This report updates the Questions & Answers document that was distributed in 1999. The earlier report summarized some of the basic issues related to the effectiveness of the Conditional Release Program. Research findings were used to answer questions such as: Does the program work? Why does it work? For what types of clients does it work best? What is the cost? In the current paper, these and other basic questions having to do with public protection, community reintegration, and cost-effectiveness have been addressed with outcome information from the three years that have elapsed since the last report. To better answer some of the questions, research from published articles over the past decade and from reports of past years is also cited.
The Conditional Release Program (CONREP) is charged with the treatment and supervision, in community settings, of persons referred by criminal courts or by the Board of Prison Terms to the Department of Mental Health. For most of these patients, the conditional release or community phase of treatment comes after a lengthy stay in state hospitals as the result of serious violent offenses. Understandably, the primary public concern is that community re-entries be accomplished with the lowest possible levels of reoffense. Secondarily, the public's interest is that the Conditional Release Program address the mental disorders of patients so that they can make adequate social adjustment to their communities and incur less dependence on public social services. These two concerns are expressly stated in Penal Code 1617, which mandated a formal evaluation of the Conditional Release Program:
The State Department of Mental Health shall research the demographic profiles and other related information pertaining to persons receiving supervision and treatment in the conditional release program. An evaluation of the program shall determine its effectiveness in successfully reintegrating these persons into society after release from state institutions. This evaluation of effectiveness shall include, but not be limited to, a determination of the rates of reoffense while these persons are served by the program and after their discharge.
The Forensic Conditional Release Program has been in operation since January 1986. The population served is comprised of persons adjudicated Not Guilty by Reason of Insanity (NGI, Penal Code 1026), Incompetent to Stand Trial (IST, Penal Code 1370), Mentally Disordered Sex Offender (MDSO, Welfare and Institutions Code 6316), and the Mentally Disordered Offender (MDO, Penal Code 2960). Beyond the common overriding goal of public protection from potential reoffenses by patients, the goals of treatment, length of time patients stays in CONREP programs, and mechanisms for program exit differ across categories.
NGI patients are committed to the Department of Mental Health to be treated in state hospitals until such time as the court agrees they are ready for conditional release to community outpatient treatment. The community outpatient treatment is carried out by a local forensic conditional release program until the client is found by the court to be restored to sanity or until the local program recommends the patient be returned to a state hospital.
The goal of treatment for IST patients is that they achieve trial competency. Typically, trial competency is reached during state hospitalization. Such patients proceed from hospital to trial with no period of community treatment provided by the Forensic Conditional Release Program. However, the court sometimes approves placement of IST patients in a community program in lieu of, or after, a period of state hospitalization. The length of time an IST client can be under Department of Mental Health jurisdiction is limited to a total of 36 months in either the hospital or in community treatment.
The MDSO commitment statute was repealed in 1982. Although no new offenders have come into the system since then, persons in state hospitals and community programs at the time the law was repealed continue to be subject to its provisions. These provisions include hospital treatment until such time as the court agrees that the person may be safely treated on supervised outpatient care. This outpatient period lasts until the court deems the individual "not a danger to the health and safety of others" (in which case the person is discharged from jurisdiction), or until the person is revoked to state hospitalization.
MDO patients come from the state prison system. If they meet the six criteria under PC 2962, prisoners are transferred to state hospitals and may subsequently be transferred to conditional release programs, as a condition of parole. Among the criteria are: the crime involved force or violence; a major mental disorder was a cause or aggravating factor in the commission of the crime; the disorder is not in remission or cannot be kept in remission without treatment; the prisoner must have been in treatment in prison for 90 days or more in the past year; and the person must represent a substantial danger of physical harm to others.
The most recent (1996) category includes patients in the Sex Offender Commitment Program (SOCP). This category is made up of persons convicted of certain sex offenses who, nearing the completion of terms of confinement in state prison, are found by courts to meet criteria by which they are civilly committed to the Department of Mental Health. Although the details of SOCP commitment are complex and beyond the scope of this report, criteria of commitment include a diagnosed mental disorder and multiple sex offenses of a predatory nature. Some SOCP patients will make transitions to the community via CONREP, but at this time, the number of patients in this category is too small to permit research follow-up.
The Forensic Conditional Release Program is state-financed and state-directed. Patient services are provided by local vendors. These local vendors can be county mental health programs or private service-providers that contract with the State. As specified in California Penal Code Sections 1600-1615 and 2960-2972 the Program, with the approval of local courts (or, in the case of MDOs, the Board of Prison Terms), controls the movements of cases within the above legal categories from state hospitals to community outpatient settings. Once the patients are placed in community settings, the Program provides for their supervision and treatment.
As in earlier reports, questions are followed by brief, research-based answers. At the end of the paper, references, tables, and graphic displays are included for interested readers. These correspond to the parenthetical numbers included in the body of the questions-and-answers.