Release Conditions Research Articles

Conditional release and cannabis use: Concerns and challenges for community reintegration.

This article, which serves as a perspective review, delves into the complexities of cannabis use among individuals preparing for or already on conditional release (CR). These complexities include an association between cannabis use and mental illness and dealing with the fact that the use of illicit substances, such as cannabis, is against CR rules, leading to potential revocation. A focus of this article is the deleterious effects cannabis and synthetic derivatives of cannabis can have for individuals on CR. The article concludes with six-specific recommendations for managing cannabis use in this population with a focus on careful and detailed risk assessments that considers the relationship between substance use and dangerousness, the role of protective factors, the need for a detailed conditional release plan, inpatient and community-based interventions aimed at increasing individual autonomy, and education on the dangers of cannabis use for both the treatment team and the insanity acquittee.

Reconsidering risk assessment with insanity acquittees.

States continue to rely on conditional release (CR) as an effective and cost-effective way to manage individuals found not guilty by reason of insanity (NGRI). Research has demonstrated that insanity acquittees returning to the community have low recidivism rates and moderately low revocation rates. This study followed 238 individuals found NGRI in Oregon who were evaluated with the Historical, Clinical, Risk-20 (HCR-20; Webster, Douglas, Eaves, & Hart, 1997) and placed in the community on CR. The majority of individuals on CR (n = 157, 66%) maintained their release throughout the entire follow-up period (between 4 and 9 years), but 81 (33.6%) had their release revoked during the follow up. In considering the efficacy of violence risk assessment in predicting CR outcome with NGRI acquittees, the HCR-20 was mostly unrelated to CR outcome. Only two items from the HCR-20, both from the Risk Management scale (exposure to destabilizers and stress) predicted revocation, but not imminence to CR revocation. This paper reconsiders how risk assessments are utilized with insanity acquittees and provides a roadmap for improving risk assessments with this unique population by relying on risk assessment results to plan effective interventions to reduce the likelihood of revocation and violence. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Assessing Field Reliability of Forensic Decision Making in Criminal Court

ABSTRACTThe current study evaluated field reliability of forensic judgments in a state circuit court setting. Utilizing panels of three independently appointed examiners, Hawaii’s system for evaluating mentally ill defendants charged with felonies provides a naturalistic laboratory for investigating decision-making processes in examiners and judges. The study focused on competency to stand trial (CST), criminal responsibility (NGRI), and postacquittal conditional release (CR) using a methodology adopted from clinical medicine and natural sciences. The entire adjudicative process from examination to judicial determination is examined as a forensic classification model. Examiner agreement and judicial consensus for 450 forensic reports were examined to assess performance in a non–crossed-data measurement design. Reliability of psycholegal constructs (CST, NGRI, postacquittal CR) was assessed using a novel reliability estimator (Krippendorff’s alpha: KALPHA). This is the first study in the forensic mental health literature to examine interrater agreement for postacquittal conditional release decision making. Findings revealed adequate performance for CST, poor performance for CR, and marginal performance for NGRI decisions. Judges demonstrated independence in the presence of panel disagreements. Across the board, examiners demonstrated high levels of inconsistency in judgments. Factors associated with poor reliability, including task complexity, are discussed. The findings raise concerns about the overall quality of psycholegal decision making in criminal proceedings, especially in NGRI and CR determinations.

Conditional Release of Forensic Psychiatric Patients Consistent with or Contrary to Behavioral Experts' Recommendations in the Netherlands: Prevalence Rates, Patient Characteristics and Recidivism After Discharge from Conditional Release.

The present study examined a group of 447 Dutch forensic psychiatric patients on conditional release (CR). After a brief overview of the Dutch CR system for forensic psychiatric patients is presented, two sets of factors were studied: factors associated with behavioral experts' recommendations on CR readiness (prevalence rates of recommendations in contrast to or consistent with the judge's decision on CR, written vs. oral recommendations and consensus among parties); and characteristics of forensic psychiatric patients on CR imposed consistent with or contrary to behavioral experts' recommendations (i.e., demographic variables, psychopathology, judicial background and outcomes of violent behavior). Patients on CR consistent with or contrary to the behavioral experts' recommendations did not differ in demographic background variables and psychopathology. Patients on CR contrary to the behavioral experts' recommendations, however, had more prior convictions, and their index offense more often included a sex offense and a property offense (with or without violence) as compared to patients on CR consistent with the behavioral experts' recommendations. In addition, decisions contrary to the behavioral experts' recommendations were more often reached after a 3-month continuation adjournment and after an appeal. Also, patients on CR contrary to the behavioral experts' recommendations were less often found to have been on trial leave before their CR. Finally, recidivism rates were found to be much higher for those on CR contrary to, as compared with those on CR consistent with the behavioral experts' recommendations. However, when corrected for other well-known static predictors of recidivism, this significant difference was no longer prevalent. The implications for evaluators' CR readiness reports and lessons that may be learned from the Dutch forensic psychiatric CR system are discussed. Copyright © 2016 John Wiley & Sons, Ltd.

Assessing Insanity Acquittee Recidivism in Connecticut.

For over 30 years now the movement and status of insanity acquittees in Connecticut has been supervised by the Psychiatric Security Review Board (PSRB). During this time, 365 acquittees have been committed to the jurisdiction of the PSRB, 177 individuals have achieved conditional release (CR) and 215 acquittees have been discharged from PSRB jurisdiction. This article examines revocation of CR by the PSRB, arrests of acquittees on CR, and provides the first report of arrests following discharge from the PSRB's jurisdiction. The literature on relevant aspects of recidivism is reviewed and compared with findings in Connecticut. There is little available literature about recidivism of insanity acquittees following release from supervision. In the present sample of individuals discharged from the PSRB, 16% were rearrested, a rate that compares favorably with other discharged populations of offenders. For discharged acquittees, community supervision on CR prior to discharge from the PSRB had a statistically significant effect on decreasing the risk of subsequent rearrest, as did both the length of stay in the hospital and the duration of commitment to the PSRB. This article presents descriptive information about revocations, arrests on CR, and arrests following discharge. These data are consistent with criminal justice studies demonstrating the value of community supervision in lowering recidivism. Copyright © 2016 John Wiley & Sons, Ltd.

Conditional Release Placements of Insanity Acquittees in Oregon: 2012–2014

Between January 1, 2012 and December 31, 2014, there was a large population (N = 200) of insanity acquittees placed on conditional release (CR) in the state of Oregon. This article looks at the demographic and system characteristics of this large group of individuals. The authors then focus on the initial housing placement and what happens to individuals after their release in relation to their housing placement. In Oregon, insanity acquittees are either conditionally released directly by the court or placed in the hospital prior to potential CR by a supervising board. In general, once CR occurs, individuals tend to stay in their initial placement without moving to less structured levels of care, raising concerns about transinstitutionalization. This is especially true for individuals released to the most structured living arrangement (secure residential treatment facility). Those individuals who are conditionally released to less structured settings have a higher rate of revocation back to the hospital. Those individuals who do move to less structured levels of care usually have longer hospital stays and start off in more structured levels of care to start their CR. Copyright © 2016 John Wiley & Sons, Ltd.

Examiner Agreement and Judicial Consensus in Forensic Mental Health Evaluations

The reliability of forensic methods continues to be controversial. Hawaii is unique in utilizing a three-panel system for evaluating criminal defendants for competency to stand trial (CST), not guilty by reason of insanity (NGRI), and postacquittal conditional release (CR). The study examined independent forensic reports with judicial determinations to assess examiner agreement and judicial consensus. Examinees (N = 450) were defendants charged with felony offenses. Three groups of examiners conducted independent forensic mental health evaluations: community-based psychiatrists, community-based psychologists, and psychologists employed by the Courts & Corrections branch of the Hawaii Department of Health. Five classes of reliability estimators were examined in a noncrossed data measurement design. The study examined field reliability of CST, NGRI, and CR as operationalized psycholegal constructs. Overall, findings revealed wide variability in examiner consensus and agreement between examiners and judges, depending on type of examination. Factors associated with examiner disagreement are discussed. Findings are similar to field reliability for other types of complex decision making. Procedural standardization, application of structured professional methods, use for forensic assessment instruments, and de-bias assessment are recommended to improve the quality of forensic mental health opinions.

Freedom in paradise: Quality of conditional release reports submitted to the Hawaii judiciary

Annually thousands of insanity acquitees are released from mental hospitals when they are no longer determined to be dangerous. This research examined quality of post-acquittal Conditional Release (CR) reports submitted to the Hawaii Judiciary. Hawaii utilizes a “three panel” system for assessing trial felony competency, criminal responsibility, and conditional release, where typically two psychologists (one Department of Health and one community-based) and one community-based psychiatrist submit independent reports to the Court. One hundred fifty CR reports were rated using a 44-item report quality measure. Interrater reliability trials indicated good to excellent agreement between quality ratings. Overall level of report quality was poor regardless of examiners' professional discipline, employer, or board certification status. Concordance rates for CR opinions were poor. Level of agreement between the judicial determination and majority recommendations was also poor. Reasons for the poor quality and level of agreement are discussed with recommendations for report quality improvement, including standardization of procedures and use of forensic risk assessment instruments.

Factors associated with the conditional release of persons acquitted by reason of insanity: a decision tree approach.

Most NGRI (not guilty by reason of insanity) acquitties are hospitalized for some period of time following acquittal, which raises the question of when an individual can be safely released into the community. The conditional release (CR) of persons acquitted by reason of insanity, therefore, provokes the question of public safety. This study examines the CR systems in four states--Connecticut, Maryland, New York, and Ohio. A study sample of 529 persons acquitted as NGRI from 1985 to 1987 was followed up for at least five years to determine who is conditionally released. Following a description of the CR systems, findings suggestive of the role of dangerousness and diagnosis as predictors of CR are presented. Personal characteristics are also significant factors in predicting who will be released. The length of hospitalization for this population and other descriptive factors such as history of hospitalization, arrests, substance abuse, family violence, and living arrangements are also addressed.