An outpatient psychiatry program for offenders with mental disorders found not guilty by reason of insanity.
OBJECTIVE
Rehospitalization and criminal recidivism were examined among a group of offenders with mental disorders adjudicated as not guilty by reason of insanity and mandated to receive treatment in a forensic psychiatric outpatient program as a condition of release.


METHODS
A retrospective chart review was conducted for 43 offenders with mental disorders who were acquitted as being not guilty by reason of insanity for the index offense and were active in the outpatient treatment program in 1996. Data were abstracted on sociodemographic, psychiatric, and criminal characteristics predating the index offense; rehospitalizations and new crimes and rearrests after the offense; and clinical and psychosocial functional outcomes after enrollment in the outpatient program.


RESULTS
For the 43 patients, the mean length of stay in the program was 68 months, with a range of 4.9 months to 18.4 years. Almost two-thirds of the patients were diagnosed as having schizophrenia, schizoaffective disorder, or a nonaffective psychotic disorder; 58 percent had a comorbid substance use disorder, and 63 percent had an axis II diagnosis. Since program enrollment, 20 patients (47 percent) were rehospitalized at least once, and eight (19 percent) were rearrested or had committed a new crime. At the end of 1996, only nine (24 percent) were in full remission, and 26 (68 percent) showed at least one indicator of difficulty reintegrating into the community.


CONCLUSIONS
Even after treatment in a specialized forensic program, this sample of offenders with serious mental disorders remained impaired symptomatically and functionally. Although avoidance of rehospitalization is considered a successful outcome, rehospitalization is preferable to rearrest for this forensic population.
Kravitz
H M
HM
Department of Psychiatry, Rush Medical College, Rush University, Chicago, IL, USA. hkravitz@rpslmc.edu
Kelly
J
J
D000328:Adult; D000553:Ambulatory Care; D002648:Child; D003134:Commitment of Persons with Psychiatric Disorders; D003415:Crime / Q000706:statistics & numerical data; D005069:Evaluation Studies as Topic; D005260:Female; D005555:Forensic Psychiatry; D006801:Humans; D007298:Insanity Defense; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D010359:Patient Readmission