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PubMed1998

Factors associated with the conditional release of persons acquitted by reason of insanity: a decision tree approach.

Most NGRI (not guilty by reason of insanity) acquitties are hospitalized for some period of time following acquittal, which raises the question of when an individual can be safely released into the community. The conditional release (CR) of persons acquitted by reason of insanity, therefore, provokes the question of public safety. This study examines the CR systems in four states--Connecticut, Maryland, New York, and Ohio. A study sample of 529 persons acquitted as NGRI from 1985 to 1987 was followed up for at least five years to determine who is conditionally released. Following a description of the CR systems, findings suggestive of the role of dangerousness and diagnosis as predictors of CR are presented. Personal characteristics are also significant factors in predicting who will be released. The length of hospitalization for this population and other descriptive factors such as history of hospitalization, arrests, substance abuse, family violence, and living arrangements are also addressed.

Decision Trees↗
PubMed1976

Sex and race as factors affecting the attribution of insanity in a murder trial.

Two hundred and eight white male and female college students read a summary of a case of a violent murder in which an insanity plea was entered. The sex and race (black or white) of the hypothetical defendant was varied in a 2 X 2 factorial design with 52 Ss per cell. Measurements included verdict (guilty or insane), length of recommended sentence, and ratings of certain defendant characteristics. Major results were as follows: (a) harsher treatment of males as indicated by longer sentences, (b) longer sentences for white as opposed to black males among defendants found guilty, and (c) a trend toward a higher proportion of guilty verdicts for black males.

Decision Making↗
PubMed1986

Prohibiting psychiatric diagnosis in insanity trials. With special reference to John W. Hinckley, Jr.

Over 12 different diagnoses were offered in expert testimony during the Hinckley insanity trial. This multitude of diagnoses, many of them overlapping, served to focus attention on the labels themselves rather than on the psychological processes of the defendant. As a result, differences in opinion among the experts were exaggerated; more important, the testimony confused the jury. I believe that stating--or even explaining--a diagnosis is not only unnecessary but also misleading in courtroom testimony. In an application of Roy Schafer's "action language" approach (1976; Miller 1979, 1983) and consistent with the law, I recommend that diagnoses be excluded from insanity trials.

Adult↗
PubMed1979

Characteristics and disposition of persons found not guilty by reason of insanity in New York State, 1971-1976.

In order to develop an empirical profile of persons acquitted by reason of insanity from which policy could be developed, the authors studied all acquittals in New York State from 1971-1976. During this period 196 men and 29 women were found not guilty by reason of insanity. In contrast to adults admitted to state correctional facilities, the study group contained proportionately more persons who were white and older. The most frequent crimes for which subjects were tried were homicide, assault, and robbery. Most victims were acquaintances of the defendants. By 1976, 67 persons had been discharged after hospitalization ranging from 1 to 1,235 days. These defendants are still being followed after their return to the community.

Adolescent↗
PubMed2006

Law & psychiatry: insanity, guilty minds, and psychiatric testimony.

This column describes a recent Supreme Court case, Clark v. Arizona, in which an adolescent who had schizophrenia was convicted of first-degree murder of a police officer who he believed was a hostile space alien. The Arizona courts had rejected his insanity defense as well as a second defense that he lacked the required intent to commit the crime (mens rea) because his delusions interfered with his knowing that the victim was a police officer. The Court ultimately declined to overturn Arizona's rules regarding the insanity defense and mens rea. However, the column highlights the points in Justice Souter's decision that may have implications for any case involving mental health issues.

Adolescent↗
PubMed1985

The insanity defense: the case for abolition.

The author discusses psychiatrists' objections to the insanity defense, including the negative publicity generated by murder trials in which psychiatrists provide expert testimony. He also examines the legal profession's attitudes toward the defense and the pressure applied to expert witnesses through our adversarial system of justice. The abolition of the insanity defense might expedite the legal process, the author concludes, but it would not greatly affect the courtroom role of psychiatrists. Psychiatric evaluation would still be required in certain cases, such as those involving diminished responsibility and competency to stand trial.

Commitment of Persons with Psychiatric Disorders↗
PubMed1985

The insanity defense: a difficult necessity.

The author considers the merits of the insanity defense in light of three premises. First, a defendant's sanity must be taken into account both in assessing culpability and in assigning punishment for a crime. Second, all members of society must be protected against harmful acts. And third, it is the responsibility of psychiatrists to assess, but not to predict, the existence of mental illness. After briefly discussing the limitations of expert testimony and the adversarial demands of the judicial system, the author concludes that the insanity defense should be retained but altered, and that psychiatrists should bear the burdens of advocating for the mentally ill.

Commitment of Persons with Psychiatric Disorders↗
PubMed1991

New York State's system of managing insanity acquittees in the community.

New York State's Insanity Defense Reform Act of 1980 outlined specific procedures for conditional release to the community of persons found not guilty of a criminal offense by reason of insanity. To assess how well the procedures were working, the authors examined data on all clients placed on conditional release in the state between 1980 and 1987. The majority of the 331 clients so identified had been found to be dangerously mentally ill and were subsequently released to the community after extensive periods of involuntary inpatient treatment. The most common condition for community release was participation in a treatment program. While in the community, 22 percent of the clients were arrested, and 5 percent had their conditional releases revoked and were recommitted. The authors compare the New York program with similar programs elsewhere. They believe the key features of a successful program include centralized responsibility, a uniform system of treatment and supervision, and a network of community services.

Adult↗
PubMed1999

An outpatient psychiatry program for offenders with mental disorders found not guilty by reason of insanity.

OBJECTIVE: Rehospitalization and criminal recidivism were examined among a group of offenders with mental disorders adjudicated as not guilty by reason of insanity and mandated to receive treatment in a forensic psychiatric outpatient program as a condition of release. METHODS: A retrospective chart review was conducted for 43 offenders with mental disorders who were acquitted as being not guilty by reason of insanity for the index offense and were active in the outpatient treatment program in 1996. Data were abstracted on sociodemographic, psychiatric, and criminal characteristics predating the index offense; rehospitalizations and new crimes and rearrests after the offense; and clinical and psychosocial functional outcomes after enrollment in the outpatient program. RESULTS: For the 43 patients, the mean length of stay in the program was 68 months, with a range of 4.9 months to 18.4 years. Almost two-thirds of the patients were diagnosed as having schizophrenia, schizoaffective disorder, or a nonaffective psychotic disorder; 58 percent had a comorbid substance use disorder, and 63 percent had an axis II diagnosis. Since program enrollment, 20 patients (47 percent) were rehospitalized at least once, and eight (19 percent) were rearrested or had committed a new crime. At the end of 1996, only nine (24 percent) were in full remission, and 26 (68 percent) showed at least one indicator of difficulty reintegrating into the community. CONCLUSIONS: Even after treatment in a specialized forensic program, this sample of offenders with serious mental disorders remained impaired symptomatically and functionally. Although avoidance of rehospitalization is considered a successful outcome, rehospitalization is preferable to rearrest for this forensic population.

Adult↗
PubMed1999

A confusion of tongues: competence, insanity, psychiatry, and the law.

Psychiatrists share with the public some confusion and uncertainty about two highly visible forensic psychiatric examinations: competence to stand trial and criminal responsibility (insanity). The author reviews the content and context of these examinations, examines legal issues that define and underlie them, and clarifies commonly encountered areas of ambiguity and misunderstanding. The competence examination, which assesses a defendant's ability to participate in the trial process, focuses on the present state of the defendant's mental capacities. Two standards generally used are whether the defendant has a rational and factual understanding of the charges and penalties and has the ability to cooperate with the defense attorney. The examination for insanity is one of the most challenging and comprehensive in forensic psychiatry. The criteria in general address the defendant's awareness of the fact that the act was illegal, wrong, or a crime. Additional criteria address the defendant's ability to control behavior.

Forensic Psychiatry↗
PubMed2002

AAPL practice guideline for forensic psychiatric evaluation of defendants raising the insanity defense. American Academy of Psychiatry and the Law.

The insanity defense is a legal construct that excuses certain mentally ill defendants from legal responsibility for criminal behavior. This practice guideline has delineated the forensic psychiatric evaluation of defendants raising the insanity defense. The document describes acceptable forensic psychiatric practices. Where possible, standards of practice and ethical guidelines have been specified. And where appropriate, the practice guideline has emphasized the importance of analyzing the individual case, the jurisdictional case law and the state (or federal) statute. This practice guideline is limited by the evolving case law, statutory language and legal literature. The authors have emphasized the statutory language of current legal standards, as well as the state or federal courts' interpretation of those standards because the same statutory language has been interpreted differently in different jurisdictions. Similarly, this practice guideline has reviewed the state and federal trends that determine which diagnoses meet the criteria for mental disease or defect. These trends yield to jurisdictional court interpretations. Finally, the authors hope this practice guideline has begun the dialogue about formulating a forensic psychiatric opinion by surveying the various approaches used to analyze case data. The forensic psychiatrist's opinion in each case requires an understanding of the current jurisdictional legal standard and its application, as well as a thorough analysis of the individual case. The psychiatrist's analysis and opinion should be clearly stated in the forensic psychiatric report. It should be noted that the role of a psychiatric expert witness in the criminal justice system is predicated on the law's interest in individualizing the criteria of mitigation and exculpation. Forensic psychiatric analyses and formulations of opinions are, therefore, subject to change as the legal guidance changes.

Ethics, Medical↗
PubMed2002

Hendricks v. People: forcing the insanity defense on an unwilling defendant.

At least 17 jurisdictions permit insanity defenses to be entered over the objections of defendants. Those jurisdictions believe that society's interest in a just determination of the charges outweighs a competent defendant's choice. If competency includes the ability to rationally choose a plea, competent defendants should not be forced to enter insanity defenses against their wills.

Colorado↗
PubMed1992

The involvement of schizophrenic insanity acquittees in the mental health and criminal justice systems.

This article described the mental health and criminal justice involvement of a large group of schizophrenic insanity acquittees and the program designed to manage and treat these individuals. Most insanity acquittees in our system are chronically mentally ill individuals who fit well into the psychosocial rehabilitation models that have developed over the past 15 years. In addition, the use of conditional release and monitored care in the community appears to be the most realistic approach to this group of individuals who show a high degree of involvement with the mental health and criminal justice service systems. This research has continued implications for the development of outpatient civil commitment and for the attempt to give people as much liberty as they are capable of handling while being realistic about their capacities to survive in the community.

Adolescent↗
PubMed1992

The insanity defense: a South African perspective.

The insanity defence has always been a contentious issue. This study was carried out on a sample of 95 consecutive forensic, psychiatric observation cases. The cost-effectiveness of ordering routine investigations during the observation period appeared to be questionable since the results of selective special investigations yielded more useful information. It was found that there was little calculated abuse of the insanity defence, but that the situation was rather one of barely literate persons naively attempting to use it, especially in cases of serious crime. The incidence of these naive users might have been greatly reduced had there been adequate screening before the accused were sent for observation. The court generally accepted the psychiatrist's opinion with regard to mental illness and criminal responsibility. It, however, differed on occasion when it came to the disposal of those accused who were found to be mentally ill.

Adult↗
PubMed1992

Dr Rogers' 'insanity detector' and the admissibility of novel scientific evidence.

The R-CRAS (Rogers' Criminal Responsibility Assessment Scales) purports to be a systematic and empirically based approach to evaluations of criminal responsibility. This 'insanity detector' has been heralded as a reliable instrument in the resolution of the psycholegal controversies surrounding the plea of insanity. It is contended that, regardless of its possible scientific merit, most courts will find that the R-CRAS fails to satisfy the Frye test for admissibility of novel scientific evidence (that is, general acceptance by the relevant scientific community). Moreover, it is argued that the R-CRAS's potential for prejudice outweighs its probative value, in that it might unfairly bolster the testimony of the expert witness who relies upon it and might overwhelm the jury because of its 'aura of special reliability and trustworthiness'. Until such time as the R-CRAS does gain widespread acceptance and is shown to be sufficiently reliable to outweigh any potential prejudice (if ever), the author is of the opinion that forensic psychiatrists and psychologists may have to continue to conduct evaluations of criminal responsibility 'the old-fashioned way'. 'Truth does less good in the world than its appearances do harm' --La Rochefoucauld.

Expert Testimony↗
PubMed2006

Update on the disposition of military insanity acquittees.

There has been little study of the use of the insanity defense within the military judicial system, and aggregated data concerning such cases are not readily available when needed. Useful information is not consolidated in a central location, hindering potential research and the development of systemic improvements. One key area that would benefit from closer analysis is the process of the disposition of insanity acquittees. The Manual for Courts-Martial (2000 ed. Washington, DC: U.S. Government Printing Office) provides limited guidance in procedures to disposition, outlining the process in rather broad terms. The result is often a time-consuming and resource-draining process that can create significant burdens for both the military legal and health care systems. The need to address challenges within the system is discussed, and the creation of a centralized databank as a step toward improving this system is recommended.

Adult↗
PubMed1990

Disposition of insanity acquittees in the United States Military.

Recent amendments to the United States Code of Military Justice have essentially adopted the federal mental nonresponsibility rule or insanity defense. The prior standard, as outlined in the American Law Institute's Model Penal Code, has been abandoned. Notably absent is a system to address the disposition of the military insanity acquittee. This raises concerns regarding recidivism and the military's role in mitigating potential dangerousness. Relevant civilian and military law is reviewed, two cases described, and possible remedies proposed.

Adult↗
PubMed1990

Part II: Sex differences in persons found not guilty by reason of insanity: analysis of data from the Connecticut NGRI Registry.

Thirty-one female insanity acquittess from Connecticut were matched to a group of 31 male NGRIs. The samples were compared with regard to demographic, criminal, and clinical characteristics. Logistic regression analyses were used to determine predictors of criminal recidivism for the sample. Results indicated that women NGRIs were older, more likely to be married, less likely to be substance abusers, had less extensive criminal records, and were released from hospitals sooner than the men. A significant racial difference was noted: white women had less extensive criminal records and were hospitalized for shorter periods than minority women. Results of the logistic regression analyses showed that the strongest independent predictors of criminal recidivism were race and having a diagnosis other than psychosis (schizophrenia, affective or organic disorders). Findings support recent APA policy guidelines on the insanity defense.

Adult↗