Insanity defenses: contested or conceded?

The authors examined 316 Oregon criminal cases in which the accused successfully pleaded the insanity defense. Prosecutors agreed to the insanity verdict in more than four out of five cases. In most cases all examining experts diagnosed the defendant as psychotic. The smaller number of defendants who were diagnosed by the state hospital staff as displaying only personality disorders accounted for a disproportionately large percentage of the contested trials. Observing that Oregon's insanity defense system is run by consensus, the authors suggest a reorientation of the insanity defense debate.     

Overlapping Universe: Understanding Legal Insanity and Psychosis

The Insanity Defense of Not Guilty by Reason of Insanity is the defense used by some mentally disordered defendants who do not have the capacity for understanding right and wrong at the time of their criminal act. This defense has perplexed legal and mental health professionals for centuries. Though it has been a part of the legal system since the early Greeks, it has been and continues to be amended, modified, and in some jurisdictions, abolished. Moreover, despite its infrequent use, many in our society hold onto the belief that defendants can evade criminal responsibility by means of this defense. Furthermore, insanity is often equated with psychosis; however, the two are not the same and have different connotations. It is essential for any clinical psychiatrist to understand the concept of the insanity defense and how it differs from psychosis. This paper will clarify the meaning and purpose of the insanity defense and will differentiate insanity and psychosis.     

Characteristics and disposition of persons found not guilty by reason of insanity in New York State, 1971-1976.

In order to develop an empirical profile of persons acquitted by reason of insanity from which policy could be developed, the authors studied all acquittals in New York State from 1971-1976. During this period 196 men and 29 women were found not guilty by reason of insanity. In contrast to adults admitted to state correctional facilities, the study group contained proportionately more persons who were white and older. The most frequent crimes for which subjects were tried were homicide, assault, and robbery. Most victims were acquaintances of the defendants. By 1976, 67 persons had been discharged after hospitalization ranging from 1 to 1,235 days. These defendants are still being followed after their return to the community.     

The hidden effects of Montana's “abolition” of the insanity defense

Montana abolished the affirmative insanity defense in 1979. In this article we examine the effect of this change by focusing on all defendants who raised mental health in his/her defense from 1976 to 1985. We found that while post-reform insanity acquittals did dramatically decline, there was a corresponding rise in findings of incompetent to stand trial with charges dismissed, perhaps negating the desired impact. We also compared the defendants and the legal process, finding no significant differences pre to post reform.     

Filicide: Gender Bias in California Defense Attorneys' Perception of Motive And Defense Strategies

This study is the first of its kind to evaluate attorneys' perception of motive and defense strategies when presented with a fictional filicide case. A vignette-based survey was designed to elicit data regarding perception of motive and willingness to use various defenses. Participants were more likely to agree that jealousy and retaliation were motivating factors when the perpetrator was male, but agreed more strongly that mental illness was a motivating factor when the perpetrator was female. Male perpetrators were more likely to be encouraged to accept a 15-year prison term, while attorneys were more willing to use insanity and mistake as mitigating defenses when the offender was female. Gender of participants also affected the perception of motive and defense strategies used. Results suggest that female attorneys are more likely to use defenses aimed to negate mens rea and female defendants are more likely to be encouraged to use such a defense.     

Hendricks v. People: forcing the insanity defense on an unwilling defendant

At least 17 jurisdictions permit insanity defenses to be entered over the objections of defendants. Those jurisdictions believe that society's interest in a just determination of the charges outweighs a competent defendant's choice. If competency includes the ability to rationally choose a plea, competent defendants should not be forced to enter insanity defenses against their wills.     

Religious Fundamentalism and Attitudes toward the Insanity Defense: The Mediating Roles of Criminal Attributions and Attitudes toward the Mentally Ill

Religious fundamentalism typically has been associated with negative perceptions of the insanity defense and defendants who use it. This association also has translated into verdict and sentencing decisions in insanity cases, such that higher endorsement of fundamentalist beliefs was associated with more punitive decisions. However, the mechanisms underlying the relationship between fundamentalism and insanity defense attitudes is unclear. Two possible explanations for this relationship include that (a) fundamentalism is associated with more dispositional attributions, and (b) fundamentalism is associated with more authoritarian attitudes toward mental illness and the mentally ill. Using structural equation modeling, attributions and attitudes were tested as mediators of the relationship between fundamentalism and insanity defense attitudes (i.e., strict liability attitudes and injustice–danger attitudes). These relationships were examined for theists and nontheists separately. Results suggest that personal attributions mediate the relationship between fundamentalism and injustice–danger attitudes, but authoritarian attitudes mediated the relationship between fundamentalism and strict liability attitudes. These relationships were only significant for theists. Implications for research and practice are discussed at the end.     

Individual Differences Relate to Support for Insanity and Postpartum Depression Legal Defenses: The Mediating Role of Moral Disengagement

Postpartum depression defense (PPDD) is a form of insanity defense often used when mothers harm their children. Although courts have determined that insanity defenses, including PPDD, can be used as legitimate criminal defenses, such defenses are often misunderstood among jurors and laypersons. The current survey of 467 undergraduates examines relationships between individual differences and support for PPDD and the insanity defense. Need for cognition was found to be positively related to support for PPDD and the insanity defense, while legal authoritarianism (LA) was found to be negatively related to support for both defenses. Faith in intuition is negatively related to support for the insanity defense. In this sample, women are more likely than men to support the PPDD, but not the insanity defense. Additionally, relationships between support and both the need for cognition and LA are partially mediated by moral disengagement, which is negatively related to support for PPDD and insanity defenses. These results replicate a model used in different legal contexts. Implications for legal and academic communities are discussed.     

Monitoring insanity acquittees: Connecticut's psychiatric security review board

In 1985 Connecticut established an administrative psychiatric security review board to monitor the postverdict disposition of defendants found not guilty by reason of mental disease or defect. The five-member board may confine an insanity acquittee in a mental hospital, grant temporary leave, order conditional release, and terminate confinement or conditional release. Judicial review is required before a patient is discharged from the board's custody. Between 1985 and 1989, a total of 173 insanity acquittees were under the board's jurisdiction; most were hospitalized in state psychiatric facilities. The authors discuss issues that must be addressed in creating a psychiatric security review board, including the conflict between protecting the public and treating insanity acquittees, clinicians' resistance to treating these patients, and problems posed by patients who do not appear to be mentally ill or who are well known to the public.     

Postpartum psychosis and the courts

Although mental state defenses frequently are raised in cases of infanticide, legal criteria for these defenses vary across jurisdictions. We reviewed outcomes of such cases in states using M'Naughten or model penal code (MPC) standards for insanity, and the factors considered by the courts in reaching these decisions. LexisNexis and Westlaw searches were conducted of case law, legal precedent, and law review articles related to infanticide. Google and other Internet search engines were used to identify unpublished cases. Despite the differing legal standards for insanity among states, the outcomes of infanticide cases do not appear to be dependent solely on which standard is used. The presence of psychosis was important in the successful mental state defenses. This case series suggests that states that use the stricter M'Naughten standard have not been less likely than states with an MPC standard to adjudicate women who have committed infanticide as not guilty by reason of insanity.     

Treatment planning for the patient who is incompetent to stand trial

National attention has focused on criminal defendants who plead not guilty by reason of insanity, but the insanity defense is rarely successful. A far larger number of criminal defendants, estimated at 9,000 annually, are admitted for forensic and civil hospitals because they are found incompetent to stand trial. Once hospitalized, many of these defendants face the likelihood of indefinite commitment. This paper discusses issues related to he concept of incompetency to stand trial and presents an approach to treatment planning and programming designed to restore patients to competency.     

Evidence of gender bias in legal insanity evaluations: a case vignette study of clinicians, judges and students

Forensic psychiatric decision-making plays a key role in the legal process of homicide cases. Research show that women defendants have a higher likelihood of being declared legally insane and being diverted to hospital. This study attempted to explore if this gender difference is explained by biases in the forensic psychiatric assessments. Participants were 45 practicing forensic psychiatric clinicians, 46 chief judges and 80 psychology students. Participants received a written vignette describing a homicide case, with either a female or a male perpetrator. The results suggested strong gender effects on legal insanity judgements. Forensic psychiatric clinicians and psychology students assessed the case information as more indicative of legal insanity if the perpetrator was a woman than a man. Judges assessed offenders of their own gender, as they were more likely to be declared legally insane than a perpetrator of the opposite gender. Implications of and possible ways to minimize such gender biases in forensic psychiatric evaluations need to be thoroughly considered by the legal system.     

Involuntary medication treatment for competency restoration of 22 defendants with delusional disorder

There are no published data on the rates of competency restoration for adjudicated incompetent felony criminal defendants diagnosed with delusional disorder. A retrospective record review was conducted of all incompetent defendants with the principal diagnosis of delusional disorder who had undergone involuntary medication treatment for competency restoration during a 13-year period at a federal psychiatric prison hospital. Of the 181 defendants who were involuntarily medicated for competency restoration during this period, 22 had delusional disorder. Seventeen (77%) of the defendants with delusional disorder improved sufficiently for the forensic evaluators to opine that they had been restored to competency after involuntary treatment with antipsychotic medication. These results are similar to the published data of the relatively high rates of competency restoration for incompetent defendants with diagnosed schizophrenia.     

Sex offenders and insanity: an examination of 42 individuals found not guilty by reason of insanity

Although currently there is a large body of research on the characteristics and treatment of sex offenders, very little research has been conducted to investigate the characteristics of sex offenders who have been adjudicated insane. This study included 42 patients at Napa State Hospital who were adjudicated not guilty by reason of insanity (NGRI) for a sex offense. The sample was further divided into offenders whose victims were children and those whose victims were adults. Data were collected with a structured chart review instrument. A large percentage of the sex offenders received a primary diagnosis of schizophrenia or schizoaffective disorder, and many had a comorbid substance use disorder. The high percentage of sex offenders in the current study with diagnosed schizophrenia or schizoaffective disorder may represent a previously unstudied subgroup of sex offenders. An alternative explanation is that the experts did not evaluate substance use and intoxication adequately, assess for malingering, or apply the proper legal standard for insanity.     

Revisiting the deific-decree doctrine in Washington state

The deific-decree exception to Washington's M'Naughten insanity standard first appeared in case law a quarter century ago in State v. Crenshaw. A few subsequent cases have attempted to refine the contours of the deific decree; however, the deific-decree doctrine has had only limited utility as a basis for the insanity defense. After about a decade of no activity in this area, the Washington courts have recently revisited the deific-decree doctrine in a case involving two defendants.     

The negligible effects of California's 1982 reform of the insanity defense test

OBJECTIVE: The authors' goal was to determine whether changing the insanity test in California in 1982 actually affected use of the insanity defense. METHOD: They gathered information on all individuals who entered the insanity plea (N = 1,300) and all those acquitted by reason of insanity (N = 665) in seven counties in California 3 years before and 3 years after the change in the test of insanity. They focused on whether California's revision of the insanity test affected the number and rate of insanity pleas, the number and rate of insanity acquittals, the characteristics of individuals using the defense, the target offenses, and the length of stay of insanity acquittees. RESULTS: The reform did not affect the rate of insanity pleas or acquittals, the characteristics of those using the defense, or their length of confinement. CONCLUSIONS: Although the reform had no direct effects on the use of the insanity defense, the authors hypothesize that an indirect change in criminal sentencing practices led to a decrease in the number and rate of insanity pleas and acquittals.     

Dissociative identity disorder: Medicolegal challenges

Persons with dissociative identity disorder (DID) often present in the criminal justice system rather than the mental health system and perplex experts in both professions. DID is a controversial diagnosis with important medicolegal implications. Defendants have claimed that they committed serious crimes, including rape or murder, while they were in a dissociated state. Asserting that their alter personality committed the bad act, defendants have pleaded not guilty by reason of insanity (NGRI). In such instances, forensic experts are asked to assess the defendant for DID and provide testimony in court. Debate continues over whether DID truly exists, whether expert testimony should be allowed into evidence, and whether it should exculpate defendants for their criminal acts. This article reviews historical and theoretical perspectives on DID, presents cases that illustrate the legal implications and controversies of raising an insanity defense based on multiple personalities, and examines the role of forensic experts asked to comment on DID with the goal of assisting clinicians in the medicolegal assessment of DID in relation to crimes.     

Medicine court, II: Rivers in practice

The authors conducted a retrospective study of the initial impact (1986-1987) of the Rivers v. Katz decision involving patients' right to refuse treatment at New York State's largest forensic psychiatric hospital. Of 18 petitions submitted, 15 cases were adjudicated. All 15 patients were found incompetent, and all treatment plans submitted were approved by the court. Most patients selected for Rivers hearings were diagnosed as having chronic schizophrenia and/or were older than the hospital population. A comparison of the implementation of the Rivers decision with that of Rogers v. Commissioner of Mental Health in Massachusetts showed Rogers to be significantly more expensive in human resources, time, and money.     

The evolution of the american law institute test for insanity in Oregon: focus on diagnosis

In 1962, the American Law Institute published its Model Penal Code, which includes an insanity test later adopted by many states. The second paragraph of the test excludes people with certain psychiatric conditions manifested by repeated criminal or antisocial conduct from using them as a basis for an insanity defense. Oregon adopted this test in 1971. Since then, its legislature and courts have added to the conditions excluded in the second paragraph. In this article, we look at how recent Oregon appellate court decisions have culminated in a narrower and less contentious notion of which psychiatric diagnoses serve as a basis for an insanity defense. Then we discuss Oregon's expansion of the second paragraph of the American Law Institute Insanity Test in a national context.