Insanity Defense Guidelines - AAPL

1 AAPL Practice Guideline for ForensicPsychiatric Evaluation of DefendantsRaising the Insanity Defense *, Statement of IntentThis guideline is intended as a review of legal andpsychiatric factors to give practical guidance and as-sistance in the performance of Insanity Defense eval-uations. It was developed through the participationof forensic psychiatrists who routinely conduct eval-uations of competence to stand trial and have exper-tise in this area. Some contributors are actively in-volved in related academic endeavors. The process ofdeveloping the guideline incorporated a thoroughreview that integrated feedback and revisions into thefinal draft. This guideline was reviewed and ap-proved by the Council of the American Academy ofPsychiatry and the Law (AAPL) on May 19, , it reflects a consensus among members andexperts about the principles and practice applicableto the conduct of Insanity Defense evaluations.

2 Thispractice guideline should not be construed as dictat-ing the standard for this type of evaluation. Rather, itis intended to inform practice in this area. Thisguideline does not present all acceptable current waysof performing these forensic evaluations, and follow-ing it does not lead to a guaranteed outcome. Differ-ing fact patterns, clinical factors, relevant statutes,administrative and case law, and the psychiatrist sjudgment determine how to proceed in any individ-ual forensic to the approaches and methods setforth in this document will not ensure an accurateassessment of a defendant s mental state at the timeof the instant offense. These parameters are not in-tended to represent all acceptable, current, or futuremethods of evaluating defendants for and drawingconclusions about the Insanity Defense .

3 The fact sit-uation, relevant law, and the judgment of the foren-sic psychiatrist determine the ultimate conduct ofeach Insanity Defense guideline is directed toward psychiatrists andother clinicians who are working in a forensic role inconducting evaluations and providing opinions re-lated to the Insanity Defense . It is expected that anyclinician who agrees to perform forensic evaluationsin this domain has appropriate Insanity Defense is a legal construct that, un-der some circumstances, excuses defendants withmental illness from legal responsibility for criminalbehavior. The ability to evaluate whether defendantsmeet a jurisdiction s test for a finding of not crimi-nally responsible is a core skill in forensic document is intended as a practical guide toinsanity Defense evaluations of adult defendants.

4 (While the guideline does not specifically addressspecial issues that arise with youth, the principlesrelated to the Insanity Defense are largely the same,although a clinical analysis from a developmentalperspective will also be integrated into the assess-ment.) The language used throughout the documentis intended to address the Insanity Defense only, anddoes not address other issues regarding criminal re-sponsibility, such as diminished capacity or mitigat-ing mental conditions affecting report acknowledges differences between eth-ics Guidelines and legal jurisdictional requirements.*The AAPL Task Force to revise the Guideline on Forensic PsychiatricEvaluation of Defendants Raising The Insanity Defense consisted of:Jeffrey S. Janofsky, MD, Chair and Medical Director; Anne Hanson,MD; Philip J.

5 Candilis, MD; Wade C. Myers, MD; and HowardZonana, MD. Brooke Irving, JD, consulted in the preparation ofTables 1 6. The original guideline was published as: Giorgi-Guarnieri D, Janof-sky J, Keram E, Lawsky S, Merideth P, Mossman D, Schwartz-WattsD, Scott C, Thompson J Jr, Zonana H; American Academy of Psychi-atry and the Law. AAPL practice guideline for forensic evaluation ofdefendants raising the Insanity Defense . J Am Acad Psychiatry Law30(2 Suppl):S3 S40, 2002. PMID:12099305 Acknowledgments: The members of the Task Force wish to thank thefollowing AAPL members who provided written comments on variousdrafts of this document: Joanna Brandt, David Rosmarin, RichardFrierson, Richard Scarnati, Thomas A. Grieger, Steven K. Hoge, Jon-athan L. Weker, Laura L. Post, Peter Ash, Douglas Mossman, JeffreyMetzner, John Scialli, George Parker, Alan Newman, Hannah Ong,Debra A.

6 Pinals, Kahlid of financial or other potential conflicts of interest: 42, Number 4, 2014 SupplementJurisdictional rules of discovery or hearsay, amongothers, may compel the forensic psychiatrist to con-form to different practices in different for the purpose of this practice guide-line include the following:Forensic psychiatrist: a psychiatrist with forensictraining or a psychiatrist who conducts an insanitydefense disease or defect: a legal or statutory defi-nitional requisite criterion for the Insanity disorder: a disorder described in the Amer-ican Psychiatric Association s Diagnostic and Statis-tical Manual of Mental Disorders (DSM) or the In-ternational Classification of Diseases (ICD). Insanity Defense : a special Defense in the criminallaw excusing a defendant from criminal responsibil-ity.

7 A defendant whose Insanity Defense is successfulis adjudicated either not guilty by reason of Insanity (NGRI or NGI) or guilty but not criminally respon-sible (NCR), depending on the Introduction and History of the InsanityDefenseFor centuries Anglo-American law has maintainedthe principle that a person can be found not crimi-nally responsible for an offense if at the time of theoffense he was David Bazelon suc-cinctly summarized the moral basis of the insanitydefense: Our collective conscience does not allowpunishment where it cannot impose blame. 2 Insan-ity Defense rules have always been controversial. At-tempts upon the lives of kings, presidents, and gov-ernment officials have often led to review andmodification of legal standards. The most recentsuch national review occurred in the aftermath of theattempted assassination of President Ronald Reaganby John W.

8 Hinckley in case history prior to John Hinckley can bedivided into three categories that center on one sig-nificant legal event the trial of M Naughten. (Thespelling of M Naughten is quite controversial. Thereis evidence, based on his signature, that it should beM Naughten. The name has been spelled at leastnine other ways in the medical and legal have elected to use the spelling most often foundin the legal literature.)3 The legal cases prior toM Naughten, theM Naughtencase itself, and the le-gal cases afterM Naughtendefine the three historicperiods that shape our present-day understanding ofthe Insanity Pre-M NaughtenHistoryCommentary on Hebrew Scriptures as early as the6th century distinguished between offenseswhere fault could be imposed and those that occurwithout fault.

9 Examples of the latter were those com-mitted by children, who were seen as incapable ofweighing the moral implications of personal behav-ior, even when willful, and by the intellectually dis-abled and insane persons who were likened the 12th century, issues of moral wrongfulnessbegan to develop in pre-English law that raised theconcept of madness as it relates to of state began granting pardons to individualswho were convicted of a crime and obviously pardons usually ordered the accused to com-mitment and treatment in a mental institution in-stead of a prison. Unfortunately, the mental institu-tions and prisons lacked both adequate facilities andtreatment for the seriously mentally ill. Granting par-dons, however, preserved the dignity of the the 13th century, the moral wrongfulness re-quirement of Christian law was merged into Englishcommon law, to require both the presence of a crim-inal act (actus reus) and the presence of a guilty mind(mens rea).

10 Henry Bracton, who wrote the first studyof English law, noted that because children and theinsane were incapable of forming both intent andwill to do harm, they therefore did not have the ca-pacity to form a guilty reference to children, the common law set-tled into its present form between the 5th centuryand the time of Lord Coke in the 17th century: Thedoli incapaxdoctrine found in common law con-sisted of an irrebuttable presumption that childrenunder age seven were incapable of committing acrime. Between the ages of 7 and 13 (inclusive), how-ever,incapacity was presumed but was open to chal-lenge. This rebuttable presumption could be over-come by the prosecution producing evidence thatshowed the child was intelligent enough to distin-guish between right and wrong (or good and evil)and, therefore, aware of the wrongful nature of theact in knowledge of right andwrong language denotes a general capacity or statusthat young children are thought to to theM Naughtencase, English jurists madeseveral attempts to find the appropriate test for in-sanity.