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The Use of the Insanity Defense as a Jail Diversion Mechanism for Mentally Ill Persons Charged With Misdemeanors

At the time the work was completed, Dr. Schaefer was Chief Resident and Dr. Bloom was Professor Emeritus, Department of Psychiatry, School of Medicine, Oregon Health Sciences University, Portland, OR. Dr. Schaefer is now a Fellow in Forensic Psychiatry, Yale University School of Medicine, New Haven, CT, and Dr. Bloom is Dean, Drexel University College of Medicine, Philadelphia, PA. Address correspondence to: Michele N. Schaefer, MD, Connecticut Mental Health Center, 34 Park St., New Haven, CT 06518. E-mail: michele.schaefer{at}yale.edu

Heightened awareness and concern regarding the large number of mentally ill misdemeanants in jails has led to a search for alternatives to jail and to the development nationwide of jail diversion programs for offenders with mental illness. Two such mechanisms—diversion to civil commitment and the use of mental health courts—are briefly reviewed. In Oregon, however, a rather unique mechanism is used to defer mentally ill misdemeanants (in addition to felons) from the criminal justice system: the insanity defense, with subsequent placement of the individual under Psychiatric Security Review Board jurisdiction. Statistics regarding such use from 1978 to 2001 are provided. The authors compare and contrast this jail alternative with both mental health courts and diversion to civil commitment, and discuss questions related to the feasibility of larger-scale use of this mechanism.

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