Assessing Two Decades of Insanity Acquittee Release from the North Carolina Forensic Program.

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. The study also describes the association between the demographic, psychiatric, and criminological characteristics of insanity acquittees and outcomes of recidivism or rehospitalization. The results show that insanity acquittees in North Carolina have higher rates of criminal recidivism than acquittees in other states. There is also evidence of systemic bias against minority race acquittees in the insanity commitment and release process in North Carolina. Outcomes for insanity acquittees released from the state Forensic Treatment Program could be improved through the introduction of evidence-based practices widely used in other states.

Integrating forensically and civilly committed adult inpatients in a treatment mall program at a state hospital.

OBJECTIVE: This brief report presents outcome data from a 350-bed state psychiatric hospital that integrated its adult forensically and civilly committed inpatient populations within one rehabilitative program. METHODS: Dorothea Dix Hospital, located in Raleigh, North Carolina, used the "treatment mall" model to offer all of its resources to all adult patients in a centralized setting. Program participation of 100 patients from two long-term civil units was compared with program participation of 94 patients from the hospital's medium- and maximum-security forensic units. RESULTS: The forensic patients were significantly less likely to refuse to join or to leave a group, and they were better engaged in their treatment. The use of restrictive interventions and the incidence of assault were minimal for both groups. CONCLUSIONS: The experience at Dorothea Dix Hospital suggests that integrating these populations in rehabilitative programming is not only fiscally responsible but also clinically promising, with no evidence of greater disruptiveness attributable to forensic patients.