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PubMed1991

Administrative issues in the follow-up treatment of insanity acquittees.

This paper discusses issues in the community-based management of forensic patients. Community acceptance and safety demand a careful system of follow-up treatment for insanity acquittees. Many studies have examined the recidivism of this population, but few have dealt with administrative strategies to manage their care as outpatients. In this paper, we discuss our experiences in developing systems for follow-up care of insanity acquittees in the state of Maryland. Central to this work is the balancing of clinical, judicial and community concerns. The decision for outpatient care or movement of the patient to a non-forensic (regional) hospital is a significant turning point in the forensic patient's care. One of the major challenges faced by forensic mental health services is to develop consistency of practice throughout a state. A centralized system is easier to manage, but costly. A system embedded in community mental health centers is less duplicative, but requires major and ongoing educational support. A private practice model is flexible, but administratively challenging. The authors believe Maryland possesses well-developed approaches for the evaluation, treatment and conditional release of insanity acquittees. The state continues to study and redesign its systems toward increased effectiveness and efficiency.

Community Mental Health Services↗
PubMed2004

Venirepersons's attitudes toward the insanity defense: developing, refining, and validating a scale.

Given the prevalence and predictive strength of negative attitudes toward the insanity defense, we conducted three studies with 426 venirepersons to develop an understanding and a measure of public attitudes toward the insanity defense. In these studies, we developed, iteratively refined, and cross-validated the insanity defense attitude-revised (IDA-R) scale. The results suggest that IDAs are underpinned by one's degree of (a) orientation toward strict liability, and (b) concern about perceived injustice and danger associated with the defense. The IDA-R assesses these two-dimensions with good internal consistency, convergent and divergent validity, and predictive utility. The IDA-R's predictive utility generalizes across jurisdictions and manipulation of case facts. Theoretical and practical implications for research and for identifying impartial jurors at voir dire are discussed.

Attitude↗
PubMed2000

Uncontrollable frenzy and a unique temporary insanity plea.

On a bright, sunny April 1859 afternoon in Washington, D.C., a brutal murder occurred in Lafayette Park, directly across from the White House. Ironically, a close friend of President James Buchanan shot and killed his wife's lover. Daniel E. Sickles, a cuckolded U.S. Congressman, attacked and killed Philip Barton Key, the U.S. Attorney for the District of Columbia. Key was one of the eleven children of Francis Scott Key, the author of the poem that became The Star Spangled Banner. At the trial, Sickles' seven lawyers presented an insanity plea claiming that an "uncontrollable frenzy" created a 'brainstorm" resulting in temporary insanity. In addition, the defense argued that the "unwritten law" provided immunity to a husband who avenged his honor. Only lay witnesses testified as to Sickles' intense emotional outrage. There was no expert medical witness to support the insanity plea. Prosecutors maintained that the killing was a premeditated murder, or at the very least manslaughter.

District of Columbia↗
PubMed2001

On finding for defendants who plead insanity: the crucial impact of dispositional instructions and opportunity to deliberate.

One hundred twenty participants functioned as mock-jurors and as members of deliberating juries in an experiment designed to assess the impact of dispositional instruction on verdicts rendered in an insanity trial. Consistent with prior research (K. E. Whittemore & J. R. Ogloff, 1995), dispositional instruction had no effect on the verdict preferences of individual jurors prior to deliberating. Yet, as expected, the instruction manipulation had a major impact on postdeliberative decisions (i.e., group verdicts; individual juror verdict preferences). Content analyses of jury deliberations revealed that postdeliberative shifts toward harsh verdicts in uninstructed juries and toward lenient verdicts in instructed juries were mediated by the impact of the Instruction manipulation on the content of jury deliberations: uninstructed juries feared that an acquitted-insane defendant would be freed to act again, whereas instructed juries recognized that finding for an insane defendant implied his retention and treatment. Implications of these results for both legal policy and the conduct of mock-trial research are discussed.

Analysis of Variance↗
PubMed1986

Insanity legislation.

The McNaughton Rules, which are used when someone pleads insanity at the time of a homicide, are out of date and unsatisfactory. Suggestions have been made about how the insanity defence can be reformulated. The preference of a defence of diminished responsibility means abandoning an ancient and humane principle of not convicting those who are so mentally disordered as not to be responsible for their actions. There is a need for Parliament to consider changes to the law both to prevent the mentally disordered being sent to prison inappropriately, and because the Mental Health Act 1983 has not taken account of rare cases where an offender such as an epileptic might be found legally insane but not mentally disordered.

Commitment of Persons with Psychiatric Disorders↗
PubMed1980

Insanity acquittals in New York State, 1965--1978.

The author presents data on the use of the insanity defense to provide a basis for current debates on its revision. Generally, the experience in New York State in 1976--1978 reflects an increasing number of insanity acquittals over 1965--1976, but the characteristics and length of hospitalization of the defendants remained fairly similar. In addition, in some counties the defense was used often, but in others it was not used at all. The author suggests that similar, more sophisticated analyses of the actual operation of the insanity defense be carried out to establish an adequate basis for designing rational social policy.

Adult↗
PubMed1991

Monitored conditional release of persons found not guilty by reason of insanity.

This article reviews the recent literature documenting changes that have taken place in the management and treatment of insanity defense acquittees with the development of conditional release and monitored community treatment. The review demonstrates that conditional release is particularly important as a means of balancing the protection of society with the treatment of insanity defense acquittees in the least restrictive environment. The review also highlights the development of community programs based on treatment models for the chronically mentally ill. In addition, monitored community treatment programs appear cost-effective when compared with hospital-based programs. These factors point to the development in the 1990s of program standards for the release of insanity defense acquittees.

Civil Rights↗
PubMed1996

Insanity defense pleas in Baltimore City: an analysis of outcome.

OBJECTIVE: The authors studied all defendants in Baltimore City's circuit and district courts who pleaded not criminally responsible, Maryland's version of the not guilty by reason of insanity plea, during a 1-year period. The study was designed to compare the perception that the insanity plea is misused to actual outcome data. METHOD: The cohort of defendants who pleaded not criminally responsible in both the circuit and district courts during calendar year 1991 was identified. Data on demographic characteristics, crimes committed, diagnoses, and psychiatrists' opinions on criminal responsibility were collected. Trial outcome data were obtained through a search of the circuit and district court computer systems. RESULTS: Of the 60,432 indictments filed in the two courts, 190 defendants (0.31 per 100 indictments) entered a plea of not criminally responsible. All but eight defendants (0.013 per 100 indictments) dropped this plea before trial. For these eight cases, both the state and the defense agreed that the defendant should be found not criminally responsible, and the plea was uncontested at trial. The remaining defendants had their charges dropped before trial, remained not competent to stand trial at the time of the study, or withdrew their pleas of not criminally responsible before trial. CONCLUSIONS: There were no trials that contested the plea of not criminally responsible. The state and defense agreed with each other for all of the defendants who actually retained the plea at trial. The perception that the insanity defense is overused and misused is not borne out by data.

Adult↗
PubMed1988

Court-mandated outpatient treatment for insanity acquittees: clinical philosophy and implementation.

Court-mandated outpatient treatment for offenders found not guilty by reason of insanity is an alternative form of treatment in which insanity acquittees may be released into the community after serving part of their commitment in a forensic hospital. Working with this difficult population requires a close liaison with the criminal justice system and a clearly articulated treatment philosophy. Essential elements include an emphasis on structure and supervision, recognition of the importance of neuroleptic medication, a reality-based approach to therapy and a focus on the problems of everyday living, and incorporation of the principles of case management. Treatment staff must be comfortable with giving support, enforcing limits, and recommending revocation of the patient's community status when necessary. Case illustrations of successful and unsuccessful community treatment for insanity acquittees are included.

Adult↗
PubMed1990

Monitoring insanity acquittees: Connecticut's psychiatric security review board.

In 1985 Connecticut established an administrative psychiatric security review board to monitor the postverdict disposition of defendants found not guilty by reason of mental disease or defect. The five-member board may confine an insanity acquittee in a mental hospital, grant temporary leave, order conditional release, and terminate confinement or conditional release. Judicial review is required before a patient is discharged from the board's custody. Between 1985 and 1989, a total of 173 insanity acquittees were under the board's jurisdiction; most were hospitalized in state psychiatric facilities. The authors discuss issues that must be addressed in creating a psychiatric security review board, including the conflict between protecting the public and treating insanity acquittees, clinicians' resistance to treating these patients, and problems posed by patients who do not appear to be mentally ill or who are well known to the public.

Adolescent↗
PubMed1994

The Criminal Procedure (Insanity and Unfitness to Plead) Act, 1991. A case report and selected review of the legal reforms.

Procedures relating to Insanity and Fitness to Plead are reviewed with special emphasis on the problems encountered with previous legislation. The introduction of the new Criminal Procedure (Insanity and Unfitness to Plead) Act 1991, on 1 January 1992, offered greater discretion in the disposal of these defendants, but fell short of many of the recommendations made by those advocating reform. As yet, too few cases have passed through the courts to highlight particular deficiencies in the unreformed parts of the Act, but the benefits are already apparent. Finally, some of the potential pitfalls of supervision and treatment orders and other disposals are discussed and an insanity case, dealt with under the new legislation, is presented.

Adult↗
PubMed1985

The insanity defence.

The recent A.P.A. Statement on the Insanity Defence is a document important to all psychiatrists and medicolegal professionals in North America. Its contents are reviewed and contrasted with current Canadian practice on the insanity defence, as well as the proposals of the Mental Disorder Project of the Canadian Department of Justice. The American Psychiatric Association's proposal on the definition of mental disorder is contrasted with the current practice. It is also suggested that the proposal of the Mental Disorder Project to change the disposition of insanity acquittees will lead to difficulties similar to those which provoked the current crisis in the United States.

Antisocial Personality Disorder↗
PubMed1988

Forensic psychiatrists' and psychologists' understanding of insanity: misguided expertise?

The ability of mental health experts to consult on insanity cases is highly dependent on their accurate understanding of the current Canadian standard. The study surveyed experienced forensic psychiatrists and psychologists and found the majority (88%) had erroneous beliefs regarding the insanity standard. Results of a discriminant analysis suggest that experience with insanity evaluations and courtroom testimony may improve experts' understanding. Implications of these results are discussed with respect to professional training and public policy.

Canada↗
PubMed1997

Chloroform-induced insanity defence confounds lawyer Lincoln.

During an 1857 trial, the defence claimed that the accused should be absolved of wilful murder because an overdose of chloroform during surgery induced insanity. In a rare appearance as a prosecutor, Abraham Lincoln tried the case for the State of Illinois. Expert medical witnesses testified about the side effects of chloroform and chloroform-induced insanity. Significantly, Lincoln was not knowledgeable about medical jurisprudence and overlooked potential sources of evidence and expert witnesses. Defence lawyers presented an impressive array of physicians to testify about insanity, about chloroform and about the results of an overdosage during anaesthesia. Considering the state of scientific knowledge at the time, the trial was notable.

Chloroform↗
PubMed2000

Perceptions of insanity based on occupation of defendant and seriousness of crime.

The purpose was to estimate the relationship between a defendant's stated intelligence on perceptions of his sanity and responsibility. This analog study was a 2 (occupation of defendant) x 2 (seriousness of outcome) between-subjects design. A scenario involving an insanity defense was read by 190 college students who then answered a 12-item questionnaire. The hypothesis that participants would attribute less responsibility to less intelligent defendants than to more intelligent ones was partially supported. Belief in a Just World moderated these evaluations. Seriousness of outcome influenced men's perceptions of the defendant's insanity, responsibility, and sentence, but not women's. Participants seemed to be more willing to accept the possibility that the defendant was insane if the outcome of his crime was not serious.

Adolescent↗
PubMed2004

Culpability for inducing mental states: the insanity defense of Dr. Jekyll.

Insanity acquittees are often (erroneously) believed to get away with murder. This article examines one possible cause of this view--that insanity acquittees may have, to various degrees, caused or exacerbated their own mental disorder in the first instance. Such a component of prior fault is illustrated with recourse to the putative insanity defense of Dr. Jekyll, who, while almost certainly not criminally responsible at the time he committed murder (in the guise of Mr. Hyde), was culpable for bringing about that nullification of responsibility (thereby causing the conditions of his own defense). Such culpability (also found in intoxication cases) is examined in relation to medication noncompliance in mentally disordered offenders, and possible solutions for dealing with "culpable madness" are presented.

Criminal Psychology↗
PubMed1991

Tightening the reins: recent trend in the application of the insanity defence in Canada.

This article gives a critical overview of the Canadian courts' recent pronouncements on the so-called 'insanity defence', irresistible impulse, non-insane automatism and the disposition and rights of insanity acquittees. The inconsistencies and conflicts between a number of court decisions relating to section 16(2) of the Criminal Code are highlighted and reform proposals analysed.

Canada↗
PubMed1988

Drug treatment refusal and length of hospitalization of insanity acquittees.

Thirty-three insanity acquittees who had refused drug treatment were matched to a sample of nonrefusing hospitalized insanity acquittees in an attempt to measure the effect of treatment refusal on length of hospital stay. No measurable effects on the length of hospitalization were found. However, upon comparing the amount of time under court jurisdiction spent in the hospital and on conditional release in the community, it becomes evident that refusers spent significantly greater proportions of time hospitalized than the average hospitalized insanity acquittee, who had less hospitalization and spent more time on conditional release. These differences do not seem to be related to the issue of treatment refusal.

Adult↗