The “ROC” Model: Psychiatric Evaluation, Stabilization and Restoration of Competency in a Jail Setting

Abstract

Despite its well-meaning intentions, the movement toward deinstitutionalization has shifted more and more people with serious mental illness and co-occurring disorders from state hospitals to jails and prisons (Lamb and Weinberger, 2005; Human Rights Watch, 2003). There are now more than three times more seriously mentally ill persons in jails and prisons than in hospitals (Torrey, Kennard, Eslinger, Lamb and Pavle, 2010). The trend has intensified in recent years as public mental health resources, both at the state hospital level and at the local community level, continue to shrink. Even before the national recession of 2010 hit government agencies and forced them into profound and drastic cost-saving measures, reductions in public mental health services were already causing high numbers of people with severe and persistent mental illness to land in the criminal justice system. As early as 2007, Wortzel, Binswanger, Martinez, Filley & Anderson (2007) asserted that the systemic decline of public mental health resources had created a national crisis for persons judged Incompetent To Proceed (ITP) who are “log-jammed” in jails and prisons across the country. Calling it “the ITP crisis,” the Wortzel group decried the practice of jailing persons with psychotic disorders, often for long periods of time, without adequate psychiatric treatment because there are not enough forensic beds available in state hospital systems. “Hundreds of patients with severe mental illness deemed incompetent to proceed are languishing in jails around the nation, unable to access meaningful psychiatric care and not moving forward in the legal process as they await admission to grossly undersized and understaffed state hospitals... The combination of inadequate psychiatric care, the stress of incarceration and the long waits involved have yielded nightmarish results...” (Wortzel, et al., 2007, p. 357).