Chapter 9 Flashcards
Schizophrenia
serious mental illness whose sufferers lose touch with reality. People with schizophrenia exhibit a wide range of psychotic symp- toms, including hearing voices that are not actually there (audi- tory hallucinations thinking and speaking in a coherent manner (thought disorder or disorgan- ized thinking), and holding false beliefs (delusions) that affect their behaviour.
Canadian Psychiatric Review Boards
perform a key role in the forensic men- tal health system, with statutorily defined roles and responsibilities outlined in Part XX.1 of the Criminal Code. Provincial Review Boards are quasi-judicial tribu- nals (i.e., less formal legal tribunals that have powers and procedures resembling those of a court of law) responsible for overseeing and making decisions about the rights and care of individuals found unfit to stand trial or NCRMD. A Review Board usually comprises a lawyer, medical practitioner (e.g., psychiatrist), and lay person who has an interest in mental health issues and preferably is or was a consumer of mental health services. Responsibilities include recommending admission to and release from care facilities and treatment.
Fitness to stand trial
Defendants should understand and appreciate what is going on at every stage in the criminal justice process, from arrest to sentencing. A defendant charged with a serious crime has a right to a trial.
legal doctrine of incompetence originated in seventeenth-century English common law. Fitness to stand trial was considered critical because, at the time, defendants usually had to argue their own case, and it was deemed essential that the defendant demonstrate the capacity to engage in his or her own defence (Bittman & Convit, 1993). Prior to 1992, Canadian criminal law did not pre- scribe a set of clear criteria for determining whether a defendant was fit to stand trial, leaving judges and forensic experts to rely on case law. To correct this problem, Parliament enacted Bill C-30 in 1992, which resulted in significant changes to fitness determinations within the Criminal Code (1985). Section 2 of the Criminal Code now explicitly defines persons who are unfit to stand trial as those who are
unable on account of mental disorder to conduct a defence at any stage of the proceedings before a verdict is rendered or to instruct counsel to do so, and in particular, unable on account of mental disorder to (a) understand the nature and object of the proceedings, (b) understand the possible consequences of the proceedings, or, (c) communicate with counsel.
Notice that the legal criteria for fitness refer to the psychological state of the defendant at the time of trial. The defendant’s psychological state at the time of the crime is not relevant to the determination of fitness to stand trial
limited cognitive capacity standard, indicating that an accused does not need to be able to act in his or her own best interests but, rather, that he or she must demonstrate the ability to recount the facts necessary to allow the lawyer to properly present the case.
accused is automatically presumed fit to stand trial unless the court is satisfied, on the balance of probabilities
5 days to complete, but the court can order assessments for up to 60 days, given sufficiently compelling circumstances
Techniques for Evaluating Fitness to Stand Trial
Techniques for Evaluating Fitness to Stand Trial
Ron Roesch at Simon Fraser University developed the only published Canadian test, the Fitness Interview Test-Revised (FIT-R), for use by mental health professionals in FST evaluations (Roesch, Zapf, & Eaves, 2006). The FIT-R was designed as a structured clinical judgment instrument that guides evaluators through an assessment of the specific psycholegal abilities required of a defendant to stand trial in Canada. It is composed of three sections:
(1) factual knowledge of criminal procedure (2) appreciation of the nature and object of the proceedings (3) ability to participate in one’s defence and communicate with counsel.
MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA) is another widely used CST/FST evaluation instrument devel- oped by a national network of researchers in the United States (funded by the MacArthur Foundation). The MacCAT-CA assesses three key CST-related abilities over 22 items, including understanding, reasoning, and appreciation. Items are based on a vignette describing a hypothetical defendant, and evaluees must decide how the accused should respond to questions and assist his or her lawyer. In contrast to the methods of other CST FAIs, the vignette approach of the MacCAT-CA was designed to introduce legal issues in a way that distances a defendant from the specifics of his or her case. However, a CST evaluation must also include an assessment of a defendant’s capacities and knowledge in the context of his or her specific legal case, something that the MacCAT-CA does not facilitate. Another novel aspect of the MacCAT-CA is the teaching component within the CST evaluation. If a defendant cannot answer a particular question correctly, he or she is told the correct answer and then is asked more open-ended questions to see if the misunderstanding has been corrected.
Competency Restoration and Treatment
defendant who is found unfit to stand trial has his or her plea set aside (if a plea of guilty or not guilty has already been entered), the jury is dismissed (if applicable), and the defendant is placed under the supervision of a Review Board. The Review Board then determines what conditions should be imposed on the accused, weighing both the need to protect the public from the offender and the need for treatment of the accused to regain fitness. If the Review Board directs a defendant to undergo treatment to restore competency, an order must meet several criteria:
(1) Evaluators must be of the opinion that the patient will be “made fit” in a specified period of time (typically 60 days).
(2) The benefits of treatment must outweigh the risks.
(3) The proposed treatment(s) must involve the least intrusive option(s) available.
(4) The treatment approaches must typically include either medication or training about the court process or both.
If, after the stipulated treatment period, a defendant is still judged to be unfit to stand trial, he or she will continue to be supervised by the Review Board until a stay of proceedings (halting further process in a criminal trial) or absolute discharge is recommended. Because a defendant who is found unfit to stand trial cannot be held for an indeterminate and lengthy period of time without mounting a trial, the prosecution must re-establish its case again every 2 years.
stay of proceedings for an accused deemed unfit to stand trial if the following
conditions were met:
(1) The accused was unlikely to ever become fit. (2) The accused did not pose a significant threat to the safety of the public. (3) A stay of proceedings was in the interests of the proper administration of
justice.
Competency remediation typically consists of two general approaches: medication and education. By far, the most common approach involves treating defendants deemed incompetent to stand trial with psychotropic medications to address the psychiatric symptom
competency remediation involves training that is specifically designed to improve the defendant’s knowledge and under- standing of courtroom procedures. T
Not Criminally Responsible on Account of Mental Disorder (NCRMD)
Two primary issues were before the court in this trial. First, was Schoenborn suffering from a mental disorder at the time he killed his children and did he act as a result of that mental disorder? Second, had the mental disorder rendered him incapable of appreciating the nature and quality of his actions, or prevented him from knowing that killing his children was wrong? These two criteria form the basis for a finding of not criminally responsible on account of mental disorder (NCRMD) in Canada.
The modern form of “mastery of mind” is mens rea, or the “guilty mind” that must accompany wrongful behaviour. To be found guilty, it is not enough to commit a criminal act (the actus reus); one must also possess a guilty mind—an awareness of the wrong- fulness of the criminal conduct.
M’Naghten rule. The rule has
three components:
(1) a presumption that defendants are sane and responsible for their crimes
(2) a requirement that, at the moment of the crime, the defendant must have been labouring “under a defect of reason” or “from disease of the mind”
(3) a requirement that the defendant “did not know the nature and quality of the act he was doing, or if he did know it, that he did not know what he was doing was wrong.”
Section 16 of the Criminal Code outlines current Canadian law about the NCRMD defence. It states that
[n]o person is criminally responsible for an act committed or an omission made while suffering from a mental disorder that rendered the person incapa- ble of appreciating the nature and quality of the act or omission, or of knowing that it was wrong. (Section 16.1)
). The enactment of Bill C-30 in 1992 provided that following a finding of NCRMD, the court can either hold a disposition hearing or send the case to a provincial Review Board, which must hear the case within 45 days. Cases heard before the court and given a disposition other than an absolute discharge must be heard by the Review Board within 90 days. The Supreme Court also ruled that an accused has a right to direct his or her own defence, and ruled that the Crown can only raise the NCRMD defence if an accused has already put his or her mental capacity into question or where the prosecutor establishes that there are reasonable grounds to question the accused’s responsibility as a result of mental disorder
Automatism
automatism: unconscious, involuntary behaviours. The defence of automatism recognizes that under nor- mal circumstances a person’s act or behaviour must be committed voluntarily, as a result of choice or free will, and that he or she must have the capacity to form mens rea, or a “guilty mind,” at the time of the offence. Non-insane automatism refers to an involuntary action that does not arise from a disease of the mind or mental illness; instead, it results from other conditions, such as a blow to the head, poisoning, stroke, or hypoglycemia.
insane automatism refers to involuntary actions or behaviour that result from a disease of the mind, and it automatically triggers a verdict of NCRMD. For a defence of automatism to be successful, the trial judge must first conclude that there is sufficient evidence to demonstrate that the accused acted involuntarily, on a balance of probabilities, usually confirmed by psychi- atric evidence.
Assessing Mental Disorder and NCRMD
assessing insanity involves a retro- spective evaluation of the individual’s mental state at the time of the crime. This means that the evaluator must figure out how the defendant was functioning in the past (
terms used in the legal definition of insanity are more vague than those in the definition of fitness to stand trial. For example, whether an individ- ual is “incapable of appreciating the nature and quality of the act or omission” is more difficult to quantify than whether he or she has the ability to communicate with a lawyer
Rogers Criminal Responsibility Assessment Scales (R-CRAS). Developed by Richard Rogers, the R-CRAS attempts to translate the legal standards of insanity into functional components such as the ability to control one’s thoughts or behaviour. It includes five scales to evaluate diagnostic issues:
(1) malingering (2) organicity (significant brain disorder) (3) major psychiatric disorder (4) loss of cognitive control (5) loss of behavioural control.
Evaluators base their judgments of the 25-item test on an in-depth interview with the defendant and a review of relevant documents, such as mental health records and police reports (
Malingering
defendant is malingering or faking symptoms of mental illness to avoid going to trial or being held responsible for a crime. Specifically, malingering is the deliberate feigning or gross exaggera- tion of physical or psychological symptoms in order to gain a positive outcome (e.g., an insurance payment or compensatory damages) or to avoid a negative out- come
Structured Interview of Reported Symptoms (SIRS) (Rogers, Bagby, & Dickens, 1992). In administering the SIRS, the evalu- ator asks the examinee about various symptoms he or she may be experiencing, including symptoms that are unlikely to be true even for a severely disordered
