Legal Issues Associated with Mental Illness

1. Legal Issues Associated with Mental Illness

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

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

4. 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

5. 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”

6. 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”

7. 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

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

9. 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”

10. 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?

11. Civil Commitment

12. 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

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

14. Massachusetts Law • 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”

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

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