Search

This article shows how representations of women labeled as mentally ill in photography in Italy have been framed and marked by forms of violence, and how they continue to shape perceptions of women. It argues that the Italian case is a particularly interesting and revealing one, and that such images need to be viewed in the context of the shared status of photography and psychiatry as contemporarily "modern" inventions that have played important roles in reinforcing or contesting violent and institutionalized systems of surveillance and oppression of women. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Keywords: insanity; M'Naghten; choice; delusions; wrongdoing; morality EN insanity M'Naghten choice delusions wrongdoing morality 130 133 4 05/19/22 20220401 NES 220401 The M'Naghten Rules have governed the law's approach to the question of a defendant's insanity at trial since the mid nineteenth century. In conclusion, Lord Burnett CJ took the view that the jury were correctly directed; the issue of whether the defendant knew that his conduct was "wrong" was a matter for them, and they were satisfied that the defendant did know that what he was doing was wrong. [Extracted from the article]

"Gay panic" refers to a situation in which a heterosexual individual charged with a violent crime against a homosexual individual claims they lost control and reacted violently because of an unwanted sexual advance that was made upon them. This justification for a violent crime presented by the defendant in the form of a provocation defense is used as an effort to mitigate the charges brought against him. There has been relatively little research conducted concerning this defense strategy and the variables that might predict when the defense is likely to be successful in achieving a lesser sentence for the defendant. This study utilized 249 mock jurors to assess the effects of case type (assault or homicide) and juror characteristics (homophobia, religious fundamentalism, and political orientation) on the success of the gay panic defense compared with a neutral provocation defense. Participant homophobia was found to be the driving force behind their willingness to accept the gay panic defense as legitimate. Higher levels of homophobia and religious fundamentalism were found to predict more leniency in verdict decisions when the gay panic defense was presented. This study furthers the understanding of decision making in cases involving the gay panic defense and highlights the need for more research to be conducted to help understand and combat LGBT (lesbian, gay, bisexual, and transgender) prejudice in the courtroom. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Dylann Roof killed nine people in a Black church in 2015 in order to start a "war" between the white and Black races. This case is used here to develop a psychoanalytic theory of murderous racism, and even genocide. Major concepts from Freud (self-preservation, hatred, narcissism, life and death drives, delusion), Klein (projective identification), and Bion (psychotic and nonpsychotic parts of the personality) are employed. Particular attention is given to the hearing to determine Roof's capacity to represent himself after he dismissed his lawyers, who wanted to use an insanity defense to avoid the death penalty. This hearing was confronted with an undecidable dilemma, which led to legal cooperation with Roof's suicidal impulses. The deconstructive approach to undecidability, and its use in questions of law, especially as concerns the relation between psychoanalysis and the death penalty, leads to tentative recommendations for the prevention of racist murder. [ABSTRACT FROM AUTHOR]

Gay panic refers to a heterosexual man violently responding to unwanted sexual advances from a gay man. In court, the defendant may argue he was provoked or temporarily insane. This study utilized 352 jury-eligible citizens to assess differences across mediums of gay panic. Participants were asked to read vignettes depicting a control, gay panic as provocation, or gay panic as insanity condition and provide verdicts and ratings of blame and responsibility. Participants also completed measures assessing political orientation and homonegativity. Data were analyzed via a MANCOVA, a chi-square goodness-of-fit test, and general linear modeling. Verdicts, victim blame, and ratings of responsibility differed across vignette conditions, with an observed leniency effect when gay panic was claimed in either context. Homonegativity also exacerbated patterns of prodefendant views, as participants higher in homonegativity assigned higher victim blame, lower defendant responsibility, and more lenient verdicts in the gay panic conditions. The effect of political orientation was nuanced, as only republicans in the provocation condition followed the anticipated pattern in rendering more lenient verdicts. Results provide additional support for the notion gay panic defenses may be, in part, fueled by political beliefs and prejudicial beliefs against persons of sexual minority status. Drawing from a justification–suppression model, it may be that in cases of gay panic, a context is created in which prejudiced ideologies can be openly expressed via leniency on the defendant. Implications may be relevant to future criminal law policies and practices, particularly advocacy and policy efforts, judicial training, and trial consultation to attorneys for juror selection and development of trial strategy. [ABSTRACT FROM AUTHOR]

Bringing together legal, literary, and cultural studies, this article builds from a close reading of madness in William Shakespeare's play Hamlet to some psycho-social theories of malingering and the insanity defense in the modern United States. The basis of these theories is the notion that feigned madness – whether purposeful malingering or a failed insanity defense – often signifies actual madness of a lesser sort. When someone is found to be "faking it," however, that discovery can result in a widespread assumption of mental health in the person on trial, an assumption that often turns out to be wrong. [ABSTRACT FROM AUTHOR]

Sexual offending is a public health concern and societal risk requiring a multi-disciplinary approach. While current data give an indication of the frequency of sexual victimization, these figures likely underestimate the severity of the concern as many of these incidents go unreported. And while sex offender research has increased over the past several decades, particular attention to those offenders with severe mental illness remains limited. In this descriptive review, literature describing sex offenders with psychotic disorders is explored with a focus on recent research. Important considerations are described, including theories surrounding psychosis and sexual offending, hospitalization rates, recidivism, not guilty by reason of insanity (NGRI), female offenders, and treatment considerations. By exploring these important aspects of sex offenders with psychosis, conclusions are drawn and future directions are proposed, with a particular emphasis on clinical application for the mental health treatment provider. [ABSTRACT FROM AUTHOR]

Mental health professionals' attitudes toward offenders with mental illness have significant implications for the quality of care and treatment rendered, making it imperative for these professionals to be aware of their attitudes. Yet, this topical issue has received little research attention. Consequently, the present study investigates attitudes toward offenders with mental illness (insanity acquittees) in a sample of 113 registered mental health nurses in Ghana. Using a cross-sectional survey and self-report methodology, the participants respond to measures of attitudes toward offenders with mental illness, attitudes toward mental illness, conviction proneness, and criminal blameworthiness. The results show that mental health nurses who reportedly practiced for a longer duration (6 years and above) were more likely to be unsympathetic, while the male nurses who were aged 30 years and above were more likely to hold offenders with mental illness strictly liable for their offenses. Importantly, the nurses' scores in conviction proneness and criminal blameworthiness significantly predict negative attitudes toward the offenders even after controlling for their attitudes toward mental illness. Yet, when the nurses' conviction proneness and criminal blameworthiness were held constant, their attitudes toward mental illness failed to predict attitudes toward the offenders. This initial finding implies that the nurses' views regarding criminal blameworthiness and conviction may be more influential in understanding their attitudes toward offenders with mental illness relative to their attitudes toward mental illness. [ABSTRACT FROM AUTHOR]

The article discusses the Aline Loake v. Crown Prosecution Service which deals with insane harassment. It mentions that the defendant appealed against the sentence and conviction of harassment contrary to section 2 of the Protection from Harassment Act 1997 (PFHA), on grounds that she was not guilty by reason of insanity. It also mentions the application of M'Naghten Rules.

The purpose of this study was to investigate the use of cultural evidence toward an automatism defense, and whether such evidence would be detrimental or beneficial to a male versus a female defendant. U.S. participants (N = 208), recruited via Amazon's Mechanical Turk, read a fictional spousal homicide case in which the defendant claimed to have blacked out during the crime. We manipulated the gender of the defendant and whether a culture-specific issue was claimed to have precipitated the defendant's blackout. ANOVAs revealed that cultural evidence positively affected perceived credibility for the female defendant, whereas there were no differences for the male defendant. Results also demonstrated that when cultural evidence was presented, the female defendant was seen as less in control of her actions than was the male defendant. Furthermore, lower credibility and higher perceived defendant control predicted harsher verdict decisions. This investigation may aid scholars in discussing concerns regarding a clash between multicultural and feminist objectives in the courtroom. [ABSTRACT FROM AUTHOR]

Objective: The not criminally responsible on account of mental disorder (NCRMD) designation remains widely misunderstood by the public. Such misunderstandings may also be reflected in the media. As such, the aim of this study is to conduct a preliminary examination of the tone and content of recent Canadian newspaper articles where NCRMD is a major theme, comparing these to generic articles about mental illness.Methods: Articles about mental illness were gathered from major Canadian newspapers. These were then divided into two categories: 1) articles where NCRMD was a major theme and 2) articles where NCRMD was not a major theme. Articles were then coded for the presence or absence of 1) a negative tone, 2) stigmatising tone/content, 3) recovery/rehabilitation as a theme, and 4) shortage of resources/poor quality of care as a theme.Results: The retrieval strategy resulted in 940 articles. Fourteen percent ( n = 131) of all articles had NCRMD as a major theme. In comparison to generic articles about mental illness, articles with NCRMD as a major theme were significantly more likely to have a negative tone ( P < 0.001) and stigmatising tone/content ( P < 0.001) and significantly less likely to have recovery/rehabilitation ( P < 0.001) or shortage of resources/poor quality of care as a theme ( P < 0.001).Conclusions: Articles with NCRMD as a theme were overwhelmingly negative and almost never focused on recovery or rehabilitation, in stark comparison to generic articles about mental illness. [ABSTRACT FROM AUTHOR]

This paper traces the significance of the diagnosis of ‘moral insanity’ (and the related diagnoses of ‘monomania’ and ‘manie sans délire’) to the development of psychiatry as a profession in the nineteenth century. The pioneers of psychiatric thought were motivated to explore such diagnoses because they promised public recognition in the high status surroundings of the criminal court. Some success was achieved in presenting a form of expertise that centred on the ability of the experts to detect quite subtle, ‘psychological’ forms of dangerous madness within the minds of offenders in France and more extensively in England. Significant backlash in the press against these new ideas pushed the profession away from such psychological exploration and back towards its medical roots that located criminal insanity simply within the organic constitution of its sufferers. [ABSTRACT FROM AUTHOR]

This article looks into the establishment and development of two criminal asylums in Norway. Influenced by international psychiatry and a European reorientation of penal law, the country chose to institutionalize insane criminals and criminally insane in separate asylums. Norway’s first criminal asylum was opened in 1895, and a second in 1923, both in Trondheim. Both asylums quickly filled up with patients who often stayed for many years, and some for their entire lives. The official aim of these asylums was to confine and treat dangerous and disruptive lunatics. Goffman postulates that total institutions typically fall short of their official aims. This study examines records of the patients who were admitted to the two Trondheim asylums, in order to see if the official aims were achieved. [ABSTRACT FROM AUTHOR]

Objective: Regina v Presser [1958] VR 45, is the most seminal case regarding fitness to plead for accused persons in Australia and New Zealand. It is not widely understood that Presser was a 14-year-old boy with intellectual disability. We aim to describe a clearer narrative regarding Edward John Presser.Method: Review of attainable newspaper reports framed within an historical context of fitness and relevant case law.Results: Presser's narrative is described in greater detail than previously understood by clinicians and lawyers. Ramifications for fitness assessment are discussed including doli incapax and human rights considerations.Conclusions: The Presser criteria are widely applied; however, the case involved a 14-year-old boy with intellectual disability. Greater awareness of Presser's narrative assists clinicians providing expert evidence regarding fitness to plead for adolescents and persons with intellectual disability. [ABSTRACT FROM AUTHOR]

Previous literature has highlighted a number of concerns about forensic care and rehabilitation by those who use the services. The Good Lives Model (GLM) is a strength-based, humanistic approach to offender rehabilitation that has been largely overlooked by forensic mental health practitioners. This study explored the impact of a brief GLM program on forensic service users' perceptions of rehabilitation, both within and beyond therapeutic programs, using a thematically linked, multiple-case study research design. Pre-post comparisons of participants' perceptions of rehabilitation suggested three different outcomes: definite change, subtle change, and no change. Possible factors associated with participants' divergent experiences included level of exposure to the GLM, readiness to change, and practitioners' adherence to the GLM and experience with the model. The importance of attending to the wider system for successful implementation of this innovative approach is highlighted. [ABSTRACT FROM AUTHOR]

In Dusky v. United States, the United States Supreme Court established "rational understanding" as a necessary component of a defendant's competency to stand trial. Yet, rational understanding has engendered misunderstanding, stemming from inconsistent court rulings and lack of systematic attention given to definitions of rationality. The purpose of this article is to assist with the conceptualization of rational understanding as it relates to competency to proceed to trial. This will be accomplished through a review of legal decisions and scholarly papers that provide various definitions of rationality. We discuss the suitability of standardized instruments of competency and how they may assist in providing a valid metric for evaluating rational abilities. We also provide discussion of how case law, in conjunction with psycholegal research, can be used to gain nuanced insight into operationalizations of rational understanding. By gaining a thorough understanding of rationality in competency to proceed to trial evaluations, clinicians may improve on the quality and foundation of their evaluations. [ABSTRACT FROM AUTHOR]

Insanity defense is primarily used in criminal prosecutions. It is based on the assumption that at the time of the crime, the defendant was not suffering from severe mental illness and therefore, was incapable of appreciating the nature of the crime and differentiating right from wrong behavior, hence making them not legally accountable for crime. Insanity defense is a legal concept, not a clinical one (medical one). This means that just suffering from a mental disorder is not sufficient to prove insanity. The defendant has the burden of proving the defense of insanity by a "preponderance of the evidence" which is similar to a civil case. It is hard to determine legal insanity, and even harder to successfully defend it in court. This article focuses on the recent Supreme Court decision on insanity defense and standards employed in Indian court. Researchers present a model for evaluating a defendant's mental status examination and briefly discuss the legal standards and procedures for the assessment of insanity defense evaluations. There is an urgent need to initiate formal graduation course, setup Forensic Psychiatric Training and Clinical Services Providing Centers across the country to increase the manpower resources and to provide fair and speedy trail. [ABSTRACT FROM AUTHOR]

This article takes an abolitionist position towards insane automatism (or ‘the insanity defence’). With particular reference to Arlie Loughnan’s concept of ‘manifest madness’, it argues that mentally ill defendants are poorly served not only by the insanity defence as currently formulated, but by any defence which focuses on their status as ‘mentally ill’ rather than the specific excusatory elements of that illness. It contends, however, that advocates for abolition should not assume that existing criminal defences are currently primed to account for those elements. What is required is a thoroughgoing reform of all criminal defences, with mentally ill and/or disordered defendants in mind, to which abolition of the insanity defence must be secondary. [ABSTRACT FROM AUTHOR]

The author offers his views about the concept of Diminished Responsibility as it pertains to medical cases. He notes the introduction of diminished responsibility into English law with its origins traced to Lord Deas' contributions to the common law of Scotland. He cites that a plea of diminished responsibility considers extenuating circumstances such as insanity suffered by the accused. It analyzes the application of the concept in the 1867 murder case against Alexander Dingwall.

Support for the embargo against VAD for people with mental disorders includes that they have a higher likelihood of lacking decision-making capacity. All of these instruments follow the Victorian Voluntary Assisted Dying Act 2017 model, which states (Sect 9(2)): "A person is not eligible for access to voluntary assisted dying only because the person is diagnosed with a mental illness." Opponents also opine the problematic negative feelings are the product of an active mental disorder which would resolve with adequate treatment - again, there is a role for a competent psychiatrist to give an opinion on whether a full range of treatment has been applied. [Extracted from the article]

The prediction of dangerousness and the insanity defense are two areas where psychologists provide research-based expertise to the courts. Teachers of psychology can use these topics to capture the attention of students and to show how psychological research and theory can inform and influence the legal system. Specifically, teachers can use the issue of violence risk assessment to teach basic statistical concepts, the low base rate problem, the limits of long-term behavior prediction, and the superiority of scientific approaches over intuitive approaches. Teachers can use the issue of the insanity defense to show students how clinical psychologists and the legal system differ in their conceptions of mental disorder, how attributions about intentionality drive sentencing decisions, and how modern conceptions of “free will” informed by cognitive neuroscience challenge fundamental assumptions of the criminal justice system. The topics of risk assessment and the insanity defense can stimulate student discussion by linking basic psychological concepts to an area with which students are already familiar: the legal system. [ABSTRACT FROM AUTHOR]

In twentieth-century Australian criminal law a distinctive departure from the M’Naghten Rules developed as a critique of the discourse of reasoning and verdicts applying in the relevant English trials from the 1880s. The English verdict of ‘guilty but insane’ was criticized by the leading jurists as contradictory. In a sequence of influential judgments, the jurist Owen Dixon articulated an approach to the insanity defence that made room for a medico-legal discourse which broadened the possible referents of what it meant to ‘know’ the legality of an act, and also acknowledged the complex behavioural factors that might determine an act of homicide. This paper explores the shaping and significance of this departure and its comparative judicial, medical and social contexts. A concluding discussion considers whether the more flexible interpretation of the insanity defence implied by the direction of Dixon’s decisions made as much of a difference to frequency of use of the defence as the contemporaneous decline and eventual abolition of capital punishment. [ABSTRACT FROM PUBLISHER]

Noncompliance with medication therapy and mental health care is prevalent among the mentally ill. Its multifactorial dynamics can include aspects of the illness itself such as anosognosia. Noncompliance with medication can increase risk of violent or other criminal behavior, but the law currently does not recognize it as a factor in determining culpability. The legal test of insanity that focuses on a "defect of reason from disease of the mind" presumes that the disease was not self-induced. Noncompliance with medication and voluntary intoxication can both be seen as self-induced incapacities, but their adjudication is often quite different. A psychotic condition may be the basis of an excuse, whereas simple intoxication is not. The distinction is not only the obvious one of acts of omission (medication noncompliance) and acts of commission (voluntary intoxication). There are other complicating factors, such as the knowledge of the effects of noncompliance, the mental state prior to the noncompliance, and the presence of any conditions that would excuse or justify it. These and other considerations render the assignment of criminal responsibility for the noncompliant psychiatric offender complex. A possible solution to this would be the application of therapeutic jurisprudence to the noncompliant mentally ill offender. [ABSTRACT FROM AUTHOR]

Borderline personality disorder (BPD) is a complex mental disorder that straddles the line between psychosis and neurosis. As such, questions about the moral and legal responsibility of persons with BPD are especially vexing. Persons suffering with borderline personality disorder typically are impulsive and suffer from impaired volition. They also lack a stable sense of self. Nonetheless, persons with borderline personality disorder often hold long-term, stable preferences--often related to discontinuing particular problematic behaviors--and have a degree of capacity hat we argue creates prima facie conditions for holding them ethically and legally responsible. However, this limited capacity often falls short in smoothly accommodating day-to-day relationships. We argue that while a certain degree of accommodation is appropriate for persons with BPD, the diagnosis of BPD does not by itself provide sufficient grounds for voiding responsibility for criminal acts. Using a hierarchical theory of autonomy recognizing first- and second-order volition, we propose a sliding scale be used to ascertain the degree to which a person with BPD should be exculpated weighing the graveness of the act against an estimation of the congruence of second- and first-order volitions. [ABSTRACT FROM AUTHOR]

The author offers an argument on the moral significance of the insanity defence from an Anglo-American point of view. He discusses the rationale for abolishing insanity defence. He presents a definition of criminal insanity. He cites the differing approaches towards the defence in the U.S. and English settings.

This article examines the clinical and forensic (psycho-legal) aspects of methamphetamine use. The author will describe the clinical and psychiatric effects of the drug on an individual's functioning. Forensic psychological/psychiatric issues including substance-induced psychosis relevant to a not guilty by reason of insanity defense, diminished capacity, and mitigation at capital sentencing will be addressed. Case law pursuant to forensic aspects of methamphetamine use will also be thoroughly explored. [ABSTRACT FROM AUTHOR]

Objective: This paper provides an overview of the insanity defence. An historical context is offered and each element of the M'Naghten Rules is discussed, highlighting differing interpretations within various jurisdictions. Discussion is offered on the role of expert evidence in addressing the 'ultimate issue' before the courts. Significant case law in relation to the insanity defence is highlighted. Conclusions: Psychiatrists have an important role to play in addressing issues central to the M'Naghten Rules and making these accessible and comprehensible to court and jurors in particular. Insanity is a legal construct designed to determine the extent to which a person may be deemed criminally responsible for a criminal act and is often difficult to reconcile within medical and public paradigms of mental illness and justice. Principles are offered to guide psychiatrists who are called to give evidence in cases where the mental illness defence has been raised. [ABSTRACT FROM AUTHOR]

There are a lot of articles in the literature concerning description of insanity acquittees--demographics, diagnoses, frequency and success of the plea, results of release, and examiner characteristics. This article is one of few that examines retrospectively the appropriateness of insanity pleas and verdicts, and discusses possible reasons for inappropriate Not Guilty by Reason of Insanity (NGRI) verdicts. [ABSTRACT FROM AUTHOR]

A case report is described of a man who developed a single period of recurrent episodes of dissociative trance disorder (DTD) during a family stress. The cultural environment was permeated by thoughts and beliefs in magic. During one trance state, the man performed an exorcism on the 6-month-old baby of his brother-in-law, and the baby died from cerebral hemorrhage. In the 5-year follow-up, no other episodes of DTD developed, and the man is serving an 18-year sentence. Keywords: dissociative trance disorder; homicide; family relationships; child abuse; insanity defence; cultural psychiatry. [ABSTRACT FROM AUTHOR]

Objective: To describe the characteristics of individuals found not criminally responsible on account of mental disorder (NCRMD) after the 1992 Criminal Code amendments and to track their movement through the forensic system, as well as to unveil the changes to British Columbia's forensic psychiatric system that resulted from Bill C-30.Method: Profile information relating to persons found NCRMD between February 4, 1992, and February 4, 1998, in British Columbia was collected and analyzed. Community follow-up data was collected and analyzed for a 24-month period following a subject's discharge from hospital.Results: A substantially greater number of individuals entered the forensic psychiatric system in British Columbia after Bill C-30 was implemented. The post-1992 forensic psychiatric population contained fewer persons charged with serious index offences and a greater number of persons charged with relatively minor offences. The length of hospitalization for the NCRMD cohort decreased substantially after the 1992 Criminal Code amendments.Conclusion: The Bill C-30 provisions have made the NCRMD defence an attractive option for defendants and legal counsel. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to study the outcomes experienced by 2 communities after implementing pretrial diversion of offenders with mental illness.Method: The same method of diversion was implemented in a predominately urban and a predominantly rural county. We collected retrospective clinical and offence data from pretrial diversion assessments conducted in court. As well, we measured outcome for the diversion procedure in terms of actual vs expected rates of recidivism.Results: Prior psychiatric treatment was associated with the diverted group, and a criminal history was associated with the nondiverted group. In the larger, urban county the diversion option was offered more often to persons with psychoses, mood disorders, and minor offenses. Conversely, in the smaller rural county diversion was offered most often to persons accused of serious offenses. The recidivism found in urban and rural diverted groups after a year of supervised care was only 2% to 3%, but the rate of use of diversion in both counties was low, owing to selection biases.Conclusion: Pretrial diversion of offenders with mental illness accused of minor crimes is eminently feasible for both urban and rural settings, provided that police, crown, and treatment policies are coordinated to favour the treatment option rather than prosecution. INSETS: Table 1 Characteristics of persons diverted and not diverted;Table 2 Characteristics of persions diverted and not diverted;Table 3 Outcomes of application for diversion in 2 centres;Table 4 London and St Thomas Criminal Statistics [ABSTRACT FROM AUTHOR]

Objective: To discuss ethical and legal issues arising from research conducted on forensic psychiatric patients.Method: A review of the literature and ethical and legal guidelines related to research ethics with human subjects.Conclusion: Forensic patients who are research subjects are particularly vulnerable to coercion and abuse as a result of the dual vulnerabilities stemming from their status as both prisoners and psychiatric patients. Researchers in the area of forensic mental health must carefully consider ethical guidelines and ensure that the rights of participants are respected and upheld. [ABSTRACT FROM AUTHOR]

The insanity defense is a particularly controversial aspect of the interaction between law and mental health. During the past decade, many states have revised or abolished their insanity defenses. Oregon, however, chose in 1978 to retain its existing defense and create a new, unique system for the post-adjudication management of insanity acquittees. Oregon's legislature established the Psychiatric Security Review Board (PSRB), which is composed of five part-time members drawn from different disciplines, to conduct periodic hearings to determine the placement and supervision of defendants who successfully raise the insanity defense and remain mentally ill and dangerous. The PSRB has received national attention as a promising approach to managing mentally ill offenders. The authors first describe the structure and operation of the Oregon system. Then they summarize the empirical studies they have conducted of the PSRB in action. [ABSTRACT FROM AUTHOR]

Cries for reform of insanity defense statutes are often associated with notorious cases involving heinous offenses. In fact, little research exists on the reforms sparked by such cases. Reforms initiated without data on their likely impacts may lead to illusory or unintended results. A strategy to assess such changes, and any other type of insanity defense reform, is articulated in this article. This approach is substantially different from the approaches of any published reports. It rests upon a multistate scope, a systemic focus, an assessment of impacts on the entire criminal process, and a longitudinal data base. Some of the impediments to implementing such research designs and ways by which they can be overcome are discussed. [ABSTRACT FROM AUTHOR]

Since the attempted assassination of President Reagan by John Hinckley, Jr., avid attention has again focused upon the supposed deficiencies and abuses of the insanity plea, and the nation has witnessed many attempts in various jurisdictions either to alter or to abolish the plea. Unfortunately, these efforts have been conducted within a context where little empirical data on the operation of the plea is available to guide policymakers. The present article represents an effort to summarize the information that is currently available concerning the frequency with which the plea is made, the characteristics of defendants involved, and the subsequent psychiatric and criminal histories of these individuals. [ABSTRACT FROM AUTHOR]

The disposition of persons acquitted on insanity grounds has always cast a shadow on the insanity debate. Recently, the Supreme Court of the United States decided that these persons could constitutionally be given fewer procedural and substantive protections against indeterminate confinement than other persons confined for mental illness. The Court's opinion dealt with questions not directly raised by the case and may have been prompted by a general unease about the insanity defense itself. The opinion is likely to discourage many from entering such a plea in the future. [ABSTRACT FROM AUTHOR]

Discontent with the special insanity defense has resulted in pressure on legislatures and courts to change or abolish it. Most reformers urge modifications that they hope will rectify obvious abuses. This article examines the most frequently advanced moderate reforms and compares them to a more radical reform, the so-called abolition of the special insanity defense, which involves the use of the mens rea--or intent--approach as a vehicle for exculpating offenders who are seriously mentally ill, together with a greater emphasis on the dispositional stage of the process. It is argued that abolition of the insanity defense is neither immoral nor inhumane, as is often charged, if it is accompanied by such dispositional reforms. Rather, the elimination of an expanded insanity defense would result in restoring confidence in the criminal justice system and in psychiatry, would eliminate show trials, and would provide a more rational allocation of scarce mental health resources, with ultimate benefit both to the individual offender and to society. [ABSTRACT FROM AUTHOR]

The insanity defense must be retained because it is fundamentally just. Some mentally disordered defendants are so irrational at the time of their offenses that they lack the basic preconditions of moral responsibility, and therefore they must be excused. Retaining the insanity defense will not compromise public safety, nor will abolishing it lead to the remedying of associated social problems such as the substandard mental health care in jails and prisons. Nevertheless, there are real problems with the administration of the defense that must be addressed. The substantive tests must be revised, the burden of persuasion should be put on the defendant, the role of experts should be limited, and post-acquittal procedures must be made more rational. Impatience with the practical problems, which can be ameliorated by sensible reforms, should not cause society to abandon a basically fair doctrine. [ABSTRACT FROM AUTHOR]

Much of the controversy surrounding the insanity defense arises because the modern defense is not based on fundamental analysis and because it has developed in isolation from other modern mental-disability defenses. Unrelated doctrines, arising out of different early cases, have become increasingly unrealistic. Confusion and frustration ensue. The Disability of Mind (DOM) doctrine resulted from the attempt to identify the fundamental legal and moral issues in mental-disability defenses. Several moral-legal intuitions emerged that underlie the legal concept of a mental-disability excuse, whether based on mental disease, intoxication, trauma, organic damage, or some other condition. These intuitions were developed into a coherent legal doctrine intelligible, in its essentials, to juries and the public. This doctrine covers all mental-disability excuses in the law. The doctrine, key concepts, and some practical consequences that should build public confidence in the DOM defense are explained here. [ABSTRACT FROM AUTHOR]

Making insane persons liable for their criminal acts may be unjust. There are two reasons for this. If such persons are handicapped by mental illness in a way that deprives them of the ability to abide by the law, they enjoy the same excuse as anyone else who is helpless, and recognition of the excuse is a requirement of justice. Furthermore, the suffering inevitably produced by making a person liable to criminal punishment turns out to be unjustifiable in such a case, since in these circumstances the punishment is unnecessary. The injustice of punishing such persons must not be confused, however, with the injustice of holding liable a person whose act was without those mental elements required under the law for a particular crime. Conceived broadly, there are four varieties of disability that matter for a defense of insanity, and for policy reasons there must be some definite pathology to account for their presence if they are to be acceptable as the basis of a defense of insanity. [ABSTRACT FROM AUTHOR]

Psychiatric opinion as to a defendant's criminal responsibility is divided far less often than press coverage suggests. Evaluations are influenced by the settings in which they occur, the ideology and qualifications of the examiner, and the techniques of interviewing, investigation, and decision making used. If the insanity defense is as important a foundation of the criminal law as legal commentators argue, it is important to improve psychiatric evaluations by improving evaluative settings, the qualifications of evaluators, and the resources devoted to investigation and other elements of evaluations. These improvements would not, however, eliminate disagreement, which would still arise as an inevitable consequence of heterogeneity in the theories, methods, and interpretations of psychiatrists evaluating defendants. [ABSTRACT FROM AUTHOR]

For defendants in the nineteenth century seeking refuge from the death penalty, the insanity defense was like a haven eagerly sought but with difficulty secured. For defendants now, no longer at risk of the death penalty and able to take advantage of statutory defenses akin to insanity, the defense has become like a reef fearfully avoided but easily struck. The transformation of the defense from shelter to snare is best understood when traced through the attempts of defendants to establish a defense of irresistible impulse due to mental disorder. At first, irresistible impulse was pleaded as insanity under the McNaughtan Rules. When this was no longer possible, defendants turned to the defense of involuntary conduct, a defense elaborated largely in response to the development of motoring. The courts' response to this tactic has breathed new life into the McNaughtan Rules, but legislation is required to remove resulting anomalies. [ABSTRACT FROM AUTHOR]

The abolition of the insanity defense in Idaho in 1982 was the first time in recent years that an American jurisdiction had eliminated that traditional, common-law defense. Drawing upon questionnaire responses from legislators, prosecuting attorneys, and psychiatrists, we examine the circumstances surrounding this precedent-setting legislation. We conclude that the conservative ethic stressing personal responsibility for conduct, legal and illegal, seems to have been influential in bringing about the new law, although future constitutional challenges may raise issues about extension of the doctrine of strict liability in criminal cases. [ABSTRACT FROM AUTHOR]

In contrast to the jurisprudential history of the insanity defense, significant empirical research on its use and effects has emerged only in the past decade. The research is organized here around six major questions closely related to the public policy questions that have gained much currency in the wake of the John Hinckley trial. In many instances, the research data sharply conflict with popular notions of who are acquitted by reason of insanity and how long they are hospitalized after acquittal. There is considerable consistency across jurisdictions on the characteristics of acquittees and their recidivism rates, but substantial differences on the length of their detention both across jurisdictions and in different time periods within jurisdictions. Future research, to be productive for both policy and substantive purposes, requires multistate designs with a systemic approach. [ABSTRACT FROM AUTHOR]

The modern foundation for the insanity defense was put in place during the first half of the nineteenth century, between the years 1800 and 1843. During this brief period the reaction to the acquittals by reason of insanity of James Hadfield (1800) and Daniel McNaughtan (1843) shaped the present function and administration of the insanity defense in the Anglo-American world. In the case of Hadfield, the reaction of the House of Commons to his acquittal led to the passage of the automatic confinement statutes that now accompany a successful plea of insanity in most jurisdictions. In McNaughtan's case, the reaction of the House of Lords to his acquittal led to the establishment of the famous right-from-wrong test of criminal responsibility that bears his name. [ABSTRACT FROM AUTHOR]

The article focuses on the Victorian controversy on the insanity defence in Great Britain. The controversy was complex since it involved shaping conceptions of relations between nature and society and the mediation of particular institutions in the general conceptual and political framework in the society. The controversy also consisted a horror and individual human tragedy pathos in which clarification of these aspects is needed to the understand the nature of insanity defence controversy.