The Alabama Structured Assessment of Treatment Completion for insanity acquittes (The AlaSATcom)

The most complex and risky decisions made by forensic psychiatrists revolve around the decision to release insanity acquittes from custody. This decision has several levels of risk, including the potential liability to the psychiatrist as well as the possible risk to the community. A single bad outcome, even if not predictable, can have disastrous results, not only for victims, but also for the releasing facility. Since predicting violence has so many problems, we chose to look at completeness of treatment instead, so we could say to the Court, "We don't know about violence, but we do know that he has vastly improved." Since many NGRI (Not Guilty by Reason of Insanity) patients spend years in the hospital, they are also expensive. They have rights, as well; therefore the complex assessment must be done as quickly and as accurately as possible. We have developed a spread sheet program to compare these multiple factors, and have compared it against the clinical decisions we have made in more than 100 discharges. We believe this gives a framework for decision-making that will increase the consistency of this process.