Forensic Commitments and Treatment
People who come to a California state hospital through a forensic commitment are individuals who have been charged with or convicted of criminal behavior related to their mental illness. Some are referred by the criminal courts under California law for treatment that will help them to understand the criminal charges they are facing and to assist in their own defense. Others are admitted because they have been found not guilty by reason of insanity.State hospitals also treat patients who come to us through the California prison system. They are either current prison inmates, are prisoners about to be paroled, or are parolees in each case needing specialized mental health treatment.
All patients are treated with individualized treatment plans. These can include medication, individual therapy and group therapy. Each patient has a treatment team to help them develop a treatment plan. Treatment teams include a psychiatrist, a psychologist, a social worker and occupation and/or recreational therapists.
The overall goal of the treatment is to prepare the patient for what comes next after leaving our hospital. For some that will mean returning to jail and a criminal court to stand trial. For others, a return to a prison cell. Still others will be released to a community, often with out-patient treatment continuing once they are there.
Reaching this goal will include objectives that will differ depending upon many factors including the patients’ reason for commitment, the nature of their mental illness and the patients’ abilities.
The length of stay for many patients is ultimately up to a judge and not any recommendation from the hospital.
Commitment Categories of Forensic Patients
Incompetent to Stand Trial (Penal Code 1370)
Felony defendants found incompetent to stand trial by a court are placed in a state hospital, where the focus of treatment is to stabilize their condition and return them to trial competency so the court may adjudicate their pending charges. Those patients who are determined to be unlikely to regain competency are returned to the court to determine future conservatorship status.
Mentally Disordered Offenders (Penal Code 2962/2972)
Parolees who committed one of a specified list of crimes and who were treated for a severe mental disorder connected to their original crime can be committed to a state hospital as a condition of parole for a period not to exceed the length of their parole term. If the person still requires treatment at the end of their parole term, they can be civilly committed under P.C. 2972 if it is determined that they are a substantial danger to themselves or others. These commitments last for one year and may be renewed annually by the court.
Mentally Ill Prisoners transferred from prison (Penal Code 2684)
These inmate-patients are transferred from California Department of Corrections and Rehabilitation (CDCR) for inpatient mental health care with the expectation that they will return to a CDCR facility when they will no longer require inpatient treatment.
Not Guilty by Reason of Insanity (Penal Code 1026)
Patients judged by the court to be not guilty because they were insane at the time of the felony crime are committed to a state hospital for treatment for a period equal to the maximum sentence of their most serious offense. However, if the court finds that the sanity of the patient has been restored, the court may release the patient prior to reaching the maximum sentence.
Each state hospital currently has a discharge policy with the focus of planning for a discharge that is in the best interest of the patient. DSH is working on a system-wide policy to ensure consistency, including adequate chart documentation of the discharge.