Health care law relating to psychiatry

Health Care Law Relating to Psychiatry

Drug-Associated Psychoses and Criminal Responsibility

Andrew Carroll and Bernadette McSherry

Behavioral Sciences & the Law, Sep/Oct2008, Vol. 26 Issue 5,

The insanity defense exists in a variety of forms across Anglo-American jurisdictions.

Many jurisdictions follow a version of the established M'Naghten Rules (M'Naghten's Case, 1843), which refers to a fault of cause coming from an illness of the mind. For many years, the law has struggled with how to allocate criminal accountability to those affected by drugs. An intricate system of rules relating to voluntary and involuntary intoxication and crimes of specific and general intent has come about. The law draws a difference when conveying criminal responsibility to those who commit crimes while experiencing psychotic signs. If the symptoms are thought to come about because of ingesting drugs, which is an external cause, the criminal is usually convicted of the crime. If the symptoms arise from a mental illness, which is an internal cause, the offender may be afforded a defense of insanity. In reality, making such a distinction can often be difficult. There are difficulties in determining criminal accountability when the use of drugs is followed by the appearance of a psychotic illness procedure that then persists to have a sovereign existence even in the lack of the ongoing substance use.

There is a mounting amount of case law that deals with conveying accountability to those suffering from such disorders of mental state that has led to varied results. Even though a wide variety of advances have been accepted in various jurisdictions, there are three extensive approaches to the issue that can be distinguished. These are liberal, conservative, and intermediate. The major purpose of this article was to look at the key concerns for the law, expert witnesses, and policy makers that follow from these approaches. It endeavors to tease out the questions arising from the liberal, conservative, and intermediate approaches to drug-linked psychoses in order to explain the effects that each approach may have in practice. It is thought that it might be impossible for the law in this field considers present clinical doubts, but having a general idea of likely advances that the law may take will likely move the debate forward.

Evaluation

Any criminal defense brings with it issues of proof. The question as to whether there is sufficient evidence for a defense of insanity to be determined by the jury is an inquiry for the trial judge to decide. This question is generally thought to be in the absence of the jury prior to the commencement of the trial. The party raising the defense must produce sufficient evidence the evidential burden to permit the defense to be left to the jury for consideration. The burden does not require the party to prove the issue at this stage, but it is for the judge to decide whether the issue has sufficient support of evidence to at least be considered by the jury. While there are some differences according to jurisdiction, in general, if the defense is allowed by the judge to go to the jury.

The term illness of the mind is solely a legal notion. In the case of Bratty v. Attorney-General (Northern Ireland) (1963), Lord Denning declared that the foremost mental illnesses, which the doctors identify as psychoses, like schizophrenia, are plainly illnesses of the mind. Whether or not drug-associated psychosis will be considered to qualify as an illness of the mind will essentially depends on the division amid a fault of cause resulting from an underlying condition and a fault of cause caused by something external.

Reaction

There is justifiable societal concern about the links between violence and illicit substance use. Such concern finds a focal point at the debate around the boundaries for the insanity defense where drug-associated psychoses are involved. This article outlined three potential approaches that the law could adopt in relation to the issue. Each has clearly distinguishable implications for who would qualify for the defense and hence for public policy. It also looked at whether or not there is a correlation between psychiatric drug use and accountability of those of who commit crimes.

This article was very informative about how those that are being treated for a major mental disease are viewed within the legal system. There are a number of different approaches that are currently being used, all which affect the defendants in a different way. The one thing that I think was missing from this article was a better delineation about how the laws affect the practitioners and if these approaches make any difference in the way that treatment plans are designed and what drugs are being prescribed.