Since deinstitutionalization, most persons with severe mental illness (SMI) now live in the community, where they are at great risk for crime victimization.

Mentally ill patients are six times more likely to be murdered than the general population, researchers have found. The mentally ill also have higher death rates from suicide and accidental causes.

August 2007 a ''floridly psychotic" Michigan prison inmate -- died naked, lying in his urine, shackled to a concrete slab in a segregation cell. See full report (PDF)

Problems at residences that house the mentally ill include exposed electrical outlets, defective bedding, and a floor covered with cigarette burns. But the law prevents the disclosure of inspection reports and the names of facilities in violation. Arkansas Democrat-Gazette

Posttraumatic Stress Disorder occurs when we witness a trauma or something traumatic happens to us. The leading precipitating event for PTSD symptoms was death or illness of someone close, family violence, and violent crime. It a disorder when symptoms last beyond a month after the event. Children with PTSD display phobias and separation anxiety. Journal of the American Academy of Child and Adolescent Psychiatry. 5.2 million people, 3.6 percent of US adults from 18 to 54 have PTSD. Thirty percent of those who have spent time in war zones experience PTSD. One million Vietnam war veterans developed PTSD. It is estimated to be as high as 8% among veterans of the Persian Gulf War. National Institute of Mental Health

The report "Safety First" from the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, is based on a detailed study of 5,582 suicides and 186 murders by psychiatric patients in the UK between 1996-2000.

Criminal Insanity

Evolution Of The Insanity Plea University of Missouri-Kansas City School of LawPrior to the 19th century, guilt was judged by causation not intent. The insanity defense has been used throughout recorded history. Latin tribes of ancient Rome religious beliefs, believed the insane were divinely blessed, and beyond the reach of human laws.

The insanity plea is used in less than 1% of all US Criminal Justice System criminal cases; 35% of those are murder cases. One fourth of these cases are successful. Approximately 70% of the successful insanity acquittals were the results of agreements between the prosecution and defense. A jury trial is waived If evidence is presented to a judge for determination with the prosecution and defense both in agreement regarding the defendant's mental state. If they disagree expert witnesses will to testify at a jury trial. Journal of Psychiatric Practice.

The legal standard for the criminal insanity pleas is the defendant's ability to differentiate right from wrong. If they know right from wrong but are unable to act on that knowledge due to mental illness they don't meet the criteria of "criminally insane." The legal standards for criminal insanity do not match the psychiatric diagnostic criteria for conditions that render a person incapable of controlling impulses or perceived threats in a reasonable manner. Forensic psychiatric testimony establishes probable mental status during the commission of the crime. Many defendants meet the criteria for the insanity defense but it is rarely used because it almost always leads to a conviction of the defendant. The insanity defense is one of the most misunderstood aspects of forensic psychiatry.

In 1982, the US insanity defense suffered a set back in public opinion, after John Hinckley, Jr.’s acquittal for his attempt to assassinate President Reagan. In response to the verdict in the Hinckley trial, in 1984, The US Insanity Defense Reform Act was enacted by Congress.Department of Justice

The insanity defense and diminished capacity Cornell Law School

Forensic Assessment I Competency & Insanity The Institute for Criminal Justice Ethics

Does the Insanity Defense Have a Legitimate Role? Psychiatric Times by James F. Hooper, M.D., F.A.P.A., and Alix M. McLearen, M.S.

Common Psychosocial Disorders -- Health issues of concern include alcohol and substance abuse, domestic violence, mid-life crisis and depression. American Academy of Family Physicians

Psychiatric Disorders Common Among Detained Youth -- Among teens in juvenile detention, nearly 2/3rds of the boys and nearly 3/4 of the girls have at least one psychiatric disorder. These rates dwarf the estimated 15% of youth in the general population thought to have psychiatric illness, placing detained teens on a par with those at highest risk, such as maltreated and runaway youth. National Institutes of Health.

Antisocial Personality, Psychopathy, and Forensic Psychiatry Diagnosis, assessment, forensic relevance, and treatment of antisocial personality Disorder (APD) and its more severe subtype, psychopathy. Journal of Psychiatric Practice

Legal Issues Schizophrenia.com

Schizophrenia -- A number of people with schizophrenia find themselves in trouble with the law. Offenses frequently range from shoplifting, mischief, and assault to aggravated assault, arson or murder. Phillip W. Long, M.D.

In prison appropriate treatment for psychosis is rare. To allow psychosis to go untreated, is unconstitutional, and morally unjust. Todd Moore, MD

Dr Tim Amos, a forensic psychiatrist, told the Royal College of Psychiatrists that "stranger murder" by the mentally ill is unusual.

Some states are abolishing the insanity defense.

Self Harm

The mentally ill usually represent the risk of self harm.

A schizophrenic is 2,000 times more likely to commit suicide than harm someone else.

The Psychology of Suicide-Murder and the Death Penalty -- To understand individuals who seek or are attracted to the death penalty as a form of suicide, probe the syndrome. A sketch of 22 cases of murderers in the US who killed in hopes of getting themselves executed, is provided, the term suicide-murder is used instead of murder-suicide. Katherine van Wormer, MSSW, Ph.D. 1999. Journal of Criminal Justice, 27(4), 361-370.

Documenting Suicide Risk Assessment. Suicide is a common cause of action against mental health care professionals. Misdiagnosis, negligent treatment, sexual exploitation, and implanting false memories are potential suits. Documentation is a cornerstone of the defense. Journal of Psychiatric Practice

Contracting For Safety -- Caring for a suicidal patient means doing more than having them sign a promise not to attempt suicide. Relying on a statement when the stakes are so high, or allowing it to supplant appropriate care is risky and negligent. An urban myth claims a Contract For Safety in the chart diminishes liability but experience and research shows otherwise. Journal of Psychiatric Practice Vol. 11, No. 1

Competency to stand trial

Competency to stand trial is the defendant's ability to assist legal counsel in the preparation of their defense, make decisions, or plead. Incompetence to Stand Trial IST is not a defense, its not proclaimed by the defendant -- usually by a court official concerned about the defendant’s ability to understand the charges or assist with their defense. The trial is postponed for re-evaluation. It does not resolve the criminal charges. Cornell Law School.

In 1960, the U.S. Supreme Court ruled in Dusky v. United States that a defendant must have adequate ability to lucidly consult with his attorney and to clearly comprehend the charges to be Competent to Stand Trial CST.

Not guilty by reason of insanity

Not guilty by reason of insanity" NGRI pleas are based on the principle that punishment is reasonable only if the defendant is able to take criminal responsibility for their actions. This requires a diagnosis of active psychosis, schizophrenia, schizoaffective disorder, or bipolar disorder, with active psychotic features are present during the crime. After an NGRI finding they are locked in public institutions where they receive psychiatric treatment. They receive their sentences for their crimes when they are no longer considered at risk. They are frequently held in these institutions longer than if they'd been found guilty and served their sentence. (Foucha v. Louisiana the Supreme Court 1992 ruled a person could not be held indefinitely.) The National Mental Health Association supports ALI's not guilty by reason of insanity plea and opposes guilty but insane laws which preclude use of the insanity defense. NMHA supports broad ALI's Model Penal Code standards. National Mental Health Association.

Diminished Capacity or Guilty but Mentally Ill

Some states have amended laws to include diminished capacity or guilty but mentally ill. These result in a lesser conviction while the insanity defense pleads for a not guilty verdict in exchange for an indeterminate amount of time in a mental institution. Defendants with an indisputable diagnosed psychiatric mental illness determined as sane by the court's standards, are held responsible for their crimes under a Guilty but Mentally Ill (GBMI) or a Guilty but Insane verdict. Michigan was the first of 13 states to use GBMI. Physician’s Weekly"

Temporary insanity

Temporary insanity is when a sane defendant was rendered temporarily insane during the commission of the crime. This defense was first used in 1859 by New York Congressman Daniel Sickles after he killed his wife's lover, Philip Barton Key. It was a popular defense during the 1940s-50s. Assumption College

Irresistible Impulse Defense

When a perpetrator knows they are committing a crime; but are unable to control their behavior due to a mental impairment they may use the irresistible impulse defense. In 1834, Ohio,The Irresistible Impulse Test, focused on the inability of people to control their actions; concluding crimes during a fit of passion were insane, not guilty because irresistible impulse driven by mental disease causes one to act against their will. Criticisms of the test claim there is no way to identify impulses which could be resisted or controlled. In the late nineteenth century, irresistible impulse added volition to the M'Naughton Rule. By the 20th century, almost half of the states supplemented the M'Naughton Rule with the Irresistible Impulse Test.

The Substantial Capacity Test

The American Law Institute ALI of leading legal and medical professionals gathered in 1953 by to study criminal responsibility. ALI's 1962 Model Penal Code; The Substantial Capacity Test, defined the lack of substantial capacity to control behavior. Substantial capacity, similar to the M'Naughton Rule and irresistible impulse is a lack of the mental capacity required to understand the wrongfulness of an act, or conform to the law.

Incarcerated

One in six U.S. prisoners is mentally ill, many suffer from serious illnesses such as schizophrenia, bipolar disorder, and major depression. There are three times as many people with mental illness in U.S. prisons as there are mental health hospitals.  The rate of mental illness in the prison population is three times higher than in the general population.

According to the 215-page report Ill-Equipped: US Prisons and Offenders with Mental Illness prisons are dangerous and damaging places for mentally ill people. Other prisoners victimize and exploit them. Prison staff often punish mentally ill offenders for symptoms of their illness such as being noisy or refusing orders, even self-mutilation and attempted suicide. Mentally ill prisoners are more likely than others to end up housed in especially harsh conditions, such as isolation, that can push them over the edge into acute psychosis.

Death Penalty

Defendants with Mental Retardation executed in the US since the death penalty was reinstated in 1976. AdvocacyOne

The Death Penalty and Mental Retardation -The US Supreme Court ruled the execution of persons with mental retardation is not cruel and unusual punishment prohibited by the 8th Amendment. Human Rights Watch

History

De Praerogativa Regis, On the King's Prerogative, a 13th century statute gave the crown custody of the property of natural fools. A After a commission of lunacy they took wardship of the property . Under English Common law, Edward II, ruled any person with a mental functioning of a "Wild Beast" as insane.

After James Hadfield's acquittal by reason of insanity for his assassination attempt on George II, The United Kingdom Criminal Lunatics Act 1800 decreed indefinite detention of insane criminals. American Academy of Psychiatry and the Law.

In 1843, the modern insanity defense was born after psychiatrists persuaded a jury hat Daniel M'Naughton, a wood-turner from Scotland believed he was the target of a conspiracy involving the pope and British Prime Minister Robert Peel. M'Naughton planning to ambush Peel at 10 Downing Street, mistakenly shot Peel's secretary to death. After psychiatrists testified that he was delusional, the jury found him not guilty by reason of insanity. A year later, a panel of British judges codified a legal standard that has stood for over150 years, M'Naughton Rules: The insanity plea can be used if during the time of the offense, as a result of a severe mental disease or defect, the defendant was unable to understand the wrongfulness of their acts. After 20 years in a mental asylum, M'Naughton died. Slate. 

M'Naughton's did not go far enough, it should acquit those unable to control themselves despite knowledge of wrongfulness. Oxford University

The US Court of Appeals for the District of Columbia Circuit in 1954, The Durham Rule stated the existing tests of criminal responsibility were long obsolete based on years of progress in scientific research. University at Buffalo

The ALI's 1972 Brawner Rule stated that a jury should decide if:

"A person is not responsible for criminal conduct if at the time of such conduct as a result of mental disease or defect he lacks substantial capacity either to appreciate the criminality of his conduct or to conform his conduct to the requirements of the law."

The National Coalition of Mental Health Consumer/Survivor Organizations (NCMHCSO) ensure that consumer/survivors have a major voice in the development and implementation of health care, mental health, and social policies at state and national levels, empowering people to recover and lead a full life in the community.

Should Forced Medication be a Treatment Option in Patients with Schizophrenia? Judi Chamberlin debates E. Fuller Torrey, MD on Involuntary Treatment

Stem the tide of neglect. Successful treatment of people with co-occurring disorders is one of the best ways to reduce the "frequent flier" population at the county jail and ease the enormous burden their recidivism places on law enforcement and the taxpayers.

Solutions at work: Where there's the will … -- Almost half of the mentally ill suffer from anosognosia, a brain impairment that prevents them from realizing they need treatment. They don't believe they're ill, so they refuse medication that could help them. South Florida Sun-Sentinel Violence associated with sleepwalking, confusion arousals and sleep terror Insanity: Myth or Fact? University of Missouri-Kansas City School of Law

Law and Mental Health US jurisprudence, clinical work, and the law. Journal of Psychiatric Practice Vol. 9, No. 3

In 1986 Ford v. Wainwright 477 U.S. 399, the US Supreme Court ruled insane prisoners cannot be executed. Find Law

The execution of mentally ill offenders Amnesty International

An exorcism that killed Terrace Cottrell Jr,. an autistic 8-year-old boy, brought a felony conviction July 9, 2004 for Ray A. Hemphill, a school maintenance worker who spent nights and weekends preaching at his brother's strip-mall church. Milwaukee Journal Sentinel

Alice Fritz - Describes heartbreak of losing her son to violence - This boy who killed Arnie was was mentally and emotionally ill and filled with rage. His needs went unmet, his cries for help ignored and his threats dismissed. Alice Fritz

The case of Andrea Yates may be the most disturbing of all. She came to believe that she was possessed by Satan and the only way to save her children for all eternity was to kill them now so that they could get to heaven. Yates represents a misuse of the death penalty: People behind bars instead of in mental institutions because prosecutors used the death penalty to advance their careers instead of justice. Seattle PI

(Emily) Jane and (Nancy) Jean Hopkins were bright  fraternal twins. As adults they settled in exclusive Dallas neighborhoods. After Jane attended Harvard she became a chemical engineer and business woman. Jean, active in Dallas social circles, joined a national brokerage firm. Relatives noticed signs of mental illness in Jane and Jean. When Jean was pregnant she tried to kill two young sons and herself with a prescription drug overdose. After being diagnosed with bipolar disorder, she was found not guilty of attempted capital murder by reason of insanity in June 1996. On July 30, 1997, Jane, 41,fatally stabbed her 9-year-old son, 5-year-old daughter, and then killed herself at home with a kitchen knife. Dallas Morning News

John E. du Pont, 58, great-great grandson of E. I. du Pont, the French-born industrialist who founded the chemical company and one of hundreds of heirs to the family fortune, shot wrestler David Schultz, a 1984 Olympic gold medallist on Jan. 26, 1996, outside the wrestler's home on du Pont's estate, Foxcatcher Farm. Du Pont suffered from delusions of being the Dalai Lama and Jesus Christ. Paranoid schizophrenia made du Pont unable to recognize that pulling the trigger was wrong. Washington Post

In 1998, Patrizia Reggiani, Italy's "black widow," was sentenced to 26 years in jail for hiring a hit man to kill her estranged husband, fashion heir, Maurizio Gucci, Mafia-style, outside his Milan office. Her family now claims new medical tests show the extent of the brain damage from a brain tumor years ago meant she could not have planned a murder. The Scotsman

Russell Weston, the man with paranoid schizophrenia who killed two US Capitol police officers in 1998 languishes in federal prison. He is incompetent to stand trial. Treatment with medication could make him well enough to be tried, convicted, and executed, even though he was profoundly ill at when the tragic crime occurred. NAMI

In 1994, Lorena Bobbitt was found not guilty due irresistible impulse allowing her to sever her husband's penis. Harvard College

A Crime of Insanity explores the case of Ralph Tortorici, 26, a student with paranoid schizophrenia charged with assault, kidnapping, and attempted murder. How the courts dealt with his case. Public Broadcast System

Indictment fuels repressed-memory debate -- 1986 - 1992 Chicago, Patricia Burgus claimed she was convinced by psychotherapists she had memories of a cannibalistic satanic cult, being sexually abused and abusing her own sons. Burgus' sons, ages 4 and 5, were hospitalized. Burgus, treatment included 2.5 years of inpatient care costing insurance $3 million, concluded her "recovered" memories were false. Charles Patrick Ewing, JD, Ph.D. State University of New York at Buffalo

E-therapy Patients suffering from paranoia, social phobia, agoraphobia, or in remote areas, with disabilities, or busy schedules the only form of treatment available is e-therapy: mental health treatment through the Internet. It is convenient and reaches under served populations, but the risks range from a lack of nonverbal cues, risk of misdiagnosis, licensure concerns and the Health Insurance Portability and Accountability Act (HIPAA). The Journal of Psychiatric Practice

Anantomy of a Murder -- The important legal issue central to this movie plot, is the test for insanity. To the attorney and client the only viable defense is temporary insanity.

October 26, 2007

Copyright Kari Sable Burns 1994-2007