PSY100H1 Chapter Notes - Chapter 18: Insanity Defense, Cobourg, Involuntary Commitment

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Published on 14 Apr 2013
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Chapter 18
Fitness to stand trial: accused individuals must have a rational understanding of
the charges against them and the proceedings of the trial, understand the
consequences of the proceedings and be able to communicate with their lawyers;
definition from Criminal Code; aims to protect fairness of legal process and
presser accused individual’s autonomy; stems from common law requirement that
defendant conduct proper defence
oProblems: 40% of those examined in Vancouver study showed
impairments on fitness to stand trial interview (without disorder); IQ
scores one of strongest predictors related to legal abilities; include
assessment of mental disorder (as defined by law) and impairments in
legal abilities; mental disorder not sufficient on its own
oTrial: most common type of pre-trial evaluation; trials postponed if there
is reason to believe individual will become fit in foreseeable future and
can be forced to receive treatment
oDiagnosis: defendants with long histories of psychiatric problems are
more likely to be referred; those with psychiatric disorders show most
impairment; Canadian forensic psychologists leaders in developing tests of
cognitive abilities; disorganization symptoms and hallucinations more
troublesome than delusions
Fitness Interview Test: Ronald Roesch; 30-45 minute clinical
interview to develop fitness to stand trial;
Insanity: legal term; people can’t be held responsible for their acts if they were so
mentally incapacitated they could not conform to societal rules; don’t need to be
chronically insane, only insane at the time
Insanity defence: used in case of John Hinckley (shot Reagan and his press
secretary); renamed not criminally responsible on account of mental disorder
defence in Canada after 1992; case of Andre Dallaire who attempted to
assassinate Chretien (paranoid schizophrenia institutionalization, outpatient
care in community); fewer than 1 in 100 defendants file insanity plea in US and
only 26% of these result in acquittal; usually men between 20-29 who are
unmarried, unemployed, have a history of violent offences, has been diagnosed
with disorder
Battered women syndrome: Loreena and John Bobbitt; temporary insanity for
women who injure or kill abusive partners; women’s sense of helplessness and
reasonable apprehension that her life is in danger following pattern of chronic
assault; Jane Hurshman killed abusive common law partner and was acquitted
Consequences: 85% of those acquitted are sent to mental hospitals; all but 1%
put under some type of supervision and care; normally detained longer in
hospitals than they would have been in prison; indefinite detainment has been
ruled unconstitutional; little consistency across provinces with respect to amount
of time someone is detained
M’Naghten rule: person must have mens rea (guilty mind) or intention to
commit guilty act in order to be held responsible for the act; mental defect
precludes someone from knowing nature and quality of act or not knowing act is
oProblems: have to determine what is meant by “disease of the mind”; law
unclear and inconsistent and only psychoses frequently recognized;
difficult to make retrospective judgment as to whether person did not
know right from wrong at time crime was committed; disorders do not
prevent someone from knowing right from wrong (example of Dahmer)
Criticisms of insanity defence: mental health professionals often disagree about
the nature and causes of psychological disorders and evaluation of defendants’
states of mind at time crimes were committed; lawyers on each side find
professionals who agree with their view; variability in actual expertise of
psychiatrists; frequently present data and test results not connected to context of
occurrence; don’t when someone should be held responsible for their behaviours
Freedom of choice: can we force people into mental institutions and to undergo
treatment; historically, state’s legal authority to detain individuals within
Canadian insane asylums was absolute
Violet Bowyer: 1930 insanity hearing in Ontario; convicted of vagrancy and
committed to term of two years less a day; maximum sentence; after jail time, she
was referred to two medical practitioners who determined her insane and ordered
her to Ontario Hospital for the Insane in Cobourg; judge determined burden proof
was on person demonstrating sanity; misuse of civil commitment proceedings
Civil commitment: state viewed as “parent” of those who can’t care for
themselves; provincial guidelines for when someone can be hospitalized against
their will; personal freedom suspended in securing involuntary detention in a
mental health facility
Conditions for commitment: person must be “mentally ill”, in need of treatment
and pose danger or threat to safety of themselves or others; most provinces
stipulate that psychiatrists must conduct assessment and reach consensus that
criteria are met; provinces vary as to definition of terms, whether treatment is
required, informing patient of reasons for hospitalization, legal representation and
right to review panels that can grant discharge; can peace officers apprehend
individuals with a putative mental illness and period of detention
Data: most people committed are men between 25-34; mean length of stay 274
days and primary diagnosis is schizophrenia; suicide or violent tendencies
Criteria for involuntary commitment
oDangerousness to self: person is imminently suicidal; inpatient
psychiatric facility while undergoing further evaluation and possibly
treatment; all that is needed is a certification by the attending mental-
health professionals that the individual is in imminent danger to himself
oDangerousness to others: society claims right to protect itself against this
person; accuracy of forensic forecasts of dangerousness are not very
reliable or valid; criteria in Criminal Code stipulates that offence must be
serious and offender must constitute a threat to the life, safety or
physical/mental well-being of another person; can be incarcerated for
indeterminate period but National Parole Board must conduct review
every two years following 7 years of incarceration
Increased risk of violence: particularly among people with substance abuse,
personality or schizophrenic disorders; 61% of newly admitted inmates in one
study met criteria for psychiatric disorder; low rates of violent offences by
individuals with psychiatric disorders; likelihood former patients would commit a
violent act strongly related to their diagnosis and whether they had a substance
abuse problem; most likely to commit violent act within a few months of
discharge and less likely to do so as year wears on; targets of violence most often
family members, friends and acquaintances; low socioeconomic backgrounds and
impoverished neighbourhoods; other research suggests violence by mentally ill
women is underestimated by clinicians
Prevalence of involuntary commitment: very little known about rates under
Canadian civil commitment legislation; 20 year old data suggests 25% of all
hospital admissions were involuntary; involuntary admissions characterized by
male gender, longer hospital stay, clinical diagnosis of schizophrenia and history
of criminal behaviour
Civil rights
oRight to treatment: mental patients warehoused in appalling conditions
in the past; Charter protects their rights; 61% of newly admitted inmates
have severe mental disorder; seriously mentally ill received better care in
BC than any American state and half the cost (similar rates in Canada and
US); mandated that prison inmates should receive necessary mental health
services like medical treatment; only 37% of male inmates receive
treatment while in jail however; depression goes unnoticed while suicide
is the second most frequent cause of death in jail detainees; services
usually minimal and occasional
oRight to refuse treatment: fear will be given drugs that rob you of
consciousness, personality and free will; if someone is psychotic or manic,
it may be judged they cannot make a reasonable decision about treatment
and others have to decide for them; some studies suggest as many as 75%
of schizophrenics have adequate decision making capacity; in Quebec,
Ontario, Manitoba and Nova Scotia, patients deemed competent have
absolute right of refusal while BC and Newfoundland allow for competent
patients to be treated against their will; psychiatrists and family members
can seek court ruling allowing administering of treatment and most judges
will agree with them
Informed consent: patient accepts treatment after receiving full
and understandable explanation of treatment being offered and
making a decision based on his judgment of risks and benefits of
Clinicians’ duties to clients and society: clinician’s primary responsibility to
client is duty to provide competent and appropriate treatment for the client’s
problems; duty not to become involved in multiple relationships with clients; duty
to protect client confidentiality (exception: involuntary commitment, harm to self