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Research ArticleRegular Article

Assessing Two Decades of Insanity Acquittee Release from the North Carolina Forensic Program

Haseeb Haroon, Nicole Wolfe, Sara Feizi and Peter Barboriak
Journal of the American Academy of Psychiatry and the Law Online June 2023, JAAPL.230024-23; DOI: https://doi.org/10.29158/JAAPL.230024-23
Haseeb Haroon
Dr. Haroon is on the Adjunct Faculty at the Keck School of Medicine of University of Southern California, Los Angeles, CA. Dr. Wolfe is Forensic Psychiatrist, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC, and Forensic Psychiatry Fellowship Director, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Feizi is Adjunct Assistant Professor, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Barboriak was Director of Forensic Services, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC; he died March 29, 2023.
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Nicole Wolfe
Dr. Haroon is on the Adjunct Faculty at the Keck School of Medicine of University of Southern California, Los Angeles, CA. Dr. Wolfe is Forensic Psychiatrist, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC, and Forensic Psychiatry Fellowship Director, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Feizi is Adjunct Assistant Professor, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Barboriak was Director of Forensic Services, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC; he died March 29, 2023.
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Sara Feizi
Dr. Haroon is on the Adjunct Faculty at the Keck School of Medicine of University of Southern California, Los Angeles, CA. Dr. Wolfe is Forensic Psychiatrist, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC, and Forensic Psychiatry Fellowship Director, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Feizi is Adjunct Assistant Professor, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Barboriak was Director of Forensic Services, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC; he died March 29, 2023.
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Peter Barboriak
Dr. Haroon is on the Adjunct Faculty at the Keck School of Medicine of University of Southern California, Los Angeles, CA. Dr. Wolfe is Forensic Psychiatrist, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC, and Forensic Psychiatry Fellowship Director, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Feizi is Adjunct Assistant Professor, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Barboriak was Director of Forensic Services, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC; he died March 29, 2023.
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Article Figures & Data

Tables

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    Table 1

    Population Characteristics for Hospitalized and Released Insanity Acquittees

    VariableSubgroupHospitalized AcquitteesReleased Acquittees
    n%n%
    SexFemale1015.21118.0
    Male5684.85082.0
    RaceWhite3451.53252.5
    Black2740.92744.3
    Other57.623.2
    Severity of offenseHomicide3756.11727.9
    All others2943.94472.1
    Range (y)Mean ± SD (y)Range (y)Mean ± SD (y)
    Age at admission19.3–62.536.6±11.219.6–76.536.3±12.1
    Length of NGRI Hospitalization0.2–17.34.9±4.1
    Length of Stay (end of 2019)0.2–24.08.1±6.8
    • View popup
    Table 2

    Factors Associated with Length of NGRI Hospitalization (in Years): Independent Samples t Test

    VariableSubgroupsMean LOH ± SDp-Value
    SexFemale6.8 ± 5.00.087
    Male4.5 ± 3.9
    RaceWhite4.9 ± 4.40.995
    Minority4.9 ± 3.9
    Severity of offenseHomicide8.1 ± 4.2<0.001
    All others3.7 ± 3.4
    Number of victimsSingle5.1 ± 3.80.511
    Multiple4.3 ± 4.4
    Primary discharge diagnosis*0.006
    Diagnosis with psychotic disorderPresent4.9 ± 3.80.719
    Absent5.8 ± 6.3
    Personality disorderPresent6.2 ± 6.00.500
    Absent4.8 ± 3.7
    Substance use problemPresent4.8 ± 3.80.693
    Absent5.3 ± 4.7
    Discharged on clozapine or LAIYes8.4 ± 4.60.010
    No4.4 ± 3.8
    • ↵* One-way ANOVA used instead of t test for differences between several groups.

    • ↵Statistically significant findings bolded.

    • View popup
    Table 3

    Factors Associated with Reconviction - Fisher’s Exact Test, Odds Ratio with 95% CI

    VariableSubgroups% of Group ReconvictedOdds Ratio (95% CI)
    SexFemale0.0N/A
    Male18.4
    RaceWhite12.50.7 (0.2–2.7)
    Minority17.9
    Severity of offenseHomicide11.80.7 (0.1–3.7)
    All others16.3
    Number of victimsMultiple0.0N/A
    Single18.6
    Diagnosis with psychotic disorderPresent16.0N/A
    Absent0.0
    Personality disorderPresent20.01.8 (0.3–10.3)
    Absent12.5
    Substance use problemaPresent21.65.8 (0.7–49.9)
    Absent4.5
    Multiple substance use problemsbPresent28.05.8 (1.1–31.2)
    Absent6.3
    Discharged on clozapine or LAIYes25.02.1 (0.4–12.8)
    No13.5
    Sub-analysis for Violent Reconvictions
    VariableSubgroups% of group with violent reconvictionOdds Ratio (95% CI)
    Personality disorderbPresent100.0N/A
    Absent0.0
    • a p  = 0.077. b p  < 0.05.

    • Statistically significant findings bolded.

    • View popup
    Table 4

    Association of Length of NGRI Hospitalization with Reconviction and Rehospitalization - Fisher’s Exact Test, Odds Ratio with 95% CI

    LOH Comparison PairsSubgroup% of Group RehospitalizedReadmission Odds Ratio% of Group ReconvictedReconviction Odds Ratio
    <1 year vs. ≥1 year< 1 year27.31.0 (0.2–4.2)9.10.5 (0.1–4.6)
    ≥ 1 year28.016.3
    <2 years vs. ≥2 years< 2 years30.01.2 (0.4–3.8)20.01.8 (0.4–7.4)
    ≥ 2 years26.812.5
    <5 years vs. ≥5 years< 5 years35.32.4 (0.7–8.0)23.57.7 (0.9–66.0)
    ≥ 5 years18.53.8
    <10 years vs. ≥10 years< 10 years29.12.1 (0.2–19.0)16.7N/A
    ≥ 10 years16.70.0
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Journal of the American Academy of Psychiatry and the Law Online: 53 (1)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 53, Issue 1
1 Mar 2025
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Assessing Two Decades of Insanity Acquittee Release from the North Carolina Forensic Program
Haseeb Haroon, Nicole Wolfe, Sara Feizi, Peter Barboriak
Journal of the American Academy of Psychiatry and the Law Online Jun 2023, JAAPL.230024-23; DOI: 10.29158/JAAPL.230024-23

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Assessing Two Decades of Insanity Acquittee Release from the North Carolina Forensic Program
Haseeb Haroon, Nicole Wolfe, Sara Feizi, Peter Barboriak
Journal of the American Academy of Psychiatry and the Law Online Jun 2023, JAAPL.230024-23; DOI: 10.29158/JAAPL.230024-23
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Keywords

  • insanity acquittee
  • recidivism
  • state hospital
  • discharge
  • community release

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