forensic psych EXAM 3
Describe the Ohio standard for insanity. What are the prongs of the Ohio standard?
- "A person is 'not guilty by reason of insanity' relative to a charge of an offense only if the person proves, in the manner specified in section 2901.05 of the Revised Code, that at the time of the commission of the offense, the person did not know, as a result of a severe mental disease or defect, the wrongfulness of the person's acts." - ohio's standard is derived from the modern standards ( m'naghten, durham etc.) but is not identical
What is parens patriae?
- "parent of the nation" - government/state is responsible for protecting mentally ill individuals from themselves
what is the CAI?
- 13 component, semi-structured interview - bunch of questions that tap different aspects of understanding ex: What is a plea bargain?", "What is the role of a judge? ...of a jury? ..." - doesn't have any norms that would allow one to compare one person's responses to another - works well because it is very flexible, you can deviate easily
Approximately what percentage of individuals evaluated for competency to stand trial are malingering?
- 15%
what is the ECST-R?
- 18 item semi structured interview that has 4 scales - Factual Understanding of Courtroom Proceedings - Rational Understanding of Courtroom Proceedings - Consult with Counsel - Overall Rational Ability first 3 of these scales were developed specifically to evaluate the 3 Dusky prongs - can be scored and is standardized, have good reliability and validity - has validity scales for over-reporting and under-reporting
how many Competency evaluations occur out of all felony cases?
- 2-8%
What percentage of referred defendants are deemed incompetent to stand trial?
- 20%
What percentage of insanity defenses result in acquittal?
- 25%
How many states do not have an insanity standard?
- 4 - Montana abolished the insanity defense in 1979, Idaho in 1982, Utah in 1983, and Kansas in 1996 - These states have alternative methods for hospitalizing the criminal mentally ill E.g., the number of civilly committed IST patients increased after abolishing insanity standards in Montana
What is not knowing the nature and quality of one's actions?
- A rare occurrence that is characterized by not knowing what you are doing - example: strangling someone but thinking you're squeezing a fruit
what is criminal competency?
- AKA "Adjudicative competency" or "Fitness" - Defendants must understand the nature and purpose of the criminal proceedings to ensure that they receive a fair trial - This belief is rooted in the 6th Amendment of the US Constitution
American Law Institute test (ALI) Rule
- AKA brawner rule, group of lawyers - ALI sought to reform insanity law in 1962 - "A person is not responsible for criminal conduct if at the time of such conduct as a result of mental disease or defect he lacks substantial capacity either to appreciate the criminality (wrongfulness) of his conduct or to conform his conduct to the requirements of law" - ALI expands the M'Naghten standard (which focuses only on knowing) by allowing the role of emotion to substantially diminish one's appreciation of wrongfulness - ALI is meaningfully more liberal than M'Naghten and more conservative than the Product Rule - All federal courts and many state courts use this standard
what is a Mental health advanced directive?
- Allow the patient to make any treatment decisions before they become incapacitated - hospital staff are unware of their existence and are hesitant to encourage use because the see this as refusals of care - 4% to 13% of psychiatric patients had signed an advanced directive (Swanson et al., 2006) - Over 77% of patients reported they would complete one if someone assisted them (Swanson et al, 2006)
assessment and treatment of committed patients?
- Assessment should be comprehensive: Utilize psychological measures Collateral information Consider malingering Be aware of statutory definition of mental illness - Treatment is an integral part of civil commitment: Least restrictive treatment environment must be considered Outpatient treatment is often effective, compared to traditional inpatient hospitalization
questions asked in a clinical competency interview?
- Can the defendant provide a coherent account of the alleged instant offense? - Any delusional content presented in relation to the alleged instant offense? - Does the defendant know their legal charges? - Do they know if the charges are felonies or misdemeanors, and do they know the difference? - Do they have a rational understanding of potential consequences should they be found guilty? ¡Incarceration, Probation, Fines - Roles of Key Courtroom Figures: prosecutor, judge, jury, defense attorney/lawyer - Does the defendant understand the impartiality of the judge and jury? - Does the defendant understand the adversarial nature of the trial proceeding? - asked if they understand their plea options: not guilty, guilty, not guilty by reason of insanity, no contest - asked about plea bargains: - asked about proper courtroom behavior
If a defendant is found not competent to stand trial, what are the possible outcomes?
- Competency Restoration (can occur on either inpatient or outpatient) - Dismissed Charges (without prejudice) meaning they could be brought back later on - charges could be dismissed due to a ruling in the Jackson v. Indiana case
what are some forensic instruments specifically designed to assess competency to stand trial?
- Competency to Stand Trial Assessment Instrument (CAI) - Evaluation of Competency to Stand Trial-Revised (ECST-R) - MacArthur Structure Assessment of Competence Assessment-Criminal Adjudication (MacCAT-CA)
why is Identification of mental illness as a risk factor for violence is controversial?
- Encourages stereotypes of the mentally ill - Vast majority of mentally ill are not violent and are more likely to be victims of violence than perpetrators - The relationship is complex and depends on the mental illness itself, presence of certain symptoms, and substance abuse
what are the 2 usual paths for civil commitment?
- Extended Commitment - Emergency Commitment
Which is easiest to assess: dangerousness to others, suicide risk, or the presence of grave disability? Why?
- Grave disability - no need to predict future risk
competency opinions?
- In a CST evaluation report, the expert opines on competency (ultimate opinion) or competency prongs (penultimate opinion) - Judge's final determination of competency usually coincides with expert opinions (Zapf et al., 2004) - Independent experts tend to arrive at the same opinions on competency - For example, three independent evaluators had a moderate level of agreement in 71% of CST evaluations (Gowensmith et al., 2012)
Describe the emergency commitment process in Ohio. How long can someone be held on emergency commitment?
- Initial hold can be authorized by a psychiatrist, physician, clinical psychologist, psychiatric nurse specialist or nurse practitioner, health officer, parole officer, police officer, or sheriff. in order for this to be placed..... - Individual must "represent a substantial risk of physical harm to self or others if allowed to remain at liberty pending examination" - Individual is then taken to a hospital (if not there already) and must receive an initial exam within 24 hours - "If the chief clinical officer believes that the person is a mentally ill person subject to court order, the chief clinical officer may detain the person for not more than 3 court days"
What factors make insanity evaluations difficult? (NGRI evaluations)
- Legal standards vary across states and are often unclear; there are questions about what exactly qualifies as a mental disease - Determining insanity at the time of the offense is retrospective; its not sufficient to determine someone's current mental status, we have to figure out what is was at a certain point in the past - No universally accepted interviews/psychological tests
What does research suggest regarding the effectiveness of different competency restoration treatments?
- Most effective treatment for psychotic patients is medication - Some argue that educational treatments give a false sense of artificial competence - Restoration groups have been shown to be somewhat effective (Siegel & Elwork, 1990), but it is unclear whether they have any effect beyond medication (Zapf & Roesch, 2011)
Approximately what percentage of defendants are restored to competency?
- Over 75% of all hospitalized defendants are restored to competency - Unrestorable individuals tend to have long-standing, severe psychotic symptoms or cognitive deficits
civil commitment laws are shaped by what 2 major legal doctrines?
- Parens Patriae ("parent of the nation"): Protect mentally ill from themselves - Police Power: Protect society from mentally ill
What are the most common diagnoses among defendants found incompetent to stand trial?
- Psychotic disorder (43%) - Organic diagnosis (38%) - Intellectual Disability (30%) Majority of psychotic defendants are competent (Zapf et al., 2004)
what are some protective factors against suicide?
- Social support - Coping skills - Active in treatment - Hopefulness - Dependents - Religiousness - Fear of disapproval - Fear of pain, injury, suicide, or death
what general measures of malingering are commonly used in CST evaluations?
- Structured Interview of Reported Symptoms (SIRS) - Miller-Forensic Assessment of Symptoms Test (M-FAST) - Test of Memory Malingering (TOMM) - Word Memory Test (WMT)
What event prompted the Insanity Reform Act? (1984)
- The assassination attempt on Ronald Reagan led to reform when John Hinckley was acquitted as NGRI - Shifted burden of proof to defendant for federal cases - Reduced standard of proof (to clear and convincing evidence) STORY LINE: - john Hinkley followed Regan out of a hotel - fired 6 shots - hitting Regan and secretary and officer and secret service agent - he was portrayed as being obsessed with the movie taxi driver - his attempt was intended to impress that actor in the movie - found not guilty by reason of insanity - committed in hospital and now lives in Virginia on conditional release
what is the extended commitment process in Ohio?
- The committed person must have a mental illness: "a substantial disorder of thought, mood, perception, orientation, or memory that grossly impairs judgment, behavior, capacity to recognize reality, or ability to meet the ordinary demands of life" - Must represent "a substantial risk of physical harm" to self or others OR - Must represent "a substantial and immediate risk of serious physical impairment or injury to self as manifested by evidence that the person is unable to provide for and is not providing for the person's basic physical needs because of the person's mental illness..."
What is the importance of Jackson v. Indiana (1972) for competency to stand trial outcomes?
- Theon Jackson, was 27 and was deaf and mute - he could not write/communicate through other means - he got charged stealing 2 purses - found incompetent to stand trial - ended up being confined to a state hospital for about 3.5 years - court's ruling was: Defendants cannot be held more than a reasonable period of time necessary to determine whether there is a substantial probability that they will attain capacity in the foreseeable future"
how do the courts define mental illness?
- There is no clear-cut definition, but typically only severe and treatable mental illnesses like schizophrenia and major mood disorders qualify - Intellectual disabilities, substance abuse, and personality disorders are typically excluded from the criteria - this problem applies to more than just civil commitment
if someone experiences problems with one or more of the dusky prongs....
- Those problems do not have to be related to a mental illness (but in most cases the defendant does have a severe mental illness) - What types of mental illness would affect prong #1 (factual understanding)? - What about prong #2 (rational understanding)? - What about prong #3 (consult with counsel)? - for prongs 2 and 3, schizophrenia and bipolar disorder can affect those
What percentage of cases use the insanity defense?
- about 1% of all criminal cases
What is capacity for suicide and what does it help explain?
- an important piece of suicide risk assessment helps explain what leads people to transition from suicide ideation to attempt components of capacity of suicide: - Access to lethal means - Knowledge of, and comfort with, available lethal methods - Acquired or dispositional tolerance for pain, injury, or death
What is a grave disability? Who is most likely to be committed for grave disability?
- an individual is unable to care for themselves and provide for their own basic needs (showering, eating etc.) - Young people, not the elderly, are those typically committed for grave disability because the elderly who need this care are more likely to receive services through alternative avenues like nursing homes rather than psychiatric hospitals
O'Connor v. Donaldson case? (1975)
- an individual must exhibit BOTH a mental illness and dangerousness to be civilly committed - Donaldson was a man who was confined to an understaffed state hospital in Florida alongside violent patients for 15 years despite not being dangerous to himself -
how many competency evaluations take place each year in the US?
- approx. 60,000
Structured and actuarial violence risk assessments are typically not used to evaluate current dangerousness because why?
- assessments focus on risk of future harm, not imminent risk
how do the courts define dangerousness?
- at risk for committing bodily harm to others or engaging in suicidal attempts, gestures, or ideation - Some jurisdictions rely on imminence of the threat to self or others, something likely to happen in the near future
Why is third-party information so important in insanity evaluations?
- because determining insanity evaluations at the time of the offense is retrospective - if we have to figure out the mental status of a defendant from years ago, we would need third party police records, hospital records, informant reports, etc.
How is the Ohio insanity standard the same as, or different than, the M'Naghten or ALI standards?
- borrows the mental disease/defect and wrongfulness prongs of M'Naghten - does not address the nature and quality of the act as M'Naghten does or whether the defendant could conform their conduct to the requirements of the law which is part of the ALI standard - Ohio standard is more conservative than the other modern legal standards - issues such as whether the defendant understands the nature of their acts or whether they were impulsive at the time of offense are not considered - all standards require that the defendant has to have a mental disease/defect
what is the labeling effect?
- can impact whether or not someone is judged to have a mental illness - when someone has been labeled as mentally ill, clinicians are going to continue to see them as mentally ill, disregarding their current symptoms - Individuals who have been institutionalized (or are being evaluated for institutionalization) are more likely to be labeled as mentally ill
what is competency and what are examples?
- capable of making decisions or exercising rights and being treated as unimpaired person - legally we are assumed to be competent until we show we are not Criminal proceedings examples: - Waive Miranda rights - Plead guilty - Dismiss counsel - Serve a sentence - Be executed Stand trial**** civil proceedings examples: - Ability to parent a child - Serve as a witness - Make medical decisions
In a CST evaluation, what is typically assessed that is not a part of the Dusky prongs?
- clinical interviews and behavior in court
Lessard v. Schmitt case? (1972)
- commitment proceedings should have same safeguards as criminal proceedings - ex: right to trial and right to an attorney - Alberta Lessard was hospitalized after reported suicide attempts and she was diagnosed with paranoid schizophrenia - during this process she was interviewed by a judge without notice/ legal council present and was assigned 2 physicians and a guardian - she was not offered an attorney but on her own retained a personal lawyer who assisted her - the judge who had initially okayed her hospitalization repeatedly extended the hospitalization saying that she was still "mentally ill" - Lessard eventually brought a class action suit against the state on behalf of all involuntarily committed adults in the state, arguing that her due process rights had been violated - a federal district court eventually upheld the right to constitutional protections for commitment proceedings meaning that individuals who are being petitioned for civil commitment have a right to an attorney and have their case heard by a judge
What type of competency evaluations are most psychologists wary of conducting? Why?
- competency to be executed - the political and ethical issues involved in capital punishments - have to be aware of personal biases
what is the Most prominent and frequently examined aspect of criminal competencies?
- competency to stand trial - CST can be traced back to historical English common laws prohibiting trials in absentia (Stafford, 2003) - A defendant cannot be absent from his/her own trial
Durham and Product Rule (1954)?
- court ruled that The crime "must be the offspring or product of mental disease in the defendant" - The criteria are more liberal and include: 1)The presence of a severe mental disease or defect 2)The crime was the product of this disease or defect Application of these standards is complicated: - Difficulty defining mental disease or defect - Difficulty establishing whether a crime is a product of a mental disease - Only New Hampshire and Maine use this standard
What did Rosenhan's Being Sane in Insane Places study demonstrate?
- demonstrated the problem of the labeling effect - A group of confederates presented to several different mental institutions with a single complaint: I hear a voice saying things like 'empty' and 'thud' - If admitted, they denied hearing voices anymore or any other mental health symptoms - All confederates were admitted, diagnosed with a major mental illness, and held between 7 days and 2 months involuntarily
what is the Dusky standard? (1960)
- dominant competency to stand trial standard in the US - dusky v. US: has been influential on modern competency statutes - According to the Court's ruling, a defendant must exhibit: "Sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding—and whether he has a rational as well as factual understanding of the proceedings against him"
Why are risk assessments (assessments of dangerousness) difficult to complete when evaluating for commitment?
- don't always have the luxury of reviewing detailed records and carefully applying an actuarial or SPJ risk assessment tool - these are not always appropriate for this type of risk assessment - often require an immediate decision with limited information - ex: Uncooperative patient, Lack of records and Historical information difficult to obtain
how has the M'Naghten standard been criticized?
- for being too conservative, likely to result in fewer insanity acquittals - Most conservative of the three modern insanity standards - Does not consider volitional aspects of behavior that may be impaired by a mental illness - does not capture all the ways someone could be insane
Identify the two outcomes of the Insanity Reform Act?
- g
What kind of protections does a patient have in extended commitment hearings?
- g
how did the new laws and advancement in psychiatric medication impact?
- huge decrease in the number of commitments in public hospitals - 558,000 (1955) - 100,000 (current) - resulted in a significant movement from parens patriae to police power - AKA: less about the state stepping in to tell patients how to take care of themselves and more about the sages protecting people from the mentally ill as needed
what do insanity evaluations typically include?
- interviews, psychological testing, and a review of records
what is the ILK?
- inventory of legal knowledge - malingering measure specific to competency evaluation - Basic legal knowledge questions that even people with severe mental illnesses or limited legal knowledge usually get correct - consists of true/false questions
what is civil commitment?
- involuntary hospitalization or mandated treatment of mentally ill individuals who exhibit dangerous tendencies toward themselves or others
why do we have an insanity defense?
- it is a legal compromise to one of our society's moral dilemmas - Society believes that criminals should be punished - Society also believes that it is inappropriate to punish someone who does not know what they are doing and/or cannot control their behavior When there is an absence of mens rea ("guilty mind")
As discussed in class, how is gender associated with suicide risk?
- it is one of the major risks of attempts and ideation - attempt more, but men succeed more 3x because men use more lethal methods
How restrictive must be the setting in which a committed individual is treated?
- least restrictive setting
what does research suggest regarding the quality of standard practices for conducting competency evaluations?
- low quality - reviews found that CST evaluation reports are lacking - Skeem et al. (1998) reviewed 100 competency evaluations and found that most did not provide adequate reasoning for their conclusions - Robinson & Acklin (2010) reviewed 150 competency evaluations and described them as demonstrating "pervasive mediocrity with no respect for quality"
Why is it important for us to make sure defendants are competent to stand trial?
- most frequently conducted evaluations - legal system built upon adversarial process, and rights to fair trial
is insanity a diagnosis?
- no - it is a legal term
Wyatt v. Stickney case? (1972)
- patients have a right to treatment that gives them a realistic opportunity to improve their mental condition - due to funding cuts 20 different mental health professionals were laid off from Bryce hospital - large number of affected patients and staff brought a class action lawsuit in the US district court arguing that patients in the state could not receive appropriate care due to lack of staffing - the judge agreed stating that involuntarily committed patients unquestionably have a constitutional right to receive such individual treatment
Sell v. United States case? (2003)
- patients hospitalized as incompetent to stand trial may be involuntarily medicated as part of restoration treatment if: 1. the treatment is medically appropriate 2. the treatment does not have significant side effects 3. and less intrusive methods are considered - sell was a dentist who was charged with 56 counts of mail fraud, 6 counts of medicate fraud and one count of money laundering - he was found competent to stand trial and released on bail - his mental health state decompensated while on bail and his bail was revoked - he accrued an attempted murder charge while on bail because he was caught on video conspiring to kill the FBI officer who arrested him - he was again evaluated for competency to stand trial and was found incompetent and was sent to the hospital - at the hospital he refused to take his medication and filed a court challenge in attempt to stop the hospital from medicating him - the lower court upheld the hospitals right to medicate over objection, but that decision was appealed and eventually made its way to the US supreme court
What is competency restoration?
- process by which an incompetent defendant becomes competent
what are the most common treatments in competency restoration?
- psychotropic medications, educational groups, and individual education - Most effective treatment for psychotic patients is medication - Incompetent to stand trial patients can be involuntarily medicated with a court order (Sell v. United States, 2003) - a lot of defendant's Most likely reason to refuse is psychotic delusions (Ladds & Convitt, 1994)
What are the common misconceptions regarding insanity acquittals?
- public tends to grossly over-estimate how frequently the defense is successfully used and grossly under-estimate the consequences of being found NGRI (Silver, Cirincione, & Steadman, 1994) - for example the myth is that the insanity is used frequently, but in reality it is only used in about 1% of all criminal cases - myth is that those using the insanity defense are frequently acquitted, but only about 25% are successful - Myth is that NGRI is a way to avoid serious consequences of crime, but the Fact is Only 15% of those found NGRI are released back to community. of those: - 12% have a conditional release, 3% ordered to outpatient treatment, and 1% are unconditionally released - Remaining 85% of NGRI acquitees are sent to mental hospitals indefinitely How long are insanity acquittees confined? - Myth: Not very long - Fact: An average of 33 months (much longer in some jurisdictions) - On average, NGRI acquittees spend more time in the hospital than they would have spent in prison if they had pled Guilty - Myth: Most insanity acquittees were charged with murder - Fact:15% of insanity acquittees were charged with murder (Callahan et al., 1991) - Myth: Insanity acquittees are especially dangerous after they are released - Fact: Re-offending rates are similar between NGRI patients released from hospitals and general offenders released from prisons (Pasewark et al., 1982; Kravitz & Kelly, 1999)
lake v. Cameron case? (1966)
- required that treatment should be in least restrictive setting - women with mental illness held at St. Elizabeth's hospital in Washington DC - for years despite not being dangerous to anyone / herself - she petitioned for release and eventually the courts ruled that patients who are not dangerous should not be confined if a less restrictive alternative is available - treated as outpatients
Identify the common diagnoses of defendants who cannot be restored to competency.
- severe thought disorder - intellectual disability - have long-standing, severe psychotic symptoms or cognitive deficits
what is emergency civil commitment?
- short-term usually only a few days - Less formal, with fewer protections - Allows for a short hospitalization (e.g., 24 hours to one week) - Also requires re-evaluation to maintain commitment (typically after 48 hours) - Wancheck & Bonnie (2012) found that this might be too short of a time-frame for an accurate evaluation - 72 hours may be more appropriate - This would reduce the total length of hospitalization and number of future commitments - BASIC PURPOSES: ensure the immediate safety of the patient/community, stabilization of acute psychiatric problems, lastly, give treatment team enough time to decide whether long-term commitment is needed
what is police power?
- state's obligation is not to protect to the individual from themselves, but to protect society from the individual
What is the most commonly used standard for insanity?
- the M'Naghten standard - implemented in 26 states
Who typically raises the issue of competency to stand trial?
- the defense attorney
what are the problems with criteria for civil commitment?
- the seriousness of the mental illness - how the courts define mental illness - the labeling effect - how the courts define dangerousness - not good at risk assessment in the settings that it is needed
Washington v. Harper case? (1992)
- the state can forcibly medicate some individuals if treatment is medically appropriate and unlikely has detrimental side effects - Harper was an inmate in the Washington prison system, he had a history of being violent when not taking his antipsychotic medication - he was sent to the special offenders center twice and was forced to take medication involuntarily - during the second hospitalization he filed suit in state court arguing that his 14th amendment right to due process had been violated - the trial court rejected his claim but the state supreme court reversed the decision siding with harper - the state supreme court argued that medication could only be administered to a competent, non-consenting inmate if the state could prove in a trial that forced medication was necessary and the benefits outweighed the risk
What was the first insanity standard (that dominated English law)?
- the wild beast test - For someone to be insane, he must be totally deprived of his understanding and memory, and not know what he is doing anymore than an infant, a brute, or a wild beast - compared human's thinking to that of a wild beast - dominated English law until 1843
what is the MacCAT-CA?
- unlike the others, this Assesses competency with a series of questions using a vignette - "Fred hits Larry with a pool cue—what crime might Fred be charged with?" Assesses three different areas of competence: - Understanding - Reasoning - Appreciation the Vignettes may not apply directly to the defendant's case - advantage: in competency interviews defendants sometimes have trouble separating important legal concepts from the facts of their case, they might refuse to define the guilty plea because they think that would interpret them as admitting guilt, by focusing on a hypothetical case the defendant can show that they know about the legal system without getting tangled up in the details of their own case - disadvantage: part of assessing competency does involve assessing whether a client understands key aspects of their own case, and you can't assess that directly if you are using a hypothetical vignette
What is the longest that someone can be committed for competency restoration in Ohio?
- up to a year also depends on seriousness of crime: Up to a year (serious felonies) Up to six months (less serious felonies) 60 days (M-1 or M-2) 30 days (M-3, M-4, or MM)
what is extended civil commitment?
- used for commitments that are long-term - individuals have Numerous civil protections - Attorneys become less adversarial and some protections may be diminished in trial - Average length of hearings is 12 minutes (Leavitt & Maykuth, 1989) - The patient is typically committed from 2 weeks to one year - There are periods of formal re-evaluation needed to maintain commitment (e.g., every three months)
Are the majority of mentally ill individuals competent to make their own medical decisions?
- yes - Involuntarily committed individuals still have the right to make medical decisions (this category includes mental health treatment) - Appelbaum (1995) found that 50% of schizophrenia patients and 76% of severely depressed patients had passing scores on a measure of competency to make medical decisions
what does insanity focus on?
-on mental state at the time of the offense (MSO )
What are the three prongs of the M'Naghten standard?
1) Must suffer from a severe mental illness or disease of mind 2) They either did not know the nature and quality of their act OR 3) They did not know it was wrong - 1843, daniel M'Naghten developed delusions that the Tory party (ruling political party at the time) were out to get him - he travelled to London to kill the Prime Minister to protect himself but shot the Prime minister's secretary instead by accident - the prosecution agreed that he was mentally ill but under the wild beast test they claimed that his mental illness was not so severe to justify complete removable of responsibility - 9 witnesses testified that he was insane because his delusional beliefs made him unable to tell the difference between right and wrong - he was committed to a mental hospital for the rest of his life THE RULING STATED: - it must be clearly proved that, at the time of the committing of the act, the party accused was labouring under such a defect of reason, from disease of mind, as not to know the nature and quality of the act he was doing; or, if he did know it, that he did not know he was doing what was wrong"
Under which conditions can a mental health provider act without informed consent?
1) There is a greater risk if treatment is delayed 2) A reasonable person would consent 3) The person would normally consent to the treatment (if able to consent)
What are the three prongs of the Dusky competency standard? Describe each.
1)defendant must have A factual understanding of the court proceedings, meaning they must understand the basic facts about how the court works and the basic facts of the allegations against them 2)A rational understanding of the court proceedings, meaning they not only understand in principle how the courts work, but how the different aspects of the system function and affect each pother, and understand the facts of their own case and how that applies to the general understanding of the court system 3) The ability to assist in own defense through consulting counsel, means they're able to work with an attorney in favor of their own defense - competency evaluations Focus on the present - based on Capacity rather than Willingness - defendants need to have a Reasonable degree of understanding, the bar is considered fairly low for this area
what are the steps for extended commitment?
1.A petition to the court for court-ordered commitment 2.Court review of the petition 3.Formal psychological evaluation 4.Hearing after the evaluation has been conducted, patient allowed to attend 5.Commitment of the individual
what are the two universal criteria for civil commitment?
1.Presence of a mental illness 2.Presence of dangerousness to self or others
Borum and Grisso evaluation? (1995)
Borum & Grisso (1995) forensic psych researchers, examined standard practices for conducting competency evaluations - 51% of psychologists view testing as essential (49% as optional) - Standards of practice vary considerably - Clinical interview is the most common method for evaluating competency (used in nearly all CST evaluations)
what are other competency evaluations?
Competency to Waive Miranda Rights: - Miranda v. Arizona (1966) established that suspects must have the ability to knowingly, voluntarily, and intelligently waive their rights Competency to Refuse the Insanity Defense: - Frendak v. United States (1979) established that defendants must understand the insanity plea and consequences of entering an insanity plea Competency to be Treated/Make Medical Decisions: - Informed consent is required before someone receives a medical procedure Competency to Execute a Will: - Banks v Goodfellow (1870): A testator must know they are making a will, know the nature of the property, and know the manner in which the will distributes it - Evaluation is conducted after the testator has passed away - Have to rely on third-party interviews and records to determine their functional abilities and preferences
Describe the change in hospitalization rates from the early 1900's to today. What two factors drove this change?
Early 1900's: - Patients were hospitalized indefinitely based on a mental health professional's recommendation - no real need for Precise diagnosis or assessment of dangerousness to self or others not required 1960's-Current: - people started to point out that this was a deprivation of civil rights for psychiatric patients who were hospitalized against their will - hospitalized under questionable circumstances - patients had very little say of what happened to them or when they could be released - Antipsychotic meds allowed for the release of individuals and was more effective - Patients were granted more civil rights
Dusky is interpreted differently in different jurisdictions
For example, Ohio has a two-prong interpretation
what are major risk factors for suicidal ideation and attempts?
History of suicidal behavior Hopelessness Impulsivity Gender
how does Ohio define dangerousness, grave disability and mental illness?
Mental illness defined: - "A substantial disorder of thought, mood, perception, orientation, or memory that grossly impairs judgment, behavior, capacity to recognize reality, or ability to meet the ordinary demands of life" Dangerousness defined: - "A substantial risk of physical harm to self or others" Grave disability defined: - "A substantial and immediate risk of serious physical impairment or injury to self as manifested by evidence that the person is unable to provide for and is not providing for the person's basic physical needs"
what other variables are relevant to CST evaluations?
Professional differences - Forensic Psychologists, compared to Forensic Psychiatrists, psychologists: - Gather more comprehensive information - Prepare more detailed and useful reports Professional setting (outpatient v. inpatient) - Outpatient settings are more likely to use psychological testing, take more time, conduct fewer clinical interviews
What are the criteria for competency to stand trial (CST) in Ohio, and how do they compare to the Dusky standard?
To be Competent to Stand Trial in Ohio, the defendant must be capable of: - "[U]nderstanding the nature and objective of the proceedings against the defendant" - "[A]ssisting in the defendant's defendant - the Ohio capacity are rooted in the prongs but are framed differently - the first prong of Ohio, essentially combines the factual and rational prongs of Dusky
What are the key differences between competency and insanity evaluations?
competency: - mental illness does not need to be present - focuses on present - domain: civil/criminal - must establish competency before entering a plea insanity: - mental illness does need to be present - focuses on past - domain: criminal - requires admitting to the crime in order to mount the defense
assessment of danger primarily focuses on what?
suicide risk assessment
