Punishment or treatment?

Although there is strong support among the general public for providing insanity acquittees with mental health treatment, it is also believed that insanity acquittees should be punished when they break the law. Prior studies of the lengths of confinement of insanity acquittees have yielded inconsistent results. This article draws upon a large-scale, multistate study of insanity pleas to explore the question: Is society able to withhold punishment against persons acquitted of criminal charges due to insanity? Results indicate that offense seriousness is a more important factor than mental disorder in determining the lengths of confinement of persons foundNot Guilty by Reason of Insanity and that persons found guilty are more likely to be released without ever having been confined than persons acquited by reason of insanity. Implications for invoking offense seriousness as a primary criterion in assessments of dangerousness are discussed.     

The Impact of Insanity Acquittees on Missouri's Public Mental Health System

Even though state departments of mental health have primary responsibility for the care, custody, and treatment of insanity acquittees, the impact of insanity acquittees on the public mental health system is generally lacking in policy discussions and as a topic for policy research. This issue has received increased attention in Missouri, where insanity acquittees now occupy half of the long-term public psychiatric hospital beds. This article examines the presence of Missouri's insanity acquittees on the state's public mental health system and includes the impact on goals, fiscal costs, inpatient and community psychiatric services, and inpatient treatment staff. As states consider managed care and other cost containment measures, it remains to be seen if the high costs associated with extensive use of hospitalization of insanity acquittees to promote public safety will influence policy changes to more community-based insanity acquittee systems.     

Follow-up after release of insanity acquittees, mentally disordered offenders, and convicted felons

The authors compared 127 insanity acquittees in the state of Maryland with a matched prisoner control group of 127 convicted felons and a comparison group of 135 mentally disordered prisoners transferred for hospital treatment. Subjects were followed from five to 17 years after discharge from hospital or release from prison. Subsequent arrests, hospitalizations, employment, and functioning of these large cohorts were studied and compared. The study focused on outcome data at five years after release. The authors found that, at five years postrelease, 54.3 percent of the insanity acquittees, 65.4 percent of the prisoner control group, and 73.3 percent of the mentally disordered prison transfers were rearrested. At 17 years postrelease, rearrest rates increased to 65.8 percent of the insanity acquittees, 75.4 percent of the prisoner controls, and 78.4 percent of the prison transfers. Significantly more mentally disordered prison transfers than NGRIs were rehospitalized during the follow-up period. Overall, the prison transfers had significantly poorer outcomes on nearly all variables studied compared with the other two groups. The authors conclude that although there were a substantial number of rearrests among insanity acquittees, that group had a statistically significantly lower rate of criminal activity compared with the other two groups of offenders.     

The review panel process: an algorithm for the conditional release of insanity acquittees

The release of insanity acquittees requires making informed decisions regarding both the presence and severity of an individuals' mental illness and the dangerousness of these individuals. This study evaluated the usefulness of employing structured assessments of mental health and violence risk factors in the conditional release decision-making process. All persons found Not Guilty by Reason of Insanity at East Louisiana Mental Health System, Forensic Division who underwent a review panel between July 1, 1997 and July 1, 1999 were included in this study. The Classification and Regression Tree analysis was utilized to arrive at cutpoints that would optimize the predictive ability of the decision tree analysis. The results indicated that the Community Outpatient Treatment Readiness Profile score was the strongest predictor -- all patients receiving a score of 62 or greater on this scale were recommended to remain at the facility. When women were recommended for release, it was to civil facilities and with moderate levels of symptoms. For males with moderate symptoms, low PCL-R scores were associated with recommendations for release, whereas high scores were associated with recommendations for continued commitment. Our data suggests that algorithms may be useful to governing bodies when making release decisions.     

Psychiatric history,due procedural safeguards,and the use of discretion in the criminal justice process

Using a stratified random sample of all male inmates released from one state's correctional facilities during a 13-month period (N = 550), this research investigates the impact of an extralegal variable (history of psychiatric hospitalization) on decisionmaking in stages in the criminal justice system at which defendants are granted more and fewer due procedural safeguards. On the basis of the work of Goffman and Green, it is hypothesized that this variable will not equally affect decisions made at various points in the criminal justice process. Instead, psychiatric history will have less impact at points in the process where the defendant is granted more due procedural safeguards (e.g., sentencing), with its significance increasing where the defendant receives fewer due procedural safeguards (e.g., parole). The results are consistent with the hypothesis: A history of psychiatric hospitalization was not significant in the decision regarding sentence length, though it became highly critical in the decision to parole, even after other legal and extralegal variables were controlled. The context in which these decisions are made may also be relevant to a fuller understanding.     

Drug treatment refusal and length of hospitalization of insanity acquittees

Thirty-three insanity acquittees who had refused drug treatment were matched to a sample of nonrefusing hospitalized insanity acquittees in an attempt to measure the effect of treatment refusal on length of hospital stay. No measurable effects on the length of hospitalization were found. However, upon comparing the amount of time under court jurisdiction spent in the hospital and on conditional release in the community, it becomes evident that refusers spent significantly greater proportions of time hospitalized than the average hospitalized insanity acquittee, who had less hospitalization and spent more time on conditional release. These differences do not seem to be related to the issue of treatment refusal.     

Part I: The NGRI Registry: initial analyses of data collected on Connecticut insanity acquittees

The NGRI Registry is a comprehensive census database collected by the Law and Psychiatry Division of the Department of Psychiatry at the Yale University School of Medicine. This longitudinal database was compiled following a systematic search of all available docket books from the superior courts and mental health records from the state hospitals in Connecticut beginning in January 1970. Detailed life span information is available for 364 insanity acquittees identified during the search. Comparative analyses with four other locales suggested that there were regional differences in diagnoses of and crimes committed by the acquittees. These initial analyses demonstrate the promise of this registry becoming one tool for collaborative research on issues relevant to law and mental health.     

DHHS human subjects protection: the new regulations revisited

In January of 1981 DHHS released its revised regulations for the protection of human subjects. These new regulations established five categories of federally funded research--primarily in the educational, social and behavioral sciences--which, at local Institutional Review Board (IRB) US ISSN (0193-7758) 1168 option, could be made exempt from mandated peer review. A survey of the 562 member IRB system was conducted to determine, among other things, what policies individual review boards had established with regard to these optionally exempted categories. 341 (61%) of the IRBs responded to the survey. Results indicate that the IRBs have overwhelmingly opted to maintain review procedures at some level in each of the "exempted" categories and that these procedures, as well as the other DHHS standards, are being applied almost universally to all research regardless of funding source. This article presents data on IRBs and their implications for the educational, social and behavioral sciences.     

A tale of two bounties: the impact of competing fees on physician behavior

This study examines how the volume of privately insured services provided in hospital inpatient and outpatient departments changes in response to reductions in Medicare physician payments. We hypothesize that physicians consider relative payment rates when choosing which patients to treat in their practices. When Medicare reduces its payments for surgical procedures, as it did in the late 1980s, physicians are predicted to treat more privately insured patients because they become more lucrative. We use data from 182 hospitals for seventeen major procedures groups, covering a forty-five-month period between 1988 and 1991 that encom passes a twenty-four-month period before the reduction in Medicare fees and twenty-one months after the reduction. Our findings are consistent with the predictions for a number of procedure groups, but not for all of them. One implication of the findings is that societal savings from Medicare fee reductions are overstated if one does not also consider spillover effects in the private insurance market.     

Canadian Human Rights Commission recommends prison needle exchange programs

In a report released on 28 January 2004, the Canadian Human Rights Commission recommended that the Correctional Service of Canada (CSC) implement a pilot needle exchange program in three or more correctional facilities, at least one of them a women's facility, by June 2004.     

The effect of time served on recidivism: An interdisciplinary theory

The research reported in this paper is concerned with the functional relation between the probability that an individual offender will recidivate and the time that the offender has served in prison as a consequence of the offense. Theory suggests that time served affects recidivism through both specific deterrent and social bonding effects. The former is hypothesized to produce an inverse relation between recidivism and time served; the latter, a direct relation. The paper reviews the literature concerning these two theoretical relations. The review provides the basis for the establishment of a multiequation model whose principal result is to suggest that, more than likely, the recidivism/time served relation is a U-shaped function. The empirical model used to evaluate the hypothesis that the function is U-shaped uses the occurrence of a new arrest as its dependent variable. The model is estimated using OLS and LOGIT procedures. The data used for estimation relate to 1425 prisoners released from the North Carolina prison system in 1980. Recidivistic outcomes are measured at the end of the first and second years subsequent to their release. The research is unique in that it represents the first effort to synthesize the economist's specific deterrence model with the sociologist's social bonding model. The theory provides an explanation for the failure of past empirical work to establish a relation between time served and recidivism. The research is also unique in its a priori assumption of a U-shaped behavioral relation and its attempt to measure that particular relation. The data support the hypothesis that time served affects postprison recidivism rates and that the direction of the effect varies by offense class.     

Medicaid Program; Medicaid eligibility quality control, progressive reductions in federal financial participation for FYs 1982-84, payment for physician billing for clinical laboratory services, and utilization control of skilled nursing facility services: removal of obsolete requirements--HCFA. Final rule

This final rule removes several obsolete sections of the Medicaid regulations that specify rules and procedures for disallowing Federal financial participation for erroneous medical assistance payments due to eligibility and beneficiary liability errors as detected through the Medicaid eligibility quality control program for assessment periods from 1980 through June 1990. The Medicaid regulations that contain the rules and procedures for the progressive reductions in Federal financial participation in medical assistance expenditures made to the States for fiscal years 1982 through 1984 are removed to reflect the repeal of the statutory bases for the reductions. The Medicaid regulations that provide for physician billing for clinical laboratory services that a physician bills or pays for but did not personally perform or supervise are removed to reflect the statutory repeal of this provision. In addition, the rule removes obsolete regulations that prescribe requirements concerning utilization control of Medicaid services furnished in skilled nursing facilities. This rule is part of the Department's initiate to reinvent health care regulations and eliminate obsolete requirements.     

Not guilty by reason of insanity: a research note

The question of the insanity defense centers around the moralist-determinist debate. Insanity defense laws are premised on the assumption that individuals choose between right and wrong, and are responsible for that choice. Mental disease, however, can overpower, and thus, not of their own volition, insane persons become out-of-control. Hence, they cannot be held responsible for their behavior or subject to criminal punishment. It is the purpose of the insanity defense, of course, to distinguish between offenders in need of punitive disposition and ones where a medical-custodial disposition is best. The research presented here indicates that defendants who successfully raise the plea of NGRI do not beat the rap. In other words, they do not spend fewer days in confinement via an NGRI plea than had they been convicted and sentenced. Thus, for the reasons of justice, equity, and fairness the insanity defense should be kept intact. The wave of public fear and reaction to the decision in a few highly publicized cases is insufficient grounds for eliminating the plea. Not only is the use of the insanity defense infrequent, but defendants who select it give up important safeguards. Namely, they are unable to plea bargain, are stigmatized as "mad and bad," have no access to probation or parole, and are confined for an indeterminate amount of time. That some would call this leniency we find surprising. And, of course, we should not forget the findings reported here. NGRI acquittees spend more time being locked up. Defendants who successfully raise the NGRI plea are confined until professionals say they are no longer dangerous.(ABSTRACT TRUNCATED AT 250 WORDS)     

CRITICAL ASPECTS OF PARENTING PLANS FOR YOUNG CHILDREN

The debate about the benefits and drawbacks of overnight schedules for young children is hotly contested in family law. This study investigated connections between occurrence of overnights, schedule consistency, number of caregivers, and young children's adjustment to parental separation and divorce. Families ( N = 161) with children aged 6 years or younger were recruited at the time of filing for divorce or child custody (if unmarried); follow-up data were obtained from 132 families 15 to 18 months later. Results indicated that parenting plan variables are related to children's social, cognitive, and emotional behavior, with caregivers and schedule consistency more salient than overnights. Girls benefited from overnights and more caregivers, whereas boys did not. Overnighting children aged 4 to 6 years when their parents filed manifested fewer problems 1.5 years later than did younger children. Even when controlling for parental conflict and parent-child relationship variable, the constellation of parenting plan variables contributed to young children's adaptation.     

Post-Hinckley insanity reform in Oregon

The 1983 Oregon legislature responded to public pressure to narrow the application of the insanity defense by eliminating personality disordered individuals from consideration for an insanity verdict. This article examined the effects of the statutory change, and found no significant change in the frequency of insanity acquittals of personality disordered subjects between the three pre-reform years (n = 21) and the three post-reform years (n = 14). We also reviewed how the Psychiatric Security Review Board handled these patients once committed to their jurisdiction. We constructed a matched comparison group of psychotic acquittees and found that in the pre-reform years the personality disordered subjects spent less time in the system and less time in the hospital than the psychotic patients. However, in the post-reform years their time in the system and time in the hospital was the same as the psychotic controls. There were fewer decisions to discharge personality disordered patients from the system after the reform, although this difference may be due to factors other than the statutory reform itself. The conclusion is that narrowing the insanity defense is a worthy goal which may be difficult to achieve.     

Is Something Better Than Nothing? The Effect of Short Terms of Mandatory Parole Supervision

This article reports the findings of a quasi-experimental evaluation of a mandatory early parole program. New Jersey’s Statutory Early Release (SER) law required that all inmates, with few exceptions, be released onto parole six months before the expiration of their sentence. SER participants (n = 405) were matched using propensity scores to two groups of similar offenders who left prison in the year prior to the implementation of the SER statute. Comparison groups include former inmates that were released either unconditionally (n = 4,507) or onto standard parole (n = 5,657). At the conclusion of the matching routines, 395 SER-parolee pairs and 394 SER-unconditional release pairs were identified. Outcomes measures, including comparisons of rearrest and reconviction rates, are reported pre and post matching, and at 6-, 12-, and 18-month intervals. Individuals enrolled in the SER program demonstrated significantly reduced arrest rates during the SER supervision period when compared to unconditionally released offenders, though differences do not persist past six months. Offending rates for both SER participants and matched parolees were generally similar, with some significant variation in arrest rates emerging after 12 months.     

Factors that influence jury decision making

Investigated whether information regarding the disposition of insanity acquittees and the defendant's mental state at the time of the trial, had a significant effect on mock jurors' verdicts. Two trials were used to assess whether results generalize across cases. participants read excerpts from a trial in which the accused's mental state at the time of the trial (symptom free, neurotic symptoms, or psychotic symptoms) and the disposition instructions (no instructions, indeterminate disposition, and capped disposition) were varied. Participants then rendered a verdict of guilty, not guilty, or not criminally responsible on account of mental disorder (NCRMD). Participants who thought the accused was psychotic at the time of the trial were more likely to render a verdict of NCRMD than guilty, and they were more likely to render a verdict of NCRMD than those who thought the accused was normal. No significant differences were found for disposition. Finally, a significant difference for verdicts was found between trials.     

Quality mammography standards--FDA. Final rule

The Food and Drug Administration (FDA) is amending its regulations governing mammography. Amendments are being made to the requirements for accreditation bodies; procedures for facility certification; and quality standards for mammography personnel, equipment and practices, including quality assurance. This action is being taken to provide increased assurance of adequate and consistent evaluation of mammography facilities on a nationwide level and compliance of the facilities with quality standards. It also carries out the intent of Congress that FDA replace the existing interim rules with more comprehensive final regulations.