Reforming Competence Restoration Statutes: An Outpatient Model

Defendants who suffer from mental illness and are found incompetent to stand trial are often ordered committed to an inpatient mental health facility to restore their competence, even if outpatient care may be the better treatment option. Inpatient facilities are overcrowded and place the defendants on long waiting lists. Some defendants then spend weeks, months, or even years in their jail cell, waiting for a transfer to a hospital bed.Outpatient competence restoration programs promise to relieve this pressure. But even if every state suddenly opened a robust outpatient competence restoration program, an obstacle looms: the statutes governing competence restoration, which default to the inpatient treatment model. Several states mandate inpatient restoration in their statutory scheme. The rest allow for outpatient restoration, but the language of these laws often preserves the inpatient default by requiring defendants to meet a series of nebulous criteria before allowing them to participate in outpatient treatment. This Article is the first to examine how the language of competence restoration statutes, even those that allow for outpatient treatment, defaults to commitment to an inpatient facility. I do so by examining the wide latitude these statutes give to judges to place defendants in inpatient care and show how that discretion, paired with widespread false presumptions about the mentally ill, leads to overcommitment of incompetent defendants in state mental health facilities.I propose amendments to these statutes that will encourage judges to place defendants in outpatient care. Statutes must flip from inpatient-required or inpatient-unless to outpatient-unless, defaulting to outpatient treatment unless some specific criteria justify committing the defendant to an inpatient facility. Such a change would relieve pressure on inpatient facilities, opening up space for those who truly need inpatient treatment for competence to be restored. It would also ensure that specific criteria—not misunderstandings or fears about the mentally ill—inform the decision to commit the defendant to inpatient care

It Doesn\u27t Pass the \u3ci\u3eSell\u3c/i\u3e Test: Focusing on The Facts of the Individual Case in Involuntary Medication Inquiries

Criminal defendants who are incompetent to stand trial have a significant liberty interest in refusing the antipsychotic medication that could restore their competency. The Supreme Court cautioned that instances of intrusion upon that right “may be rare,” and, in Sell v. United States, it laid out what it believed to be stringent criteria for when a defendant could be medicated against his will. Yet, since Sell, trial courts have ordered over sixty-three percent of defendants involuntarily medicated. These individuals did not pose a danger to themselves or others, and they were rarely accused of crimes that involved damage to individuals or property. But the medication of these defendants, once predicted to be “rare,” has instead become routine. In this article, I argue that the overmedication of non-dangerous defendants is a result of the structure of the Sell test and its tilt in favor of the government. The use of a checklist of four threshold elements favors the issuance of medication orders because the court need not balance the defendant’s liberty interest in avoiding medication against the government’s interest in administering it. In addition, three of the four boxes on the checklist concern medical questions about the efficacy and side effects of antipsychotic medication that will fall in the government’s favor in the vast majority of cases. However, while the Sell test contains the seeds of the overmedication problem, it also contains the solution. The first factor of the test requires courts to consider whether the government interest at stake is “important,” and it mandates that courts assess the “facts of the individual case” to determine if the government interest crosses that bar. While few courts have delved deeply into this factor, some have looked to the nonviolent nature of the crime or the government’s minimal likelihood of success on the underlying criminal charge in concluding that the government interest in prosecuting the defendant was not important. I argue that more courts can and should follow this path. Such an approach would limit the involuntary medication of defendants to those exceptional cases where it is truly warranted

Analogical Reasoning

This chapter from our book Legal Writing in Context aims to demystify analogical reasoning for law students

Pandemic as Opportunity for Competence Restoration Decarceration

Before the pandemic, a defendant found incompetent to stand trial was often stranded in jail for weeks or months as she waited for an inpatient bed to open at a psychiatric facility. While there, she usually received no treatment, her mental health deteriorated, and she was astonishingly likely to be abused and neglected. She almost certainly came out of jail in a worse state than she was when she went in. The pandemic has made this desperate situation even worse. Now that wait in jail is both longer, as many psychiatric facilities stopped accepting new patients as they dealt with outbreaks or imposed social distancing measures, and more dangerous. Jails have been the sites of some of the worst virus outbreaks in the country. The solution to this problem is simple: release defendants. There is no inherent magic to inpatient treatment that renders it superior to community treatment. Even if community treatment is unavailable—a common problem in many jurisdictions—it is far worse to keep a person found incompetent in jail, where she will likely decompensate, suffer abuse or neglect, and, now, be exposed to a pandemic, than to release her. Pre-pandemic, judges rarely released defendants found incompetent to stand trial for two reasons. First, many competence restoration statutes default to the inpatient option; some even require it. Second, judges, like most people, harbor deep-seated fears of individuals with mental illness, and they are reluctant to release individuals who they suspect may be dangerous, even if that suspicion is founded on stigma instead of fact. But the pandemic has forced judges’ hands, and some are opting to release individuals who would have been slated for inpatient care and extended jail waits pre-COVID-19. In the District of Columbia, thirty-five people in competence proceedings were released. In Washington, a man charged with robbery was ordered to inpatient treatment; after he waited over three months in jail for a transfer, a judge dismissed the charge. While these are certainly small numbers, they indicate an opportunity to experiment with the decarceration of individuals found incompetent to stand trial. As the pandemic drags on, and defendants found incompetent remain stuck in limbo, pressure to decarcerate may continue to mount. Thus, while the pandemic has made the already egregious lag times for competence restoration treatment worse, it might also contain the seeds of a solution to this intractable problem. A crisis of this proportion might be the one thing that could shake the criminal justice system out of its assumption that defendants should be detained while they wait for an inpatient bed to open

Genome-wide association study identifies common and low-frequency variants at the AMHgene locus that strongly predict serum AMH levels in males

Anti-Müllerian hormone (AMH) is an essential messenger of sexual differentiation in the foetus and is an emerging biomarker of postnatal reproductive function in females. Due to a paucity of adequately sized studies, the genetic determinants of circulating AMH levels are poorly characterized. In samples from 2815 adolescents aged 15 from the ALSPAC study, we performed the first genome-wide association study of serum AMH levels across a set of ∼9 M ‘1000 Genomes Reference Panel’ imputed genetic variants. Genetic variants at the AMH protein-coding gene showed considerable allelic heterogeneity, with both common variants [rs4807216 (PMale = 2 × 10−49, Beta: ∼0.9 SDs per allele), rs8112524 (PMale = 3 × 10−8, Beta: ∼0.25)] and low-frequency variants [rs2385821 (PMale = 6 × 10−31, Beta: ∼1.2, frequency 3.6%)] independently associated with apparently large effect sizes in males, but not females. For all three SNPs, we highlight mechanistic links to AMH gene function and demonstrate highly significant sex interactions (PHet 0.0003–6.3 × 10−12), culminating in contrasting estimates of trait variance explained (24.5% in males versus 0.8% in females). Using these SNPs as a genetic proxy for AMH levels, we found no evidence in additional datasets to support a biological role for AMH in complex traits and diseases in men

Developing an Undergraduate Community Psychology Program in a Graduate Institution

This article provides an overview of the undergraduate degree program in community psychology at DePaul University. The recommendation of an undergraduate student ignited latent student and faculty interest. A program-bigger than a course but smaller than a major-was developed in 2005-2006 and was first offered in 2006-2007. Subsequently, this Community Concentration has been well received by students and has grown to an enrollment of about 20-25 students annually (Glantsman, McMahon, & Njoku, 2015). Graduates have gone onto positions in community and public agencies, graduate school in community psychology and related fields, and other relevant contexts. We highlight the three primary phases in the history of the Community Concentration: (1) building upon a receptive institutional context, (2) creating the program, and (3) developing learning opportunities. For each phase we identify focal elements important to its success. We consider their transferability to other educational settings that include both undergraduate and graduate community psychology educational opportunities. We note the accomplishments, challenges and strengths of the program. Finally, we offer this case study to encourage faculty in other educational institutions to develop more and better learning opportunities for undergraduate students in community psychology

Developing an Undergraduate Community Psychology Program in a Graduate Institution

This article provides an overview of the undergraduate degree program in community psychology at DePaul University. The recommendation of an undergraduate student ignited latent student and faculty interest. A program-bigger than a course but smaller than a major-was developed in 2005-2006 and was first offered in 2006-2007. Subsequently, this Community Concentration has been well received by students and has grown to an enrollment of about 20-25 students annually (Glantsman, McMahon, & Njoku, 2015). Graduates have gone onto positions in community and public agencies, graduate school in community psychology and related fields, and other relevant contexts. We highlight the three primary phases in the history of the Community Concentration: (1) building upon a receptive institutional context, (2) creating the program, and (3) developing learning opportunities. For each phase we identify focal elements important to its success. We consider their transferability to other educational settings that include both undergraduate and graduate community psychology educational opportunities. We note the accomplishments, challenges and strengths of the program. Finally, we offer this case study to encourage faculty in other educational institutions to develop more and better learning opportunities for undergraduate students in community psychology

Predicting and Reducing Aggression and Violence Toward Teachers: Extent of the Problem and Why it Matters

Although violence prevention has largely focused on students, national and state-level studies suggest that teacher-directed violence warrants attention by researchers, policy makers, and school stakeholders. In this chapter, we provide an overview of the empirical literature on teacher-directed violence, including the extent of the problem, types of violence teachers experience, measurement issues, and how this problem varies across perpetrators and social contexts. We specify recommendations for assessment, including developing and using reliable and valid measures to better understand teachers\u27 experiences with violence. Violence prevention approaches are described, and we advocate for assessment and intervention that incorporate teacher experiences. Using a social-ecological model, we outline intervention strategies that address school violence that affects students, teachers, and administrators at the microsystem, mesosystem, exosystem, and macrosystem levels. Ultimately, we need to take the entire school ecology into account to reduce violence and create an effective teaching and learning environment where everyone feels safe

Sulfide Generation by Dominant Halanaerobium Microorganisms in Hydraulically Fractured Shales

Hydraulic fracturing of black shale formations has greatly increased United States oil and natural gas recovery. However, the accumulation of biomass in subsurface reservoirs and pipelines is detrimental because of possible well souring, microbially induced corrosion, and pore clogging. Temporal sampling of produced fluids from a well in the Utica Shale revealed the dominance of Halanaerobium strains within the in situ microbial community and the potential for these microorganisms to catalyze thiosulfate-dependent sulfidogenesis. From these field data, we investigated biogenic sulfide production catalyzed by a Halanaerobium strain isolated from the produced fluids using proteogenomics and laboratory growth experiments. Analysis of Halanaerobium isolate genomes and reconstructed genomes from metagenomic data sets revealed the conserved presence of rhodanese-like proteins and anaerobic sulfite reductase complexes capable of converting thiosulfate to sulfide. Shotgun proteomics measurements using a Halanaerobium isolate verified that these proteins were more abundant when thiosulfate was present in the growth medium, and culture-based assays identified thiosulfate-dependent sulfide production by the same isolate. Increased production of sulfide and organic acids during the stationary growth phase suggests that fermentative Halanaerobium uses thiosulfate to remove excess reductant. These findings emphasize the potential detrimental effects that could arise from thiosulfate-reducing microorganisms in hydraulically fractured shales, which are undetected by current industry-wide corrosion diagnostics. IMPORTANCE Although thousands of wells in deep shale formations across the United States have been hydraulically fractured for oil and gas recovery, the impact of microbial metabolism within these environments is poorly understood. Our research demonstrates that dominant microbial populations in these subsurface ecosystems contain the conserved capacity for the reduction of thiosulfate to sulfide and that this process is likely occurring in the environment. Sulfide generation (also known as “souring”) is considered deleterious in the oil and gas industry because of both toxicity issues and impacts on corrosion of the subsurface infrastructure. Critically, the capacity for sulfide generation via reduction of sulfate was not detected in our data sets. Given that current industry wellhead tests for sulfidogenesis target canonical sulfate-reducing microorganisms, these data suggest that new approaches to the detection of sulfide-producing microorganisms may be necessary