Arraignment of Mental Health Detainees a Matter of Geography

BOSTON – "Justice delayed is justice denied" applies to both a defendant’s right to a speedy trial and a mentally ill defendant’s right to get medical help, investigators said at the annual meeting of the American Academy of Psychiatry and the Law.

A study of people with mental illness arrested in New York City found that proximity to inpatient psychiatric services appeared to be associated with a more rapid time to arraignment in Manhattan, compared with either Brooklyn or Queens, reported Dr. Susan M. Gray and her colleagues from the Bellevue Hospital Center and New York University, both in New York City.

In New York state, detainees are supposed to be arraigned within 24 hours of arrest, giving them prompt access to counsel and the beginnings of a legal defense. But detainees with mental illness might go for more than a month without an arraignment hearing. That gives them time for treatment, but it also delays their access to legal counsel, said Dr. Gray, who encountered such patients at Bellevue while doing a fellowship at NYU.

"I would be taking care of patients who were in custody for 3 or 4 weeks with no legal counsel and no opportunity for mental fitness exams, and yet they’re getting treated. Later, if they get a mental fitness exam, they might pass it when they wouldn’t have if they had been arraigned within the first couple of days, which can affect the outcomes of their cases," she said in an interview.

If people with mental illness received a timely arraignment as they are entitled to by law, however, the disposition of their cases might be very different, such as a finding of being unfit to stand trial, or a transfer of their case to civil rather than criminal court, Dr. Gray said.

The investigators conducted a retrospective chart review of patient detainees who were admitted to the forensic psychiatric inpatient service at Bellevue through the hospital’s Comprehensive Psychiatric Emergency Program (CPEP). Out of 202 patients admitted from February 2010 through March 2011, 181 had data on arrest and arraignment dates available.

The authors identified for each record patient demographics, admission diagnosis, discharge diagnosis, borough of arrest, date of admission to the CPEP (the presumed arrest date), date of arraignment or discharge to police custody (with the assumption that arraignment would be within 24-48 hours), and a top criminal charge.

They found that there were no significant differences in time to arraignment by age group or race/ethnicity, but patients with a discharge diagnosis of psychosis had significantly longer mean times to arraignment than those with a nonpsychotic diagnosis (8.6 vs., 7.19 days, P less than .004).

Those with a top criminal charge of a misdemeanor waited significantly less for arraignments than those with felony charges (7.28 vs., 9.18 days, P less than .022).

The borough of arrest also made a difference, with those nabbed in Manhattan being arraigned within a mean of 6.4 days, vs. 10.66 days in Brooklyn (P less than .000 vs. Manhattan), and 11.05 days in Queens (P less than .003; P for Manhattan vs. all boroughs less than .000). No significant differences were found between Manhattan and either the Bronx (8.3 days) and Staten Island (7.0 days).

The results jibe with the impressions of clinicians that times to arraignment in Brooklyn and Queens are longer than those in the other boroughs, the authors noted. They pointed out that there are weekly in-house arraignments for male detainees hospitalized at Bellevue, and that these services are performed with more dispatch for those arrested in Manhattan or the Bronx, which are geographically more convenient to the hospital’s Manhattan campus. In Brooklyn, such arraignments previously had been performed at Kings County Hospital, but that facility closed in 2004.

"While we do not have data regarding time to arraignment prior to 2004, it is likely that the closing of this service, which accepted male pre-arraignment detainees and was much more convenient for Brooklyn and Queens, had an impact on how and when arraignments are scheduled for these patient-detainees. This may demonstrate an unforeseen consequence of closing an important psychiatric service and should be considered in light of increasing local and national restrictions on health care funding," the investigators wrote.

The authors did not disclose a funding source. Dr. Gray said she has no relevant conflicts of interest.

BOSTON – "Justice delayed is justice denied" applies to both a defendant’s right to a speedy trial and a mentally ill defendant’s right to get medical help, investigators said at the annual meeting of the American Academy of Psychiatry and the Law.

A study of people with mental illness arrested in New York City found that proximity to inpatient psychiatric services appeared to be associated with a more rapid time to arraignment in Manhattan, compared with either Brooklyn or Queens, reported Dr. Susan M. Gray and her colleagues from the Bellevue Hospital Center and New York University, both in New York City.

In New York state, detainees are supposed to be arraigned within 24 hours of arrest, giving them prompt access to counsel and the beginnings of a legal defense. But detainees with mental illness might go for more than a month without an arraignment hearing. That gives them time for treatment, but it also delays their access to legal counsel, said Dr. Gray, who encountered such patients at Bellevue while doing a fellowship at NYU.

"I would be taking care of patients who were in custody for 3 or 4 weeks with no legal counsel and no opportunity for mental fitness exams, and yet they’re getting treated. Later, if they get a mental fitness exam, they might pass it when they wouldn’t have if they had been arraigned within the first couple of days, which can affect the outcomes of their cases," she said in an interview.

If people with mental illness received a timely arraignment as they are entitled to by law, however, the disposition of their cases might be very different, such as a finding of being unfit to stand trial, or a transfer of their case to civil rather than criminal court, Dr. Gray said.

The investigators conducted a retrospective chart review of patient detainees who were admitted to the forensic psychiatric inpatient service at Bellevue through the hospital’s Comprehensive Psychiatric Emergency Program (CPEP). Out of 202 patients admitted from February 2010 through March 2011, 181 had data on arrest and arraignment dates available.

The authors identified for each record patient demographics, admission diagnosis, discharge diagnosis, borough of arrest, date of admission to the CPEP (the presumed arrest date), date of arraignment or discharge to police custody (with the assumption that arraignment would be within 24-48 hours), and a top criminal charge.

They found that there were no significant differences in time to arraignment by age group or race/ethnicity, but patients with a discharge diagnosis of psychosis had significantly longer mean times to arraignment than those with a nonpsychotic diagnosis (8.6 vs., 7.19 days, P less than .004).

Those with a top criminal charge of a misdemeanor waited significantly less for arraignments than those with felony charges (7.28 vs., 9.18 days, P less than .022).

The borough of arrest also made a difference, with those nabbed in Manhattan being arraigned within a mean of 6.4 days, vs. 10.66 days in Brooklyn (P less than .000 vs. Manhattan), and 11.05 days in Queens (P less than .003; P for Manhattan vs. all boroughs less than .000). No significant differences were found between Manhattan and either the Bronx (8.3 days) and Staten Island (7.0 days).

The results jibe with the impressions of clinicians that times to arraignment in Brooklyn and Queens are longer than those in the other boroughs, the authors noted. They pointed out that there are weekly in-house arraignments for male detainees hospitalized at Bellevue, and that these services are performed with more dispatch for those arrested in Manhattan or the Bronx, which are geographically more convenient to the hospital’s Manhattan campus. In Brooklyn, such arraignments previously had been performed at Kings County Hospital, but that facility closed in 2004.

"While we do not have data regarding time to arraignment prior to 2004, it is likely that the closing of this service, which accepted male pre-arraignment detainees and was much more convenient for Brooklyn and Queens, had an impact on how and when arraignments are scheduled for these patient-detainees. This may demonstrate an unforeseen consequence of closing an important psychiatric service and should be considered in light of increasing local and national restrictions on health care funding," the investigators wrote.

The authors did not disclose a funding source. Dr. Gray said she has no relevant conflicts of interest.

BOSTON – "Justice delayed is justice denied" applies to both a defendant’s right to a speedy trial and a mentally ill defendant’s right to get medical help, investigators said at the annual meeting of the American Academy of Psychiatry and the Law.

A study of people with mental illness arrested in New York City found that proximity to inpatient psychiatric services appeared to be associated with a more rapid time to arraignment in Manhattan, compared with either Brooklyn or Queens, reported Dr. Susan M. Gray and her colleagues from the Bellevue Hospital Center and New York University, both in New York City.

In New York state, detainees are supposed to be arraigned within 24 hours of arrest, giving them prompt access to counsel and the beginnings of a legal defense. But detainees with mental illness might go for more than a month without an arraignment hearing. That gives them time for treatment, but it also delays their access to legal counsel, said Dr. Gray, who encountered such patients at Bellevue while doing a fellowship at NYU.

"I would be taking care of patients who were in custody for 3 or 4 weeks with no legal counsel and no opportunity for mental fitness exams, and yet they’re getting treated. Later, if they get a mental fitness exam, they might pass it when they wouldn’t have if they had been arraigned within the first couple of days, which can affect the outcomes of their cases," she said in an interview.

If people with mental illness received a timely arraignment as they are entitled to by law, however, the disposition of their cases might be very different, such as a finding of being unfit to stand trial, or a transfer of their case to civil rather than criminal court, Dr. Gray said.

The investigators conducted a retrospective chart review of patient detainees who were admitted to the forensic psychiatric inpatient service at Bellevue through the hospital’s Comprehensive Psychiatric Emergency Program (CPEP). Out of 202 patients admitted from February 2010 through March 2011, 181 had data on arrest and arraignment dates available.

The authors identified for each record patient demographics, admission diagnosis, discharge diagnosis, borough of arrest, date of admission to the CPEP (the presumed arrest date), date of arraignment or discharge to police custody (with the assumption that arraignment would be within 24-48 hours), and a top criminal charge.

They found that there were no significant differences in time to arraignment by age group or race/ethnicity, but patients with a discharge diagnosis of psychosis had significantly longer mean times to arraignment than those with a nonpsychotic diagnosis (8.6 vs., 7.19 days, P less than .004).

Those with a top criminal charge of a misdemeanor waited significantly less for arraignments than those with felony charges (7.28 vs., 9.18 days, P less than .022).

The borough of arrest also made a difference, with those nabbed in Manhattan being arraigned within a mean of 6.4 days, vs. 10.66 days in Brooklyn (P less than .000 vs. Manhattan), and 11.05 days in Queens (P less than .003; P for Manhattan vs. all boroughs less than .000). No significant differences were found between Manhattan and either the Bronx (8.3 days) and Staten Island (7.0 days).

The results jibe with the impressions of clinicians that times to arraignment in Brooklyn and Queens are longer than those in the other boroughs, the authors noted. They pointed out that there are weekly in-house arraignments for male detainees hospitalized at Bellevue, and that these services are performed with more dispatch for those arrested in Manhattan or the Bronx, which are geographically more convenient to the hospital’s Manhattan campus. In Brooklyn, such arraignments previously had been performed at Kings County Hospital, but that facility closed in 2004.

"While we do not have data regarding time to arraignment prior to 2004, it is likely that the closing of this service, which accepted male pre-arraignment detainees and was much more convenient for Brooklyn and Queens, had an impact on how and when arraignments are scheduled for these patient-detainees. This may demonstrate an unforeseen consequence of closing an important psychiatric service and should be considered in light of increasing local and national restrictions on health care funding," the investigators wrote.

The authors did not disclose a funding source. Dr. Gray said she has no relevant conflicts of interest.