Insanity Defense Research Articles

Parricide and homicide NGRI offenders: How do they differ?

The aim of the present study was to provide a forensic psychiatric characterization of perpetrators of parricide who were found not guilty by reason of insanity (NGRI). We conducted a study involving 52 NGRI patients who had committed homicide or attempted homicide within the Department of Forensic Psychiatry in Thessaloniki, Greece, between January 2015 and 2020. Subjects were categorized into two groups: parricide (n = 21) and a control group (n = 31). Our findings revealed that in the parricide group, the majority of patients were unmarried males in their thirties, with a history of prior contact with mental health services and nonadherence to treatment. Additionally, they had a background of substance abuse and exhibited violent behavior before the index crime. A notable trend observed among parricide offenders was the tendency to seek hospitalization, possibly as a means of distancing themselves from stressful family environments, based on information obtained in the interviews conducted as a part of this research. All instances of parricide involved the use of sharp weapons, and the crimes were consistently committed in private settings. Symptomatology among parricide patients was assessed as moderate to severe, with a significant long-term risk observed following the crime. The primary differences identified between the two groups were the higher pre-crime voluntary admissions and the elevated estimated postcrime risk observed in the parricide group. Early intervention, comprehensive assessment of risk factors, family support, and assistance in resolving conflicts and reintegrating patients into society are emphasized as critical interventions that can potentially prevent future tragedies.

Heterogeneity in momentary affective experiences related to suicidal urges in a non-clinical sample of adult handgun owners and non-owners recruited from the community

Although suicide is complex and heterogeneous, most suicide theories assume that suicidal urges occur primarily in the context of extreme emotional distress. Newer models of suicide based on complex systems theory propose greater heterogeneity in suicidal experiences across individuals and groups, such that some, but not all, suicidal thoughts, urges, and behaviors are associated with extreme negative affect. The present study investigated individual differences in affective states experienced during suicidal urges among 138 adults recruited from the community; 81 (59.1 %) owned handguns and 57 (41.6 %) did not. Participants self-reported their current affect and urge to kill themselves 6 times per day for 28 consecutive days via ecological momentary assessment. Positive and negative affect ratings varied significantly during suicidal urges. The association of positive and negative affect with suicidal urges significantly varied within and between handgun owners and non-owners. Results suggest suicidal urges are characterized by high affective heterogeneity.

Fifty Years of Psychiatric Classification and Epidemiology Interactions: What is a Mental Disorder?

Psychiatric clinical diagnostic formulation has evolved over time. The changes alter our understanding and our ability to provide a public health perspective on the epidemiology of mental disorders in large populations. Epidemiology is an important perspective and set of tools to assess prevalence, treated prevalence, untreated prevalence, individual risks for mental disorders, and possible links to the etiology of disorders by following the trails of environmental exposures, biological measures, interpersonal dynamics, and genetic risk factors. As communities develop health-care services to treat individuals with mental disorders, knowledge about their prevalence and treatment requirements is also important. Since severe mental disorders may require institutional care, the diagnostic criteria used may either protect an individual’s liability for dangerous behavior (i.e. the insanity defense) or be used to control political and social dissidents. The criteria may also be used to determine evidence-based treatment options and eligibility for disability benefits. In this paper, using my vantage points as a physician scientist and public health officer, with leadership positions in national federal and professional mental health organizations, I address the developments in these areas over the past 50 years that have influenced institutional positions in the U.S. National Institute of Mental Health, the World Health Organization, the American Psychiatric Association, and the Center for the Study of Traumatic Stress. These perspectives may aid the next generation of investigators to advance the epidemiological and mental disorder classification scientific fields.

Navigating the intersection of psychiatry and law: Insights into insanity defense and fitness to stand trial in the Indian legal system

In the complex landscape of forensic psychiatry, the intersection of mental health and the legal system presents challenges that demand clear guidelines for effective navigation. This letter delves into the pivotal roles psychiatrists play in assessing the insanity defense and determining fitness to stand trial, crucial aspects intertwined with the principles of justice and human rights. Moreover, we elucidate the nuanced interpretation of Section 22 of Bhartiya Nyaya Sanhita (previously Section 84 of the Indian Penal Code), which delineates the criteria for absolving individuals of criminal responsibility due to mental illness. Comparisons with McNaughten’s rule highlight subtle differences in legal frameworks and their implications for verdicts of "not guilty by reason of insanity." Furthermore, our article emphasizes the importance of interdisciplinary collaboration between psychiatry and forensic medicine to enhance comprehension of legal complexities thereby improving the management of forensic patients. With a visual aid we will facilitate understanding of the multifaceted concepts discussed herein. By fostering dialogue and collaboration, we aim to contribute to a more informed and equitable legal approach to individuals with mental health concerns within the criminal justice system.Top of Form

Dissociation and the insanity defense: A review of U.S. Federal appellate case law.

Pathological dissociation is relatively common in the United States and may be associated with violent or criminal behavior. Dissociative Disorders, especially Dissociative Identity Disorder, are considered controversial diagnoses by some in the psychiatric and legal professions. Individuals who offend during dissociative states may not be criminally responsible if they meet the legal standard for insanity, however, insanity pleas based on dissociative symptoms are rare. This review examined Federal appellate case law for potential legal barriers to the insanity defense for dissociative conditions and any restrictions imposed on related expert evidence. Few rulings directly addressed these questions but there do not appear to be any unique barriers for dissociation-related insanity pleas. Some cases provided valuable insights regarding the admission of expert evidence, effective expert testimony, and the role of defense counsel.

Alison C. Pedley, Mothers, Criminal Insanity and the Asylum in Victorian England. Cure, Redemption and Rehabilitation

Alison C. Pedley, <i>Mothers, Criminal Insanity and the Asylum in Victorian England. Cure, Redemption and Rehabilitation</i>

An integrated model for criminal responsibility in action: How Swedish criminal law operates without an insanity defence

AbstractIn nearly all criminal justice systems, a defendant’s severe mental disorder can trigger special rules that excuse or exempt the defendant. Swedish criminal law adopts an alternative approach that considers all defendants to be equal in terms of accountability, or capacity for responsibility, and lacks any rules that excuse or exempt a defendant with a severe mental disorder or disability. This paper presents the first comprehensive study of how Swedish criminal law functions without an insanity defence. The analysis focuses on the legal assessment of mens rea and offers observations regarding the Swedish model that are of particular relevance for discussions concerning the potential and pitfalls of an “integrated” model for criminal responsibility.

A patient`s trajectory with autism spectrum disorder leading to forensic psychiatric institutionalisation

IntroductionAutism-spectrum-disorder (ASD) is a heterogenous neurodevelopmental condition with a wide range of symptoms. Typical deficits, such as impairment in social communication and interactions, can lead to violent behaviours. However, ASD is often underdiagnosed and little is known about patients with ASD in forensic institutions.ObjectivesTo highlight the diagnostic challenges and offending behaviour of people with ASD in the context of the criminal justice system (CJS) through a case report.MethodsThe case report is based on exploration, third party anamnesis, medical documentations and court filesResults A 25-year-old man was placed in detention in 2021 after having committed a dangerous threat to unknown persons and was considered not guilty by reason of insanity. Since early childhood the patient presented with extreme mood swings and impulsive-aggressive outbursts that led to criminal mischief later on. During elementary school he developed concentration problems as well as specific learning deficits. Due to his deviant social behaviour, he was rejected from his peer group. Over the course of the years, he showed no significant responses to different psychopharmacological treatment approaches. His social anxiety grew and ultimately, he started experimenting with various drugs and drinking excessive amounts of alcohol, which induced multiple psychotic episodes. Due to the psychotic exacerbations, he was repeatedly admitted to psychiatric units for acute treatment, however the autistic disorder remained untreated. At the time of the crime an independent psychiatric assessor diagnosed schizophrenia simplex and multiple drug abuse. The patient had been in psychiatric treatment since the age of 5 and received multiple diagnoses such as combined personality disorder, different subtypes of schizophrenia, ADHD, Tourette syndrome, depressive disorder and ASD at the age of 14. Nevertheless, prior to his detention he had never received a complex therapy focusing on his ASD. According to the verdict he was admitted to a medium secure forensic ward in Lower Austria, where he was treated with antipsychotic and anxiolytic medication. Furthermore, he participated in the day-structuring treatment program ensuring routine.Conclusions Neurodevelopmental disorders such as ASD often impose a diagnostic challenge, particularly without intellectual disability. This can lead to under- and misdiagnosis, inadequate treatment or even criminal behaviour. Impaired theory of mind, poor emotional regulation and problems with moral reasoning should be recognized and treated specifically early on to prevent further damage to both the individual and society.Disclosure of InterestNone Declared

Insanity Defence Under the Indian Criminal justice System

The "Insanity Defence" within the framework of the Indian Legal System serves as a protective measure for individuals accused of criminal offenses, especially when they lack the mental capacity to understand the nature of their actions or differentiate between right and wrong. This defence aligns with the legal principle “Actus non facit reum nisi mens sit rea,” which emphasizes that for an action to be deemed unlawful, it must be accompanied by a guilty mind. Consequently, punishing individuals who are not accountable for their actions would contravene fundamental human rights enshrined in the Constitution of India. To delve deeper into the concept of the insanity defence, it's essential to trace its origins and development within English law and its subsequent impact on Indian legal statutes. It's crucial to understand that insanity defence isn't merely a matter of suffering from a mental illness; rather, it requires a demonstration that the accused lacked the mental capacity to comprehend the consequences of their actions. Thus, the burden of proof lies with the accused, who must provide compelling evidence to establish their state of insanity, akin to the standard of “preponderance of the evidence” often seen in civil cases. This paper seeks to analyze the intricacies of insanity within the legal framework and how it has evolved into a potential loophole within the current judicial system.

Analysis of Doctrine of Insanity Defense in English Criminal Law

A person suffering from legal insanity cannot be held responsible for his criminal act. English criminal law recognizes the doctrine of the insanity defense against the criminal responsibility of an accused. The objective of this paper is to study the English law on insanity defense using the doctrinal legal analysis approach. The findings show that English law deals with legal insanity differently than medical insanity. However, the opinion of the medical professionals is mandatory to determine the legal insanity of a person. Furthermore, the standard of evidence to determine legal insanity is the balance of probabilities. English law treats the insanity defense as distinct from the defense of automatism and diminished capacity and the incompetency to stand trial is also dealt with differently than the defense of insanity in English law. English law on the defense of insanity must be interpreted comprehensively by adopting multidisciplinary approaches.

Disorder in the Court: Morality, Myth, and the Insanity Defense

Disorder in the Court: Morality, Myth, and the Insanity Defense

Forensic mental health in Kuwait: filling the gaps

The case of M’Naghten (1843) laid out the insanity defence test for the British legal system. Later, many countries basing their criminal legislation on the British common law system, including the Criminal Act of Kuwait, adopted the test. The Act forms the basis for forensic psychiatric assessments. Several countries amended their criminal laws to provide a better balance between public safety and human rights protection. However, the Criminal Act of Kuwait remains unchanged for offenders with mental illness since its enactment in the early 1960s, with several gaps concerning the detention mechanisms and the discharge of such offenders. However the Kuwait Mental Health Law (2019) eventually filled these gaps. This paper describes the function of forensic mental health services in Kuwait, discusses and compares the Criminal Act of Kuwait with other nations’ criminal laws and describes the forensic section of the Kuwait Mental Health Law (2019).

Unfitness to stand trial and the social model of disability: challenges for Latin American criminal justice

ABSTRACT The social model of disability has contributed important legislative modifications to civil law in several Latin American countries. Substitute decision-making regimes are being replaced by supports in the exercise of legal capacity based on the rights, will, and preferences of persons with disabilities. The Committee on the Rights of Persons with Disabilities has pointed out that the legal concepts of ‘unfitness to stand trial’ and ‘not guilty by reason of insanity' are contrary to the Convention on the Rights of Persons with Disabilities. In the field of Latin American criminal law, the social model still bears scant influence in dogmatic and criminal procedures. Mexico and Argentina have recently incorporated procedural accommodations and support in their criminal procedural codes, which is an advance in terms of compliance with the CRPD. The reforms have not led to further discussion on the concepts of unfitness to stand in trial and inimputabilidad or their harmonisation with human rights standards, and thus persons with disabilities who are found not guilty by reason of insanity are sent to prison to receive treatment in Mexico, and in Argentina they are derived to civil judges and placed in psychiatric hospital. Despite changes, most local authors maintain traditional views.

The Child Soldier, the Defence of Insanity and Dominic Ongwen

The Child Soldier, the Defence of Insanity and Dominic Ongwen

The Viability of Insanity Defense in Federal Revocation Proceedings

The Viability of Insanity Defense in Federal Revocation Proceedings

Avoiding the Question: The Court's Decision to Leave the Insanity Defense in State Hands in &lt;i&gt;Kahler v. Kansas&lt;/i&gt;

Avoiding the Question: The Court's Decision to Leave the Insanity Defense in State Hands in &lt;i&gt;Kahler v. Kansas&lt;/i&gt;

Treatment of mentally disordered offenders in Italy: prisons and REMS

In Italy, the treatment of dangerous patients found not guilty by reason of insanity (NGRI) underwent a radical reform in 2014 with the Law 81, that promulgated the closure of secure hospitals, Ospedali Psichiatrici Giudiziari (OPG), that provided psychiatric care within a secure setting. OPG were replaced by new psychiatric facilities called Residence for the Execution of a Security Measure (REMS) which currently host NGRI patients who cannot be sent to prison. Eight years after the creation of the REMS, many questions still need to be addressed in relation to their functions, limitations, and cooperation with the other services. This article describes the process of deinstitutionalisation of psychiatric care in Italy over the past forty years, which culminated in the creation of the REMS. The functioning of the REMS and some of the issues that have emerged since their creation are explored, and possible solutions are proposed. Finally, the impact of the 2014 reform on psychiatric care in Italian prisons is highlighted.

Insanity Defense in US Law: A Critical Analysis

Insanity Defense in US Law: A Critical Analysis

Evolution of Modern Insanity Defense: A Critical Review

Evolution of Modern Insanity Defense: A Critical Review

The Japanese M’Naghten Rule: the assessment of the insanity defence in Japan

ABSTRACT The assessment of the insanity defence for mentally disordered offenders is a significant issue in murder trials in Japan. While acts of insanity are not punishable in theory, insanity is not an absolute defence even when proven; that is, the existence of a mental disorder that influenced the crime does not guarantee that an offender will not face the death penalty. Decisions about the sanity and responsibility of mentally disordered offenders are often made without evident basis, and the lack of guidelines in this regard often leads to subjective assessments. This article provides an overview of the problems surrounding the assessment of the insanity defence, mainly the psychiatric evaluations and the wrongness limb of the M’Naghten Rules as applied in Japan. Supplemented by case examples to illustrate the inconsistencies in the decision-making process, this article highlights the need for greater clarity and consistency in the assessment of the insanity defence.