Department of Psychology, Fairleigh Dickinson University, Teaneck, New Jersey, USA.
Division of Continuing & Professional Studies, Palo Alto University, Palo Alto, California, USA.
CNS Spectr. 2020 Apr;25(2):161-172. doi: 10.1017/S1092852919001597. Epub 2019 Nov 20.
Beginning in the 1960s, a steady decline in the number of inpatient psychiatric beds has occurred across the United States, primarily as a result of stricter civil commitment criteria and a societal movement toward deinstitutionalization. Concomitant with this decrease in psychiatric beds has been a steady increase in the number of mentally ill individuals who are arrested and processed through the criminal justice system as defendants. One consequence of this has been an explosion in the number of defendants referred for evaluations of their present mental state-adjudicative competence-and subsequently found incompetent and ordered to complete a period of competency restoration. This has resulted in forensic mental health systems that are overwhelmed by the demand for services and that are unable to meet the needs of these defendants in a timely manner. In many states, lawsuits have been brought by defendants who have had their liberties restricted as a result of lengthy confinements in jail awaiting forensic services. The stress on state-wide forensic systems has become so widespread that this has reached the level of a near-national crisis. Many states and national organizations are currently attempting to study these issues and develop creative strategies for relieving this overburdening of forensic mental health systems nationwide. The purpose of this article is to review the current state of the research on competence to stand trial and to highlight those issues that might be relevant to the issue of criminalization of individuals with mental illness in the United States.
从 20 世纪 60 年代开始，美国的住院精神病床位数量稳步下降，主要是由于更严格的民事承诺标准和社会向去机构化的转变。随着精神病床位的减少，被逮捕并通过刑事司法系统作为被告处理的精神疾病患者数量稳步增加。其结果之一是，被转介进行当前精神状态——审判能力评估的被告人数激增，随后被判定为无能力，并被命令完成一段能力恢复期。这导致法医心理健康系统不堪重负，无法及时满足这些被告的需求。在许多州，由于长时间被监禁等待法医服务，被告的自由受到限制，因此提起了诉讼。州法医系统的压力如此广泛，以至于已经达到了全国性危机的程度。许多州和国家组织目前正试图研究这些问题，并制定创造性的策略来缓解全国法医心理健康系统的负担过重问题。本文旨在回顾目前关于审判能力的研究状况，并强调那些可能与美国将精神疾病患者刑事定罪问题相关的问题。
