Ch. 16 Ethical & Legal Issues Flashcards
(29 cards)
criminal commitment
- individual with a psychological disorder is alleged to have committed a crime
- confines a person to a forensic or mental hospital either for:
determination of competency to stand trial → understand what is going on and why they are on trial, orderly in court, contribute with lawyer capacity
after acquittal by reason of insanity
insanity defense
- “insanity” is a legal term
- defendant not responsible if knowing right from wrong is compromised
- fewer than 1% if cases; rarely successful
- usually requires assistance from psychiatrists or clinical psychologists
compromised issues of right and wrong
existence of remorse; defect of reason at the time of the crime, having voices in their head saying this person was violent or bad
fewer than 1% plead insane
- very difficult to establish the difference between right and wrong
- intellectual disability
assistance from professionals
- reliability and validity
- jury does not understand content of topic being discussed by experts
American Law Institute (ALI) Guidelines, 1962
- not responsible of criminal conduct if, at the time of conduct, there was mental disease/defect resulting in lack of capacity to appreciate criminality or of conforming to law
- “mental disease/ defect”–does not include abnormality manifested by repeated criminal/antisocial conduct
- solitary confinement, repeat offenses, drug use, alcohol abuse, DUIs
Insanity Defense Reform Act, 1984
- eliminated irresistible impulse component
- changed ALIs “lacks substantial capacity…to appreciate” to “unable to appreciate” (more stringent)
- mental disease/defect must be “severe”
passion or temporary insanity not included - shift burden of proof from the prosecution to the defense
- first time insanity addressed at federal level
Not Guilty by Reason of Insanity (NGRI)
- both sides agree that the person committed the crime
- at issue is responsibility for the crime
- indefinite commitment to a forensic/mental hospital until “recovered” → no real recovery, only rehabilitation
John Hinckley → Reagan Assassination
Guilty but Mentally Ill (GBMI)
- guilty and responsible; maximizes changes of incarceration
- mental illness plays a role in sentencing
MH professional input
committed to hospital until no longer mentally ill
then sent to prison for remainder of sentence - most are incarcerated; psychiatric care not guaranteed
- mitigating factor → lessening of sentence or charges
Current Insanity Pleas
- most common: NGRI and GBMI
- 2020: US Supreme Court allows states to decide whether they wish to allow insanity defense
Kansas, Montana, Idaho, Utah - burden of proof rests with defendant
competency to stand trial
- must be decided before responsibility is determined
- accused must be able to participate in defense
- trial is delayed; accused receives treatment to restore competency
- bail automatically denied
- determination of competency cannot last longer than maximal possible sentence
- if medication can produce rationality, trial can be held
-forced medication to restore competency in very limited circumstances
forced medication
alternative treatments fail; medication is likely effective, won’t interfere with right to defend self, government interest in prosecuting
1960 supreme court decision
“…ability to consult with lawyer with reasonable degree of rational understanding”
“…has a rational as well as factual understanding of the proceedings against him”
capital punishment
- legally sane at time of execution? → may not be at time due to years living in prison
- US Supreme Court 2002
intellectual disability → cruel and unusual punishment
definition of intellectual disability varies by state
no federal oversight
civil commitment
- in any state, an individual can be committed against will if:
has a psychological disorder
is danger to self or others - formal (i.e., court order) or informal
informal emergency commitment
- no court involvement initially
- physician certificate (PC) allows person to be detained without a court order
- 24 hours - 20 days
- supposed to be a psychiatric facility but can be a jail
- further detainment requires formal judicial commitment
Preventative Detention and Predicting Dangerousness
- how do we decide about danger?
- 3% of violence in US linked to psychological disorders
- 90% of people with psychotic disorders are not violent (but this changes if they are unmedicated)
predicting dangerousness
factors that influence accuracy
- history of violent acts
- return to environment of violent act
- “on the brink”
- failure to engage in treatment
- assisted outpatient treatment (mandated)
increase medication compliance
protecting patient rights
- least restrictive alternative
- right to treatment
- right to refuse treatment
least restrictive alternative
- hospitals are the most restrictive
- treatment restricting liberty handled very carefully
right to treatment
- state provides after civic commitment
- requirements for mental hospitals
- civil commitment stats must be periodically reviewed
right to refuse treatment
- unless harm is clear and imminent → who gets to decide?
- unless less intrusive interventions less likely to reduce danger
deinstitutionalization
1950s: states discharged as many as possible and discouraged admission
- “treat them in the community”
- most cities lack sufficient community and health facilities
- inability to receive government assistance without established residency
- became vagrants and ended up in jail
transinstitutionalization
- nursing homes, nonpsychiatric hospitals, prisons
- 17-30% in prison have serious psychological disorder
- police officers called on for the work of mental health professionals
- mental health courts, crisis intervention teams
