Legal Issues Associated with Mental Illness

Current Legal Issues criminal commitment civil commitment right to refuse treatment Future Legal Issues associated with advances in brain imaging technology

Criminal Commitment (after a crime) Insanity defense Competency to stand trial Competency to be executed

Insanity Defense (NGRI) Used in less than 1% of criminal cases Successful in only 25% of cases Successful case: John Hinkley Jr. Unsuccessful case: Mucko McDermott Unsuccessful then successful: Andrea Yates

Insanity Defense (NGRI) 1. M’Naghten Rule –Defendant did not know right from wrong at time of act –Based on English law –“right/wrong test,” “knowledge test,” “cognitive test” 2. Irresistible impulse –A pathological impulse or drive compelled person to commit the crime – “irresistible impulse test” 3. Durham Rule –Act was a product of mental disease or defect –not used since 1972 –“product test”

Insanity Defense (NGRI) 4. American Law Institute (ALI) - Combined M’Naghten and irresistible impulse - NGRI if lacked capacity, because of mental disease or defect at time of act, to appreciate wrongness of act or conform conduct - Mental disease cannot include ASPD - burden of proof on prosecutor - “substantial capacity test”

Insanity Defense (NGRI) 5. Insanity Defense Reform Act –After NGRI in John Hinkley Jr. trail –Eliminated the irresistible impulse component –Changed wording of ALI from “lacked substantial capacity to appreciate” to “unable to appreciate” –Mental disease must now be severe –Shifted burden of proof of insanity to defense –If person recovers from mental illness, can then be incarcerated 6. Guilty but mentally ill (GMI) - Jeffrey Dahmer case

- Jones vs. U.S. Insanity Defense (NGRI) Controversial NGRI Pleas - altered states of consciousness - altered personality states Does NGRI actually help defendants? So what is the current standard? - federal courts - state courts

Competency to stand trial Person must have rational and factual understanding of the proceedings against him Person must have sufficient present ability to consult with lawyer rationally More people committed for incompetency than found NGRI Consequences for being found incompetent “synthetic sanity”

Competency to Be Executed A person must be judged legally sane to be executed Can a person be forced to take medication that will make him legally sane enough to be executed? –Sidenote: What is the treating psychiatrist’s ethical duty in such a case? –Sidenote: Body Integrity Identity Disorder Should a physician assist a BIID sufferer?

Civil Commitment

Involuntary Civil Commitment Historical misuses –Unconventional thinking or behavior –Women who did not “know their place” –Deprive one of estate or property –Misdiagnosis –Disobedience to parents –Cultural misunderstandings –Undesirable group –Drug and alcohol addiction

Involuntary Civil Commitment Criteria for Civil Commitment - Danger to self - Danger to others - Unable to provide for own basic needs

May be restrained on emergency basis for 3 days on psychiatric opinion Then must seek court order for additional commitment Psychiatrist must decide whether “dangerous” Massachusetts Law

Right to treatment versus Right to refuse treatment Examples: neuroleptics naltrexone

Future Legal Issues lie detection prediction of violence bias detection brain death brain enhancements