Mentally disordered offenders and the law: Research update on the insanity defense, 2004–2019

Adjorlolo, Samuel; Chan, Heng Choon; DeLisi, Matt

doi:10.1016/j.ijlp.2019.101507

Cited by 14 publications

(14 citation statements)

References 57 publications

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“…Most developed countries practice insanity defence legislation (Stuckenberg, 2016 ) which means that offenders are not to be held responsible if they ‘lack the guilty mind or intent’ (Adjorlolo et al ., 2019 ). Offenders deemed unfit to stand trial or found not guilty by reason of insanity can be diverted from sentencing.…”

Section: Introductionmentioning

confidence: 99%

Crimes and sentences in individuals with intellectual disability in a forensic psychiatric context: a register-based study

Edberg

Chen

Andiné

et al. 2022

Epidemiol Psychiatr Sci

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Aims To study associations between intellectual disability (ID) and sexual and violent offending among individuals subject to pre-trial forensic psychiatric assessment. To investigate sentences following pre-trial forensic psychiatric assessment in offenders with and without ID. Methods A population-based observational study using data from pre-trial forensic psychiatric assessments in Sweden (1997–2013), the Swedish National Crime Register and several other Swedish national registers. The study population consisted of 7450 offenders (87% men, 13% women) who were subject to forensic psychiatric assessment in 1997–2013, of whom 481 (6.5%) were clinically assessed as having ID. Results ID offenders were more likely than non-ID offenders to have a sexual crime as an index crime [26.2 v. 11.5%, adjusted odds ratio (OR) 2.7, 95% confidence interval (CI) 2.02–3.58] as well as previous convictions regarding sexual offending (10.4 v. 5.6%, adj OR 2.3, 95% CI 1.70–3.12). These associations were restricted to male offenders; sexual offending was uncommon among women. Comorbid attention-deficit hyperactivity disorder reduced the association between ID and sexual offending (adj OR 2.7 v. 3.1, p = 0.017), while comorbid autism spectrum disorder had no significant influence on the association (adj OR 2.7 v. 3.0, p = 0.059). Violent crime was equally common among ID and non-ID offenders. Offenders with ID were more likely than non-ID offenders to be sentenced to forensic psychiatric care or community sanctions and measures (such as probation, conditional sentences or fines) than to prison; however, 15% of individuals who received an ID diagnosis during the forensic psychiatric assessment were sentenced to prison. Previous criminal convictions, concurrent antisocial personality disorders and substance use disorders were associated with a higher probability of a prison sentence among offenders with ID. Conclusions Sexual crime is overrepresented among offenders with ID compared to offenders with other mental disorders than ID in forensic psychiatric contexts. ID offenders become subject to forensic psychiatric care and forensic psychiatric services need evidence-based treatment programmes for offenders with ID. In addition, there is a need for early intervention strategies suitable for disability services and special education schools, in order to address the complex needs of individuals with ID and prevent sexual and violent offending.

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Section: Introductionmentioning

confidence: 99%

Crimes and sentences in individuals with intellectual disability in a forensic psychiatric context: a register-based study

Edberg

Chen

Andiné

et al. 2022

Epidemiol Psychiatr Sci

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“…Studies have shown that forensic experts do not always agree in their evaluations of CR [ 2 , 12 , 53 , 54 ]. This is even more evident in jurisdictions that request several evaluations by independent experts or expert teams [ 43 ], with reported agreement as low as 55.1% [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

“…In most countries, when there is a question of criminal responsibility (CR), psychiatrists or psychologists provide evidence to the court regarding a defendant’s mental state at the time of the alleged offense. Such evaluations are perhaps the most challenging for mental health professionals [ 1 , 2 ]. In most jurisdictions, an opinion of criminal irresponsibility can only be reached if a severe mental disorder is present, but not all disorders qualify [ 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

Use of assessment instruments in forensic evaluations of criminal responsibility in Norway

Løvgren

Laake

Reitan³

et al. 2022

BMC Psychiatry

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Objectives Assessment instruments are often used to enhance quality and objectivity in therapeutic and legal settings. We aimed to explore the use of instruments in Norwegian reports of forensic evaluations of criminal responsibility; specifically, whether this use was associated with diagnostic and forensic conclusions. Methods Our study has an exploratory cross-sectional design. We examined 500 reports filed with the Norwegian Board of Forensic Medicine in 2009–2018 regarding defendants indicted for the most serious violent crimes. The first author coded data from all reports according to a registration form developed for this study. Two co-authors then coded a random sample of 50 reports, and inter-rater reliability measures were calculated. The first author coded 41 reports for calculation of intra-rater reliability. Descriptive statistics are presented for the use of assessment instruments, and a generalized linear mixed model (GLMM) was used to estimate associations between the use of instruments and diagnostic and forensic conclusions. Results Instruments were used in 50.0% of reports. The Wechler’s Adult Intelligence Scale (WAIS), Historical Clinical Risk-20 (HCR-20), and the Structured Clinical Interview for DSM disorders (SCID I), were used in 15.8, 13.8, and 9.0% of reports, respectively. The use of instruments increased from 36% in 2009 to 58% in 2015; then decreased to 49% in 2018. Teams of two experts wrote 98.0% of reports, and 43.4% of these teams comprised two psychiatrists. In 20.0% of reports, the diagnostic conclusion was schizophrenia, and in 8.8% it was other psychotic disorders. A conclusion of criminal irresponsibility was given in 25.8% of reports. Instruments were more often used in reports written by teams that comprised both a psychiatrist and a psychologist, compared to reports by two psychiatrists. The use of instruments was strongly associated with both diagnostic and forensic conclusions. Conclusion Instruments were used in 50% of reports on forensic evaluations of criminal responsibility in Norway, and their use increased during the study period. Use of instruments was associated with diagnostic and forensic conclusions.

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“…This is mainly due to the specific histories of criminal justice and psychiatry in each country ( 2 , 3 ). Despite the well-documented epidemiological and service-level differences regarding the management of these people in Europe ( 4 ), it remains that in many countries, criminal responsibility, whose origin dates back to the Bablylonian Talmud (written around 500 AD), Roman law, and Greek philosophy ( 5 ), is a key concept in the criminal sanctioning of people diagnosed with mental health disorders ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

Psychiatric Hospitalizations of People Found Not Criminally Responsible on Account of Mental Disorder in France: A Ten-Year Retrospective Study (2011–2020)

Fovet¹,

Baillet²,

Hörn³

et al. 2022

Front. Psychiatry

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BackgroundCriminal responsibility is a key concept in the criminal sanctioning of people diagnosed with mental health disorders who have committed crimes. In France, based on the recommendations of one or more expert psychiatrists, a judge can declare a person not criminally responsible on account of mental disorder (NCRMD) if, at the time of the offense, the person was presenting a psychiatric disorder that abolished or altered his/her capacity for discernment and/or ability to control his/her actions. In such a case, the judge also generally orders an involuntary psychiatric hospitalization. The objectives of this study were to (1) describe longitudinal retrospective administrative data of psychiatric hospitalizations for people found NCRMD, (2) identify the age, sex, and principal diagnoses of these individuals, and (3) characterize the trajectories of their psychiatric care before and after NCRMD psychiatric hospitalization.MethodsWe used discharge reports from the French national hospital database called Programme de médicalisation des systèmes d'information (PMSI) to gather longitudinal data that describe psychiatric hospitalizations for people found NCRMD between 2011 and 2020, the age, sex, and principal diagnoses of these patients, the length of their hospitalization, and the trajectories of their psychiatric care before and after their NCRMD psychiatric hospitalization.ResultsWe identified 3,020 patients who were hospitalized for psychiatric care after having been found NCRMD between 2011 and 2020. The number of admissions on these grounds has remained stable over this period, ranging from 263 in 2011 to 227 in 2021. They were mostly young men diagnosed with a psychotic disorder (62%). The majority (87%) were hospitalized in general psychiatric hospitals, and only 13% were admitted to maximum-security units (Unités pour malades difficiles, UMD). The median duration of hospitalization for these patients was 13 months. Our results show that 73% of the patients had already been hospitalized prior to their NRCMD hospitalization. The rehospitalization rate within 5 years of discharge from NCRMD psychiatric hospitalization was 62%.ConclusionWe conducted the first study investigating the psychiatric hospital treatment of people declared NCRMD in France. There is an urgent need for further studies to investigate the clinical characteristics of these patients.

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Mentally disordered offenders and the law: Research update on the insanity defense, 2004–2019

Cited by 14 publications

References 57 publications

Crimes and sentences in individuals with intellectual disability in a forensic psychiatric context: a register-based study

Crimes and sentences in individuals with intellectual disability in a forensic psychiatric context: a register-based study

Use of assessment instruments in forensic evaluations of criminal responsibility in Norway

Psychiatric Hospitalizations of People Found Not Criminally Responsible on Account of Mental Disorder in France: A Ten-Year Retrospective Study (2011–2020)

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