Treating the not guilty by reason of insanity outpatient: a two-year study.

Issues concerning the safety and effectiveness of treatment of not guilty by reason of insanity (NGRI) patients in the community have come under increased public scrutiny and professional discussion in recent years. I Despite the intensity of controversy in this area, few objective data exist relative to these concerns. Thus, meaningful decisions regarding safe and effective treatment of the NGRI patient in the community are difficult to make in the absence of valid, empirically based data. The aim of this study was to address this limitation by presenting objective data as to the psychiatric and psychologic functioning of NGRI outpatients in response to treatment. Although studies of institutional management of the NGRI hospitalized population are available, few published reports exist regarding the functioning of NGRI patients in court-ordered treatment within the community. One unpublished study (Lebow and Madden, personal communication, 1978) suggests that after an adequate course of hospitalization, a five-year intensive court-supervised outpatient treatment program for NGRI patients can be effective in reducing psychologic decompensation and criminal recidivism. Additionally, Silve~ and Bloom et al. have recently presented follow-up data for NGRI acquittees discharged into community treatment programs, which suggest that under such conditions, a substantial reduction in rearrest/recidivism rates may be possible. The major objective of the present study, therefore, was to evaluate more comprehensively the adequacy of psychologic adjustment of NGRI outpatients through repeated longitudinal assessments, utilizing standardized clinical interviews and a select battery of self-rating instruments.