The Mentally Disordered Offender (Mdo)

Front 1

What is mental status?

Back 1

The level of global functioning one is subject to at ANY GIVEN POINT in time.

Front 2

What 7 mental capacities are considered under mental status?

Back 2

Memory
Orientation
Sensorium (hallucinations)
Drive
Affect
Cognition/Concentration
Delusions

Any Axis I condition can be characterized in terms of disruption to one or more of these areas.

Front 3

If someone tells of weird smells and/or sounds (hallucinations), what concept of mental status may be affected?

Back 3

Sensorium

Front 4

Can depression affect mental status.

Back 4

Yes, "drive" is considered within mental status.

Front 5

Criminal responsibility is...

Back 5

the culpability of an accused which may be reduced by a mental illness or condition.

culpability = degree of freewill

Front 6

What is Actus Reus?

Back 6

Simply means that the accused did indeed commit the crime. Actus reus is require for conviction.

Front 7

What is the psychiatrist's involvement in determining Actus Reus?

Back 7

usually nonexistent! Establishing Actus Reus is not the usual domain of psychology.

Front 8

What is Mens Rea?

Back 8

Mens Rea is the degree of guilt (which influences the severity of sanctions, based on level of mindfulness.)

Unless proved otherwise, mens rea is assumed to be present. [Similar with fitness to stand trial: there is a presumption of fitness.]

Front 9

What does MSO stand for? What "rea" is it relevant to?

Back 9

Mental Status at the time of Offense

MSO is relevant to mens rea.

Front 10

High speed driving on bad roads is an example of what "grade" of mental status?

Back 10

Recklessness.

Front 11

Is Recklessness considered to be of a greater or lesser grade of mental status than Negligence?

Back 11

Recklessness is graded as higher in degree of mental status..

Front 12

Is fitness to stand trial concerned with MSO?

Back 12

No!!

Front 13

What does OER stand for?

Back 13

Order for Examination and Report

Front 14

When was "Fitness to Stand Trial" first addressed?

Back 14

It has a lengthy history, but was first addressed in British CL in the 17th century.

Front 15

What were the first three explanations for inability for someone's inability to defend themselves? And what actions were taken for each type?

Back 15

1. Mute by malice (uncooperative)
-tortured until he pleaded

2. Mute by visitation from God (Genuinely mute dute to illness, insanity, etc.)
-NOT PROSECUTED

3. Mute by visitation from the devil
-tested by water (to separate those unwilling to plea from those truly unable -- same idea with torturing)

Front 16

In 17th Cent. Britain, what were the criteria underlying fitness to stand trial?

Back 16

-sufficient age (in Canada that means 12 or older)
-cognitively adequate
-"sane"

Front 17

Today, does one's status as "insane" proclude the possibility that they are fit to stand trial?

Back 17

Today, it is possible to be "insane" and still be fit unless the mental disorder compromises certain abilities.

Front 18

An "insane" person can still be fit to stand trial, unless the mental disorder compromises one's ability to:

(List three abilities.)

Back 18

1. Understand the role of key courtroom participants. (and the adversarial nature of the proceedings).
2. Understand that he is charged with a criminal offense (and that a range of outcomes are possible).
3. Instruct counsel
-participate in a viable defense
-challenge a prosecution witness

Note that there is NO requirement that the defendant must act in his own best interest.

Front 19

How does memory affect fitness to stand trial?

Back 19

Lack of memory for the events (amnesia) is not enough to limit fitness.

Neither is the mere existence of a diagnosis.

Front 20

Can fitness to stand trial change over time? during the trial?

Back 20

Yes. And the judge can send defendant for treatment to "become fit."

The questions of fitness can be raised at any time in the trail. It doesn't have to be at the start.

Front 21

For what "other" 2 reasons might a judge prescribe a "maker fit order"/assessment on an individual?

Back 21

May use the order as a mechanism to force treatment on a person who is clearly in need of services, but not strictly certifiable.

Also, it makes for a good "stall tactic" since the standard timeframe for a fitness evaluation is 30 days. (and prosecutors may hope the patient inadvertently confesses)

Front 22

How common is it for a patient to be found unfit?

Back 22

Relatively rare.

Front 23

What two concepts do lawyers often confuse?

Back 23

Lawyers often confuse fitness questions with MSO and criminal responsibility.

Front 24

If found unfit, the defendant can be sent to a psychiatric hospital for what length of time?

Back 24

for UP TO (maximum) two years

Front 25

True or false: If found unfit to stand trial, the defendant can be sent to a psychiatric hospital for an indefinite amount of time (if he doesn't become unfit).

Back 25

False. "PREVIOUSLY" this was the case. Now, max = 2 years.

Would have made for a lousy defense strategy for minor crimes!

Front 26

What are four characteristics of the typical unfit patient?

Back 26

1. Low IQ
2. No fixed address
3. Lengthy psychiatric history
4. Few supports in the community (glad to be in the hospital!)

Front 27

What other competencies of the accused are "relevant"? Name 5. (One is US only.)

Back 27

1. Competency to confess
2. Competency to refuse an insanity defense
3. Competency to refuse counsel
4. Fitness to testify
5. Competency to be sentenced and executed (US only)



Competency to refuse an insanity defense:
-it may be a disadvantage if a finding of guilt carries less onerous consequences
-assessment is based on level of insight in that domain

Front 28

Are confessions by an insane person admissible?

Back 28

Yes. (Remember, competency to confess is not precluded by insanity: an "insane" person can still be fit to stand trial given if fulfilling certain requirements).

However, such confessions are not admissible if investigators USED their mental illness to obtain the confession.

Front 29

When is a person considered to have the "competency to refuse counsel"?

Back 29

When there is a heavy emphasis on appreciation of the possible legal ramifications and when the refusal is NOT based on delusional/paranoid beliefs.

Front 30

When is a person said to have "fitness to testify"?

Back 30

When they have an understanding of truth vs. falsehood.

With children, they are usually about 7 to 10 years of age.

Front 31

What is needed for "Competence to be sentenced and executed"?

Back 31

The defendant must understand available avenues of appeal and that he understands the reasons for his punishment.

-Making them competent is an ethical issue.

-Assumed competent unless shown otherwise.

Front 32

Is MSO impairment necessary for NCR finding?

Back 32

YES.

Front 33

When was MSO first addressed?

Back 33

The idea has its roots in ancient Greece: Lunatics and low funcitoning individuals were not held responsible for their actions if the case could be made that they didn't know right from wrong.

More recently, however, the goals of deterrence and retribution are seen as inapplicable to MSO.

Front 34

More recently, the goals of deterrence and retribution are seen as inapplicable to MSO.

Is this unchallenged?

Back 34

No. The ideas of inapplicable deterrence and retribution are being questioned.

Front 35

How often is the MSO/"insanity" defense used?

Back 35

1/500 to 1/1000

Front 36

What % of the time is the insanity plea successful.

Back 36

Only about 30% of the time.

Like unfitness, it is no tan efficient defense for minor crimes, though it can result in drastically shorter sentences for major crimes.

Front 37

What is the M'Naughton (MacNaughton) rule?

Back 37

It is the rule of determining whether someone is criminally responsibility: the defendant knew what he was doing and knew that it was wrong/potentially harmful.

Front 38

Where did the "M'Naughton"rule arise from?

Back 38

M'Naughton wanted to kill PM Peel but shot his private secretary Edward Drummond by accident, instead. M'Naughton had no remorse, believing that the Tories compelled him to do it. "They follow me, persecute me, wherever I go, and have entirely destroyed my peace of mind."

Daniel M'Naughton was never tried.

Front 39

Is the M'Naughton rule still relevent?

Back 39

It is applicable only to extremely impaired individuals: it is seen as overly rigorous.

Front 40

What is the Durham rule? And the problem with it?

Back 40

It replaced the M'Naughton rule. NCR was accepted when the crime was the product of a mental defect or disease.

But it crumbled under interpretation of antisocial personality as a mental disorder.

Front 41

What is the ALI test?

Back 41

A test of NCR.

[Seems to combine both the Durham rule and the M'Naughton rule?]:

Defendant failed to appreciate the wrongfulness of the act, or could not conform his behavior to law as a result of a mental illness or defect.

Front 42

Canadian Criminal Code (section 16)

"No person is criminally responsible for an act committed or an omission made while suffering FROM A MENTAL DISORDER that rendered the person incapable of...

Back 42

appreciating the [N]ature and [Q]uality of the act or omission OR of [K]nowing it was wrong."

-Requires excellent knowledge of psychopathology, cognitive issues, malingering, etc.

Front 43

In terms of MSO/Criminal Responsibility, is there a defense of "temporary insanity"?

Back 43

Such a defense is essentially not available because the defense has to show the disorder is of a chronic and persistent nature (!)

BUT, AUTOMATISM defense are rare exceptions because they neutralize mens rea (?)

Front 44

What makes an automatism defense successful?

Back 44

An automatism defense is successful if there is evidence that the defendant SOUGHT TREATMENT for the condition.

Automatism defense are unlikely to be successful unless there is evidence that the defendant sought treatment for the condition: e.g., post -concussional state, epilepsy, sleepwalking, "battered wife syndrome", involuntary intoxication.
(Reason: You would be aware of these factors and are responsible to mitigate them.)
-If successful, an automatism defense is great because you don't wind up in a psychiatric hospital, and are not found guilty.

Front 45

What happens if you're found NCR?

Back 45

You come under jurisdiction of Alberta BOR
-Not a true court, but proceedings are highly similar. Judge, lay person(s), psychiatrist(s), Crown, defense, treatment team, patient, forensic director.
-Release tends to be slow and gradual after several hearings where you are retained on full warrants.

Front 46

What use can a lawyer make of mens rea in the absence of insanity?

Back 46

A lawyer can speak of diminished capacity (which is relevant to cases where specific intent--versus general intent--is at issue)

This may result in conviction of a lesser charge. (E.g., manslaughter instead of first degree murder) (By law, manslaughter is considered less culpable than murder.)

ALSO, questions of a defendant's character may also be raised since even an insane individual may deliberately commit a crime quite apart from his illness. (An NCR defense would not be available in this case.)

Front 47

Are courts increasingly restricting psychologists' testimony to the matter of the accused criminal intent, or to the capacity of the accused to form criminal intent?

Back 47

Increasingly, some courts are restricting psychologists' testimony to matter of capacity of the accused to form criminal intent, not the criminal intent itself.

-This is reasonable in view of the difficulty of MSO assessments.

Front 48

What are some other disorders that have attracted NCR defenses? Name 6.

Back 48

XYY

Hypoglycemia (the twinkie defense)

Posthypnotic states

Dissociative states

PTSD

PMS

Front 49

Proposing an NCR defense on the basis of a dissociative state is most viable for what type of people?

Back 49

: Not viable for outgoing, sociable, low-anxiety individuals (better for anxious, neurotic, self-centered, immature types)

Front 50

What is GBMI?

Back 50

"Guilty But Mentally Ill" is a category that exists in the US, but not in Canada.

Front 51

What kinds of tools are available for MSO assessment?

Back 51

There are few reasonably good tools available, such as the RCRAS (Rogers Criminal Responsibility Assessment Scale).

They are typically based on collateral as well as clinical information.

Since consistency in portraying an illness is difficult to maintain over time, the best approach is arguably to compare the claims of impairment to acts performed, and reported symptoms and signs to known disorders.