The differential impact of deinstitutionalization on white and nonwhite defendants found incompetent to stand trial

Previous studies have reported that state mental hospital deinstitutionalization has resulted in the processing of the mentally ill through the criminal justice system. Using pre- and postdeinstitutionalization samples of defendants found incompetent to stand trial (IST) selected from three states, this study examines changes in the mental health and arrest histories of white and nonwhite ISTs. These data reveal a significant increase in the number of nonwhite ISTs. Also, after deinstitutionalization, nonwhite ISTs had significantly more prior arrests and hospitalizations than white ISTs. There were, however, no differences in the offenses for which whites and nonwhites were arrested.     

Examining the use of the M-FAST with criminal defendants incompetent to stand trial

The Miller Forensic Assessment of Symptoms Test (M-FAST) was developed to provide evaluators with a brief, reliable, and valid screen for malingered mental illness. This study examined the initial validity of the M-FAST in a sample of 50 criminal defendants found incompetent to stand trial because of a mental illness. The M-FAST total score and items were compared with the Structured Interview of Reported Symptoms (SIRS) and the fake-bad indicators of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Results indicated good evidence of construct and criterion validity, demonstrated by t tests, receiver operating characteristics analysis, and high correlations between the M-FAST, SIRS, and the fake-bad indices on the MMPI-2. Tentative cut scores for the M-FAST total score and scales were examined and demonstrated high utility with the sample of criminal defendants incompetent to stand trial.     

A comparison of criminal sexual conduct defendants based on victim age

This study compared defendants charged with Criminal Sexual Conduct whose victims were <6 years of age with defendants whose victims were 12 or more years of age. The study included 163 men referred to the evaluation unit of a state center for forensic psychiatry. Thirty-eight men had younger victims (YVs) and 125 men had older victims (OVs). The variables of comparison were defendant demographic and psychiatric variables frequently identified in the sex offender literature. Controlling for other demographic and psychiatric variables by use of logistic regression modeling, elderly defendants (60 years or greater), and incest offenders were three times more likely to have YVs (Odds Ratio [OR] 3.08 and 3.11, respectively). Unlike previous studies defendants with serious psychiatric pathology (psychosis or mania) were no more likely to have YVs (OR 0.66) than were defendants without psychosis.     

Use of a television crime-drama series to promote legal understanding in mentally ill, incompetent defendants: a pilot study

Videotaped material is used for educational purposes in many areas of medicine. In forensic facilities, programs designed to restore competency to stand trial (CST) in incompetent, mentally ill defendants have utilized videotaped courtroom proceedings as learning tools. This pilot study reviewed the progress of incompetent defendants (N = 15) who participated in a program that utilized videotaped segments of the television crime-drama "Law & Order", among other techniques, to promote CST in individuals deemed unfit to stand trial. The authors hypothesized that participation in at least one cycle of the Competency Restoration Group (CRG)'s curriculum would be associated with improvement in the areas of understanding, reasoning and appreciation. In order to assess whether the group was beneficial to the patient's treatment goal of competency restoration, patients were screened using the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA) prior to starting the group and after completing a cycle of the group's curriculum. The Wilcoxon signed ranks test was employed to analyze the results from the pre- and post-group MacCAT-CA testing. The tests yielded significant (p < 0.005) post-test differences in the hypothesized direction for each of the three subsections: Understanding, Reasoning, and Appreciation as well as a significant post test improvement in the total MacCAT-CA scores. These results suggest that a didactic program, using a popular crime drama series, can be effective in facilitating learning in competency restoration programs. Limitations of this study include its lack of a control group and small population.     

Ironies of inclusion: social class and deinstitutionalization

This paper discusses changes in the social organization of mental institutionalization as they relate to developments in the wider social and economic environment. Despite dramatic changes in the system of inpatient psychiatric care during the last three decades, the historic division of labor between the private and the public system (with the latter treating the poor, the unemployed, and the nonwhite) has not ceased to exist. At the same time, under the influence of the postwar trend towards greater political integration of disadvantaged and marginal groups into society's central value systems, treatment of the mentally ill has become less segregated and more voluntary. An important implication of these two interacting trends--the changed legal position of the patient vis-à-vis the provider and the deteriorating economic position of the user of public psychiatric facilities--has been the exceeding irrelevance of one of the basic tenets of psychiatric care: that clinical treatment precedes social functioning. With two vignettes of chronic patients the article illustrates how symptoms and survival are fused in the contemporary, inclusionary system of care.     

Sexual predator civil commitment: a comparison of selected and released offenders

This study compared two groups of sex offenders who were considered for civil commitment under Florida's Jimmy Ryce Act: Two hundred twenty-nine sex offenders who were recommended by forensic evaluators to be civilly committed and 221 sex offenders who were recommended for release. It was hypothesized that selected offenders would be more likely to display risk factors for sex offense recidivism than those who did not meet criteria. Data analyses revealed that selected offenders, as a group, scored significantly higher on actuarial risk assessment instruments. There were also significant differences between the groups on other risk factors that have been empirically correlated with sexual recidivism. Selected offenders had higher frequencies of paraphilia diagnoses and antisocial personality. These findings supported the hypotheses and suggested that evaluators are correctly selecting for civil commitment those sex offenders who have a mental abnormality predisposing them to sexual violence and who are at higher risk for reoffense.     

Surrogate decision-making for incompetent elderly patients: the role of informal representatives

Informal or unofficial representation refers to the practice (more common in some European jurisdictions than in others), that persons not designed by a court or by the patient himself, make medical decisions on the patient's behalf in case of their incompetence. If the law provides for this, it is usually next of kin (spouse, children, brothers and sisters, etc.) who are allowed to act in such a capacity. Informal representation raises several questions. Are family members always familiar with what their relative would have wished, ready to take responsibility, and not too much reigned by their emotions? The basic legal concern is whether there are sufficient procedural and other safeguards to protect the incompetent patient from representatives who do not serve their best interests. In addressing these issues, after a brief survey of the law in the Netherlands as compared with that in Belgium, Germany and England/Wales, we will argue that informal representation as such is not at variance with international and European standards. However, an 'informal' approach to surrogate decision-making should always go together with sufficient protection of the incompetent patient, including procedural safeguards with regard to the decision that the patient is incompetent, limits to the decision-making power of informal representatives and effective forms of conflict resolution.