Length of stay for 25,791 California patients found incompetent to stand trial

Referrals and admissions to state psychiatric hospitals of criminal defendants found Incompetent to Stand Trial (IST) are on the rise in the state of California and other parts of the country. Studies of treatment outcomes of this population have primarily focused on factors that determine competency and/or restorability. However, as IST patients place an increasing resource burden on state psychiatric hospital systems, other outcomes such as length of stay (LOS) are becoming increasingly important for practitioners and policy makers to understand. This study employs the largest sample of IST patients in the literature; it includes all IST patients admitted to California's state psychiatric hospitals between 2003 and 2016. This study analyzes demographics, clinical diagnoses, and hospital placement as predictors of LOS. Results suggest that demographics, with the exception of age, are poor predictors of LOS. However, diagnoses, especially of severe mental disorders (e.g., schizophrenia) were strongly related to LOS. Hospital placement was the strongest predictor of LOS. Explanations of these results and implications for forensic practitioners are discussed.