forensic psychiatry blok vi
Post on 03-Jun-2018
218 Views
Preview:
TRANSCRIPT
-
8/11/2019 Forensic Psychiatry Blok Vi
1/53
FORENSIC PSYCHIATRY
Prof. Dr. dr.H. SOEWADI MPH, SpKJ (K)
DEPARTEMENT OF PSYCHIATRY
SCHOOL OF MEDICINE
GADJAH MADA UNIVERSITY
2009
-
8/11/2019 Forensic Psychiatry Blok Vi
2/53
PSYCHIATRY:
THE MEDICAL SPECIALTY CONCERNED WITH
THE STUDY, DIAGNOSIS, TREATMENT, AND
PREVENTION OF BEHAVIOR DISORDERS OR
MENTAL DISORDERS
PSYCHIATRIST IS :
A PHYSICIAN WHO HAS HAD ADVANCED
TRAINING IN THE DIAGNOSIS AND TREATMENTOF MENTAL DISORDERS
-
8/11/2019 Forensic Psychiatry Blok Vi
3/53
Forensic Psychiatry
Is a general term that denotes the interface
between law and psychiatry. The field of forensic psychiatry:
the psychiatric expert witness
criminal law and psychiatry
insanity the guilty but mentally ill offender
diminished capacity
competency to stand trial
involuntary hospitalization and conservatorship
the right of patients, informed consent
the right to treatment and the right to refuse treatment
confidentiality and privileged communication
-
8/11/2019 Forensic Psychiatry Blok Vi
4/53
FORENSIC PSYCHIATRY
ABOUT 30 % OF MEN IN PRISON HAVEA PSYCHIATRIC DISORDER OF A SEVERITYREQUIRING TREATMENT
THE COMMONEST DIAGNOSES ARE
SOCIOPATHY AND ALCOHOLISM; THERE IS ALSO AN EXCESS OF MENTAL
SUBNORMALITY , FUNCTIONAL PSYCHOSIS,ORGANIC BRAIN DISEASE, AND EPILEPSYAMONG PRISONERS.
HOWEVER , SOCIAL AND CULTURAL FACTORSARE MORE IMPORTANT THAN PSYCHIATRICILLNESS IN CAUSING CRIME
-
8/11/2019 Forensic Psychiatry Blok Vi
5/53
FORENSIC PSYCHIATRY
MALE PRISONERS OUTNUMBER FEMALEONES 30-FOLDS
CULTURAL FACTORS PROBABLY ACCOUNT
FOR MOST OF THIS DISCREPANCY, BUT THEINCREASED FREQUENCY OF CRIMINALBEHAVIOUR AMONG MEN WITH THE XYYGENOTYPE SUGGESTS THAT BIOLOGICALFACTORS ALSO CONTRIBUTE
FEMALE PRISONERS HAVE MORE MENTAL ANDPHYSICAL DISEASE THAN MALE ONES
-
8/11/2019 Forensic Psychiatry Blok Vi
6/53
MURDER
THERE ARE 400-500 MURDERS PERYEAR IN ENGLAND AND WALES ,
IN 75 % OF CASES THE VICTIM IS WELL
KNOWN TO THE MURDERER, MOSTOFTEN THE SPOUSE.
ABOUT 50 % OF MURDERERS HAVEA SERIOUS PSYCHIATRIC ABNORMALITY
MANY COMMIT SUICIDE AFTER THEIRCRIME
-
8/11/2019 Forensic Psychiatry Blok Vi
7/53
THE MAIN PSYCHIATRICCONDITIONS WHICH CAN LEAD TO
MURDER ARE :1. PSYCHOSES : A SEVERELY DERPESSED
PERSON MAY MURDER CHILDREN OR OTHERRELATIVES BECAUSE OF A DELUSION THATTHEY ARE GOING TO SUFFER A WORSE FATE.
2. SCHIZOPHRENICS MAY COMMIT MURDERUNDER THE INFLUENCES OF PARANOIDDELUSIONS.
3. PUERPERAL PSYCHOSISACCOUNTS FOR
SOME, BUT NOT ALL, CASES OF INFANTICIDE.4. SOCIOPATHICPERSONALITY DISORDER
5. DRUG-INDUCEDSTATES
-
8/11/2019 Forensic Psychiatry Blok Vi
8/53
THE MAIN PSYCHIATRICCONDITIONS WHICH CAN LEAD TO
MURDER ARE : MORBID JEALOUSY
MENTAL HANDICAP, IN WHICH
FRUSTRATION MAY BEEXPRESSED BY VIOLENCE
EPILEPTIC AUTOMATISM: THIS IS
A RARE CAUSE , AND THERE IS NOSIGNIFICANT ASSOCIATIONBETWEEN MURDER AND EPILEPSY
-
8/11/2019 Forensic Psychiatry Blok Vi
9/53
ABNORMAL EEG
ABOUT 75 % OFMURDERERS WHOSE
CRIME WAS APPARENTLYMOTIVELESS HAVE ANABNORMAL EEG
-
8/11/2019 Forensic Psychiatry Blok Vi
10/53
UNFIT TO PLEAD LESS OFTEN, A MENTALLY
ABNORMAL OFFENDER ACCUSEDOF MURDER OR OTHER SERIOUS
CRIME IS FOUND UNFIT TO PLEAD,AND IS SENT DIRECTLY TO APSYCHIATRIC HOSPITAL.
IF HE RECOVERS HE MAY BE
REQUIRED TO STAND TRIAL
-
8/11/2019 Forensic Psychiatry Blok Vi
11/53
UNFIT TO PLEAD
THE GROUNDS FOR BEING UNFIT TOPLEAD, ARE : INABILITYTO INSTRUCT COUNSEL,
TO APPRECIATE THE SIGNIFICANCE OFPLEADING,
TO CHALLENGE A JUROR,
TO EXAMINE A WITNESS, OR
TO UNDERSTAND THE EVIDENCE ORCOURT PROCEDURE
-
8/11/2019 Forensic Psychiatry Blok Vi
12/53
PLEA IN MURDERA RARE PLEA IN MURDER
CASES IS NOT GUILTY BYREASON OF INSANITY, WHEN
THE OFFENDER FULFILS THEMCNAUGHTEN RULES , THAT ISHE EITHER DID NOT KNOW THENATURE AND QUALITY OF HISACT, OR DID NOT KNOW THAT ITWAS WRONG
-
8/11/2019 Forensic Psychiatry Blok Vi
13/53
PLEA IN MURDER
A DELUDED PATIENT IS ASSUMED TO BEUNDER THE SAME DEGREE OFRESPONSIBILITY AS HE WOULD BE IFTHE DELUSIONS WERE TRUE.
IF THIS PLEA IS SUCCESFUL, THEACCUSED IS SENT TO A SPECIALHOSPITAL
ABOUT HALF THOSE ACCUSED OF
MURDER CLAIM AMNESIA FOR THEEVENT, BUT THIS IS NOT AN ADEQUATEDEFENSE , NOR IS DRUNKENNESS
-
8/11/2019 Forensic Psychiatry Blok Vi
14/53
RAPE
Rape is sexual intercourse with
a woman without her consent
About 400 rapes are reportedannually in England and Wales ,
but most cases are probably not
reported
-
8/11/2019 Forensic Psychiatry Blok Vi
15/53
The following types or rapist
are described :
1. Inhibited men who are unable to formnormal sexual relationship
2. Aggressive violent men with contempt
for women3. The psychiatrically ill or mentally
handicapped
4. Group rape, by gangs of youth whosemembers would probably not committhe crime individually
-
8/11/2019 Forensic Psychiatry Blok Vi
16/53
the aggressive type
Of those convicted, 90 % do not
repeat the crime , but the aggressive
type may do so as well ascommitting other violent crimes ,
and may required secure care and
anti libidinal drugs
Centres for counseling rape victims
have been set up in some cities
-
8/11/2019 Forensic Psychiatry Blok Vi
17/53
SHOPLIFTING
Women shoplift more often than men, andshoplifting is the most common crimeamong female prisoners
A minority of shoplifting episodes areorganized crimes
About two-thirds of female shoplifters aredepressed middle-aged women
In Londons West End, about a third areyoung foreign women without psychiatricdisturbance
-
8/11/2019 Forensic Psychiatry Blok Vi
18/53
SPECIAL HOSPITALS
Special hospitals exist for the treatment ofpsychotic, sociopathic, or mentallyhandicapped patients who havecommitted violent crimes
They include broadmoor , Rampton ,Moss Side and Park Lane in England , andCarstairs in Scotland
All patients are compulsorily admitted and
detained under the Mental Health Act, themajority from the courts, some fromprisons or psychiatric hospitals
-
8/11/2019 Forensic Psychiatry Blok Vi
19/53
Violence
Violence to others, violence to self ,
damage to property, and sex
offences are the most frequentreasons for admission
The length of stay is several years
but about half the patients areeventually fit for discharge or
transfer to conventional psychiatric
hospitals
-
8/11/2019 Forensic Psychiatry Blok Vi
20/53
other topics with
forensic implicationsSome other topics with forensic
implications are dealt with in
other parts of the book : sexual
deviations , juvenile delinquency
and baby battering , and the
Mental HealthAct
-
8/11/2019 Forensic Psychiatry Blok Vi
21/53
Criminal Responsibility
It is established principle of English law that manis responsible for his own actions-that is to saythat he intends their result
Therefore is follows that in the eyes of the law hemust bear the responsibility for them
In the case of serious offences, responsibility isthe more likely to be questioned
In the case of an individual suffering from mental
illness committing a crime, it has been for manyyears argued that the mans state of mind mustimpair his responsibility for his acts.
-
8/11/2019 Forensic Psychiatry Blok Vi
22/53
test of insanity
This has, however , not been easy to
establish in a court of law since the law
assumes everyone is sane , and insanity has
to be proven
Since the law assumes everyone is sane ,
and insanity has to be proven
Since 1843 the courts have used theMacNaughten Rules as a test of insanity .
-
8/11/2019 Forensic Psychiatry Blok Vi
23/53
MacNaughten rules
These rules arose following the trial formurder of Daniel MacNaughten whokilled Sir Robert Peels private secretary
MacNaughten had paranoid delusionsand was acquitted on the direction of thejudge
Subsequently judges formulated the rulesas they have been know ever since, as a
of answers to questions put to them bythe house of lords .
-
8/11/2019 Forensic Psychiatry Blok Vi
24/53
In practice the rules seek theanswer to the questions
1. Regarding the offence, did theaccused know the nature andquality of the act?
2. If he did, did he know he was doingwrong ?
3. If he knew the nature and quality of
the act, was he labouring under adelusion ?
-
8/11/2019 Forensic Psychiatry Blok Vi
25/53
responsibility
Despite their apparent simplicity, the rules
can be difficult to apply and make for only
a limited acknowledgement of impaired
responsibility
For years they have been the subject of
controversy, both here and in the USA .
Nevertheless they are still widely appliedas tests of insanity in capital cases
-
8/11/2019 Forensic Psychiatry Blok Vi
26/53
diminished responsibility
Since the homicide Act of 1959 thelaw in England and Wales hasacknowledged the concept of
diminished responsibility, which canbe invoked if an accused person isshown to be suffering from suchabnormality of mind ..as
substantially to impair hisresponsibility.
-
8/11/2019 Forensic Psychiatry Blok Vi
27/53
diminished responsibility
The concept of diminishedresponsibility has not been acceptedwithout reserve, and it has been
pointed out that once allowance ismade for diminished responsibilityone is calling into question the wholeidea of criminal responsibility at any
level. A question that remains unresolved
-
8/11/2019 Forensic Psychiatry Blok Vi
28/53
ARSON
About 40 % of serious fires are started deliberately.Types of arsonist include :
1. Those with a criminal motive , e.g. obtaininginsurance money or concealing evidence ofcrime . They usually have sociopathicpersonalities
2. Psychotic patients motivated by delusions
3. Those with abnormal personality or low
intelligence who start fires for excitement orrevenge. They often repeat the office and requiresecure detention
-
8/11/2019 Forensic Psychiatry Blok Vi
29/53
Testamentary capacity
The ability to make a valid will depends on
the possession of sound diposing mind .
This is not defined in law but the concept is
derived from the notion that the person
concerned should fulfill the following criteria :
he should understand the implications of the
act of making a will, have a good idea of theextent of the estate and know who are the
likely beneficiaries
-
8/11/2019 Forensic Psychiatry Blok Vi
30/53
Testamentary capacity
Mental illness, whether through psychosis or
organic cerebral disease, does not
automatically debar someone from making a
valid will, since even in chronic schizophreniaand in dementia there are often well-
preserved areas of lucidity and contact with
reality
A doctor should never witness a will
irrespective whether or not he is a beneficiary
-
8/11/2019 Forensic Psychiatry Blok Vi
31/53
THE PSYCHIATRIC EXPERT WITNESS
THERE ARE TWO KINDS OF PSYCHIATRIC/PHYSICIAN
TESTIMONY (EXPERT WITNESSES):
A PSYCHIATRIST/PHYSICIAN WHO HAS EXAMINED OR
TREATED A PATIENT MAY BE CALLED AS A WITNESS ANDASKED TO PROVIDE INFORMATION ABOUT THE PATIENTS
CONDITION AND TREATMENT, INCLUDING, AT TIMES,
OPINIONS ABOUT CAUSATION, AND PROGNOSIS
A DIFFERENT SITUATION EXISTS WHEN A
PSYCHIATRIST/PHYSICIAN IS ASKED TO PERFORM ANEXAMINATION OR TESTIFY AS AN EXPERT SPECIFICALLY
FOR LEGAL PURPOSES.
-
8/11/2019 Forensic Psychiatry Blok Vi
32/53
Psychiatrist/Physicianstestify
The psychiatrist/Physician called on
to present clinical testimony should
be willing to testify if the patient
wishes the psychiatrist/physician to
do so, or if the privilege of
confidentiality has been waived by
the patient, or if the psychiatrist islegally required to testify.
-
8/11/2019 Forensic Psychiatry Blok Vi
33/53
Psychiatrist/Physicianstestify The psychiatrist should maintain adequate
records and properly prepare to give testimony.
Preparation should include close familiarity with
the details of the patients clinical condition andtreatment and some knowledge of the pertinent
legal issues.
A preliminary conference with the attorney acting
for the patient is often useful. The attorney may wish a written report before the
court appearance
COMMON REASONS FOR
-
8/11/2019 Forensic Psychiatry Blok Vi
34/53
COMMON REASONS FORINCOMPETENCE TO STANDTRIAL LOW INTELLIGENCE OR DEMENTIA THAT
IMPAIRS THE DEFENDANTS
UNDERSTANDING OF THE TRIAL
PROCESS
DEPRESSION AND SELF-DEFEATING
BEHAVIOR THAT LIMIT THE
DEFENDANTS MOTIVATION FOR THE
BEST OUTCOME AT TRIAL MANIA THAT IMPAIRS THE DEFENDANTS
ABILITY TO ACT APPROPRIATELY IN THE
COURTROOM
COMMON REASONS FOR
-
8/11/2019 Forensic Psychiatry Blok Vi
35/53
COMMON REASONS FORINCOMPETENCE TO STAND
TRIAL PARANOID DELUSIONS THAT IMPAIR THEDEFENDANTS ABILITY TO WORK WITH DEFENSE
COUNSEL
DISORGANIZED THINKING THAT IMPAIRS THE
DEFENDANTS CONCENTRATION AND
ATTENTION
IRRATIONAL DECISION MAKING ABOUT THE
DEFENSEAS THE RESULT OF DELUSIONS,
DISORGANIZED THINKING, LOW INTELLECT, ORDEMENTIA
HALLUCINATIONS THAT DISTRACT THE
DEFENDANT FROM ATTENDING TO THE TRIAL
-
8/11/2019 Forensic Psychiatry Blok Vi
36/53
COMPETENCY AND SANITYEVALUATIONS
EQUATING PSYCHOSIS WITH INCOMPETENCE TOSTAND TRIAL
CONFUSING COMPETENCY TO STANDTRIAL WITH
INSANITY
EQUATING PSYCHOSIS AT THE TIME OF THE ACTWITH INSANITY
CONCLUSORY REPORTS THAT FAIL TO STATE THE
BASIS FOR THE OPINION
PSYCHODYNAMIC EXPLANATION FOR THE OFFENSEGIVEN AS AN EXCUSE, RATHER THAN FOCUSING ON
THE LEGAL STANDARD FOR SANITY
-
8/11/2019 Forensic Psychiatry Blok Vi
37/53
COMMON ERRORS INCOMPETENCY AND SANITY
EVALUATIONS FAILURE TO READ RELEVANT MEDICAL RECORDS
FAILURE TO INTERVIEW THE DEFENDANT
DESIRE FOR JUST OUTCOME, INFLUENCING THE
ACCURACY OF THE REPORT
FAILURE TO ADDRESS THE CORRECT COMPETENCY OR
SANITY STANDARD IN THAT PARTICULAR JURISDICTION
EVALUATING COMPETENCY IN THE PAST RATHER THAN
THE PRESENT
EVALUATING SANITY IN THE PRESENT RATHER THAN AT
THE TIME OF THE CRIME
-
8/11/2019 Forensic Psychiatry Blok Vi
38/53
PRACTICE GUIDELINES
IN ASSESSING COMPETENCY TO STAND TRIAL,FOCUS ON DEFENDANTS PRESENT MENTAL
FUNCTIONING
IN EVALUATING SANITY, FOCUS ON THE
DEFENDANTS MENTAL STATE AT THE TIME OF
THE OFFENSE
ASSESS THE IMPACT OF THE DEFENDANTS
MENTAL ILLNESS ON THE AREAS OF
FUNCTIONING ADDRESSED BY THE COMPE-
TENCY AND SANITY STANDARDS
-
8/11/2019 Forensic Psychiatry Blok Vi
39/53
PRACTICE GUIDELINES
A DEFENDANT MAY BE SERIOUSLY
MENTALLY ILL BUT STILL BE
COMPETENT TO STAND TRIAL OR
LEGALLY SANE
THE CRITICAL ISSUE IS THE IMPACT OF
THE DEFENDANTS MENTAL ILLNESS ON
THE AREAS OF FUNCTIONINGADDRESSED BY THE COMPETENCY AND
SANITY STANDARDS.
-
8/11/2019 Forensic Psychiatry Blok Vi
40/53
PRACTICE GUIDELINES
GENERAL PSYCHIATRISTS WHO AGREE TO
PERFORM A COMPETENCY OR SANITY
EVALUATION MUST KEEP IN MIND THAT THEIR
OPINION WILL BE HIGHLY INFLUENTIAL WITHTHE COURT AND WILL CARRY SERIOUS CON-
SEQUENCES.
FORENSIC PSYCHIATRISTS ROUTINELY
PERFORM A COMPETENCY AND SANITY
EVALUATION
SUMMARY OF INSANITY
-
8/11/2019 Forensic Psychiatry Blok Vi
41/53
SUMMARY OF INSANITYSTANDARDS
WILD BEAST TEST (REX V. ARNOLD 1724)-- A MAN MUST BE TOTALLY DEPRIVED OF HISUNDERSTANDING AND ME- MORY SO AS NOT
TO KNOW WHAT HE IS DOING, NO MORE THAN
AN INFANT, A BRUTE, OR A WILD BEAST
IRRESISTIBLE IMPULSE TEST (REGINA V.
OXFORD 1840) - IF SOME CONTROLLINGDISEASE WAS, IN TRUTH, THE ACTING POWER
WITHIN HIM WHICH HE COULD NOT RESIST,
THEN HE WILL NOT BE HELD RESPONSIBLE
-
8/11/2019 Forensic Psychiatry Blok Vi
42/53
SUMMARY OF INSANITY STANDARDS
MNAGHTEN RULE (MCNAUGHTANS CASE
1843) -- A MEN TAL DISEASE OR DEFECT AT THE TIMEOF THE ACT WHICH CAUSED THE DEFENDANT NOT TO
KNOW THE NATURE AND QUALITY OR THE
WRONGFULNESS OF THE ACT
DURHAM RULE (DURHAM V. UNITED STATE
1954)-- THE ACCUSED IS NOT CRIMINALLYRESPONSIBLE IF HIS UNLAWFUL ACT IS THE PRODUCT
OF A MENTAL DISEASE OR DEFECT
-
8/11/2019 Forensic Psychiatry Blok Vi
43/53
SUMMARY OF INSANITYSTANDARDS
MODEL PENAL CODE (AMERICAN LAW
INSTITUTE 1955) --A PERSON IS NOTRESPONSIBLE FOR CRIMINAL CONDUCT IF AT
THE TIME OF SUCH CONDUCT, AS A RESULT OFMENTAL DISEASE OR DEFECT, HE LACKS
SUBSTANTIAL CAPACITY TO APPRECIATE THE
WRONGFULNESS OF HIS CONDUCT (COGNITIVE
ARM) OR TO CONFORM HIS CONDUCT TO THE
REQUIREMENTS OF THE LAW (VOLITIONAL
ARM)
-
8/11/2019 Forensic Psychiatry Blok Vi
44/53
A deposition
The psychiatrist may be required to give
testimony in the form of a deposition
a deposition is a device for taking sworn
testimony before trial for use at trial.
Its purpose is to preserve testimony for
later use in case where the witness might
not be available at trial for any reason.
-
8/11/2019 Forensic Psychiatry Blok Vi
45/53
A deposition
A deposition may take place in the
doctors own office or at any convenient
place.
Usually only the opposing attorney and acourt reporter are present.
Witness giving deposition testimony are
under oath just as if they were in court.
-
8/11/2019 Forensic Psychiatry Blok Vi
46/53
A subpoena
A subpoena is an order, backed by the
authority of a judge, for the witness to
appear at a deposition or in court.
It usually also requires that the physicianproduce the patients clinical records, or
that the records be made available to the
attorney, in which case a personal
appearance is not required.
-
8/11/2019 Forensic Psychiatry Blok Vi
47/53
A subpoena
Failure to comply with a subpoena is punishable as
contempt of court.
A subpoena to appear at a deposition or in court will
specify a particular time and place.
In the case of depositions, reasonable requests for changesin time and place of appearance will usually be granted by
the attorney for the requesting party.
The psychiatrist may not have to be subpoenaed if there is
an agreement to testify voluntarily.
The arrangements for time and place then be agreed onbetween the attorney and the doctor.
-
8/11/2019 Forensic Psychiatry Blok Vi
48/53
An Expert
Expert witnesses should be prepared to
give their professional qualifications. A
prepared resume is helpful, including
education, postgraduate training,licensing, specialty board certification,
membership in professional
organizations, publications, honors and
awards, and any other informationrelevant to establishing the psychiatrists
credentials as an expert.
-
8/11/2019 Forensic Psychiatry Blok Vi
49/53
An Expert
In providing forensic psychiatric
testimony, psychiatrist are in quite a
different role. They may or may not have
performed a clinical examination of thelitigant, or if they did, the examination was
performed solely for legal purposes.
Usually it is not the patient who seeks the
examination, and control over the findings
is not retained by either the psychiatrist or
the subject of the examination
-
8/11/2019 Forensic Psychiatry Blok Vi
50/53
Perform clinical examination
It is generally preferable to perform an
appropriate clinical examination whenever
possible.
A forensic doctor/psychiatrist may
sometimes be called on to provide
testimony on purely hypothetical issues or
to give opinions about scientific or clinicalissues relevant to the legal questions.
-
8/11/2019 Forensic Psychiatry Blok Vi
51/53
Perform clinical examination
Forensic expert testimony requires much more
legal knowledge than ordinary clinical testimony.
Difficult ethical problems may arise in the
practice of forensic psychiatry. A person beingexamined by a doctor may be confused about the
function of the forensic specialist and may
assume the existence of a traditional clinical
relationship, believing that the examination is
for the patients benefit or that what the patient
and specialist say is confidential.
-
8/11/2019 Forensic Psychiatry Blok Vi
52/53
Fee for testify
The psychiatrist who testifies as an expert
in court or in a deposition or who prepares
a report for any legal purpose is entitled to
a reasonable fee. In all cases it should be understood
clearly how much will be paid, when
payment will be made, and who is
responsible for payment.
-
8/11/2019 Forensic Psychiatry Blok Vi
53/53
Fee for testify
Although lawyers are permitted to take
most civil cases on a contingent fee basis,
it is not ethical for doctors to agree to a
contingent fee for professional servicesand testimony.
It is not improper, if circumstances
warrant, to request partial payment in
advance.
top related