Aspects of Civil Commitment
1. Involuntary hospitalization or mandated treatment...
2....or mentally ill individuals...
3....who exhibit dangerous tendencies...
4....towards themselves or others
Parens Patriae "parent of the nation
Protect mentally ill from themselves
Police Power
Protect others from mentally ill
How many people were psychiatrically hospitalized in the 1950's compared to now?
500,000 compared to less than 100,000
What reasons led to the change in the number of people that were hospitalized?
More civil rights given to patients, and the development of antipsychotic medications
What was the result of the O'Connor v. Donaldson (1975) case for civil commitment laws?
An individual must exhibit both a mental illness AND dangerousness to self or others in order to be civilly committed
Why are mental disorders like substance use typically excluded from the courts definition of mental illness?
There are several problems that make the determinations of mental illness and dangerousness more complicated
Labeling Effect
A form of bias illustrated by the infamous Rosenhan study: Sane in Insane Places
Does a labeling effect increase or decrease the chances of someone being institutionalized when evaluated for civil commitment?
Individuals who have been institutionalized (or are being evaluated for institutionalization) are more likely to be labeled as mentally ill
What were the results of the Rosenhan Study?
The number of people admitted into the hospital and the average length of stay demonstrated the power of labeling effects
Why are risk assessments more difficult in the context of civil commitments?
There is typically a need for an immediate decision with limited information
Grave Disability
Occurs when an individual is unable to care for themselves and provide for their own basic needs (e.g., showering, eating, etc.)
Extended commitments
Numerous civil protections are in place
However, many attorneys became less adversarial and therefore some protections may be diminish
Average length of hearings is 12 minutes
Typically the patient is committed from 2 weeks to one year
There are periods o
Emergency commitments
Less formal with fewer protections
Authorized by a law enforcement officer or mental health professional
Allows for a short hospitalization (e.g., 24 hours to one week)
Also requires re-evaluation to maintain commitment (typically after 48 hours)
Wancheck
Define the main types of outpatient commitment
-Traditional Outpatient commitment
-Preventative commitment
-Conditional Release
Traditional Outpatient Commitment
Individual meets criteria for civil commitment but the least restrictive setting is the community
Preventative Commitment
Individuals DO NOT meetcriteria for civil commitment but expected to deteriorate and meet the criteria in the future
Conditional Release
Individual has been recently released from a psychiatric hospital with the condition that they participate in outpatient treatment
What are the criticisms of preventative commitment?
Leads to more people who are involuntarily given treatment
What are the criticisms of conditional release?
Gives power back to mental health professionals
Is outpatient commitment frequently utilized?
Outpatient Commitment is rarely utilized
What percentage of patients are involuntarily committed?
Over 30%
Is the percentage of patients who are coerced likely to be higher or lower than the percentage of patients involuntarily hospitalized?
Higher
According to research reviewed in class and in the book, how can a patient's perception of coercion be reduced?
Persuasion, Threat or show of force, Legal force, Giving an order, Deception
Which of the following groups is most likely to make a patient feel coerced: friends, family, law enforcement, or mental health professionals?
Mental health professionals provide the most important source of coercion
Procedural Justice
The notion that an individual has been treated fairly regardless of outcome
How is procedural justice related to a patient's perception of the level of coercion?
Patient perceptions of level of coercion is related to their perception of procedural justice
How is procedural justice related to outcome?
The notion that an individual has been treated fairly, regardless of outcome.
What are the primary implications of Sell v. United States (2003) for civil commitment treatment?
Patients hospitalized as incompetent to stand trial may be involuntarily medicated if 1) the treatment is medically appropriate ; 2) the treatment does not have significant side effects; and 3) less intrusive methods are considered
Are the majority of the mentally ill competent enough to make medical decisions?
Yes
What is a mental health advanced directive?
Allows the patient to make any treatment decisions before they become incapacitated
What percentage of patients have signed a mental health advanced directive?
4-13%
What percentage of patients would like to complete one a mental health advanced directive is someone helped them?
Over 77%
Which is easier to assess, suicide risk or the presence of grave disability?
Grave Disability
Why is grave disability easier to assess?
The clinician does not need to make a prediction
Which amendment is the basis for legal standards relating to competency to stand trial?
6th Amendment
What happens if a defendant is found not competent to stand trial?
The legal proceedings are put on hold until they are restored to competency
What is the most frequently conducted competency evaluation?
Competency to Stand Trial (CST)
What prohibiting trials in absentia mean?
A criminal proceeding in a court of law in which the person who is subject to it is not physically present at those proceedings. In absentia is Latin for "in the absence".
What are the two prongs of the Dusky competency standard?
-A factual and rational understanding of the court proceedings
-The ability to cooperate with one's attorney
True or False: In order to be found not competent to stand trial, defendants must have a mental illness
False, they do not
How often do competency evaluations occur?
Attorneys have some doubt about their client's competency in as many as 15% of felony cases, however, they only request a competency evaluation in half of these cases
How often are people found not competent to stand trial?
Only 20% of competency evaluations opine that a defendant is not competent to stand trial
Who typically raises the issue of competency to stand trial?
The defense attorney followed by the judge
True or False: After an evaluation is ordered, forensic psychologists frequently testify in Court regarding a defendant's competency to stand trial
False?
If a defendant is found not competent to stand trial, what are the possible outcomes?
Competency Restoration
Dismissed Charges
What is the importance of Jackson v. Indiana (1972) for competency to stand trial outcomes?
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
What is the most frequently used method of assessment in competency evaluations?
Clinical Interview
What is the most infrequently used method of assessment in competency evaluations?
Competency Specific Tests
True or False: Evaluators and judges typically agree in their opinions on competency to stand trial
True
What are the primary characteristics of the CAI?
What is a plea bargain?"
"What is the role of a judge?...or a jury?..."
Criticized for lack of norms
More like a 'cheat sheet' than a measure
What are the primary characteristics of the MacCAT-CA?
-Assesses competency with a series of questions regarding a vignette
-Assesses three different areas of competence: understanding, reasoning, and appreciation
-Criticized because the vignettes may not directly apply to the defendant's case
How are the CAI and MacCAT-CA different?
CAI- 13 component semi-structured interview, more like a cheat sheet than a measure
MacCAT-CA- Assesses competency with a series of questions regarding a vignette. Assesses three different areas of competence: understanding, reasoning, and appreciation. C
Explain what the following aspect of competency evaluations mean (Grisso, 1988):
Provides a description of functional abilities
-Provide a description of functional abilities
-Describe casual explanation for deficits in functional abilities
-Consider how deficits and the situation interact
-Provide a conclusory opinion
-Identify prescriptive interventions to restore individual to
Approximately what percentage of individuals evaluated for competency to stand trial are malingering?
15% of CST evaluees are malingering
What are the most common diagnoses among defendants found incompetent to stand trial?
-Psychotic Disorder (43%)
-Organic Diagnosis (38%)
-Intellectual Disability (30%)
What are the differences between the practices of forensic psychologists and psychiatrists who conduct competency to stand trial evaluations?
Forensic Psychologists
-use more collateral information
-Produce more clinical notes
-Complete more useful reports
-More frequently use psychological testing
-Use more and longer interviews
-Spend more time preparing than forensic psychologists
What were the findings of Skeem et al. (1998) and what were the implications of it for competency assessment?
Found that most did not provide reasoning for their conclusions
What is competency restoration?
Process by which an incompetent defendant becomes competent
What are the common characteristics of defendants who cannot be restored to competency?
Unrestorable individuals tend to have long-standing, severe psychotic symptoms or cognitive defects
What is the most effective competency restoration treatment for psychotic patients?
Medication
What is artificial competence?
Some argue that educational treatments give a false sense of artificial competence
What was the primary implication of Ford v. Wainwright (1986)?
Competency to be executed
Why are most psychologists wary of conducting competency to be executed assessments?
Ford v. Wainwright? ee
How does an evaluator determine 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 died
-Have to use third-party interviews and rec
What are the key differences between civil commitment, competencies, and insanity in terms of time frame?
Civil Commitment- Focuses on present and future
Competencies- Focuses on present
Insanity- Focuses on past
Does the defendant need to admit to the crime in order to be found insane?
Yes
What are the two prongs of the M'Naghten standard?
1) Must suffer from a severe mental disease or severe mental defect
2) As a result, they either did not know the nature and quality of their act or did not know it was wrong
What are examples of severe mental diseases that would qualify for an insanity defense?
Psychotic Disorders and Bipolar Disorder
What does it mean to "not know the nature and quality of one's actions"?
A very rare occurrence that is characterized by having no idea what one is doing
Rank the three main insanity standards (M'Naghten, Product Rule, and ALI) in terms of how conservative they are (i.e., conservative standards would be the hardest for defendants to use successfully)
M'Naghten is the most conservative of the three modern insanity standards. ALI Rule is second, and Product Rule is third.
Rank the three main insanity standards in terms of number of states that apply each standard
M'Naghten- 26 states including Ohio
Product- New Hampshire
What is the American Law Institute?
A group of lawyers that draft proposed laws and suggest legal reforms but do not have any legal authority to make these changes binding in law
What is the primary difference between the ALI standard and the M'Naghten standard?
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
What prompted the Insanity Reform Act?
John Hinkley after the assassination attempt on Ronald Regan
True or False: The verdict of Guilty but Mentally Ill was primarily intended to replace existing insanity standards
False, it was not
What three things must be present to be found guilty but mentally ill?
1) Be guilty of the offense
2) Be mentally ill at the time of the offense
3) Not be mentally insane at the time of the offense
What are the criticisms of the guilty but mentally ill verdict?
Criticized because it allows juries and judges to avoid confronting the issue of insanity
How many states do not have an insanity standard?
4: Montana, Idaho, Utah, Kansas
Why don't acquittal rates differ across the three major standards in mock juror studies?
Research indicates that jurors fall back on heir own misconceptions of what insanity means, despite the jury instructions.
How often is the insanity defense used?
1% of cases
How often are those using the defense acquitted?
26% of cases
What percentage of insanity acquittals are freed immediately after the trial?
15% of cases
-12% conditional release
-3% outpatient treatment
-1% released scot-free
What percentage of insanity acquittals committed murder?
About 15%
True or False: Insanity acquittals spend less time institutionalized that if they had been convicted of the crime they were charged with
False, equal time
True or False: Insanity acquittals have re-offending rates that are higher than the general offender who is sent to prison
False, similar rates
Why does the time frame of insanity evaluations make these assessments especially difficult?
You have to determine insanity at the time of the offense which may have been several months prior
True or False: Expert opinions vary depending on the insanity standard used
True, they vary
About how often do judges and juries agree with expert opinions in insanity cases?
Upwards of 90%
What is a diminished capacity defense?
Testimony regarding mental status at the time of the crime without claiming insanity