HD9 - Implementation Report of the Department of Mental Health and Mental Retardation on the Establishment of a Forensic Evaluation Training and Research Center

  • Published: 1983
  • Author: Commissioner of Health and Mental Retardation
  • Enabling Authority: House Joint Resolution 22 (Regular Session, 1980)

Executive Summary:
Prior to the 1980 session of the General Assembly, there were numerous indications that a substantial proportion of criminal defendants committed to state inpatient facilities for forensic evaluation did not need hospitalization and could be adequately and more economically evaluated on an outpatient basis at community mental health clinics. It was believed that what was needed was the training of teams of mental health professionals at the clinics to do forensic evaluations on an outpatient basis.

On March 8, 1980, the General Assembly agreed to House Joint Resolution No. 22 which in essence requested the Commissioner of Mental Health and Mental Retardation to establish a Forensic Evaluation Training and Research Center for training professionals in the skills of forensic evaluation, to establish related demonstration service projects and to report to the General Assembly describing the progress and the impact of this program.

In order to implement the subject resolves of the General Assembly, the Department developed a contract with the University of Virginia, Institute of Law, Psychiatry and Public Policy to establish the Forensic Evaluation, Training and Research Center. The requested demonstration projects were targeted for six jurisdictions to receive training, Radford, Roanoke, Charlottesville, Alexandria, Richmond and Portsmouth, and for six other jurisdictions to serve as controls, Arlington, Chesapeake, Norfolk, Petersburg and Suffolk.

Summary of the salient features of the program is as follows:

Protocols for both outpatient forensic evaluation and screening relative to mental status at the time of the alleged offense were developed as was a 350-page training manual and curriculum for the program. Teams of community mental health professionals at the target areas were trained between October, 1980 and May, 1981. This was followed by close follow-up, continuing education and evaluation of the results and impact during the first year of operation of the program.

It was not possible to conduct the competency to stand trial evaluations for the courts without fee as had been desired. A reasonably equitable fee schedule, however, was developed through the office of the Executive Secretary of the Supreme Court.

To assist judges, prosecutors and defense attorneys, educational meetings were held, and a 20-page informative booklet was developed and distributed.

The Center also developed an Advisory Committee of select judges, Commonwealth's attorneys and defense attorneys to resolve issues which arose concerning trainees and the performance of forensic evaluations.

There was coordination between the Forensic Unit at Central State Hospital and the Center, both in the training itself and in the subsequent follow-up of trainees for purposes of assessment and continuing education.

Collection of data to determine impact included information relative to state hospital admission of criminal defendants for evaluation, comparative costs, level of knowledge of trainees, evaluation of forensic report quality, use of screening evaluation pertinent to mental status at the time of the alleged offense and assessment by members of the legal profession.

Prior to the pilot project, during fiscal year 1979 through 1981, the annual number of inpatient forensic evaluations had remained relatively constant. During the operational year of the project, the in-hospital evaluations required by trained localities dropped by 46% whereas the community-based outpatient forensic evaluations of the trained areas increased from an average of 193 evaluations per year to 291 evaluations during the year of the project, an increase of close to 50%. The control areas showed no comparable change.

Estimated costs for inpatient forensic evaluations were determined to be $2,745 per evaluation of each hospitalized patient as compared with $455 for each community-based outpatient forensic evaluation. Implementation of the community-based forensic evaluation in the demonstration project was determined to reduce the overall costs for forensic evaluations by 32%.

Study of the forensic knowledge of community mental health professionals trained in the project showed a mean test score of 75% compared to 50% for a comparable group who had not received the training.

As rated by judges, Commonwealth's attorneys and defense attorneys as a measure of the trainees' competence, the quality of their forensic evaluation reports was determined to be of high quality.

Utilizing the Center developed protocol for screening pertinent to mental status at the time of the alleged offense, 44% of the defendants were determined not to be in need of such an in-depth MSO evaluation, further decreasing the need for hospitalization.

A survey of the legal profession's assessment of the forensic evaluations produced by the trained clinics of the project indicates that it was quite satisfied with the overall quality of the community-based forensic evaluation services being rendered by the clinics of the trained jurisdictions.

Certification of evaluators by the Forensic Evaluation Training and Research Center has been made an integral part of the Center's operation.

Significant progress has been made in establishing a statewide community-based mental health forensic evaluation system and plans have been made for further statewide development of a graduated three-tiered system which will integrate and coordinate community-based outpatient services, with services rendered by regional civil hospitals and the Central State Hospital Forensic Unit.

Pertinent revisions of Sections 19.2-169 of the Code of Virginia were accomplished and enacted by the 1982 session of the General Assembly. Additional legislative suggestions for consideration, contained in this report, relate to the reimbursement of forensic evaluators, the qualification of clinical social workers to perform competency evaluations for the courts, and the competency of defendants to plead guilty.