A clinical evaluation of maximum security hospital patients by staff and independent psychiatric consultants.

The psychiatric evaluation of mentally ill offenders and defendants has become a major task at the crossroads of the Criminal Justice and Mental Health Systems. Criminal courts, often burdened and backlogged, are further handicapped in the trial and sentencing of criminal offenders and defendants by the lack of readily available, uniform, high quality psychiatric and psychological diagnostic services on a pretrial and presentence level. Since courts often lack such services, they use medium and maximum forensic security hospitalization, and extravagant and frequently inappropriate placement for many pretrial defendants and presentence offenders who could be evaluated under less restrictive and less costly circumstances. The inappropriate use of limited state forensic mental hospital facilities is further compounded by other problems. Once a state has a facility designated to house mentally ill persons involved with the Criminal Justice System, the facility then tends to receive a clinically difficult group of civilly committed persons who are assaultive or considered "troublemakers" by the staffs of other state mental hospitals. These clinically difficult patients have been assessed as requiring "maximum security," or at least greater surveillance than the ordinary state hospital claims it can provide. However, in recent years, the right to treatmentl.2 in the least restrictive setting has received a great deal of attention and now must also be considered for patients housed in forensic hospital facilities. . Added to the problem of inappropriate referral is one of undue retention. Psychiatrists often lack legal direction or guidance with respect to their actual or imagined vulnerability to civil rights' violations if the patient is involuntarily treated for longer than necessary.5 Similarly, a psychiatrist who discharges or provides leave for the patient who shortly proceeds to murder or seriously assault someone can then be faced with a lawsuit.. Community fear and political response also add to the pressure for retention of mentally ill persons involved with the Criminal Justice System, even for nonviolent offenses. The double label of mentally ill and charged or convicted is translated into the label "criminally insane" by both the press and the public. Bentz