Insanity acquittee outcomes in New Zealand.
OBJECTIVE
This paper examines clinical and forensic outcomes for defendants found not guilty by reason of insanity in New Zealand, and explores the implications for policy development and clinical rehabilitation in this population.


METHODS
All insanity acquittees disposed of by the courts as special patients after 1976 and released before 2004 are described. Their duration of inpatient care, rates of reconviction and rehospitalization following release are examined. The high resolution rate for violent crime reported to police suggests that reconviction rates are a reasonable proxy for violent reoffending. Factors predicting duration of inpatient care and reoffending are analysed.


RESULTS
Severity of Index Offence was the only variable predicting duration of inpatient care of the 135 special patients. Offenders of more serious offences were securely detained for longer periods--averaging 6 years in the case of those charged with murder. Most patients were readmitted over the decade following discharge. Only 6% had violently reoffended 2 years after release into the community. Prior offending, age at release, ethnicity and gender predicted reoffending, but not diagnosis or duration of inpatient admission.


CONCLUSIONS
Following discharge into the community, insanity acquittees are reconvicted of violent crimes at a very low rate, although readmission to hospital is common. It may be that insanity acquittees are initially detained in hospital longer than is clinically indicated, and that safe forensic community treatment can occur at an earlier stage of recovery without compromising public safety.
Skipworth
Jeremy
J
Medlicott Unit and Regional Forensic Psychiatry Service, Canterbury District Health Board, Christchurch, New Zealand. jeremy_skipworth@moh.govt.nz
Brinded
Phil
P
Chaplow
David
D
Frampton
Chris
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D003134:Commitment of Persons with Psychiatric Disorders / Q000706:statistics & numerical data*; D003415:Crime / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D006708:Homicide / Q000706:statistics & numerical data; D006801:Humans; D007298:Insanity Defense / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D008875:Middle Aged; D009520:New Zealand; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D012307:Risk Factors; D014754:Violence / Q000706:statistics & numerical data