Journal of the American Academy of Psychiatry and the Law

No abstract text is available yet for this article.

No abstract text is available yet for this article.

The adoption of the widely used four specific skills model of decisional capacity assessment, first proposed by Appelbaum and Grisso in 1988, has become widely accepted in clinical practice. Many jurisdictions have, through legislative action, incorporated one or more of these skills into state law as part of the legal definition of decisional capacity. These statutes pose a challenge for physicians hoping to revise these criteria, as some commentators have recently proposed. This article categorizes and analyzes existing state statutes that define decisional capacity or designate certain classes of individuals to render such assessments...

As racial influences on forensic outcomes are identified in every aspect of practice, scholars are exploring methods to disentangle race from its historical, economic, and attitudinal antecedents. Because jurisdictions vary in these influences, definitions and data may differ among them, creating inconsistencies in analysis and policy. This retrospective database review compared differences in racial outcomes among 200 pretrial defendants, 160 Black and 40 White, exploring a wide range of socioeconomic, clinical, and forensic influences before, during, and after hospitalization...

There has been robust interest in the influence of cognitive and implicit biases that can hamper a forensic mental health evaluator's ability to provide objective opinion evidence. By contrast, literature exploring the biasing effects of the examiner's unacknowledged and unprocessed emotions has been scanty. Borrowing from concepts originating from psychodynamic treatment literature, this article explores how a forensic mental health evaluator's emotional and transferential reactions can affect the assessment process and formulation of findings...

Collateral interviews can be an integral source of third-party information used in a range of forensic mental health assessments. Although family members and spouses often have the most knowledge about the evaluee, research suggests that they may also experience distress related to the legal proceedings. This article discusses the nature and purpose of collateral interviewing with close collateral contacts, comparing collateral interviews with direct interviews with evaluees. The secondary consequences of having a justice-involved family member are considered, including the possibility of vicarious trauma...

There is limited research on female sex offenders and their offending characteristics. The sociocultural description of women as being nurturing, nonaggressive and, more significantly, nonsexual has diverted the attention from female sexual offending. Although reports have shown that female sex offenders make up two percent of the whole sex offender population, the true rate is remarkably higher because the caretaking behavior of women masks their sexual offenses. The purpose of our study is to explore the characteristics of female sex offenders...

Minority and Indigenous populations have disproportionate representation within forensic mental health services. Social determinants of health and systemic discrimination have contributed to the difficulties these populations have in accessing care, as well as significant differences in care trajectories. In addition, staffing and structural equity, diversity, and inclusion (EDI) challenges permeate forensic systems as in other health care settings. There is little literature to guide forensic mental health services in how best to provide equitable, diverse, and inclusive practices for patients, families, and staff...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

Ashekun and colleagues' study of the association between adverse childhood experiences (ACEs) and arrests in persons with serious mental illness (SMI) provides more evidence for the importance of addressing the broader needs (beyond narrowly defined symptoms of mental illness) of clients with SMI and criminal legal contact. Furthermore, the article supports the need to appreciate fully the intersection of behavioral health and criminal justice and the intersectionality of mental health and race (i.e., the additive adversities experienced by individuals with SMI who also face race-based inequities)...

This study investigates the predictive validity of two risk instruments for stalking, the Guidelines for Stalking Assessment and Management (SAM) and the Stalking Risk Profile (SRP), in a sample of 86 forensic psychiatric patients. We compare these tools against a well-validated violence risk assessment measure (Historical, Clinical, Risk Management-20, Version 3 (HCR-20V3)) for violent and stalking-related outcomes. Dynamic (mutable) components of each tool were rated at three annual intervals and revealed significant change across time...

Over the past two decades, an increasing proportion of North Carolina state psychiatric hospital beds have been used to house forensic patients. Insanity acquittees occupy almost all forensic-designated beds in the state. Despite the effect insanity acquittees have on state hospital use in North Carolina, outcomes for acquittees after they are released from the state hospital are unknown because of a lack of previous research. This study evaluates postrelease outcomes for insanity acquittees discharged from the North Carolina Forensic Treatment Program between 1996 and 2020...

Involuntary civil commitment for individuals who are chronically impaired as a result of their substance use remains highly controversial. At present, 37 states have legalized this practice. Increasingly, states are allowing private third-parties, such as friends or relatives of the patient, to petition courts for involuntary treatment. One such approach, modeled on Florida's Marchman Act, does not determine status based on the petitioning party's willingness to commit to pay for care. In contrast, Kentucky's approach, widely known as "Casey's Law," predicates such involuntary commitment on the third party's willingness to commit in advance to pay for the patient's treatment...

Despite high rates of mental illness among incarcerated people in the United States, use of electroconvulsive therapy (ECT) remains limited in jails and prisons. There are some published guidelines regarding the provision of mental health care, including ECT, in U.S. correctional facilities, but little attention has been paid to the use of ECT for individuals sentenced to death. This article examines ECT within the context of the death penalty, including court consideration of ECT in capital cases and historic uses of ECT to facilitate execution of people on death row...

The procedures and outcomes of conditional release of insanity acquittees is a relatively neglected area of forensic psychiatric research. The release procedures vary in individual states, resulting in a wide range of approaches, from the careful selection of appropriate patients and strict monitoring in the community, to literally no mechanism for ensuring the future safety of such individuals. In North Carolina there are institutional barriers which even hinder research on the outcomes of such cases. Haroon and colleagues report on the post-release outcomes of insanity acquittees in North Carolina from 1996 to 2020...

COVID-19 strongly affected referral of individuals from Oregon's courts and the ability of Oregon State Hospital (OSH) to accept patients. Despite acceleration in the decline in civil commitment, competency to stand trial (CST) admissions increased, causing a bed crisis at OSH, which in turn affected community hospitals and jails. In 1993, the Ninth Circuit Court of Appeals mandated admission of jail detainees to OSH within seven days after a judicial order for CST evaluation or restoration. During COVID, as the number of such patients increased to crisis proportions, average jail detention times exceeded seven days...

The topic of self-induced intoxication causing automatism is a complex legal question that straddles the border of psychiatry, the law, and social policy. It has been argued that women and children are predominantly positioned as victims of sexual and domestic violence, in which substances often play a part. This consideration sensitizes society to any legal measures that may potentially excuse, mitigate, or absolve perpetrators. The legal systems in Canada, the United States, and the United Kingdom have dealt with these situations as best as they can, sometimes inconsistently and sometimes coming into conflict with the public discourse and subsequent legislation...