Article

A prospective comparison of four insanity defense standards.

Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, PA 15213.
American Journal of Psychiatry (Impact Factor: 13.56). 02/1991; 148(1):21-7.
Source: PubMed

ABSTRACT Controversy about the formulation of the insanity defense has been intense, but little empirical work is available regarding how different standards affect court findings. The major aims of the present study were to determine if different standards for determining insanity produced different judgments and to provide a broad descriptive picture of those cases in which the standards appeared to make a difference.
Four forensic psychiatrists were asked to indicate whether they thought 164 defendants met any or all of four insanity tests: 1) the American Law Institute (ALI) cognitive criterion, 2) the ALI volitional criterion, 3) the APA test, and 4) the M'Naghten rule.
The four psychiatrists determined that 97.5% of the defendants met the ALI volitional criterion, 73.9% met the APA criterion, 70.3% met the M'Naghten rule, and 69.5% met the ALI cognitive criterion. Nearly two-thirds of the defendants met all four insanity tests, and 24.4% met only the ALI volitional test. Few defendants met cognitive tests without also meeting the ALI volitional test. Elimination of the volitional test for insanity reduced the rate of psychiatric recommendations of acquittal by 24.4%.
These findings highlight the fact that the primary logical division between volitional and cognitive standards appears to be powerful but that distinctions between types of cognitive standards are not terribly powerful. In addition, the variation among individual raters must be viewed as an important determinant of how any insanity standard is applied.

1 Bookmark
 · 
335 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This paper provides a review of the legislative reforms and case law that have impacted the defense of Not Criminally Responsible on Account of Mental Disorder (NCRMD) in Canada over the past three decades. As in other jurisdictions internationally, we observe that legislative reforms of procedural, as opposed to substantive, aspects of the NCRMD defense have impacted the manner in which NCRMD criteria are applied in common practice. More people are being declared NCRMD in recent years, and there is greater heterogeneity in the offending and psychiatric profiles of these individuals, suggesting that NCRMD criteria are being applied more liberally over time. In light of the substantial growth of the forensic mental health system over the past two decades, witnessed both in Canada and abroad, we propose that the study of motivational influences underlying the offending behaviors of persons with serious mental illness (SMI) is necessary to begin disentangling symptom-based offending from violent and antisocial behaviors that may have other motives. This, in turn, can help to determine legal issues, better define the nature of each person's offending and treatment needs, and provide a more fine-grained analysis of the drivers behind the growth experienced by the forensic system. Copyright © 2013 John Wiley & Sons, Ltd.
    Behavioral Sciences & the Law 07/2013; 31(4). DOI:10.1002/bsl.2067 · 0.96 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Patients diagnosed with schizophrenia display poor premorbid adjustment (PPA) in half of the cases. Attention deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) are common child psychiatric disorders. These two facts have not previously been linked in the literature. Aims: To determine the prevalence of ADHD/CD problems retrospectively among patients with psychoses, and whether and to what extent the high frequency of substance abuse problems among such patients may be linked to ADHD/CD problems. Method: ADHD and CD problems/diagnoses were retrospectively recorded in one forensic (n = 149) and two non-forensic samples (n = 98 and n = 231) of patients with a psychotic illness: schizophrenia, bipolar or other, excluding drug-induced psychoses. Results: ADHD and CD were much more common among the patients than in the general population-the odds ratio was estimated to be greater than 5. There was no significant difference in this respect between forensic and non-forensic patients. Substance abuse was common, but substantially more common among patients with premorbid ADHD/CD problems. Conclusions: Previous views regarding PPA among patients with a psychotic illness may reflect an association between childhood ADHD/CD and later psychosis. The nature of this association remains uncertain: two disorders sharing some generative mechanisms or one disorder with two main clinical manifestations. Childhood ADHD and particularly CD problems contribute to the high frequency of substance abuse in such groups.
    Nordic journal of psychiatry 03/2014; 68(8). DOI:10.3109/08039488.2014.892151 · 0.99 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: People who live in society are bound together by laws based on duties and rights. Even though primarily born out of acceptance and respect for one another, these laws, part of an ethical system of communal life, are also utilitarian in their essence. Though accepting the above postulates, people are at times the subject of feelings, drives, and actions contrary to respectful interaction with others. Society has, therefore, created criminal laws, codified through the centuries, with the purpose of controlling the deviant and impulsive behavior of some of its members in order to maintain, in as much as possible, societal homeostasis. Ethical principles, such as beneficence and non-maleficence, especially in a democratic society, are basic to legal systems whose purpose is to dispense justice in its various courts of law, where victims and miscreants, represented by their respective advocates, contend over guilt and exculpation. The majority of criminal cases involve mentally competent persons, who maliciously do not conform to the requirements of the law and, furthermore, often do not conform to basic moral values. A small percentage of those who break the law suffer from a severe mental disorder, which, if present at the time of a crime, may annul or greatly diminish their mental capacity to appreciate the nature, quality and consequences of their criminal behavior or their capacity to conform to the requirements of the law. These persons are allowed by the law to enter an exculpatory plea and to attempt to prove at trial that they were legally insane at the time of an alleged offense. There is, in addition, a substantial cohort of persons who suffer from a severe personality disorder for whom entering a plea of not guilty by reason of insanity in United States courts at present is typically a futile exercise, even though their behavior at the time of their alleged crime was bizarre, confused and irrational. The futility of their plea stems from the practical reality that their disorder is not recognized as a mental illness.They cannot take advantage of the insanity plea because of the prevailing legal view that they cannot meet its threshold criterion. Even if they were in a court that would allow them to surmount that hurdle, they would still be subjected to exceptionally strict scrutiny.It is the argument of this thesis that, in regard to individuals suffering from a severe personality disorder, in the United States the criminal law operates if not from unfounded prejudice certainly from a foundation that disregards current scientific knowledge. The premise underlying this argument is that persons with a severe personality disorder (many of whom are capable of only marginal functioning in daily life), under severe stress, may at times undergo a personality disintegration that is tantamount to a frank psychotic episode, which should make them eligible for an insanity plea. However, United States courts, including the United States Supreme Court, have held explicitly that criminal defendants have no due process right to 2 how the insanity defense is framed or worded, what sorts of conditions it may cover or exclude, or even whether they may have the benefit of an insanity defense at all—or any number of other exculpatory concepts. (See, e.g. Montana v. Egelhoff, 518 U.S. 37 (1996); Clark v. Arizona, 126 S. Ct. 2709 (2006)). Elementary fairness suggests they ought to be allowed to assert their non-accountability in the context of an insanity defense or any other defense. Of course, it is well known that offenders at times attempt to malinger mental disorders, or to greatly exaggerate any existing mental pathology. That is a risk that is run with any offender. However, it is better to free ten guilty people than to convict one innocent one. It serves as the justification for requiring, that is, an extraordinarily high standard of proof (beyond a reasonable doubt) in criminal prosecutions. The argument of this thesis is that the preclusion to plead insanity or the non-credibility of those rare personalitydisordered offenders who are allowed to enter the plea, is based on socio-political factors rather than psychological and psychiatric ones.