A retrospective study of 43 patients who had previously been found not guilty by reason of insanity, and were enrolled in an out-patient forensic psychiatric program, found that 19 percent committed any crimes while undergoing treatment.
The study was done by Dr. Howard Kravitz and Dr. Jonathan Kelly, of the Isaac Ray Center, Section on Psychiatry and Law at Rush-Presbyterian-St. Luke's Medical Center in Chicago. The study was published in the December 1999 journal, Psychiatric Services. Dr. Kravitz is presenting the paper at 10:15 am on April 28 at a University of Chicago conference hosted by the Center for Public Mental Health Services Research called "Mandated Treatment: Legal Mechanisms and Clinical Issues."
Rush is one of the few institutions that has a contract with the State of Illinois to treat patients who are found not guilty by reason of insanity. Offenders with mental disorders who have been found not guilty by reason of insanity are thought to be at special risk for committing violent acts. Previous studies done on patients who are released unsupervised in the community have placed the recidivism rate at between 24 and 61 percent, while the psychiatric rehospitalization rate ranges from 18 to 44 percent.
In Illinois, patients found NGRI are typically sent to Elgin Mental Health Hospital, where they are evaluated for approximately 30 days. After a thorough psychiatric evaluation, the patients are either detained in the hospital or released into a state-mandated outpatient forensic psychiatric program.
The Rush study was done by reviewing charts of patients in its out-patient program in 1996. Drs. Kelly and Kravitz found that 16 percent of the patients were continuously hospitalized but had obtained permission to attend the out-patient program and another 47 percent were rehospitalized at least once. Only 19 percent committed any crime after enrolling in the outpatient program. "How you interpret these data depends on how you define recividism," Kravitz said. For instance, all of the NGRI patients were admitted to the program after committing felonies -- murders or aggravated battery or sexual assault.
The out-patient treatment program at Rush combines effective medication and both group and individual therapy, according to Kelly.
"The Rush program seeks to balance the community's need for protection against what is the most cost-effective treatment for these patients," Kelly said. "While more research needs to be done on this patient population, we can infer that this out-patient program is effective in reducing the potential for recividism," he said, adding that rehospitalization is much more preferable than reimprisonment.
Rush-Presbyterian-St. Luke's Medical Center includes the 809-bed Presbyterian-St. Luke's Hospital; 154-bed Johnston R. Bowman Health Center for the Elderly; Rush University (Rush Medical College, College of Nursing, College of Health Sciences and Graduate College); and seven Rush Institutes providing diagnosis, treatment and research into leading health problems. The medical center is the tertiary hub of the Rush System for Health, a comprehensive healthcare system capable of serving about three million people through its outpatient facilities and seven member hospitals.