History of Forensic Services
Forensic services were formally recognized by the state in 1972 when the Forensic Services Section was created at the central office level to make recommendations, long-term plans, and develop policy that would improve the quality of care and expand the services provided for forensic service recipients.
As in most states in 1972, all forensic service recipients were evaluated and treated at a prison-like maximum-security unit that had been opened in 1932. Until this time, security had been the primary emphasis, and the unit structure did much to limit the ability of the program to provide appropriate evaluation and treatment.
When the Forensic Services Section evaluated this program in light of the clinical and legal environment of 1972, the centralized program at this single, maximum-security unit raised many issues. This was further emphasized when the U.S. Supreme Court clarified some of the legal issues involved in the evaluation and treatment of forensic clients in Jackson v. Indiana, 406 US 715 (1972).
The major impact of Jackson v. Indiana was to limit the hospitalization of pretrial defendants for determination of competency to stand trial to a reasonable period of time. If the defendant were incompetent, the defendant would have to be committed under the same standards as other patients with mental illness or be released. This decision mandated an end to the practice of detaining incompetent pretrial defendants indefinitely in mental hospitals, even though they did not meet the same standards of mental illness as other patients.
Consequently, new laws were passed to conform to the requirements under the Jackson decision and to reflect the ability to serve individuals in the community without need for hospitalization. The department identified community mental health centers to serve as agents to screen pretrial defendants and established forensic programs at each of the five regional mental health institutes to provide evaluation and treatment for forensic clients whose behavior did not require maximum security. With these program changes, the number of beds needed to provide secure inpatient evaluations was dramatically reduced and a new 50 bed, smaller maximum-security unity, the Forensic Services Program, was established.
After extensive research, the department also put in place a program to train forensic evaluators. This program recognized a variety of mental health professionals to provide forensic evaluations.
Today, forensic evaluations are provided through a statewide network of community mental health centers, regional mental health institutes, and one maximum-security unit. Community mental health centers provide the initial court ordered forensic evaluation and only if the center is unable to complete the evaluation on an outpatient basis does the defendant go to an inpatient facility. Inpatient evaluation and treatment services are provided at the four regional mental health institutes, and if the defendant requires security, the maximum security program at Middle Tennessee Mental Health Institute. The majority of all court ordered pretrial evaluations are completed on an outpatient basis thereby eliminating a costly inpatient stay.
Implementation of performance standards and monitoring of all forensic services has improved the quality of services to the forensic service recipient and reduced cost to the state.