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PubMed1984

Insanity defenses: contested or conceded?

The authors examined 316 Oregon criminal cases in which the accused successfully pleaded the insanity defense. Prosecutors agreed to the insanity verdict in more than four out of five cases. In most cases all examining experts diagnosed the defendant as psychotic. The smaller number of defendants who were diagnosed by the state hospital staff as displaying only personality disorders accounted for a disproportionately large percentage of the contested trials. Observing that Oregon's insanity defense system is run by consensus, the authors suggest a reorientation of the insanity defense debate.

Crime↗
PubMed1998

Relations among mock jurors' attitudes, trial evidence, and their selections of an insanity defense verdict: a path analytic approach.

This study examined an important question relevant to the domain of the insanity defense: What are the interrelationships among important evidential and attitudinal factors which influence how jurors decide their final verdicts? To answer this question, a mock trial in which the insanity defense was argued was presented to 224 college undergraduates by means of an audiotape and slide show. Following the presentation, participants were asked to answer a series of questions regarding the trial. A path model was specified with four evidential factors as endogenous variables, i.e., evaluation of the defendant's mental status, belief that the defendant could be rehabilitated, beliefs regarding the accuracy of the expert witnesses, and mock-jurors' predeliberation verdicts. In addition, three attitudinal factors were specified as exogenous variables, i.e., attitudes toward the insanity defense, attitudes towards due process vs crime control, and attitudes towards the death penalty. The path model was consistent with previous literature, suggesting that jurors' attitudes toward the death penalty and the insanity defense had a direct effect on how they evaluated the accuracy of the expert testimony and their evaluation of the defendant's over-all mental status. In turn, mock jurors' evaluations of the defendant's mental status had a direct effect on their selections of verdict. Importantly, mock jurors' evaluations of the evidential factors, particularly the mental status of the defendant, were a stronger predictor of their selections of verdict than were their initial attitudes.

Attitude↗
PubMed1986

Oregon's Psychiatric Security Review Board: a comprehension system for managing insanity acquittees.

The insanity defense is a particularly controversial aspect of the interaction between law and mental health. During the past decade, many states have revised or abolished their insanity defenses. Oregon, however, chose in 1974 to retain its existing defense and create a new, unique system for the post-adjudication management of insanity acquitees. Oregon's legislature established the Psychiatric Security Review Board (PSRB), which is composed of five part-time members drawn from different disciplines, to conduct periodic hearings to determine the placement and supervision of defendants who successfully raise the insanity defense and remain mentally ill and dangerous. The PSRB has received national attention as a promising approach to managing mentally ill offenders. The authors first describe the structure and operation of the Oregon system. Then they summarize the empirical studies they have conducted of the PSRB in action.

Forensic Psychiatry↗
PubMed1992

Predicting success on conditional release for insanity acquittees: regionalized versus nonregionalized hospital patients.

This research compared the outcomes of two cohorts of insanity acquittees: one group was treated solely in the maximum security state forensic hospital before their release to the community (nonregionalized) and the other group was treated at the state forensic hospital and transferred for further treatment at less secure state regional hospitals (regionalized). This research describes the outcome of a group of insanity acquittees (regionalized patients) never previously studied. The applicability of a prediction model based on earlier research of insanity acquittees was tested on the patients. Findings on four outcome indicators are reported: rearrests within five years after release, overall functioning in the community five years after release, rehospitalizations for mental illness, and successful completion of the terms of the five-year conditional release (nonrevocation). Discriminant analysis was performed on the four outcome variables. The model was found to accurately predict the four types of outcome from 69 percent to 94 percent accurately for the nonregionalized insanity acquittees and from 87.5 percent to 95.8 percent for the regionalized patients. This model is currently being adapted to classify patients into potential high- and low-risk groups at the time of conditional release for the purpose of determining the intensity of outpatient supervision.

Cohort Studies↗
PubMed1990

Post-Hinckley insanity reform in Oregon.

The 1983 Oregon legislature responded to public pressure to narrow the application of the insanity defense by eliminating personality disordered individuals from consideration for an insanity verdict. This article examined the effects of the statutory change, and found no significant change in the frequency of insanity acquittals of personality disordered subjects between the three pre-reform years (n = 21) and the three post-reform years (n = 14). We also reviewed how the Psychiatric Security Review Board handled these patients once committed to their jurisdiction. We constructed a matched comparison group of psychotic acquittees and found that in the pre-reform years the personality disordered subjects spent less time in the system and less time in the hospital than the psychotic patients. However, in the post-reform years their time in the system and time in the hospital was the same as the psychotic controls. There were fewer decisions to discharge personality disordered patients from the system after the reform, although this difference may be due to factors other than the statutory reform itself. The conclusion is that narrowing the insanity defense is a worthy goal which may be difficult to achieve.

Adult↗
PubMed1989

Follow-up after release of insanity acquittees, mentally disordered offenders, and convicted felons.

The authors compared 127 insanity acquittees in the state of Maryland with a matched prisoner control group of 127 convicted felons and a comparison group of 135 mentally disordered prisoners transferred for hospital treatment. Subjects were followed from five to 17 years after discharge from hospital or release from prison. Subsequent arrests, hospitalizations, employment, and functioning of these large cohorts were studied and compared. The study focused on outcome data at five years after release. The authors found that, at five years postrelease, 54.3 percent of the insanity acquittees, 65.4 percent of the prisoner control group, and 73.3 percent of the mentally disordered prison transfers were rearrested. At 17 years postrelease, rearrest rates increased to 65.8 percent of the insanity acquittees, 75.4 percent of the prisoner controls, and 78.4 percent of the prison transfers. Significantly more mentally disordered prison transfers than NGRIs were rehospitalized during the follow-up period. Overall, the prison transfers had significantly poorer outcomes on nearly all variables studied compared with the other two groups. The authors conclude that although there were a substantial number of rearrests among insanity acquittees, that group had a statistically significantly lower rate of criminal activity compared with the other two groups of offenders.

Adult↗
PubMed1989

Defendants pleading insanity: an analysis of outcome.

The authors examined the cohort of all defendants pleading not guilty by reason of insanity over a 12-month period in Baltimore City's superior trial court. During that time, 143 of the 11,497 defendants indicted (1.2%) pled not criminally responsible. Fourteen of those defendants (10%) were subsequently found not guilty by reason of insanity. The authors found marked agreement between the prosecution and defense with only two cases leading to full trials where the issue of insanity was argued. The evaluating physician's opinion as to criminal responsibility and Axis I diagnosis, and the most serious underlying charge discriminated between those defendants found not guilty by reason of insanity and those defendants found guilty or not guilty by the court. Other demographic factors such as age, number of dependents, educational level, severity of illness, and criminal background did not discriminate between the two groups.

Baltimore↗
PubMed1986

Two year's experience under Utah's mens rea insanity law.

The author examined the records of the seven defendants found not guilty by reason of insanity (NGI) under Utah's mens rea insanity law during the first two years of its operation. In all of the cases the attorneys, judges, and experts seemed unaware of the new law or confused about its meaning. Examination revealed that the findings of insanity were negotiated with either ignorance of or indifference to the mens rea law. Under the mens rea NGI law, the rate of insanity findings for Utah increased.

Adult↗
PubMed1984

The insanity defense: effects of abolition unsupported by a moral consensus.

The insanity defense reflects the moral judgment that some criminal defendants do not deserve criminal sanctions because of mental incapacity. This Note examines the alternative formulations, such as guilty but mentally ill and diminished responsibility, that some states have enacted in the face of growing controversy over the insanity defense. It observes that the alternatives, if used in lieu of the insanity defense, distort the criminal law and do not comport with the legal doctrine of responsibility, which eschews punishing mentally ill defendants. The Note concludes that the insanity defense should not be abolished unless the moral consensus changes regarding the criminal responsibility of mentally ill defendants.

Criminal Law↗
PubMed1993

Recasting Florida's insanity defense. Two modest proposals.

Three states have established psychiatric security review boards mandated to primarily provide protection from the potentially destructive behavior of insanity acquitees. Each year in Florida there are 100 of these patients; 5% have been involved in capital offenses. These boards, as compared with the extant judiciary system, are more effective and parsimonious and serve the end of primary prevention. It is recommended that the plea, "not guilty by reason of insanity," be changed to "guilty but insane." The change is largely semantic but should result in greater prosecutorial and public acceptance of the insanity plea and be more in keeping with individual freedom for patients as provided under the Constitution.

Adult↗
PubMed1996

Myths, realities, and the political world: the anthropology of insanity defense attitudes.

The author presents the case that society's efforts to understand the insanity defense and insanity-pleading defendants are doomed to intellectual, moral, and political gridlock unless we are willing to take a fresh look at the doctrine through a series of filters-empirical research, scientific discovery, moral philosophy, cognitive and moral psychology, and sociology-in an effort to confront the single most important (but rarely asked) question: why do we feel the way we do about "these people" (insanity pleaders)? He examines this question finally through a model of structural anthropology and concludes that until we come to grips with the extent to which ours is a "culture of punishment," we can make no headway in solving the insanity defense dilemma.

Ethics↗
PubMed1998

Case notes, case histories, and the patient's experience of insanity at Gartnavel Royal Asylum, Glasgow, in the nineteenth century.

This article is concerned primarily with questions as to how and why case notes were produced and utilized, and how they may (or may not) be used by historians. More specifically, it discusses how the Glasgow Royal Asylum's case notes may be deployed to access patients' experiences of madness and confinement. The deficiencies and biases of the case record are also explored. So too is the relationship of case notes with other asylum based records, including reception order questionnaires, with a separate section on patient writings as part of the case history corpus. This leads into an analysis of how the Asylum's case notes became case histories and for what purposes. These subjects are related to changes and continuities in medical ideologies about insanity, social attitudes to the insane and the nature of medical practice in asylums. Some fundamental shifts in emphasis in the use of the case note and case history occurred in this period. These shifts were associated with an increased emphasis on organic interpretations of mental disease and on clinical approaches to insanity; with the medicalization of asylum records and the wider discourse on insanity, and with declining deference to the public at large in the presentation of cases. The survey concludes by analysing the changing place of patient testimony within the case record.

History, 19th Century↗
PubMed2004

Gender and insanity in nineteenth-century Ireland.

The nineteenth century was a period of considerable social, political, and economic change in Ireland, change that was demonstrated with particular force in relation to the care of the insane. This chapter seeks to examine some of the means through which the insane were re-figured in nineteenth-century Irish society, and looks in particular at popular conceptions of danger, the gender specificity or otherwise of insanity, and the question of celibacy as a precipitating factor in mental illness. The chapter seeks to engage with the ongoing debate in the history of psychiatry over the relative importance of gender as a factor in the admission, treatment, and discharge of the insane.

Crime↗
PubMed1978

Public perceptions of the criminally insane.

The authors interviewed 413 residents of New York State in a study of public perceptions of the criminally insane. They found that the criminally insane are generally considered dangerous, harmful, and violent, and as a class they are feared and rejected by society far more than are than are the mentally ill. However, none of the individuals identified by study respondents as criminally insane were legally classified as such. The authors believe the public confusion about who is criminally insane arises from the media's emphasis on prior history of mental treatment of individuals committing violent and bizarre crimes, and from misunderstanding of the role of mental health professionals in criminal proceedings.

Crime↗
PubMed1993

Understanding the use of the insanity defense.

Psychologists often are called upon to give their opinion about a legal concept, the insanity plea. Criminal cases that involve the insanity plea consistently receive the attention of the media and of legislators who contemplate restricting the use of the defense, yet there is little nationwide information on the use and possible abuse of the insanity defense. This paper reviews what little is known and suggests that in order to make psychologically and socially responsible decisions, more information is needed on the use and success of the plea.

Diagnosis, Differential↗
PubMed2003

The competency of criminal defendants to refuse, for delusional reasons, a viable insanity defense recommended by counsel.

This article addresses the issues of whether mentally ill defendants charged with serious crimes who refuse to plead a viable and counsel-recommended insanity defense for delusional reasons (but who are otherwise competent to stand trial) should be considered to be competent, or incompetent, to stand trial; whether such defendants should be allowed to represent themselves with a delusional defense; and whether an insanity defense may properly be imposed upon such defendants. Based on an analysis of relevant Supreme Court decisions and other relevant cases, it is concluded that such defendants should not be allowed to go forward with a delusional defense (at least until reasonable efforts to treat the defendants' delusions are made). It is also argued, however, that unless an insanity defense would be viable (as well as recommended by counsel) delusional defendants who are otherwise competent to stand trial should be permitted to go forward, and represent themselves, with the defense of their choosing.

Decision Making↗
PubMed1991

Not guilty of murder by reason of paroxysmal insanity: the "mad" doctor vs. "common-sense" doctors in an 1865 trial.

In July 1865, the Harris/Burroughs trial marked the first time in a U.S. courtroom that expert medical testimony supported a plea of paroxysmal [temporary] insanity in a murder defense. Furthermore, the "medical expert" ["mad doctor"] was pitted against "common-sense" physicians. Forensic rationales and societal reactions of the 1860s appear to be remarkably similar to what happens in the 1990s. By merely changing the antebellum language, the arguments and ripostes could readily be recycled into current temporary insanity confrontations. Sociocultural aspects of the Harris/Burroughs murder case may yield clues as to the persistence of the forensic and attitudinal stances toward temporary insanity pleas by the mass media, the physicians, the legal profession and the public.

Expert Testimony↗
PubMed1991

Designing conditional release systems for insanity acquittees.

Monitored treatment in the community, also known as conditional release, has been described as the most important advance in the treatment of insanity acquittees in the last decade. Despite the importance of the development of conditional release, however, there has been relatively little written about relevant issues and planning principles important in designing and implementing conditional release systems. The present paper discusses important considerations relevant to conditional release that are associated with key decision points within systems for persons found not guilty by reason of insanity (NGRI). Four planning principles, generalizable to all NGRI systems, are then presented in a way that integrates the previous discussion. It is concluded that conditional release plays a crucial role in the treatment of insanity acquittees and that mental health administrators may either proactively modify their systems, in a way that balances public safety with individual rights and treatment needs, or wait for the modification mandate to be forced upon them in the wake of a highly publicized, heinous offense.

Community Mental Health Services↗