The issue is one of both the patient's clinical eligibility for discharge and his or her right to live outside an institution. You may be misunderstanding the concept of "not guilty by reason of insanity" (NGRI). That's not something a forensic team determines; it's determined at a criminal trial, by a jury or (sometimes) a judge. Once adjudicated NGRI, people don't go back to court for any "trial" related to the alleged criminal activity, though a court may (or may not) retain jurisdiction over whether or not they can be released from the hospital.

You may be thinking of trial competence. People found legally incompetent to stand trial by a court (never by a forensic team, although such a team may recommend such a finding to the court) may indeed be returned to court for trial. Some remain in institutions indefinitely (if they are civilly commitable), some are discharged (if they remain incompetent for trial but are not civilly commitable), and some regain competence and are sent back to court for trial. Of the last group, some are found guilty, some not guilty, some NGRI, and some, while waiting in jail for their trials to begin, again become incompetent to stand trial.

I am concerned about the role -- appropriate or not -- of nonclinical entities such as courts and prosecutors in preventing the appropriate release of patients for whom there is apparently no legal or clinical reason to stay in the hospital. I understand that the community may be fearful of or angry at, the patient, and that there is always some level of risk when discharging any patient, but if no patients are ever discharged, then (1) justice is often poorly served; (2) some patients' rights are violated; and (3) hospitals would have to grow and grow and grow (and grow).

Comments?