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Metropolitan St. Louis Psychiatric Center

Metropolitan St. Louis Psychiatric Center (MPC) is a Joint Commission accredited 50-bed minimum security psychiatric hospital for adult inpatients in the Eastern Region of Missouri.  Serving a large area of the state, MPC treats individuals from a highly diverse catchment area that includes rural, urban and suburban populations.  MPC is home to the Forensic Pretrial Program and serves the courts in the Eastern Region of Missouri by providing forensic evaluations and treatment of defendants who have been adjudicated incompetent to proceed.  The program consists of two components—the Forensic Evaluation Unit and the Inpatient Competency Restoration Units.

The Forensic Evaluation Unit conducts pretrial and presentence evaluations of individuals ordered by the courts to undergo mental evaluations, as well as conducting the re-evaluations of patients who were admitted to one of the inpatient units at MPC—when the evaluation is due to the court at the end of the 180-day commitment or when the treatment team believes they are ready to be re-evaluated.  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.  The forensic evaluations address such issues as competency to stand trial, competency to waive Miranda rights, criminal responsibility (insanity; NGRI), battered spouse syndrome, diminished capacity, and violence risk assessment.  Intern goals related to forensic evaluation include developing an understanding of the fundamentals of forensic evaluation, developing skills in forensic interviewing, learning to write for the court, and gaining an understanding of the overlap between clinical psychology and the legal system.

The second component of the Forensic Pretrial Program is the Inpatient Competency Restoration Program, which currently consists of Units 1West and 2West (with a 50-bed total capacity).  These units receive defendants found incompetent to stand trial and occasionally those who require inpatient forensic evaluation.  Defendants who are incompetent to stand trial have a major mental illness, brain injury, intellectual disability or other condition 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., first-degree murder, kidnapping, rape, etc.), but our patients do have a wide range of presenting crimes and legal backgrounds.  In addition, 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.  Treatment on the inpatient unit is informed by information from the pretrial evaluation, particularly with respect to the defendant’s competency related deficits.  On the inpatient units, an intern can expect to be providing treatment to acutely ill, intellectually disabled and personality disordered individuals who have been committed for competency restoration.  Interns participate in specialized groups to provide competency education, individual and group interventions to address psychiatric symptoms and other interventions to assist in the return of the defendant to court.

Interns will work in both components of the Forensic Pretrial Program (inpatient & outpatient) but can choose a Treatment Focused or Evaluation Focused rotation. An intern selecting the “Evaluation Focused” rotation would participate in two (2) outpatient evaluations per week, while an intern selecting “Treatment Focused” is one (1) outpatient evaluation per week, thus creating a full forensic rotation that provides experience in forensic evaluations and in the restoration of competency to stand trial.   A rotation that consists of only working the Forensic Evaluation Unit is not available.

The Psychology Department here at MPC consists of five doctoral level psychologists—two (2) inpatient psychologists (Dr. Tracey Fintel & Dr. Erich Haezebrouck) & three (3) certified forensic examiners (Dr. Bridget Graham, Dr. Rachael Springman, & Dr. Melanie Nichols)—who represent a variety of theoretical orientations and areas of interest & expertise.  Interns will have two supervisors:  one from an inpatient unit and one from the Forensic Evaluation Unit, with the balance of supervision depending upon whether the intern selects the Evaluation Focused or Treatment Focused rotation.  Focused supervision from other staff is available for individual and group psychotherapy and on assessment cases, ensuring that interns have an opportunity to draw upon the experience of various members of the staff.  Interns will receive a minimum of two to three hours of supervision per week, with many opportunities for informal supervision.  Guided readings of the professional literature relevant to forensic evaluation, inpatient services and professional development will also be assigned to supplement supervision.