Search

Filicide is the act of a parent killing their own offspring. Previous studies indicate that there are both commonalities and distinctions between filicides committed by mothers and fathers. The main objective of this study was to compare maternal and paternal filicide with a major focus on clinical and sociodemographic features of perpetrators, incident details, and victims. Filicide cases were examined at the bedded unit of the Expertise Department of Observation of the Council of Forensic Medicine that were referred by the Turkish Ministry of Justice. A total of 51 perpetrators and 57 victims were analyzed from June 2014 to December 2023. The perpetrators were daily face-to-face interviewed by psychiatry and forensic medicine physicians. There were significant differences in sociodemographic characteristics and psychiatric conditions between maternal and paternal cases. Female perpetrators tended to be younger, unemployed, mostly targeted younger victims and used asphyxiation to kill, whereas males tended to target older victims and utilized firearms. The most common primary cause of filicide in maternal cases was "unwanted pregnancy," whereas "spousal revenge" and "anger or impulsivity" were predominant in paternal filicides. All perpetrators who were not criminally responsible were mothers, mostly diagnosed with psychotic depression. Unwanted pregnancy, psychotic depression, and postpartum psychosis should be assessed when evaluating risk for mothers, especially for infanticide. The desire for revenge on a spouse, often seen with personality disorders, impulsivity and anger, access to firearms should be screened for risk of paternal filicide, particularly in older victims. Early recognition of these factors can help in implementing prevention strategies., (© 2024 The Author(s). Journal of Forensic Sciences published by Wiley Periodicals LLC on behalf of American Academy of Forensic Sciences.)

Self-induced extreme intoxication akin to automatism (SIEA) is a complicated and controversial legal concept resistant to jurisdictional consensus. In the United States, SIEA has, at times, been considered under the concept of "settled insanity.". In the United Kingdom, the defense may be allowed for specific intent crimes, though the defendant's awareness of the foreseeability of risk is addressed at trial. In Canada, recent jurisprudence has led to legal and practice landscape changes related to self-induced extreme intoxication. Here, we provide an overview of automatism and an update on the Canadian perspective with a review of the facts and an analysis of the Supreme Court of Canada's landmark decision in R v. Brown, where the court permitted the SIEA defense to be utilized for general intent crimes and acquitted Matthew Winston Brown, a 26-year-old male with no history of mental illness, with respect to two counts of "break and enter" and one count of "aggravated assault." We review the social and legislative response to the changing case law as well as related implications for expert testimony, which may be provided by forensic mental health professionals. Given the judicial and legal implications of the recent changes for both perpetrators and victims of violent crime and given the dynamic international landscape on extreme intoxication in criminal law, the review is thought to be of interest to a broad category of stakeholders including policymakers and those working in forensic psychiatry and law., (© 2024 The Author(s). Journal of Forensic Sciences published by Wiley Periodicals LLC on behalf of American Academy of Forensic Sciences.)

Pathological dissociation is relatively common in the United States and may be associated with violent or criminal behavior. Dissociative Disorders, especially Dissociative Identity Disorder, are considered controversial diagnoses by some in the psychiatric and legal professions. Individuals who offend during dissociative states may not be criminally responsible if they meet the legal standard for insanity, however, insanity pleas based on dissociative symptoms are rare. This review examined Federal appellate case law for potential legal barriers to the insanity defense for dissociative conditions and any restrictions imposed on related expert evidence. Few rulings directly addressed these questions but there do not appear to be any unique barriers for dissociation-related insanity pleas. Some cases provided valuable insights regarding the admission of expert evidence, effective expert testimony, and the role of defense counsel., (© 2024 American Academy of Forensic Sciences.)

Behaviors that would otherwise be considered criminal acts, but occur in the context of a sleep disorder, pose challenges to the traditional application of legal principles of criminal responsibility. Determining the degree to which consciousness is present during such behaviors becomes a necessary step in assigning criminal culpability. Historically, legal defense theories of unconsciousness, automatism, and insanity have been raised to negate culpability for parasomnia related behaviors. Accordingly, proper assessment of sleep disorders in the context of criminal charges becomes critical in assisting the functions of the justice system. This article reviews principles related to the legal tradition, expert assessment, and elements of expert testimony related to criminal behaviors and sleep disorders., (© 2024 The Authors. Behavioral Sciences & The Law published by John Wiley & Sons Ltd.)

The number of women involved with forensic mental health systems internationally is rising, however, limited research has explored the characteristics of those assessed for criminal responsibility. We investigated the demographic, psychiatric, and criminological characteristics of women recommended as eligible or ineligible for the defence of Not Criminally Responsible (NCR) on account of mental disorder following a criminal responsibility assessment in Central Canada. Data were collected through retrospective chart reviews of court-ordered criminal responsibility assessments for 109 women referred for evaluations between 2003 and 2019. Accused were an average age of 34.55 years, predominately identified as Indigenous (37.7%) or Caucasian (20.8%), and had often been charged with assault (47.7%). Women identified in the reports as NCR-eligible were significantly more likely to be employed, experience delusions during the index offence, and have expert reports linking their mental health symptoms to NCR legal criteria. They were also significantly less likely to have a personality disorder, substance-related diagnosis, or have used substances during the index offence. Delusions during the index offence significantly predicted assessment recommendations when controlling for age at assessment order, current substance-related diagnosis, and whether the expert report linked mental health symptoms to NCR legal criteria. Findings indicate the key factors considered by forensic mental health professionals when conducting criminal responsibility assessments with women. Meaningful differences exist between women identified as NCR-eligible and ineligible, with findings illustrating who may be more likely to receive services within the Canadian forensic mental health system., Competing Interests: Declaration of competing interest None., (Copyright © 2023. Published by Elsevier Ltd.)

The analysis covers the case of a driver suffering from epilepsy for many years, who during an epileptic seizure, in a state of profound disturbance of consciousness, caused a road accident. Such situations usually result in the perpetrator being considered insane in relation to the allegation. The task of expert psychiatrists and psychologists is then to assess the likelihood of the perpetrator of the prohibited act repeating it, and to indicate to the court the optimal therapeutic precautionary or penal measure. These legal solutions also apply to perpetrators who were considered insane due to disturbances of consciousness occurring in the course of various somatic diseases, and not permanent mental disorders. Currently, there are no grounds for appointing expert neurologists, diabetologists, cardiologists, pulmonologists, and other specialists who would assess the legitimacy of taking precautionary measures, which may raise judicial doubts. Moreover, applying in such cases only the measures indicated in Article 93a § 1 of the Penal Code does not find any psychiatric and psychological justification. Consideration should be given to extending the catalog of protective measures to include the therapy of various somatic diseases in order to minimize the risk of developing deep mental disorders in the future. The work proposes new opinion-making solutions, which, however, requires changes in legal regulations.

Extraneous neuroscience information improves ratings of scientific explanations, and affects mock juror decisions in many studies, but others have yielded little to no effect. To establish the magnitude of this effect, we conducted a random-effects meta-analysis using 60 experiments from 28 publications. We found a mild but highly significant effect, with substantial heterogeneity. Planned subgroup analyses revealed that within-subjects studies, where people can compare the same material with and without neuroscience, and those using text, have stronger effects than between-subjects designs, and studies using brain image stimuli. We serendipitously found that effect sizes were stronger on outcomes of evaluating satisfaction or metacomprehension, compared with jury verdicts or assessments of convincingness. In conclusion, there is more than one type of neuroscience explanations effect. Irrelevant neuroscience does have a seductive allure, especially on self-appraised satisfaction and understanding, and when presented as text., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Empowerment not only benefits patients but also provides support and assistance to their family members, especially in cases when patients are subject to custodial protection sentences. The positive effects of empowerment on patients' family members may be summarized into three main aspects, including: enhancing their engagement in healthcare, alleviating their anxiety, and enhancing their caregiving skills. With regard to enhancing engagement in healthcare, family members receive health education that provides an overview of the illness, treatment options, prognosis, and key nursing points and allows them to better understand the patient's condition and actively participate in decision-making. With regard to alleviating anxiety, patients under custodial protection sentences are involved in legal problems, which results in higher levels of stress for family members compared to their peers caring for general patients. Through emotional support and active listening, nurses provide opportunities for family members to express their concerns and offer comfort and encouragement, helping them cope with difficulties and pressures. With regard to enhancing caregiving skills, the purpose of custodial protection sentences is to prevent recidivism, and family members bear significant responsibility for caregiving after discharge. Nurses can share similar caregiving experiences from their ward, educate family members about observing symptoms, and provide guidance, thereby strengthening their caregiving capabilities. In addition, with regard to the disposition of patients, nurses assist family members to understand the medical process and provide necessary guidance, ensuring family members have a clear understanding and are respected during the preparations for discharge. Based on related theoretical frameworks and practical experiences, this research highlights the positive role of empowerment in enhancing the caregiving abilities and satisfaction of the family members of patients, particularly those subject to custodial protection sentences.

Persons with neuropsychiatric disorders present specific and unique challenges for forensic experts and defense attorneys in the criminal justice system. This article reviews two potential criminal defenses: legal insanity and the various legal standards or tests of criminal responsibility that are used in jurisdictions throughout the United States (i.e., the M'Naghten standard and the American Law Institute's Model Penal Code), and the partial legal defense of diminished capacity (lacking the mental state necessary to be found guilty of a specific intent crime). The process of evaluating criminal responsibility or diminished capacity is also presented with a specific emphasis on common issues that arise in evaluating defendants with Intellectual Developmental Disorder (Intellectual Disability), Parasomnias, Seizure Disorders, and Neurocognitive Disorders., (© 2023 John Wiley & Sons Ltd.)

Epilepsy may be associated with automatisms that are classed as 'insane 'as they are deemed to have originated within the mind. 'Sane automatism' is said to occur from external factors, such as physical trauma, while 'insane automatism' is said to be innate to the individual experiencing them. To claim automatism within the context of a criminal matter requires a detailed evaluation of the behavior demonstrated and a questioning of the volitional and purposeful nature of this behavior. It is insufficient to rely upon past behavior in association with these seizures to justify the defense of automatism within a specific event. Epilepsy is often considered to be associated with an increase in violence. Proper epidemiological research, both in long-term, large population control studies and hospital-based studies, has suggested that epilepsy, per se, is not associated with an increase in violence when compared to the population at large and controlled for other familial and environmental factors., (© 2023 John Wiley & Sons Ltd.)

Insanity evaluations are often criticized for their-alleged-lack of objectivity, reliability and transparency. Structured tools to guide and support forensic evaluators during these evaluations have been developed-but they are rarely employed in forensic practice. In the present article, we consider the value of these tools for forensic practice in terms of opportunities and limitations. First, we briefly describe different insanity criteria used in Western countries. Next, we will review five structured instruments to guide insanity assessment together with their performance measures. Finally, we draw conclusions on the value of such instruments for forensic practice., (© 2023 The Authors. Behavioral Sciences & The Law published by John Wiley & Sons Ltd.)

The topic of self-induced intoxication causing automatism is a complex legal question that straddles the border of psychiatry, the law, and social policy. It has been argued that women and children are predominantly positioned as victims of sexual and domestic violence, in which substances often play a part. This consideration sensitizes society to any legal measures that may potentially excuse, mitigate, or absolve perpetrators. The legal systems in Canada, the United States, and the United Kingdom have dealt with these situations as best as they can, sometimes inconsistently and sometimes coming into conflict with the public discourse and subsequent legislation. This article presents a comparison of case law and legislation among these three countries. We review the concept of automatism and self-induced intoxication leading to automatism, and we show how the courts have dealt with this subject., (© 2023 American Academy of Psychiatry and the Law.)

Forensic evaluations have advanced considerably with the development of specialized measures validated on forensic and correctional samples. Prior to this progress, such evaluations relied heavily on extrapolations from general psychological tests to crucial, legally relevant questions. Since then, decades of empirical work have produced forensic assessment instruments (FAIs) addressing psycholegal standards in addition to forensically relevant instruments (FRIs) examining issues central to forensic practice (e.g., malingering) but not the standards themselves. This article provides a critical examination of the development, validation, and modern applications of six published FAIs that each address one of three broad criminal forensic issues (i.e., insanity, competency to stand trial, and Miranda abilities and waivers). Evaluations of the measures' reliability and validity particularly in forensic samples are highlighted. To complement FAIs, FRIs related to response styles are briefly explored. As a primary goal, forensic practitioners are provided with the knowledge and background about FAIs to enhance their criminal forensic practices., (© 2023 John Wiley & Sons Ltd.)

The procedures and outcomes of conditional release of insanity acquittees is a relatively neglected area of forensic psychiatric research. The release procedures vary in individual states, resulting in a wide range of approaches, from the careful selection of appropriate patients and strict monitoring in the community, to literally no mechanism for ensuring the future safety of such individuals. In North Carolina there are institutional barriers which even hinder research on the outcomes of such cases. Haroon and colleagues report on the post-release outcomes of insanity acquittees in North Carolina from 1996 to 2020. The findings of the researchers are analyzed in light of the lack of a formal post-release monitoring system in their state, contrasted with outcomes in states where a strict monitoring program is in place. Commentary is provided on the study findings, including associations between demographic, psychiatric, and criminological characteristics of insanity acquittees and release outcomes, as well as an apparent systemic bias against minority acquittees in the insanity commitment and release process in North Carolina. Further research on this important topic, from additional state jurisdictions, is recommended., (© 2023 American Academy of Psychiatry and the Law.)

Over the past two decades, an increasing proportion of North Carolina state psychiatric hospital beds have been used to house forensic patients. Insanity acquittees occupy almost all forensic-designated beds in the state. Despite the effect insanity acquittees have on state hospital use in North Carolina, outcomes for acquittees after they are released from the state hospital are unknown because of a lack of previous research. This study evaluates postrelease outcomes for insanity acquittees discharged from the North Carolina Forensic Treatment Program between 1996 and 2020. The study also describes the association between the demographic, psychiatric, and criminological characteristics of insanity acquittees and outcomes of recidivism or rehospitalization. The results show that insanity acquittees in North Carolina have higher rates of criminal recidivism than acquittees in other states. There is also evidence of systemic bias against minority race acquittees in the insanity commitment and release process in North Carolina. Outcomes for insanity acquittees released from the state Forensic Treatment Program could be improved through the introduction of evidence-based practices widely used in other states., (© 2023 American Academy of Psychiatry and the Law.)

COVID-19 strongly affected referral of individuals from Oregon's courts and the ability of Oregon State Hospital (OSH) to accept patients. Despite acceleration in the decline in civil commitment, competency to stand trial (CST) admissions increased, causing a bed crisis at OSH, which in turn affected community hospitals and jails. In 1993, the Ninth Circuit Court of Appeals mandated admission of jail detainees to OSH within seven days after a judicial order for CST evaluation or restoration. During COVID, as the number of such patients increased to crisis proportions, average jail detention times exceeded seven days. An inevitable judicial process intensified in the U.S. District Court of Oregon after OSH requested a COVID-related modification of the seven-day limit. This commentary demonstrates more clearly than in the past that there is a negative correlation between civil commitment and competency restoration as components of an interrelated system. After updating the situation in Oregon, this article ends with suggested interventions to improve Oregon's civil and criminal commitment processes, hoping for better care of patients and improved administration of justice., (© 2023 American Academy of Psychiatry and the Law.)

Background: Forensic evaluations of legal insanity include the experts' assessment of symptoms present at the mental state examination (MSE) and the mental state at the time of offense (MSO). Delusions and hallucinations are most important. We explored how often symptoms were recorded in written forensic reports., Design: This exploratory, cross-sectional study included 500 reports of legal insanity written in 2009-2018 from cases of violent crimes in Norway. The first author read all reports and coded symptoms recorded from the experts' assessments of the offenders. Two co-authors repeated this procedure for 50 randomly selected reports. Interrater reliability was calculated with Gwet's AC 1 . Generalized Linear Mixed Models with Wald tests for fixed effects and Risk Ratios as effect sizes were used for the statistical analyses., Results: Legal insanity was the main conclusion in 23.6% of the reports; 71.2% of these were diagnosed with schizophrenia while 22.9% had other psychotic disorders. Experts recorded few symptoms from MSO, but more from MSE, although MSO is important for insanity. We found a significant association between delusions and hallucinations recorded present in the MSO and legal insanity for defendants with other psychotic disorders, but no association for defendants with schizophrenia. The differences in symptom recordings between diagnoses were significant., Conclusion: Few symptoms were recorded from the MSO. We found no association between presence of delusions or hallucinations and legal insanity for defendants with schizophrenia. This may indicate that a schizophrenia diagnosis is more important to the forensic conclusion than the symptoms recorded in the MSO., (© 2023. The Author(s).)

This Article analyzes the 2021 judgment of the Supreme Court of Pakistan in the case of Mst. Safia Bano v. Home Department, Government of Punjab. The case has garnered significant local and international attention due to the Court's ruling that a death sentence may not be carried out on a defendant who has a mental illness. Setting the case against the backdrop of Pakistan's Islamic and colonial contexts, this article argues that the Supreme Court has reshaped the insanity defense in Pakistani law by placing the determination of a defendant's mental state mainly in the hands of medical professionals. However, the Court's reliance on medical professionals and the subsequent downplaying of the "moral capacity" element of the insanity defense-a determination of law made by courts-has created an obstacle for courts to punish offenders more stringently in future cases due to the popular belief that mental health professionals are ill-equipped to answer broader questions of justice for victims and society. The article recommends that this issue can be remedied by establishing an objective legal test for insanity that considers Islamic law, Pakistani precedent, and advances in medical science.

The responsibility of persons with brain disorders who commit offenses may depend on how their disorders alter brain mechanisms for culpability. Criminal behavior can result from brain disorders that alter social cognition including a neuromoral system of intuitive moral emotions that are absolute (deontological) normative codes and that includes an emotion-mediated evaluation of intentionality. This neuromoral system has its hub in the ventromedial prefrontal cortex (VMPFC) with other frontal, anterior temporal-amygdalar, insular, and right temporoparietal connections. Among brain disorders, investigators report offenses in persons with brain tumors, epilepsy, and traumatic brain injury, but it is those with a form of dementia with VMPFC pathology, behavioral variant frontotemporal dementia (bvFTD), who are most prone to criminal behavior. This review presents four new patients with bvFTD who were interviewed after committing offenses. These patients knew the nature of their acts and the wrongness of the type of action but lacked substantial capacity to experience the criminality of their conduct at the intuitive, deontological, moral emotional level. Disease in VMPFC and its amygdalar connections may impair moral emotions in these patients. These findings recommend evaluation for the experience of moral emotions and VMPFC-amygdala dysfunction among persons with antisocial behavior, with or without brain disease., Competing Interests: Declaration of Competing Interest None., (Published by Elsevier Ltd.)

The United Nations Convention on the Rights of Persons with Disabilities requires states parties to 'recognize that persons with disabilities enjoy legal capacity on an equal basis with others in all aspects of life.' This mandate has sparked debate about the interpretation of legal capacity, including within the criminal context as applied to the retrogressively named 'insanity defense.' Yet, under-examined are two questions: First, what defenses should defendants with psychosocial disabilities be able to invoke during criminal prosecutions? Second, what kind of evidence is consistent with, on the one hand, determining a defendant's decision-making capacity to establish culpability and, on the other hand, the right to equal recognition before the law? Developments in neuroscience offer a unique prism to grapple with these issues. We argue that neuroscientific evidence of impaired decision-making, insofar as it presents valid and interpretable diagnostic information, can be a useful tool for influencing judicial decision-making and outcomes in criminal court. In doing so, we oppose the argument espoused by significant members of the global disability rights community that bioscientific evidence of psychosocial disability should be inadmissible to negate criminal responsibility. Such a position risks more defendants being punished harshly, sentenced to death, and placed in solitary confinement., (© The Author(s) 2023. Published by Oxford University Press on behalf of Duke University School of Law, Harvard Law School, Oxford University Press, and Stanford Law School.)

In 1954, the Canadian government established the Royal Commission on the Law of Insanity as a Defence in Criminal Cases. While its final report had little impact at the time, the creation of the commission points to the emergence of insanity as a newly complex problem within the context of postwar Canada. Spurred on by the growing psychiatric profession and the destabilization of capital punishment as a viable sentence, the commission quickly realized that the building blocks of its solution - legal and psychiatric expertise - were largely incompatible. This article explores the commission's problematization of insanity, which, far from providing solutions, highlighted the difficulties surrounding the integration of both psychiatric and legal knowledges of the day. The commission played an important role in upholding the status quo, and it provides an early example of the stasis that would characterize this area of the law until the early 1990s.

The International Criminal Court (ICC) case against Lord's Resistance Army commander and former child soldier Dominic Ongwen of Uganda resulted in a guilty verdict and 25-year prison sentence. Mr. Ongwen unsuccessfully raised defenses based on mental health. These included fitness to stand trial, insanity under Article 31(1)(a) of the Rome Statute (a first at the ICC), mitigation in sentencing based on diminished mental capacity, duress (also a first), and the cumulative effects of mental health and duress. These defenses were hampered by limited and ambiguous textual support, which occurs in a politico-legal context that is cautious regarding such defenses. Another group of challenges comes from the inherent difficulty of international forensic practice. In regard to how mental health affects the duress defense, the text of the Rome Statute and the Ongwen decision create a burdensome legal framework for defendants, particularly where mental illness limits but does not "destroy" decision-making, as Article 31(1)(a) requires for an insanity acquittal. Going forward, defense teams may attempt to address the court's all-or-nothing conception of mental illness, perhaps arguing a diminished mental capacity theory that accounts for psychiatric function that is reduced but not destroyed., (© 2023 American Academy of Psychiatry and the Law.)

This article raises the question of the prospect of a common approach to mentally ill offenders in Europe, through a comparative discussion of the criminal insanity rules and systems in Norway and Bulgaria. The underlying motivation is to fill a gap in current legal research where the insanity discourse is still to a certain extent nationally oriented. Bulgaria is to date not represented at all in the international discussion of criminal insanity. Starting out from recognizing the different history, rules, culture and welfare of Norway and Bulgaria, the authors argue that these countries have a similar practical understanding of insanity and how it is associated with mental disorders as well as common challenges in their forensic and legal systems. These insights can provide a basis for further comparative explorations concerning a possible harmonization of insanity law in Europe., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

There are cases in forensic psychiatric evaluations with inconclusive information or with important information missing. In such situations, when new information becomes available the judge may ask an expert to supplement his/her report in the light of new information. For the purpose of this study, we collected 42 supplemental evaluations written in the University Psychiatric Hospital Vrapče to determine possible factors which were associated with changes in supplemental evaluations. The following data were gathered: demographic data, types of criminal offenses, reasons for the supplement evaluation, court questions, and diagnoses. Changes in supplemental evaluations occured more often when the defendants were diagnosed with a personality disorder (PD) only, compared to those who had a PD with a comorbidity, especially substance use disorders. Defendants with the diagnosis of a substance use disorder were 63.7% less likely to have changed experts' evaluations. The evaluations remained the same when the reason for supplemental evaluations were new witnesses' testimonies. Considering the principle of economy of actions in a judiciary system, a more critical approach should be taken when the judge requests a supplemental report.

Persons with intellectual disability charged with sexual crimes (PWID/SC) pose a unique challenge for the forensic psychiatrist. They represent a heterogeneous group whose motivations and pathology range from a simple lack of adaptive functioning to more complex comorbid paraphilic disorders. Although there is a growing body of literature on the risk assessment and treatment of PWID/SC, there is a relative lack of guidance and research on the evaluation of these individuals throughout the legal processes that follow being charged with a sexual crime. To address this deficit, this article reviews the literature germane to several key aspects of this process. We first review the current understanding of intellectual disability and sexual pathology. We identify landmark legal decisions that may relate to PWID/SC. We then review the literature related to PWID/SC and competency assessments, defenses involving mental disease or impairment, sexually violent predator evaluations and court-mandated pharmacotherapy. We aim to both bring attention to this unique forensic population and highlight areas for further research and exploration., (© 2022 American Academy of Psychiatry and the Law.)

Guina et al. summarize the literature on neurodevelopmental conditions and crime, focusing on the use of the insanity plea for this population. There have been a small number of cases in several jurisdictions, using both cognitive and volitional prongs, generating questions about the use of the defense for people with neurodevelopmental conditions. There are theoretical scenarios in which the defense seems appropriate, such as the argument that higher order moral reasoning is contingent on a series of developmental steps, including the development of theory of mind. Other lines of argument could be based on differences in conceptual thinking, reasoning, language, memory, attention, executive functioning, emotional regulation, and impulsivity. There are multiple barriers, however, to the use of the defense, including its antiquated language, which does not reflect our current conceptualizations of mental conditions and disorders. Another barrier is associated with the implicit stigmatization of defining a different way of being as a disorder, a position at the core of the important and burgeoning neurodiversity movement. It is not clear whether neurodevelopmental conditions will become the basis for an increasing number of insanity pleas, but more information in the form of primary data and good analysis is a critical next step., (© 2022 American Academy of Psychiatry and the Law.)

Western legal systems recognize the right to self-defense as a right of individuals, under certain circumstances, to use physical force to defend themselves from an aggressor. This right requires an honest and reasonable belief of the person asserting it regarding the circumstances in which force is used. Some jurisdictions also permit a defense of imperfect self-defense, allowing for reduced culpability for the crime of homicide if a person's beliefs are honest but unreasonable. If the unreasonable belief is based on a mental illness, however, the defense is disallowed in every jurisdiction in the United States. This development relies upon an untenable position that false beliefs produced by mental disorders should be excluded based on erroneous assumptions about psychotic illness. This article argues that the current precedent is incoherent with the core structure of criminal responsibility and in tension with current scientific understandings and should change to do justice., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Criminal responsibility is a key concept in the criminal sanctioning of people diagnosed with mental health disorders who have committed crimes. In France, based on the recommendations of one or more expert psychiatrists, a judge can declare a person not criminally responsible on account of mental disorder (NCRMD) if, at the time of the offense, the person was presenting a psychiatric disorder that abolished or altered his/her capacity for discernment and/or ability to control his/her actions. In such a case, the judge also generally orders an involuntary psychiatric hospitalization. The objectives of this study were to (1) describe longitudinal retrospective administrative data of psychiatric hospitalizations for people found NCRMD, (2) identify the age, sex, and principal diagnoses of these individuals, and (3) characterize the trajectories of their psychiatric care before and after NCRMD psychiatric hospitalization., Methods: We used discharge reports from the French national hospital database called Programme de médicalisation des systèmes d'information (PMSI) to gather longitudinal data that describe psychiatric hospitalizations for people found NCRMD between 2011 and 2020, the age, sex, and principal diagnoses of these patients, the length of their hospitalization, and the trajectories of their psychiatric care before and after their NCRMD psychiatric hospitalization., Results: We identified 3,020 patients who were hospitalized for psychiatric care after having been found NCRMD between 2011 and 2020. The number of admissions on these grounds has remained stable over this period, ranging from 263 in 2011 to 227 in 2021. They were mostly young men diagnosed with a psychotic disorder (62%). The majority (87%) were hospitalized in general psychiatric hospitals, and only 13% were admitted to maximum-security units ( Unités pour malades difficiles, UMD ). The median duration of hospitalization for these patients was 13 months. Our results show that 73% of the patients had already been hospitalized prior to their NRCMD hospitalization. The rehospitalization rate within 5 years of discharge from NCRMD psychiatric hospitalization was 62%., Conclusion: We conducted the first study investigating the psychiatric hospital treatment of people declared NCRMD in France. There is an urgent need for further studies to investigate the clinical characteristics of these patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Fovet, Baillet, Horn, Chan-Chee, Cottencin, Thomas, Vaiva, D'Hondt, Amad and Lamer.)

The insanity defense represents one of the most controversial and debated evaluations performed by forensic psychiatrists and psychologists. Despite the variation among different jurisdictions, in Western countries, the legal standards for insanity often rely on the presence of cognitive and/or volitional impairment of the defendant at the time of the crime. We developed the defendant's insanity assessment support scale (DIASS) based on a wide view of competent decision-making, which reflects core issues relevant to legal insanity in many jurisdictions. To assess the characteristics of the DIASS we asked 40 forensic experts (16% women; years of experience = 20.6 ± 12.9) to evaluate 10 real-life derived forensic cases with the DIASS; cases included defendants' psychiatric symptom severity, evaluated through the 24-itemBrief Psychiatric Rating Scale (BPRS). Exploratory factor analysis by principal axis factoring was conducted, which disclosed a two-factor solution explaining 57.6% of the total variance. The DIASS showed a good internal consistency (Cronbach's alpha = 0.86), and substantial inter-rater reliability (Cohen's kappa = 0.72). The capacities analyzed through the DIASS were mainly affected by mania/excitement and psychotic dimensions in nonresponsible and with substantially diminished responsibility defendants, while by hostility and negative symptoms in responsible defendants. The DIASS proved to be an effective psychometric tool to guide and structure insanity defense evaluations, in order to improve their consistency and reliability., (© 2022. The Author(s).)

This article, which serves as a perspective review, delves into the complexities of cannabis use among individuals preparing for or already on conditional release (CR). These complexities include an association between cannabis use and mental illness and dealing with the fact that the use of illicit substances, such as cannabis, is against CR rules, leading to potential revocation. A focus of this article is the deleterious effects cannabis and synthetic derivatives of cannabis can have for individuals on CR. The article concludes with six-specific recommendations for managing cannabis use in this population with a focus on careful and detailed risk assessments that considers the relationship between substance use and dangerousness, the role of protective factors, the need for a detailed conditional release plan, inpatient and community-based interventions aimed at increasing individual autonomy, and education on the dangers of cannabis use for both the treatment team and the insanity acquittee., (© 2022 John Wiley & Sons Ltd.)

In its recent Kahler decision, the U.S. Supreme Court ruled that Kansas' abolition of the state's insanity defense was constitutional. It did so by framing the matter as a choice between the state's mens rea defense as a type of insanity defense. In analyzing the two approaches, the Court missed the fundamental importance of rationality in criminal mental responsibility, a constitutional requirement for other criminal competencies, and a condition well described in the Court's mens ruling. The Court's acceptance of the abolition of a special insanity defense is a public policy in the direction of further criminalizing and punishing rather than providing prompt and proper treatment to those with serious mental illness, at a time when increasing modern research demonstrates the success of insanity acquittee dispositions with improved treatment and management resulting in lower rates of relapse and criminal recidivism.rea defense as a type of insanity defense. In analyzing the two approaches, the Court missed the fundamental importance of rationality in criminal mental responsibility, a constitutional requirement for other criminal competencies, and a condition well described in the Court's Panetti ruling. The Court's acceptance of the abolition of a special insanity defense is a public policy in the direction of further criminalizing and punishing rather than providing prompt and proper treatment to those with serious mental illness, at a time when increasing modern research demonstrates the success of insanity acquittee dispositions with improved treatment and management resulting in lower rates of relapse and criminal recidivism., (© 2022 American Academy of Psychiatry and the Law.)

The legalization of cannabis raises many queries, one of which regards the criminal liability of users under the influence of cannabis when crimes against the person are committed. This perspective review consequently aims to examine the defense of mental disorder (also referred to as the insanity defense) in Canadian criminal law and revise court decisions involving cases with cannabis use rendered in the field between 1995 and 2021. The purpose was to specify the factors allowing Canadian criminal courts to grant or refuse the defense of mental disorder to help further operationalize the jurisprudential criteria for forensic practice. We noted that presence of a severe and persistent primary psychopathology was the most decisive factor when determining the verdict of the accused who consumed cannabis., (© 2022 John Wiley & Sons Ltd.)

Forensic mental health experts play a crucial role in criminal responsibility evaluations. However, the quality of these assessments has at time come under scrutiny and has been heavily criticized. A literature review revealed significant differences between countries concerning legal frameworks and procedures for conducting these assessments. The findings suggest that although some countries can be seen as a "role model", there still is room for improvement., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: The public often perceives the insanity defense as a "get out of jail free card". Conversely, several studies demonstrate the substantial control imposed upon these defendants. This study compares Review Boards decisions regarding people found not criminally responsible on account of mental disorder (NCRMD) to criminal courts decisions regarding convicted offenders for similar offenses in Canada., Method: Detention, using logistic regression, and duration under detention and supervision, using Cox regression, were compared between a cohort of 1794 individuals found NCRMD in three Canadian provinces (Quebec, Ontario, and British Columbia) between 2000 and 2005 followed until 2008 from the National Trajectory Project and a national sample of 3,20,919 Canadians convicted of criminal offense from Statistics Canada's Criminal Court Survey., Results: Individuals found NCRMD are 3.8 times (95% CI 3.4-4.3) more likely to be detained than convicted offenders as well as 4.8 times (95% CI 4.5-5.3) and 2.9 times (95% CI 2.6-3.1) less likely to be released from detention and supervision, respectively. One year after the verdict, 73% of the NCRMD accused were still under legal supervision and 42% were still in detention, whereas these proportions were, respectively, 41 and 1% for their convicted counterparts. Interaction effects show that sex, age, jurisdiction, number of offenses, and severity of crimes committed have a differential impact on decisions applied to NCRMD accused compared to convicted persons., Conclusion: Contrary to popular perceptions, the insanity defense is not a loophole. Differences as to factors influencing the trajectories of the two samples confirm that Review Boards are able to distance their practices from the criminal courts and can set aside, at least in part, the principles of proportionality and punitiveness governing the traditional sentencing practices., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Martin, Charette, Leclerc, Seto, Nicholls and Crocker.)

Introduction: In 1992, New Zealand's mental health legislation created the distinct concept of a 'restricted patient' - effectively creating a pathway into forensic patient status, but via the civil committal process, without the patient passing through the criminal justice system en route. This regime was aimed at civilly committed patients who present "special difficulties" because of the danger they pose to others. It remains in force but has attracted little scrutiny., Objective: This paper traverses the background to restricted patient status, and the legal regime, before describing and analysing, in anonymous form, the circumstances of all those declared to be restricted patients, and their outcomes, since the regime began. It then considers the continuing appropriateness of this legal regime in light of contemporary human rights principles., Methods: We reviewed the records of every person placed under restricted patient status since the legislation came into force over a nearly 30-year-period., Results: New Zealand's restricted patient status is rarely used. Only eight people have been subject to such orders (seven male, median age 45 years at the making of the order). All had a history of violent offending and had previously been forensic patients. None re-offended after becoming a restricted patient, but they spent longer as compulsory inpatients than patients unfit to stand trial or not guilty by reason of insanity. There is no evidence they were uniquely dangerous. The legal criteria, namely, that the person presented with "special difficulties", are unclear and have been interpreted differently by the judiciary. They have sometimes included the risk of inadequate care being provided by mental health services., Conclusion: Given the rarity with which restricted patient status has been used in New Zealand, the subsequent evolution and development of forensic services providing alternative pathways through care, and its problematic human rights aspects, we would not recommend equivalent restricted patient provisions to other countries. We suggest this hybrid form of civil/forensic compulsory mental health treatment is a form of arbitrary detention and incompatible with human rights norms. It should be omitted from New Zealand's next Mental Health Act., (Copyright © 2021. Published by Elsevier Ltd.)

Mental impairments as a result of intoxication with alcohol or drugs have never been accepted as bases for an insanity defense. However, most U.S. jurisdictions have agreed that when the downstream effects of substance use lead to longer-term impairment, this circumstance can serve as legitimate grounds for an insanity plea. A recent Massachusetts case illustrates the application of this doctrine of "settled insanity." Although subject to criticism as excusing volitional behavior, recognition of the interplay between endogenous dispositions and the effects of substances suggests the wisdom of allowing settled insanity pleas.

The present investigation was designed to systematically examine the insanity defense typology proposed by Brown (2018) using a large sample of cases wherein there was support for the insanity defense. A total of 187 court-ordered cases in which an insanity defense was supported were categorized based on the typology. The sample comprised of mostly single, middle-aged males who had been charged with a felony and diagnosed with a psychotic disorder. About half the sample was ultimately adjudicated not guilty by reason of insanity by the court. About two-thirds of the cases were categorized into one of the seven insanity defense subtypes using a coding scheme developed by the author of the typology. Inter-rater agreement occurred 82% of the time. The most frequent subtype was Paranoid Self-Defense, followed by "But It's Mine" and Paranoid Protection of Others. There were few differences among these subtypes based on demographic, clinical, offense, and outcome variables, except for presence of a primary psychotic disorder and offense type. Implications and ideas for future research are discussed., (© 2021 John Wiley & Sons Ltd.)

In the post-Hinckley era, four states (Montana, Idaho, Utah, and Kansas) abolished their traditional insanity statutes in 1979 in favor of what are in certain circumstances mens rea insanity statutes. These changes were controversial and attracted early attention of legal scholars and courts in the individual states and at the U.S. Supreme Court. A 2006 Supreme Court decision in Clark v. Arizona had distinct but related concerns that helped crystallize the Court's attention on both mens rea and traditional insanity defense statutes. This decision led to a dramatic precedent that may have settled these matters for generations to come. This article will discuss the changes in the Arizona statutory and case law and the interplay between these changes and the important decisions of the U.S. Supreme Court during the same time span. The result of the changes has led to a situation in Arizona where, for the most serious criminal defendants with mental illness, there is no current mechanism to acquit a defendant on the basis of insanity by a mens rea statute or otherwise., (© 2021 American Academy of Psychiatry and the Law.)

Numerous studies have highlighted significant correlations between major psychiatric disorders and criminal behavior. However, the plethora of literature on criminality among patients with major psychiatric disorders originated in the West. The objective of the present paper is to review criminal behavior among individuals with mental illness in Arab countries. Attributes of individuals assessed by forensic psychiatric committees and identifying various aspects that may reinforce criminality among individuals with mental illness were considered. Following the PRISMA guidelines, a systematic review of literature from three databases (Scopus, PubMed, and Web of Science) was carried out. A total of 20 articles were included. The publications span between 1975 and 2020 and originated in seven different Arab countries including Egypt, Kuwait, Iraq, Saudi Arabia, Tunisia, Jordan, and Algeria. Individuals evaluated by forensic psychiatric committees were predominantly males. Excluding substance use disorder, psychotic disorders were the most commonly diagnosed disorders among individuals evaluated by forensic psychiatry committees. Concerning schizophrenia, concomitant substance use and nonadherence to therapy were significantly associated with increased criminality. The review demonstrates that substance use is certainly linked to violence. There is a significant association between mental illness and criminal behavior. Therefore, awareness of different characteristics and risk factors behind criminal behavior among mentally ill offenders could allow us to design and implement effective preventative measures. The Arab's contribution in this field of forensic psychiatry is relatively small. Indeed, further investigation and contributions from the Arab world are required., (© 2021 American Academy of Forensic Sciences.)

There are some distinct methodological challenges, and possible pitfalls, for neuroethics when it evaluates neuroscientific results and links them to issues such as moral or legal responsibility. Some problems emerge in determining the requirements for responsibility. We will show how philosophical proposals in this area need to interact with legal doctrine and practice. Problems can occur when inferring normative implications from neuroscientific results. Other problems arise when it is not recognized that data about brain anatomy or physiology are relevant to the ascription of responsibility only when they are significantly correlated with the psychological capacities contemplated by the legal formulations of responsibility. We will demonstrate this by considering two significant cases concerning psychopathy. Some paradigms that aim at measuring higher-order capacities, such as moral understanding, have limited validity. More robust paradigms for the study of learning in restricted controlled conditions, on the other hand, have limited ecological validity across individuals and context to be of any use for the law.

Neuroimaging offers great potential to clinicians and researchers for a host of mental and physical conditions. The use of imaging has been trumpeted for forensic psychiatric and psychological evaluations to allow greater insight into the relationship between the brain and behavior. The results of imaging certainly can be used to inform clinical diagnoses; however, there continue to be limitations in using neuroimaging for insanity cases due to limited scientific backing for how neuroimaging can inform retrospective evaluations of mental state. In making this case, this paper reviews the history of the insanity defense and explains how the use of neuroimaging is not an effective way of improving the reliability of insanity defense evaluations.

Elderly persons can get involved in the criminal justice system as victims or as perpetrators. The interaction of elderly persons with mental illness at various cross-sections of the judicial process needs thoughtful consideration. Through this review, the authors approach this less studied aspect of forensic psychiatry. Concerning the evaluation of a prisoner, three scenarios need focused consideration: evaluation for fitness to stand trial before a competent court, evaluations for an insanity defense, and fitness for sentencing. At the same time, incarcerated elderly who developed dementia or a severe mental illness at any point of time during the trial or in prison need specific approaches. In this article, the authors discuss the acts and case laws relevant to navigating these legal scenarios. We discuss existing mental health care provisions for protecting the health interests of elderly care in prison., Competing Interests: Declaration of Conflicting Interests: This article has not been published or simultaneously submitted, or already accepted for publication elsewhere. The manuscript has been read and approved by all the authors, the requirements for authorship as stated earlier in this document have been met, and each author believes that the manuscript represents honest work. To the best of our knowledge, this work does not infringe upon any copyright or property right of any third party. There is no conflict of interest., (© 2021 Indian Psychiatric Society - South Zonal Branch.)

The criminal responsibility of offenders with mental disorders is a key issue in forensic psychiatry. Japan's implementation of the Medical Treatment and Supervision Act and Lay Judge Act in the early 2000s raised public awareness of this issue. To determine how criminal court judges in Japan assess the criminal responsibility of offenders, we examined 453 district court verdicts that mention psychiatric evidence. We extracted elements from each verdict that may be associated with courts' decision-making regarding criminal responsibility and analyzed the relationship between each element and the adjudication of criminal responsibility. We investigated the changes in each element's prevalence over time. A logistic regression analysis revealed that the following were independently associated with the court decisions that offenders' criminal responsibility was intact: understandable motivation for committing the offense, homogeneity of the offense from the defendant's usual behavioral pattern, a coherent process used to commit the offense, alertness while offending, and absence of psychotic symptoms. We observed that recent verdicts are more focused on the offender's perception of illegality and the coherence of the offending process while disregarding the defendant's consciousness and memory while offending. Thus, the courts focus on some specific elements for evaluating the criminal responsibility of each offender., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In 1995, the Kansas legislature adopted what is referred to as the " mens rea approach" and abolished the affirmative insanity defense. This approach allows a defendant to be acquitted who lacks the requisite mental state for the crime, without consideration of the defendant's understanding of wrongfulness. In Kahler v. Kansas , the U.S. Supreme Court recently held that this restrictive approach does not violate due process and that a state is not required to adopt an insanity test which considers a defendant's moral capacity at the time of the crime. Four other states currently follow the mens rea approach, or some form of it. In this article, we first discuss a brief history of insanity defense laws in the United States. We then outline relevant legislative history and precedent in Kansas and other states that have adopted the mens rea approach. We next discuss the Supreme Court's reasoning in Kahler The significance of this test is further discussed, including Eighth Amendment considerations. We advocate for continued education of the public, legislators, and the judiciary regarding the use, application, and necessity of an affirmative insanity defense., (© 2021 American Academy of Psychiatry and the Law.)

Trauma and posttraumatic stress disorder (PTSD) are common among psychiatric and criminal populations, yet there have been few studies among forensic psychiatric populations and no known studies have specifically examined insanity acquittees. This study aimed to identify the prevalence of trauma and to assess recognition of PTSD in forensic settings. Using a cross-sectional self-report survey methodology, we examined traumas, adverse childhood experiences (ACEs), and PTSD in insanity acquittees ( n = 107). Most insanity acquittees experienced trauma (86%, averaging 11 events) and ACEs (76%, averaging 3 types). The most commonly experienced traumas were sudden death of a loved one, witnessed death or serious injury, adult physical assault, and motor vehicle accident. Women were significantly more likely to experience any ACE (especially witnessing domestic violence, household members with mental illness, emotional abuse, and emotional neglect) and adult sexual assault. PTSD prevalence was 25 percent, with 97 percent of cases being previously undiagnosed. Sexual traumas and younger age were significantly associated with PTSD. These results suggest that insanity acquittees have high levels of trauma, ACEs, and PTSD. While PTSD was about seven times more common than in previous findings in the general population, it frequently goes undiagnosed in forensic settings. Potential explanations and implications of our findings are discussed., (© 2021 American Academy of Psychiatry and the Law.)

Objective: The present research examined whether concurrent expert testimony ("hot tubbing") and court-appointed testimony reduced adversarial allegiance in clinical experts' judgments compared with traditional adversarial expert testimony., Hypotheses: We predicted Hypothesis 1: Defense experts would render more not responsible judgments and lower ratings of criminal responsibility than would prosecution experts; Hypothesis 2: Adversarial allegiance effects on experts' judgments would be heightened for adversarial experts and attenuated for concurrent experts over time; Hypothesis 3: Adversarial and concurrent experts would report higher dissonance than would court-appointed experts and adversarial experts' ratings would increase over time, concurrent experts' ratings would decrease, and court-appointed experts' ratings would remain unchanged., Method: Clinicians and advanced clinical doctoral students conducted simulated criminal responsibility evaluations for the prosecution, defense, or court. We categorized participants as favoring the prosecution or defense based on their preexisting attitudes and randomly assigned them to the adversarial, concurrent, or court-appointed expert testimony conditions. Participants completed a dichotomous responsibility judgment, strength of responsibility ratings, and cognitive dissonance measure after initial evidence review (n = 93), report completion (n = 52), and testimony (n = 48). Concurrent experts generated a joint report outlining areas of agreement and disagreement before providing testimony., Results: Concurrent testimony did not eliminate adversarial allegiance. Adversarial and concurrent experts' perceptions of responsibility did not significantly differ (d = .04, 95% CI [-.64, .71]) or change over time (ηp2 = .03); however, prosecution experts-across testimony types-rated the defendant as significantly more responsible than did defense experts (d = 1.87, 95% CI [1.06, 2.67]). Concurrent and adversarial experts did not differ in their reports and minimally differed in testimony content., Conclusions: Experts who initially favored the prosecution or defense showed adversarial allegiance regardless of expert testimony method, and we observed no attenuation of this bias over the course of their case involvement. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The recent U.S. Supreme Court case of Kahler v. Kansas determined that the Kansas mens rea laws were sufficient to stand as the state's only insanity defense statute. In this issue of The Journal, Landess and Holoyda describe the legal reasoning that led to this decision and the persistent concerns about the wisdom of the decision. This commentary is meant to serve as a mirror image to Landess and Holoyda's article, as it focuses on the impact of Kahler on severely mentally ill individuals faced with criminal charges in the four mens rea states: Montana, Idaho, Utah, and Kansas. The authors assert that the absence of a traditional insanity defense disrupts the criminal justice process, adds the pressure of greater numbers of individuals pushed into the competency-to-stand-trial and competency-restoration systems, resurrects the guilty but mentally ill verdict from the condemnation of history, and forces people with serious mental iillness into prisons without any evidence that the prisons are up to the task of adequately caring for them., (© 2021 American Academy of Psychiatry and the Law.)