Patient Characteristics and Outcomes Related to Successful Outpatient Competency Restoration.

Criminal defendants have a fundamental right to a fair and speedy trial. However, individuals found incompetent to stand trial are unable to move forward in the adjudication process and are often mired in protracted legal proceedings. If competency restoration is statutorily permissible and can be conducted in the outpatient setting, we propose that it should be considered based on burgeoning empirical data. We present data from an outpatient forensic clinic in which individuals are conditionally released to receive competency restoration in the community. Results indicated that three variables, including being single/never married, having comorbid intellectual disability and mental illness, and having one's conditional release revoked, were negatively related to successful restoration. The final model explained approximately one-third of the variance in restorability and correctly classified 75% of cases. Results demonstrate that individuals can be safely released to the community and successfully restored to competency in the outpatient setting. Utilizing outpatient competency restoration would not only reduce strain on inpatient facilities, but would also reduce the cost of treatment. Copyright © 2017 John Wiley & Sons, Ltd.

What factors are related to success on conditional release/discharge? Findings from the New Orleans forensic aftercare clinic: 2002-2013.

The present study investigated the empirically based factors that predicted success on conditional release among a sample of individuals conditionally discharged in Louisiana. Not guilty by reason of insanity acquittees and individuals on conditional release/discharge for incompetency to stand trial were included in the study. Success on conditional release was defined as maintenance of conditional release during the study period. Recidivism (arrest on new charges) and incidents were empirically evaluated. Success on conditional release was maintained in over 70% of individuals. Recidivism was low, with only five arrests on new charges. Success on conditional release was predicted by financial resources, not having a personality disorder, and having fewer total incidents in the program. After controlling for the influence of other variables, having an incident on conditional release was predicted by a substance use diagnosis and being released from jail. Individuals conditionally released from jail showed fewer number of days to first incident (67 vs. 575 days) compared with individuals discharged from the hospital. These data provide support for the successful management of forensic patients in the community via conditional release, although they highlight specific factors that should be considered when developing community-based release programming. Conditional release programs should consider empirical factors in the development of risk assessment and risk management approaches to improve successful maintenance of community-based forensic treatment alternatives.

Scylla and Charybdis: dual roles and undetected risks in campus mental health assessments.

Recent high-profile events involving the mental health of students and the subsequent impact on the campus community have focused attention on the need for quality mental health care and informed risk assessment on college campuses. When on-campus clinicians are asked to provide direct clinical care to students and to perform objective evaluations of at-risk students at the request of university administrators, there is a potential for multiple role conflict. Campus clinicians may find themselves involved in maintaining a difficult balance between student and university interests. We describe some of the problems that arise in balancing decisions between the two, with a specific emphasis on threats to confidentiality and informed consent, dual role conflicts, and the limits of clinical expertise.

The use of telemedicine to evaluate competency to stand trial: a preliminary randomized controlled study.

To investigate whether forensic evaluations can be performed reliably using telemedicine, we compared the results on a standard competency assessment instrument using telemedicine (TM) and live interviews (LI). Two board-certified forensic psychiatrists used the Georgia Court Competency Test (GCCT) to evaluate 21 forensic psychiatric inpatients. Half of the patients were randomly assigned to a telemedicine interview and half were assigned to a live interview. Total scores on the GCCT were similar for both raters, indicating high levels of agreement between telemedicine and live interviews. Patient and provider satisfaction were measured and indicated that, although patients did not express a preference for a particular interview modality, providers reported greater satisfaction with live interviews. Findings suggest that one aspect of competency to stand trial can be reliably evaluated using telemedicine and that patients perceive telemedicine as an acceptable alternative to a standard live interview. The limited sample size precludes definite conclusions and further studies involving a larger forensic study population are warranted.

Are release recommendations for NGRI acquittees informed by relevant data?

We conducted a retrospective review of factors involved in clinical recommendations for release of patients adjudicated not guilty by reason of insanity (NGRI). Medical records from 91 patients in a maximum security forensic hospital who participated in a formal hearing process to determine suitability for release were reviewed. The purpose of the study was twofold: (1) to examine the process involved in day to day clinical decision-making regarding release from a maximum security forensic hospital and (2) to determine what factors in a patient's clinical and legal history were related to recommendation decisions. Multivariate statistical methods revealed that among the clinical, demographic, and legal information available to clinicians at the time a formal release recommendation was made two factors emerged that were significantly related to release recommendations: PCL-R score and the age at which the patient committed his first criminal offense. Patients with high levels of psychopathy and those who engaged in criminal behavior at a younger age were less likely to be recommended for release from a maximum security forensic hospital.

Mental health needs of cohabiting partners of Vietnam veterans with combat-related PTSD.

The objectives of this study were to perform an initial needs assessment of partners of Vietnam veterans with combat-related posttraumatic stress disorder (PTSD) and to assess the partners' current rates of treatment use. A telephone survey was conducted with 89 cohabitating female partners of male combat veterans who were receiving outpatient PTSD treatment at two Department of Veterans Affairs medical centers. Although large majorities of partners rated individual therapy and family therapy to help cope with PTSD in the family as highly important, only about one-quarter of the partners had received any mental health care in the previous six months. The most commonly requested service was a women-only group.

Anxiety-related differences in affective categorizations of lexical stimuli.

Effects of emotional valence on attention have been shown to occur even when stimuli are presented outside awareness. The impact of negative valence on stimulus processing has been demonstrated to be particularly salient in anxiety. Therefore, it has been hypothesized that compared to nonanxious individuals, anxious individuals have an enhanced ability to detect the valence of negative stimuli. However, it remains unclear whether anxious individuals are better at identifying the valence of threatening stimuli or, rather, more likely to label ambiguous stimuli as threatening. To investigate these hypotheses, high and low anxious participants categorized lexical stimuli as "safe" or "dangerous." Stimuli were presented at durations that allowed for both conscious (unmasked) and nonconscious (masked) processing. Results show that on masked trials, anxious individuals evidenced an enhanced ability to correctly classify threatening information, whereas nonanxious participants demonstrated an enhanced ability to correctly classify neutral or positive information. Signal detection analyses indicated results were explained by a response bias, whereby anxious individuals were more likely than nonanxious individuals to categorize masked words as threatening and nonanxious individuals were more likely to categorize masked words as nonthreatening. No group differences for nonword stimuli emerged, suggesting that anxiety-related response bias tendencies are activated only after detection of a weak semantic signal.