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Commentary: Biases That Affect the Decision to Conditionally Release an Insanity Acquittee

Dr. Fox is Deputy Director of Training, Law and Psychiatry Division, Department of Psychiatry, Yale University School of Medicine, New Haven, CT. Address correspondence to: Patrick K. Fox, MD, Department of Psychiatry, Yale University School of Medicine, 34 Park Street, New Haven, CT 06519-1187. E-mail: patrick.fox{at}po.state.ct.us

The care and management of hospitalized insanity acquittees can be quite challenging. As patients progress in treatment, clinicians must invariably address whether the patient is ready to be returned to the community, balancing the liberty interests of the acquittee with the protection of society. The process by which this determination is made is far from simple and involves review of clinical interview and collateral information, identification of indicators of outcome post-discharge, and the use of structured risk assessment instruments. The decision to release an acquittee conditionally is also influenced by an array of factors that emanate from within the clinician, within the institution, the mental health system, the courts, and the broader society. While such biases affect a clinician's objectivity, they are also a natural part of the evaluation process. Their identification is essential so that the degree to which such biases influence the conditional release decision can be more fully understood and addressed.