Chap 18: Mental Health and the Law Flashcards
What is the Charter of Rights and Freedoms?
Section 1 - Guarantee of Rights and Freedoms. Section 2: Fundamental Freedoms. 7 - legal rights. 8 - right to be secure. 9- right not to be arbitrary detained. 12 - equality before and under law and protection and benefit of law. States everyone is entitled to these rights and freedoms. Section 15 (1) of Charter of Rights and Freedoms - extends right of equality to mentally ill people - Canada is one of few countries that explicitly extends general rights found in our constitution to mentally ill. Workplace discrimination of mentally ill still occurs. All provinces share same Charter-driven principles in their legislation - diffs exist in how these principles are realized. also includes provisions allowing some people to be removed from society if they act in a way that infringes on rights of others to a free and democratic society.
What is criminal commitment?
procedure that may confine a person in a mental institution either for determination of competency to stand trial or after a verdict of not criminally responsible on account of mental disorder. Part XX.1 of Criminal Code provides a mini-code setting out procedures for dealing with mentally disordered individuals who are in criminal courts.
What is civil commitment?
provided for in provincial statutes is a procedure by which a mentally ill and dangerous person who may not have broken a law can be deprived of liberty and incarcerated in psychiatric hospital.
What is NCRMD?
Can not argue facts of case - accused is guilty, burden of proof shifts to demonstrating why the accused is not responsible. Procedure - with sufficient evidence, referred to the Ontario Review Board (ORB), ordered to a mental health forensic unit, the ORB will schedule an initial hearing, psychiatrist recommends findings to the court, judge makes final decision - Guilty or NCR. If there is not sufficient evidence for any of these points - person is guilty.Outcomes: Guilty - regular sentencing (or more if malingering is proven), regular sentencing + treatment, reduced sentence. NCR verdict - suspended sentence, criminal commitment (forced into mental health treatment), conditional discharge - person no longer a threat but must continue to take meds and weekly check ins with mental health professional, absolute discharge - should you recommit and were not taking meds or receiving therapy you can never plead NCR again.
Not criminally responsible on account of mental illness. NCRMD involves the legal argument that a defendant should not be held responsible for an illegal act if it is attributable to mental illness that interferes with rationality or that results in some other excusing circumstance. The insanity defense is very rare, is usually only successful when applied to severely disordered individuals and people deemed insane are still typically detained for long periods and may greatly exceed otherwise appropriate sentence. New law - Bill C-54 makes it possible for certain people deemed high risk to possibly be detained indefinitely until judge has been able to determine that the high-risk NCRMD offenders are no longer a threat to public. The most common diagnoses found among those with NCRMD designation was psychotic spectrum disorder and ⅓ had co-occuring substance abuse problem. Women had fewer risk factors for recidivism. Reconviction rate was 16.7%.
What was the Rex. v. Hadfield case?
Hadfield first shot at King George II because he believed king’s death would herald the end of the world and second advent of Christ - found not guilty because insanity - he was returned to prison because there was no better alternative - the Criminal Lunatics Act was established allowing people to be sent to place deemed fit by court including mental institution.
What was the Regina v. M’Naghten case?
M’Naghten Rules - formulated in aftermath of murder trial - set out to kill British PM but had mistaken his secretary for him. He claimed he had been instructed to kill him by God. This led to the rules that - to establish a defence of insanity, it must be clearly proved that at the time of committing, the party accused was labouring under such a defect of reason, from disease of the mind, as not to know the nature and quality of the act doing or if they did know, they did not know what they were doing was wrong. The issue of being able to tell right from wrong as component of insanity defense has been subject of some debate.
What was the outcomes of the Regina v. Chaulk case?
two youth, B and E + murder. Know the laws but believe they are above them - traditionally led to guilty verdict. Argue killing justified because losers deserve to die, were not aware that the act was morally wrong, diverted to mental institution.
The legal system defined wrong in terms of legally wrong - expanded to include morally wrong in Regina v. Chaulk case.
What was the Regina v. Swain case?
Regina v. Swain - led to proclamation of Bill C-30 - created mini-code dealing with mentally disordered accused. Man threatening manner toward family and arrested for assault causing bodily harm. He swung at children, hit wife, spoke about spirits and fought with the air. Was trying to save family from devil. He recovered after receiving drug treatment. Bill C-30 included change in terminology - not guilty by reason of insanity was altered to NCRMD. Review boards now determine fate within 45 days of verdict and thereafter not less than annually - must consider current mental status and risk to society posed. Can discharge individual or order detention in hospital. In Bill C-30 there is a list of issues for which assessments may be ordered: fitness to stand trial, criminal responsibility, infanticide and disposition. Time limits are specified for their assessment.
What was the Regina v. Conception
Conception was to stand trial for sexual assaults’ but had schizophrenia - he was alleged to have sexually assaulted a staff member at CAMH - deemed unfit to stand trial and judge ordered he receive treatment but not at CAMH - sent to treatment facility with lack of resources.
What is neurolaw?
Neurolaw - accused suffers from some form of brain dysfunction and related processing deficits could not have helped it. Can inform issues ie. free will, responsibility, moral judgement and punishment.
What is fitness to stand trial?
Mental fitness of individuals to stand trial must be decided before they can be determined responsible or not. Have to be mentally present as well as physically. Decisions may be changed on appeal if fitness of defendant is in question and has not been adequately assessed. One measure in Canada is Fitness Interview Test- Revised. 3 components: asses whether person 1) understands nature and purpose of legal proceedings 2) understands possible or likely consequences and 3) capable of communicating with their lawyer. Is very valid. Louis Riel was deemed insane as he was unable to discern right from wrong - but was executed anyways. Psychologists are regarded as qualified to provide assessments under Youth Criminal Justice Act and dangerous offender legislation but only medical practitioners can provide court-ordered assessments of fitness and criminal responsibility. Psychs often assist physicians through psychological evaluations.
For what reasons can a person be committed to psychiatric hospital against their will?
judgement is made that they are 1) mentally ill 2) danger to self or others. Specific commitment procedures fit into one of two categories: formal or informal. Formal or judicial is by court order. Can be requested by any reasonably citizen. Judge will order mental health examination. The person has right to object these attempts and court hearing can be scheduled. This procedure is covered by provincial legislation that permits an ex parte hearing before a justice of the peace. Generally a justice of the peace is peritted to have individual held against their will for up to 72 hours for assessment purposes only. A prospective patient who comes forwards themselves can undergo same process. Informal emergency commitment of mentally ill can be accomplished by hospital staff who deem a patient unstable to be released. Civil commitment -
What is community commitment/CTOs?
CTOs stipulate individual will be released back into community if adhere to recommended treatments.The inability of mentally ill people to make treatment decisions is a key factor in CTOs. ¾ people with one lacked basic capacity to make treatment decisions. Mandatory outpatient treatment has benefits in certain situations. CTOs in Ontario are named Brian’s Law after sportscaster killed by man with schizophrenia who did not adhere to treatment Individuals in Ontario subject to a CTO retain a number of rights: 1. Right of review by Consent and Capacity Board with appeal to courts each time CTO is issued or reviewed. 2. Mandatory review by Consent and Capacity Board every second time a CTO is reviewed. 3. Right to request re-examination 4. Right of review of a finding of incapacity to consent to treatment. Patient is free to withdraw consent at any time. Ethical concerns and false notion that CTOs allow a degree of autonomy and self-determination is coercive. Prominent diagnoses for CTOs - schizophrenia and schizoaffective disorder.
What is actuarial prediction?
uses statistics to make predications. They are more likely than clinical ratings to use quantitative ratings and less likely to be influenced by subjective biases. They involve greater consistency because the creators have already specific with precision the info involved, strategies fo data and required analyses. They are also easier to review. They may be too rigid and cannot be altered to consider individual factors of potential importance. They are derived from specific populations so the generalizability of statistical formulae to other pops is always an issue.
What is the HCR-20?
The HCR-20 is a more structured assessment device developed in Canada. HCR is historical variables, clinical variables and risk variables. Historical - previous violence, early maladjustment, history of mental disorder and PDs. Clinical variables - unresponsive to treatment, lacking insight and acting impulsively. Risk - lack of social support and experience of stressful events. It includes ceratin factors that have not been robust predictors of risk in previous studies and it is not an actuarial measure because the checklist items were not selected on basis of empirical links. However, it fares as well as other measures and there is evidence for its usefulness.
