Court-mandated outpatient treatment for insanity acquittees: clinical philosophy and implementation

Court-mandated outpatient treatment for offenders found not guilty by reason of insanity is an alternative form of treatment in which insanity acquittees may be released into the community after serving part of their commitment in a forensic hospital. Working with this difficult population requires a close liaison with the criminal justice system and a clearly articulated treatment philosophy. Essential elements include an emphasis on structure and supervision, recognition of the importance of neuroleptic medication, a reality-based approach to therapy and a focus on the problems of everyday living, and incorporation of the principles of case management. Treatment staff must be comfortable with giving support, enforcing limits, and recommending revocation of the patient's community status when necessary. Case illustrations of successful and unsuccessful community treatment for insanity acquittees are included.