Insanity Defense Evaluations - Basic Procedure And Best Practices

Main Category: Psychology / Psychiatry
Article Date: 07 Jan 2009 - 8:00 PST

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The insanity defense existed long before psychiatry; references to it can be found dating back to biblical times. The Babylonian Talmud refers to the insanity defense in the statement: "It is an ill thing to knock against a deaf mute, an imbecile, or a minor. . . . if they wound others they are not culpable."

The insanity defense represents a prominent symbol of the relationship between law and psychiatry.2 Despite the fact that it is infrequently raised and seldom successful, the insanity defense is the subject of intense legal and public scrutiny. Psychiatrists are often called on by the criminal justice system to evaluate a defendant's sanity - a forensic evaluation that requires significant training and expertise. This article pro¬-vides a brief overview of the basic principles for evaluating a criminal defendant's sanity at the time of an offense.

Insanity standards

In 1981, John Hinckley was found not guilty by reason of insanity (NGRI) for his attempted assassination of President Ronald Reagan. Public outrage about the verdict led to demands for reform. As a result, the Federal Insanity Defense Reform Act of 1984 narrowed the insanity standard in federal jurisdictions. The revised federal standard is a McNaughtan standard with the requirement of a severe mental disease or defect at the time of the act: "At the time of the commission of the acts . . . the defendant, as a result of severe mental disease or defect, was unable to appre¬ciate the nature and quality or the wrongfulness of his acts."

The majority of jurisdictions in the United States use a similar insanity standard that addresses only knowledge of wrongfulness. A minority of states add some variation of the irresistible impulse test, where evidence of volitional impairment may be considered. Approximately 1% of defendants who are charged with a felony plead insanity, and only 15% to 25% of those who plead insanity are actually found NGRI.4 Juries are significantly less likely to render an insanity verdict than are judges.

James L. Knoll, IV, MD and Phillip J. Resnick, MD

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Psychiatric Times
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