Metropolitan St. Louis Psychiatric Center (MPC) is a Joint Commission accredited 50-bed psychiatric hospital for adult inpatients in the Eastern Region of Missouri. Serving a large area of the state, Metropolitan St. Louis Psychiatric Center treats individuals from a highly diverse catchment area that includes rural, urban and suburban populations. While diverse backgrounds and socioeconomic levels are represented within the inpatient population, persons with less education and fewer resources are in majority. Approximately 50% of the patients represent minorities, with the majority of those individuals being African-American.
MPC is home to the Forensic Pretrial Program and serves the courts in the Eastern Region of Missouri by providing evaluations of criminal defendants who are awaiting trial, patients who have been on probation but are having problems due to mental health or other issues, and persons being detained under the Sexual Predator Act (these evaluations are done off site). This Program consists of two components—the inpatient Competency Restoration Units and the Forensic Evaluation Unit.
Units 1West and 2West are the Competency Restoration Units. These units receive defendants found incompetent to stand trial and those who require inpatient forensic evaluation. Defendants who are incompetent to stand trial have a major mental illness, brain injury, mental retardation or other condition that is severe enough to cause them to be unable to understand the legal proceedings against them or to cause them serious impairment in working with the defense attorney. Our job is to provide comprehensive, intermediate-term psychiatric care and competency restoration services in order to prepare the patient to return to court and face the charges against them. Because MPC is minimum security, we typically do not have patients with the more violent types of crimes (e.g., murder, kidnapping, rape, etc.), but our patients do have a wide range of presenting crimes. As well, because so many conditions can cause someone to be incompetent, the range of mental disorders we treat is broad. The patients are committed for 180 days at a time, but we can return them to court sooner when possible, or we may treat them longer if the case presents such challenges.
The second component of the Forensic Pretrial Program is the Forensic Evaluation Unit. This unit conducts pretrial, presentence and sexual predator evaluations of individuals ordered by the courts to undergo mental examinations. The Certified Forensic Examiners have been trained to conduct court-related evaluations in a way that bridges the gap between clinical mental health assessments and the legal standards in Missouri law. We address such issues as competency to stand trial, competency to waive Miranda rights, criminal responsibility (insanity; NGRI), battered spouse syndrome, diminished capacity, risk for future dangerousness and sexual predator commitment.
Interns can choose one of two tracks: to work both components of the Forensic Pretrial Program, creating a full forensic rotation that provides experience in forensic evaluations and in the restoration of competency to stand trial, or work primarily on an Inpatient Competency Restoration Unit with a sampling of work on the Forensic Evaluation Unit. A rotation that consists of only working on the Forensic Evaluation Unit is not available. The goals of the evaluation part of the rotation are to educate the intern on the fundamentals of forensic evaluation, the develop skills in forensic interviewing, apply report writing skills to the court as a specialized setting, and to gain understanding of the overlap between clinical psychology and the criminal process. The inpatient component builds on the knowledge learned in the evaluation component and gives direct inpatient experience in an intermediate treatment setting with acutely ill, mentally retarded and personality disordered individuals who have been committed for competency restoration. The intern participates in specialized groups to provide competency education, group and individual interventions to address psychiatric symptoms, and other interventions to assist in the return of the patients to court. Depending upon the intern’s preference, the proportion of time in each component of the Program will be managed to balance the desire for greater or lesser evaluation and treatment experience.
The Psychology Department at Metropolitan St. Louis Psychiatric Center consists of six doctoral level psychologists with a variety of theoretical orientations and areas of interest/expertise. Interns are matched with a primary supervisor who provides the majority of the training and supervision during the rotation. Focused supervision from other staff is available for individual and group psychotherapy and on assessment cases, insuring that interns have an opportunity to draw upon the experience of various members of the staff. Interns receive a minimum of two to three hours of supervision per week, with many opportunities for informal supervision as the intern works with the psychologist on the unit. Guided readings of the professional literature relevant to inpatient services/professional development are available to supplement supervision.