Other Criminal Trial–Related Competency Issues

Chapter 7 addresses other competency issues that may arise in conjunction with criminal justice proceedings. There are a range of such issues, and each potentially targets a different functional capacity. They include the competence to waive your Miranda rights and confess to a crime or make other self-incriminating statements; the competence to plead guilty and waive your right to a trial; the competence to waive your right to an attorney and represent yourself; and the competence to testify. This chapter provides a brief examination of the history and evolution of each of these competency issues, their governing standards, and related judicial procedures. To frame this discussion, an examination is provided of various potential impacts of mental disorders on each of these criminal trial-related competencies.

Mental Disorders and Criminal Behavior

Chapter 1 provides core background information regarding mental disorders and their functional impact, particularly when associated with criminal behavior and defendants facing trial. This chapter dissects various myths pertaining to mental disorders, presents an overview of the different models used to understand, explain, and respond to mental disorders, and explores the diagnosis and differentiation of mental disorders.

Alternatives and Closing Remarks

The concluding chapter, Chapter 12, notes alternatives—such as diversion and mental health courts—to the commonly employed criminal justice proceedings that are being explored in the hope that they may be better suited for processing defendants with a mental disorder and thereby help to resolve some of the thorniest issues faced by the criminal justice system and society. It closes by reiterating the challenging nature of this field and stresses the important role that forensic mental health evaluators and their evaluations can play.

Insanity Defense Variations and Alternatives for Addressing the Criminal Responsibility of a Defendant with a Mental Disorder

Because of continuing reservations about the insanity defense but with the underlying consensus that a defendant’s mental disorder at the time of the offense should in some cases be relevant when determining criminal responsibility, various iterations of and alternatives to the insanity defense have been recognized. Chapter 9 addresses a number of these variations, such as the deific decree defense, the PTSD defense, the battered spouse/child syndrome defense, and the urban psychosis defense, as well as the abolition of the insanity defense or related mental health evidence, shifting the burden of proof to the defendant, heightening the level of proof required to establish the defense, the guilty but mentally ill verdict, the diminished capacity defense, and the so-called temporary or “he/she snapped” defense. This chapter also discusses other criminal responsibility issues that a defendant’s mental disorder may impact, namely, the mens rea (criminal intent) and actus reus (criminal act) elements of a criminal prosecution. For example, if a defendant lacked control over his or her actions, a crime is not considered to have occurred. Thus, the law recognizes an automatism or unconsciousness argument, which may encompass epilepsy, a concussion, or a fugue state. More controversial are the sleep-walking defense and the “multiple personality disorder” defense. This chapter also addresses the two USSC rulings germane to these various iterations and alternatives.

Introduction

High-profile cases have drawn considerable attention to society’s ongoing struggle with how to approach and manage cases involving criminal offenders with a mental disorder. In these cases questions arise whether it is fair and just a) to conduct criminal proceedings while a defendant is experiencing a mental disorder and b) to hold individuals who were experiencing a mental disorder at the time of the crime fully accountable for their actions and punish them accordingly. What, if any, special rules and procedures should be employed? No set of issues poses a greater challenge to the criminal justice system than how to respond to individuals whose criminal actions can be attributed to a mental disorder or are experiencing a mental disorder during the course of their trial. Indeed, these cases illuminate who we are as a society.

Dispositions after the Competence to Stand Trial Hearing

At the close of the CST hearing, the defendant will be found to be either CST or IST. Chapter 6 addresses what occurs next. If the defendant is found to be CST, the trial proceedings usually resume where they left off, although scrutiny of the defendant’s CST should continue. If the defendant is found to be IST, the trial proceedings will generally remain suspended while custodial treatment is typically ordered for the defendant as the State is given an opportunity to try and restore the defendant’s CST. This chapter provides an overview of the continuing evolution of these placements, as well as a pair of rulings by the USSC that set a ceiling on how long IST defendants can be held by the State in an attempt to restore their CST, established these defendants have a right to refuse medication prescribed to facilitate this restoration, and specified the criteria that must be met if the State wants to administer this medication over a defendant’s objection. Although, as discussed, the increased use of correctional facilities for these placements may be questionable, the systematic resolution of the issues arising following a CST hearing that has emerged provides greater assurance that these determinations are made in a relatively fair and just manner.

Procedural Aspects of Competence to Stand Trial Determinations

Chapter 5 continues the discussion of CST issues, but focuses on the procedural aspects of these determinations, an oftentimes overlooked but key component as the presence or absence of procedural hoops can be outcome-determinative. Traditionally, CST hearings were handled informally by the presiding trial judge with few procedural checks in place, affording these judges considerable discretion in reaching their decision. As unease with this arrangement emerged, procedures were put in place by state legislatures to guide and shape the decision-making process, although some of these procedures have been challenged as unlawfully skewing the results. In response, the Supreme Court has issued a pair of rulings that provide a framework for examining these procedures, although a range of potential challenges remain unaddressed. In addition, as this chapter concludes the text’s examination of the substantive standards and procedural requirements governing CST hearings, an overview is provided of what forensic evaluators should address in their assessments, reports, and testimony regarding defendants’ CST, as well as a series of factors that can complicate these determinations.

Overview of Forensic Mental Health Assessments

Chapter 2 presents an overview of forensic mental health assessments and their deployment within the criminal justice system. This chapter describes how forensic mental health assessments are conducted, the multiple steps taken in the course of these assessments, and the challenges and tensions associated with providing them within the criminal justice system. In addition, it delineates their distinctive nature and how they differ from clinical evaluations and mental health treatment. This chapter also discusses a key question that frequently arises in conjunction with these assessments, namely, distinguishing a genuine report of a mental disorder and its impact from malingering (i.e., the faking of an illness), and strategies for making this distinction.

Procedural Aspects of Insanity Defense Determinations

Chapter 10 addresses the trial-related procedures used to evaluate an insanity defense, with the USSC generally having left it to the states to decide for themselves what procedures to employ. Although they often share some common features, the states have also adopted—like the numerous variations in their insanity tests—different procedures for generating related forensic mental health evaluations, reflecting the widespread uncertainty and disagreement over how to handle these cases. This chapter describes some of these procedures and the controversies associated with them.

The Insanity Defense

Chapter 8 addresses the insanity defense, its lengthy and controversial history, its basic threads and iterations, its evolution over time, the current tests employed, and the lack of consensus regarding what the relevant standard should be. This chapter also describes the rationale for and opposition to the defense—although most seem to agree that at least under some circumstances a defendant’s mental status at the time of the crime is a factor that should be relevant during subsequent criminal proceedings—and various widely-held myths regarding its prevalence, use, and impact. The chapter begins with descriptions of a series of notorious cases where an insanity defense was raised or widely thought to have been raised. For better or for worse, these cases have generally shaped the public’s perception of this defense. The chapter ends with an account of the single U.S. Supreme Court ruling that directly addressed whether the insanity tests currently employed are subject to constitutional scrutiny.