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Haroon H, Wolfe N, Feizi S, Barboriak P. Assessing Two Decades of Insanity Acquittee Release from the North Carolina Forensic Program. J Am Acad Psychiatry Law 2023; 51:342-352. [PMID: 37399257 DOI: 10.29158/jaapl.230024-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Over the past two decades, an increasing proportion of North Carolina state psychiatric hospital beds have been used to house forensic patients. Insanity acquittees occupy almost all forensic-designated beds in the state. Despite the effect insanity acquittees have on state hospital use in North Carolina, outcomes for acquittees after they are released from the state hospital are unknown because of a lack of previous research. This study evaluates postrelease outcomes for insanity acquittees discharged from the North Carolina Forensic Treatment Program between 1996 and 2020. The study also describes the association between the demographic, psychiatric, and criminological characteristics of insanity acquittees and outcomes of recidivism or rehospitalization. The results show that insanity acquittees in North Carolina have higher rates of criminal recidivism than acquittees in other states. There is also evidence of systemic bias against minority race acquittees in the insanity commitment and release process in North Carolina. Outcomes for insanity acquittees released from the state Forensic Treatment Program could be improved through the introduction of evidence-based practices widely used in other states.
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Affiliation(s)
- Haseeb Haroon
- Dr. Haroon is on the Adjunct Faculty at the Keck School of Medicine of University of Southern California, Los Angeles, CA. Dr. Wolfe is Forensic Psychiatrist, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC, and Forensic Psychiatry Fellowship Director, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Feizi is Adjunct Assistant Professor, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Barboriak was Director of Forensic Services, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC; he died March 29, 2023.
| | - Nicole Wolfe
- Dr. Haroon is on the Adjunct Faculty at the Keck School of Medicine of University of Southern California, Los Angeles, CA. Dr. Wolfe is Forensic Psychiatrist, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC, and Forensic Psychiatry Fellowship Director, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Feizi is Adjunct Assistant Professor, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Barboriak was Director of Forensic Services, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC; he died March 29, 2023
| | - Sara Feizi
- Dr. Haroon is on the Adjunct Faculty at the Keck School of Medicine of University of Southern California, Los Angeles, CA. Dr. Wolfe is Forensic Psychiatrist, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC, and Forensic Psychiatry Fellowship Director, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Feizi is Adjunct Assistant Professor, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Barboriak was Director of Forensic Services, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC; he died March 29, 2023
| | - Peter Barboriak
- Dr. Haroon is on the Adjunct Faculty at the Keck School of Medicine of University of Southern California, Los Angeles, CA. Dr. Wolfe is Forensic Psychiatrist, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC, and Forensic Psychiatry Fellowship Director, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Feizi is Adjunct Assistant Professor, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Barboriak was Director of Forensic Services, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC; he died March 29, 2023
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Russell C, Pang M, Nafeh F, Farrell Macdonald S, Derkzen D, Rehm J, Fischer B. Barriers and facilitators to opioid agonist treatment (OAT) engagement among individuals released from federal incarceration into the community in Ontario, Canada. Int J Qual Stud Health Well-being 2022; 17:2094111. [PMID: 35787743 PMCID: PMC9258049 DOI: 10.1080/17482631.2022.2094111] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Introduction Correctional populations with opioid use disorder experience increased health risks during community transition periods. Opioid Agonist Treatment (OAT) can reduce these risks, but retention is a key challenge. This study addresses a knowledge gap by describing facilitators and barriers to OAT engagement among federal correctional populations released into the community in Ontario, Canada. Methods This article describes results from a longitudinal mixed-methods study examining OAT transition experiences among thirty-five individuals released from federal incarceration in Ontario, Canada. Assessments were completed within one year of participants’ release. Data were thematically analyzed. Results The majority (77%) of participants remained engaged in OAT, however, 69% had their release suspended and 49% returned to custody. Key facilitators for OAT engagement included flexibility, positive staff rapport, and structure. Fragmented OAT transitions, financial OAT coverage, balancing reintegration requirements, logistical challenges, and inaccessibility of ‘take-home’ OAT medications were common barriers. Conclusions Post-incarceration transition periods are critical for OAT retention, yet individuals in Ontario experience barriers to OAT engagement that contribute to treatment disruptions and related risks such as relapse and/or re-incarceration. Additional measures to support community OAT transitions are required, including improved discharge planning, amendments to OAT and financial coverage policies, and an expansion of OAT options.
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Affiliation(s)
- Cayley Russell
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Michelle Pang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Frishta Nafeh
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | | | - Dena Derkzen
- Policy Sector, Research Branch, Correctional Service of Canada, Ottawa, Ontario, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada.,Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Benedikt Fischer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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