In the 1970s, 1960s, and before, those who found themselves behind bars became members of a forgotten population. Except for the rare offender who achieved celebrity-status notoriety, such as ''the bird man of Alcatraz'' or Charles Manson, most defendants and offenders faded into oblivion with the last bang of the judge's gavel. Those confined behind bars, whether in jail and pretrial or in prison and serving sentence, were dismissed from society's collective awareness. Needs of inmates were of no concern to most citizens and policy makers. Therapeutic optimism surged with development of more effective treatments for mental disorders, yet jail and prison inmates remained least likely to receive empathic concern. Against the backdrop of the many jails and prisons that were underfunded, understaffed, and without adequate, if any, mental health services, stood the occasional model house of correction with a multi-disciplinary correctional and social service staff, and programmatic opportunities for inmate self-improvement, an uncommon exception to the deplorable rule.
Ironically, while mental health services behind bars were inadequate to nonexistent, commentators criticized the procedural excesses of competence to stand trial determinations. Stone (1976), for example, described abuses of excess by defense attorneys, prosecutors, judges, and psychiatrists. Too many defendants were remanded for inpatient competency assessment and/or restoration. Lengths of hospitalizations were much too long. In the late 1970s Steadman (1979) produced empirical evidence showing that, at least in the state of New York, those found incompetent to stand trial were not much better or worse off than those who were not found incompetent.
Importantly, Lindsay Hayes' (Hayes, 1989; National Center on Institutions and Alternatives, 1981) surveys in the 1970s and 1980s brought to light the serious problem of jail suicides. Hospital populations declined while jail and prison populations soared, often overwhelming the facilities' capabilities. Psychiatrists, psychologists, and social workers took increasing interest in this population. Forensic specialties with central interests in litigants claimed incarcerated populations for treatment. With imprisoned populations expanding unchecked