Treatment and Evaluations

The Oklahoma Forensic Center provides services for Pretrial Defendants as an evaluation of adjudicate competence and ODMHSAS inpatient services for evaluations, treatment, competency restoration, as well as care, treatment and evaluation for those deemed to be NGRI/NGRMI (not guilty by reason of insanity/mental illness).

All consumers admitted to the Oklahoma Forensic Center are additionally provided with consistent and innovative forensic psychiatric service and case management. Service includes comprehensive Psychiatric evaluations, medication management, pharmacological consult and psychoeducation, and comprehensive treatment collaboration.

Insanity/Mental Illness for criminal charges is a legal concept and by law, a defendant must be presently competent in order to plead NGRI/NGRMI.

If found “insane/mentally ill” at the time of a crime then court has determined that the individual could not understand, due to a mental illness, the:

nature,
consequences, or
wrongfulness of their crime(s) at the time of their crime(s)

Finding of insanity/mental illness = not guilty of a crime and cannot be retried. Consumers cannot be discharged without the court's permission, regardless of the opinion of medical staff or the opinion of the forensic mental health administration. The NGRI/NGRMI program goal is to provide a therapeutic environment with specified guidelines to decrease the consumer's level of risk to society.

Nationally, NGRI/NGRMI are likely to spend just as much time confined in a mental health facility as they would have in prison.

Non-murder cases typically spend longer
Murder cases typically spend approximately the same amount of time

Oklahoma: NGRI/NGRMI typically results in longer period of confinement.

Processes for Evaluation

Forensic Services

Pretrial Defendants
NGRI/NGRMI Acquittees

DMHSAS/OFC psychologists conduct initial, outpatient court-ordered evaluations of adjudicative competence for pretrial defendant adults in District Courts across all 77 counties in the State of Oklahoma.
Evaluations of defendants include a review of legal documents, mental health/medical/educational and/or other pertinent records; in-person or virtual clinical interview, psychological testing (if needed), production of a written report summarizing the evaluation, and courtroom testimony (if needed).
Types of assessment for adjudicative competence could include:
Competency-specific measures (i.e., MacArthur Competence Assessment Tool–Criminal Adjudication; Evaluation of Competency to Stand Trial-Revised; Competence Assessment for Standing Trial for Defendants With Mental Retardation (sic)).
Measures of symptom and/or performance validity (Test of Memory Malingering, Miller Forensic Assessment of Symptoms Test, Structured Interview of Reported Symptoms, Second Edition, Inventory of Legal Knowledge).
General measures of personality, intellect, and/or adaptive functioning (Minnesota Multiphasic Inventory-3; Personality Assessment Inventory; Wechsler Adult Intelligence Scale, Fourth Edition; Adaptive Behavior Assessment System, Third Edition).

For adult defendants found to be incompetent to proceed by a State of Oklahoma District Court, said defendants are subsequently committed to OFC for treatment, therapy, and training to restore them to adjudicative competence.
After defendants are admitted to OFC, they are assigned to a unit and treatment team, consisting of a psychiatrist, social worker, and nurse.
Once the individual has been deemed behaviorally stable enough to leave the secure unit by their treatment team, that consumer is then referred to a Standard Competency training group. ----The curriculum for the Competency Restoration group at OFC was developed in-housed by the psychology department, in consultation with other similar forensic institutions across the county. The material is educational in nature, and designed to provide a basic overview of the adversarial nature of the criminal justice system. Consumers are also provided with a written copy of the materials, as well as basic descriptions of the person’s case, potential penalties if convicted, etc.
The Competency restoration group has three tiers: (1) Standard Group, ran by unit staff which consists of an overview of courtroom roles and procedures, lasting six sessions across two weeks. Consumers are then given a brief quiz of the material to assess mastery of it. If the consumer passes, they proceed to the (2) Advanced Group, ran by a pre-doctoral psychology intern, which focuses on more advanced concepts such as rational application of case information to decision-making about how to proceed in a criminal case (hypothetical). If the consumer is unable to pass the (1) Standard Group quiz, they have the opportunity to take it a second time. If the consumer is still unable to pass it the second time, they are then placed in the (3) Special Needs Group, which consists of the same material as the (1) Standard Group, but presented in a more broken down, simplified form, to assist with information acquisition. If the consumer is able to demonstrate mastery of the material while in the (3) Special Needs Group, they are then able to be moved to the (2) Advanced Group.
As consumers progress in their treatment, the treatment team will then make a referral to the psychology department to have one of the psychologists evaluate the consumer to see if the competency restoration treatment has been successful and if the consumer now appears to meet statutory criteria for adjudicative competence. If the opinion of the evaluator is that the consumer does appear to meet said criteria, then a letter is drafted to the Court and the consumer is referred to their referring county for further disposition. If the opinion of the evaluator is that the consumer still does not appear to meet criteria, then a detailed progress note addressing the evaluator’s concerns is provided to the consumer’s treatment team, so that any adjustment to treatment can be made in an attempt to address those concerns. As is the case with outpatient adjudicative competence evaluations, inpatient evaluations can also utilize all of the same psychological assessment measures noted above, if and/or as needed.

Once a defendant has been adjudicated as Not Guilty by Reason of Insanity (for cases adjudicated prior to November, 2016) or Not Guilty by Reason of Mental Illness (for cases adjudicated after November, 2016), they are initially ordered to OFC for statutorily required 45-day evaluation to see if the person is (1) dangerous to the public peace or safety because the person is a person requiring treatment, or (2) if not believed to be dangerous to the public peace or safety, the person is in need of continued supervision as a result of unresolved symptoms of mental illness or a history of treatment noncompliance.
As part of the 45 day assessment, a separate violence risk assessment is also conducted. The violence risk assessment consists of a lifetime pattern evaluation of the individual, which includes extensive record reviewing (as available), clinical interviews, collateral interviews, as well as psychological testing.
Psychological testing for violence risk assessments include violence risk specific measures (i.e., Hare Psychopathy Checklist-Revised, Second Edition; HCR-20 V3; Violence Risk Appraisal Guide, Revised; Structured Assessment of Protective Factors for violence risk).
Measures of symptom and/or performance validity (Test of Memory Malingering, Miller Forensic Assessment of Symptoms Test, Structured Interview of Reported Symptoms, Second Edition, Inventory of Legal Knowledge).
General measures of personality, intellect, and/or adaptive functioning (Minnesota Multiphasic Inventory-3; Personality Assessment Inventory; Wechsler Adult Intelligence Scale, Fourth Edition; Adaptive Behavior Assessment System, Third Edition).
If a consumer is subsequently found to meet criteria to remain in the NGRI/NGRMI program at OFC, a subsequent violence risk assessment update is completed on the consumer at the two-year mark, and then any subsequent updates are done at the request of either the consumer’s treatment team, the Forensic Review Board, or DMHSAS/OFC administration.

If an NGRI/NGRMI acquittee is ultimately committed to the DMHSAS/OFC NGRI/NGRMI program, that consumer is then eligible to engaging in psychology department-led individual and group psychotherapy.

Individual psychotherapy is initiated upon consumer request through a treatment team referral to the psychology department, and is carried out by either psychology staff and/or pre-doctoral interns.
Group psychotherapy is also voluntary, consistent with the Recovery Model orientation of DMHSAS, and based upon consumers signing up and being screened by psychology department as being appropriate for groups.
Group psychotherapy consists of two main types of groups: (1) Process Group and (2) Alternative Groups. Process groups are run year-round and are consumer-topic driven. Alternative groups are eight session/eight week groups based upon either empirically-based and/or empirically-supported treatments (i.e., anger management, stress management, social skills, substance use treatment, etc.).

2020 Treatment and Evaluation Data

In 2020, 930 evaluations were completed across all counties in Oklahoma.

Outcome of Evaluation

Opinion	Number (%) of Total Evaluations
Competent to stand trial	600 (65%)
Incompetent, but can attain competency	262 (28%)
Incompetent, but cannot attain competency	30 (3%)
Cannot be determined	38 (4%)

Treatment and Evaluations

Types of NGRI/NGRMI evaluations due to mental illness or in need of continued supervision

NGRI/NGRMI Treatment

Processes for Evaluation

Forensic Services

Outpatient Evaluations

Inpatient Services

2020 Treatment and Evaluation Data

Outcome of Evaluation

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