Kenneth L. Appelbaum

The Designated Forensic Professional Program: A state government-university partnership to improve forensic mental health services.

As the law/mental health field has expanded and matured in the last 20 years, the sophistication required by mental health professionals in order to respond appropriately to legal questions has grown significantly. Courts and legislatures define a growing number of legal competencies. Judges and attorneys are more familiar with mental health law than they were 10 or 20 years ago.

Criminal-justice-related competencies in defendants with mental retardation

Individuals with mental retardation have impairments in intellectual functioning and adaptive behavior. These impairments can affect trial-related competencies during criminal proceedings. Problems can arise at three stages of criminal proceedings: confession and waiver, proceeding to trial, and functioning at trial. The authors review the effects of mental retardation on general functioning and the potential trial-related consequences of these impairments. A companion paper provides guidance for detecting mental retardation during forensic evaluations.

Correctional Mental Health Research: Opportunities and Barriers

In March 2007, a national work group met to review the state of mental health research in correctional settings. Participants identified gaps in current knowledge and topics most in need of further research. The discussion of important subjects for further investigation focused on five broad, and often overlapping, content areas: epidemiology, research methodology, functional behaviors, efficacy of interventions, and safety. Barriers to conducting correctional research that the group identified included funding difficulties, resistance from stakeholders, restricted access to subjects, limited information technology, ethical concerns, and institutional review board (IRB) requirements. Potential strategies for overcoming these barriers, such as setting appropriate priorities, easing the burden of research protocols, identifying key collaborators, and facilitating the IRB-approval process, were also discussed.

Assessment of criminal-justice-related competencies in defendants with mental retardation.

Mental retardation can affect trial-related competencies of criminal defendants. This paper provides guidance on detecting mental retardation during forensic evaluations and on how to report findings to the court. Issues related to habilitation of defendants with mental retardation also are addressed.

Stimulant use under a prison treatment protocol for attention-deficit/hyperactivity disorder

Although stimulant medications are the mainstay of effective intervention for attention-deficit/ hyperactivity disorder (ADHD), their use presents a daunting scenario for psychiatry, nursing, and custody staff in correctional settings, where reported prevalence rates range from 9% to 45%. The reported rates, however, may overestimate actual prevalence in general and need for treatment in particular. Under a monitored protocol that required documentation of history, diagnosis, lack of response to nonstimulant treatment, and significant functional impairment, less than 1% of male inmates in the Massachusetts state prison system met criteria for treatment with stimulants. Although this protocol did not attempt to determine overall ADHD prevalence rates, the relatively low number of inmates with compelling reasons for stimulant treatment may provide a more realistic idea of the likely consequences of allowing access to this intervention.