Annette Christy

Juveniles Evaluated Incompetence to Proceed: Characteristics and Quality of Mental Health Professionals’ Evaluations

The authors studied quality of evaluations of juveniles whose competence to proceed was at issue before the court and characteristics of mental health professionals completing these reports. Many evaluators failed to address important legal issues and offered incomplete descriptions of the youths, their capacities, and the evaluation techniques used. Evaluators commented on legal competency factors in most reports, as required by law, but often failed to identify the cause of the noted incapacity or whether children met commitment criteria (also required by law). Although core competence-related abilities identified in Florida law were addressed in the majority of evaluations, assessments were less than optimal in other psycholegal and clinical domains. Seven recommendations are offered for conducting juvenile competency evaluations that are professionally sound and meet legal requirements.

Law & Psychiatry: Florida's Outpatient Commitment Law: A Lesson in Failed Reform?

An involuntary outpatient commitment law became effective in Florida in January 2005. However, only 71 orders for outpatient commitment have been issued in three years, even though during that period 41,997 adults had two or more 72-hour involuntary emergency examinations under Floridas civil commitment law. This column describes the criteria for outpatient commitment in the Florida statute and discusses possible reasons for its low rate of use, including additional statutory criteria that make filing a petition for outpatient commitment difficult, lack of community treatment resources, and lack of enforcement mechanisms.

Involuntary Outpatient Commitment in Florida: Case Information and Provider Experience and Opinions

The use of involuntary outpatient commitment (IOC) is a significant international issue. Variations can be found in Australia, New Zealand, Scotland, Ontario (Canada), Switzerland, and the United States. Its use varies considerably by country and in the United States, between states. In Florida, the IOC statute has been used sparingly. This paper first presents information about the first fifty IOC cases in Florida including a description of the pre- and post-IOC order emergency commitments and state hospital admissions of these individuals. It then provides results from a survey of mental health professionals about their experience with and opinions about IOC. The majority of the individuals with IOC orders had at least one emergency commitment in the two years pre-IOC order (n = 46; range 1–7) and in the two years post-IOC order (n = 41; range 1–13). While 41 individuals experienced 68 total emergency commitments in the 180 days prior to the IOC order, 18 individuals had 24 emergency commitments in the 180 days after the order. Eleven had at least one state hospital admission pre-IOC order, with eight having such an admission post-IOC order. Results from the survey suggest that a number of issues have reduced the use of IOC, including difficulties in applying the statute, inadequate clinical resources, and skepticism regarding the practical effect of an IOC order on positive clinical outcomes. The implications of these results for policy development are discussed.

Challenges of Diverting Veterans to Trauma Informed Care: The Heterogeneity of Intercept 2

The challenges of diverting veterans from the criminal justice system and into appropriate trauma informed mental health and substance abuse services at Intercept 2 of the Sequential Intercept Model (initial detention and initial first appearance court hearing) are discussed. Six challenges are considered, including identification of veterans and determining veteran status; navigating complex partnerships among stakeholders in the community and within the VA that are essential for a successful program, particularly in terms of a mutual understanding of the functions, resources, and philosophies of each in order to allow for cross-system collaboration; difficulties in defining and operationalizing jail diversion; the timing and logistics of diversion; and screening for trauma-related disorders in a sensitive and client-centered manner within the confines of the criminal justice system. A brief overview of the funding, policy, and program landscape related to diversion of veterans is related to the challenges of diversion generally, and specific to intercept 2, with examples from Florida’s SAMHSA-funded Jail Diversion Trauma Recovery initiative.

Suicide Assessment and Prevention During and After Emergency Commitment

The purpose of this study was to address two primary issues within the context of emergency commitment: (a) the suicide-prevention measures implemented at receiving facilities where emergency commitments occur and (b) the perceptions of key stakeholders about access to community services post-discharge. One hundred seventy-eight respondents who worked in receiving facilities, where emergency commitments occur, responded to an online survey or were interviewed. Respondents indicated the use of suicide-prevention measures such as suicide assessment tools used at intake and discharge and strategies utilized to maintain client safety when the issue of suicidality had been determined at intake. Almost half of respondents (46.6%) described the availability of community mental health treatment at discharge from emergency commitment as being “less than adequate.” Emerging themes about community service availability are discussed and include long waiting periods and funding issues.

Factors affecting jail detention of defendants adjudicated incompetent to proceed

The movement of defendants through the legal process who have been adjudicated incompetent to proceed is little studied, yet it is important. The purpose of this study was to provide empirical data regarding factors that affected the amount of time defendants adjudicated incompetent to proceed and ordered to undergo hospitalization remained in jail while awaiting transfer to a state hospital. Statewide data collected in Florida between July 2005 and June 2008 were used to determine the lengths of time incompetent defendants spent at certain stages in the legal process. The addition of forensic bed capacity following media attention and litigation resulted in a significant decrease in the amount of time defendants adjudicated incompetent to proceed waited in jail for transfer to a state hospital for treatment. The amount of time it took for completed commitment orders to be submitted to the state mental health authority by the Clerks of Court of each county accounted for a meaningful portion of days defendants spent in jail awaiting transfer to a state hospital, with considerable variation across counties with respect to waiting times. These findings reflect how various stakeholders can affect the amount of time defendants spend in jail while awaiting hospitalization. These issues are discussed in the context of controversy related to Floridas forensic mental health system, as well as issues related to the political process and funding of the states mental health authority.

Emergency commitment from nursing homes.

PURPOSE The purpose of this study was to describe emergency commitment of residents from nursing homes and to discuss relevant policy issues. DESIGN AND METHODS This study used statewide, archival emergency commitment data from July 2000 through June 2008. These data are created by entering data from paper emergency commitment initiation forms of law enforcement, mental health professionals, and judges submitted by facilities as required by Florida law. RESULTS During the 1 year from July 2007 through June 2008 there were 898 residents of Florida nursing homes with a total of 1032 emergency commitments. Some individuals had more than one emergency commitment from a nursing home during the year, with 9% having between two and five emergency commitments. One-third of the emergency commitments were for residents younger than 65. Some of these individuals also had substantial numbers of emergency commitments in the 7 years from July 2000 through June 2007. IMPLICATIONS There are facility, client, and regulatory factors that can be addressed to reduce the inappropriate usage of emergency commitments in nursing homes.