Does clozapine improve competency restoration? a case report of schizophrenia patient opined incompetent to stand trial unlikely to be restored

Journal of Mental Health and Human Behaviour ◽

10.4103/0971-8990.182092 ◽

2016 ◽

Vol 21 (1) ◽

pp. 58

Author(s):

AjayKumar Parsaik ◽

Aqeel Hashmi

Keyword(s):

Case Report ◽

Schizophrenia Patient ◽

Competency Restoration ◽

Incompetent To Stand Trial

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Forensic issues

10.1093/med/9780199360574.003.0061 ◽

2015 ◽

Cited By ~ 1

Author(s):

Erik J. Roskes ◽

Donna Vanderpool

Keyword(s):

Mental Health ◽

Habeas Corpus ◽

Sources Of Information ◽

Competency Restoration ◽

Mitigating Factors ◽

Correctional Settings ◽

Key Issues ◽

Disciplinary Process ◽

Incompetency To Stand Trial ◽

Incompetent To Stand Trial

A range of forensic psychiatry issues frequently present themselves in correctional settings. Incompetency to stand trial is one such concern. In some states, defendants found incompetent to stand trial must be managed in jail. Litigation is another important issue. Psychiatrists working in correctional settings often have increased litigation risks regarding professional negligence and other forms of liability. Especially important is understanding whether their insurer covers correctional work. One common form of litigation is habeas corpus. For example, a habeas petition could be brought to seek medical interventions denied by the detaining institution, and as such, the medical staff could be named defendants. Many class actions have involved correctional mental health care. Often clinicians working in correctional settings welcome these litigations, as they focus the attention of the courts on deficiencies in care related to inadequate resources. While such lawsuits can be sensitive, especially in the earlier phases when the outcome is in doubt, correctional psychiatrists and other clinicians may also serve as sources of information for each party to the case and to the court. Another key topic is the correctional disciplinary process. Mental health input into the disciplinary process does not address issues of responsibility but is limited to identifying mitigating factors related to mental illness when present, dispositional recommendations when clinically appropriate, and competency-to-proceed issues in the context of the disciplinary hearing. This chapter reviews key issues of relevance to correctional psychiatrists, such as competency restoration, court collaboration, and litigation related concerns.

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