Forensic Mental Health Clinical Evaluation: An Analysis of Interstate and Intersystemic Differences

Forensic mental health evaluation systems have undergone major changes during the past two decades, and the variability of service delivery systems across states is significant. We compared assessments of competence to stand trial and criminal responsibility in three states with different systems for forensic mental health evaluations: Michigan, Ohio, and Virginia. Although all three states use comparable legal criteria to judge competence and criminal responsibility, we found large, statistically significant differences among the states in the proportion of defendants referred for evaluation who were assessed as incompetent or not criminally responsible. In addition, significant differences were found in the diagnostic and offense categories of defendants referred for evaluation. Our findings suggest that the structure of a system for providing forensic evaluation services may significantly affect both the group of individuals referred for evaluation as well as evaluation outcome.     

刑事责任能力评估工具在司法精神病鉴定中的应用

目前,我国刑事责任能力采用三分法,分为完全责任能力、限定责任能力和元责任能力.但在司法精神病鉴定工作中,由于缺乏客观标准,三者的区分尚带有较大主观性,常导致不同鉴定人对同一案例的责任能力判定存在分歧.因此,刑事责任能力的评定一直是司法精神病鉴定亟待解决的难题.本文综述了在司法精神病鉴定中使用的几种责任能力评定量表及其应用情况,认为虽然目前这类量表的信度和效度存在争议,但其对提高鉴定结果的科学性、客观性提供了一种良好思路.     

Attempted altruistic infanticide in a context of psychotic decompensation induced by stress linked to the COVID-19 pandemic:a case report

The mediatization of the COVID-19 pandemic has created a lot of stress leading sometimes to mental health issues. We present a case of a thirty-year-old woman with no history of psychotic disease but some vulnerabilities and no criminal record, who attempted to kill her seven-year-old son during a brief delusional episode in the context of fear of the coronavirus. She was successfully treated by pharmacotherapy and psychotherapy. She was examined by forensic psychiatrists leading to the conclusion that her responsibility was highly diminished, and her reoffending risk was low. We add to the literature that the COVID-19 pandemic has been such a stressor for mentally vulnerable people that it could lead to severe psychiatric decompensation and even criminal acts.     

Quality of criminal responsibility reports submitted to the Hawaii judiciary

This paper is the third in a series of research reports on quality of forensic mental health evaluations submitted to the Hawaii judiciary. Previous studies examined quality of reports assessing competency to stand trial (CST) and post-acquittal conditional release, in felony defendants undergoing court-ordered examinations. Utilizing a 44-item quality coding instrument, this study examined quality of criminal responsibility reports in a sample of 150 forensic mental health evaluations conducted between 2006 and 2010 by court-appointed panels. Raters attained high levels of agreement in training and quality coding. Similar to the previous studies, overall quality of reports was mediocre, falling below the .80 quality criterion score for report elements, regardless of evaluator professional identification or employment status. Level of agreement between evaluators and judicial sanity determinations was “fair” using Cicchetti's (1994) standards for interpretation of intra-class correlations. Level of agreement was lower than previously published findings for CST reports and better than conditional release reports. Reasons for mediocre report quality and “fair” inter-rater agreement are discussed, including the fact that criminal responsibility evaluations are complex, retrospective in nature, and involve significant degrees of inference. In contrast to CST evaluations, assessment of criminal responsibility involves a mental state at the time of the offense evaluation. Threats to reliability in forensic reports are discussed. Suggestions for improvement of report quality are proffered, including standardization of procedures and report format and use of forensic assessment instruments.     

再议毒品所致精神障碍者的刑事责任能力评定

我国法律并未直接规定毒品所致精神障碍者的刑事责任问题,国内法学界和司法精神病学界对此问题仍分歧众多。争论的焦点主要集中在吸毒者陷于辨认或控制能力丧失状态下实施危害行为时该如何评定其刑事责任能力上。从法律的角度来探讨毒品所致精神障碍者的刑事责任能力评定。主张目前实践中司法鉴定人员结合吸毒者的心理态度来评定其刑事责任能力缺乏法律依据,也不适宜对案件的处理,因此不宜由司法鉴定人员以精神病学的角度来认定毒品所致精神障碍者的刑事责任能力。     

Swedish crime scene technicians: facilitations,epistemic frictions and professionalization from the outside

ABSTRACT

This article investigates the role of crime scene technicians in the Swedish criminal justice system, and particularly how Swedish crime scene technicians not only examine crime scenes but also facilitate the criminal justice system’s joint production of forensic evidence. It proposes thinking about the criminal justice system as a conglomeration of epistemic cultures, that is, of communities with different ways of producing and understanding forensic evidence. Such a perspective makes it possible to understand interprofessional frictions as epistemic frictions as well as to draw attention to the facilitations, mediations and translations that crime scene technicians perform. This perspective also makes it possible to illuminate how the crime scene technicians’ professionalization – a professionalization from the outside – affects both their future crime scene work and their facilitations.     

Criminal offense, psychiatric diagnosis, and psycholegal opinion: an analysis of 894 pretrial referrals

This article presents the results of a study of 894 criminal defendants referred by Virginia courts for evaluation of competency to stand trial or criminal responsibility. All evaluations were conducted on an outpatient basis by mental health professionals who had received specialized training in forensic evaluation. Findings as to the referral questions posed, the criminal offenses charged, and the clinical diagnoses and psycholegal opinions offered by the evaluators are described. Statistical analyses demonstrate significant relationships between both diagnosis and criminal charge and the psycholegal opinion rendered.     

Diagnosis of antisocial personality disorder and criminal responsibility

The present study empirically investigates whether personality disorders and psychopathic traits in criminal suspects are reasons for diminished criminal responsibility or enforced treatment in high security hospitals. Recently, the tenability of the claim that individuals with personality disorders and psychopathy can be held fully responsible for crimes has been questioned on theoretical bases. According to some interpretations, these disorders are due to cognitive, biological and developmental deficits that diminish the individual's accountability.The current article presents two studies among suspects of serious crimes under forensic evaluation in a Dutch forensic psychiatric observation clinic. The first study examined how experts weigh personality disorders in their conclusions as far as the degree of criminal responsibility and the need for enforced forensic psychiatric treatment are concerned (n = 843). The second study investigated associations between PCL-R scores and experts' responsibility and treatment advisements (n = 108).The results suggest that in Dutch forensic practice, the presence of a personality disorder decreased responsibility and led to an advice for enforced forensic treatment. Experts also take characteristics of psychopathy concerning impulsivity and (ir)responsibility into consideration when judging criminal accountability. Furthermore, they deem affective deficiencies sufficiently important to indicate suspects' threat to society or dangerousness and warrant a need for forensic treatment.     

Criminal Recidivism After Forensic Psychiatric Treatment. A Multicenter Study on the Role of Pretreatment,Treatment-Related,and Follow-Up Variables

This study examined associations between criminal recidivism after discharge from forensic treatment and variables related to either the time before the current forensic treatment, or the current forensic treatment, or the follow-up after discharge. Participants were treated in 12 forensic clinics according to section 63 of the German penal code. A patient was classified as a criminal recidivist when the patient or the aftercare reported that the patient was delinquent at follow-up. Patients without criminal recidivism were patients for which both perspectives (patient and aftercare) reported no delinquency at follow-up. Mann–Whitney U-tests and Fisher's exact tests were performed. Data to classify patients were available for N = 249 patients. Fifteen patients (6%) were classified as criminal recidivists. The follow-up was M = 12.58 (SD = 1.84) months, and the criminal acts occurred M = 6.00 (SD = 5.55) months after discharge. Differences between patients with and without criminal recidivism were found in pretreatment (young age at first crime, early onset of mental disorder, previous forensic treatments), treatment-related (disorder due to psychoactive substance use, gradual release abuses, outbreaks, assaults against staff, criminal act during treatment, type of discharge, outcome ratings), as well as follow-up variables (no specified housing situation, not being abstinent from psychoactive substances, inpatient readmission, course of outpatient treatment, course of mental disorder) (all p < 0.05). To conclude, it is important to consider variables related to the time before the current treatment, treatment-related variables, and variables related to the follow-up to identify the patients at risk of criminal recidivism after discharge from forensic treatment.     

人格责任论对于刑事司法精神病鉴定的应用价值

目的探讨人格责任论和动机理论相结合的方法在精神障碍患者刑事责任能力鉴定中的价值。方法回顾性分析我机构2013年及2014年实施鉴定的101例精神障碍患者的刑事责任能力,分析指标包括:精神症状对人格基本特征的反映;作案动机;被鉴定人对违法行为的评价;刑事责任能力。结果不同的症状反映了人格整体性、一致性和特殊性的异常;当症状不同时,患者实施违法行为的动机也有现实和非现实的差异;人格整体性受损者不能正常和正确地评价违法行为,几乎全部人格一致性、特殊性受影响者能认识到行为的违法性;人格的完整性和一致性受影响者刑事责任能力不完全;人格特殊性受影响者为完全刑事责任能力。结论人格责任论与动机理论相结合应用于精神障碍患者的刑事责任能力鉴定,有实用的临床意义。以行为人作为行动者的同一性进行界定,辨别患者对行为是"不能控制"还是"不予控制",值得在精神病司法鉴定工作中推广应用。     

The Criminal Justice System Creates Incentives for False Convictions

Abstract

The American criminal justice system creates incentives for false conviction. For example, many public crime labs are funded in part per conviction. We show that the number of false convictions per year in the American criminal justice system should be considered “high.” We examine the incentives of police, forensic scientists, prosecutors, and public defenders in the U.S. Police, prosecutors, and forensic scientists often have an incentive to garner convictions with little incentive to convict the right person. These incentives create what economists call a “multitask problem” that seems to be resulting in a needlessly high rate of false convictions. Public defenders lack the resources and incentives needed to provide a vigorous defense for their clients. Corrective measures are discussed, along with a call for more research.     

Educating Jurors about Forensic Evidence: Using an Expert Witness and Judicial Instructions to Mitigate the Impact of Invalid Forensic Science Testimony

Invalid expert witness testimony that overstated the precision and accuracy of forensic science procedures has been highlighted as a common factor in many wrongful conviction cases. This study assessed the ability of an opposing expert witness and judicial instructions to mitigate the impact of invalid forensic science testimony. Participants (N = 155) acted as mock jurors in a sexual assault trial that contained both invalid forensic testimony regarding hair comparison evidence, and countering testimony from either a defense expert witness or judicial instructions. Results showed that the defense expert witness was successful in educating jurors regarding limitations in the initial expert's conclusions, leading to a greater number of not-guilty verdicts. The judicial instructions were shown to have no impact on verdict decisions. These findings suggest that providing opposing expert witnesses may be an effective safeguard against invalid forensic testimony in criminal trials.     

105例凶杀案责任能力评定分析

目的探讨鉴定医生评定凶杀案例责任能力时的主要依据及影响因素。方法对总计105例凶杀案的精神病司法鉴定案例进行回顾性分析。结果无责任能力者41例(39.0%);限定责任能力者28例(26.7%);完全责任能力者36例(34.3%);与刑事责任能力的评定密切相关的因素有:凶杀行为是否由精神病理因素引起(Gamma=0.906,P=0.000),临床诊断是否为重性精神病(Gamma=0.761,P=0.000),被害人是否为家人亲属(Gamma=0.412,P=0.000)。结论从技术层面看,鉴定医生评价责任能力考虑的三个主要方面按重要性依次是:凶杀行为是否由精神病理因素引起,被鉴定人是否患有重性精神病,被害对象是否为家人亲属。     

Filicide, attempted filicide, and psychotic disorders

The objective of the study was to describe and discuss the cases of two women who faced criminal charges, one for attempting to murder her three children and the other for killing her 1-year-old boy. After a forensic psychiatric assessment of their level of criminal responsibility, these patients were considered not guilty by reason of insanity and were committed to forensic mental hospitals. These two patients received a diagnosis of paranoid schizophrenia, according to the DSM-IV-TR criteria. In both cases, psychotic symptoms were present before the manifestation of violent behavior, in the form of persecutory delusions, auditory hallucinations, and pathological impulsivity. The investigation into cases of filicide may contribute powerfully to expand our understanding of motivational factors underlying this phenomenon and enhance the odds for effective prevention.     

探讨急性酒精中毒者的刑事责任能力

我国刑法第18条第四款规定"醉酒的人犯罪,应当负刑事责任。"自从上世纪80年代末期复杂性醉酒的类型从日本引进中国后,司法精神医学界逐渐放宽了相当一部分醉酒者的刑事责任能力评定标准。这似乎有悖于现行法的规定,为了使该范围的鉴定与现行法规保持一致,笔者从医和法的两维角度探讨了如何评定急性酒精中毒者的刑事责任能力。     

法医精神病鉴定内容架构及评定要点解析

法医精神病鉴定在刑事、民事和行政三大诉讼领域中,以鉴定意见的证据形式发挥着重要作用。然而,与其重要性不相匹配的是,法医精神病鉴定学科发展尚不完善、专业发育尚不成熟,尚不能满足社会和民众的期盼和要求,甚至引发负面评价。为进一步促进法医精神病鉴定规范化、标准化建设。以法医精神病鉴定人的视角,结合法医精神病鉴定的内容架构,重点阐述法医精神病鉴定主要项目及其作用、评定要点,尤其聚焦刑事责任能力评定,阐明当前存在分歧和困难;简要介绍法医精神病鉴定人执业要求、法医精神病鉴定质量控制;以及简述法医精神病鉴定与临床精神医学实践的区别与联系。     

Gender differences in violent offending: results from a multicentre comparison study in Dutch forensic psychiatry

ABSTRACT

The past two decades, a disproportionate growth of females entering the criminal justice system and forensic mental health services has been observed worldwide. However, there is a lack of knowledge on the background of women who are convicted for violent offenses. What is their criminal history, what are their motives for offending and in which way do they differ from men convicted for violent offenses? In this study, criminal histories and the offenses for which they were admitted to forensic care were analyzed of 218 women and 218 men who have been treated between 1984 and 2014 with a mandatory treatment order in one of four Dutch forensic psychiatric settings admitting both men and women. It is concluded that there are important differences in violent offending between male and female patients. Most importantly, female violence was more often directed towards their close environment, like their children, and driven by relational frustration. Furthermore, female patients received lower punishments compared to male patients and were more often considered to be diminished accountable for their offenses due to a mental illness.     

精神分裂症患者的智力状况和刑事责任能力的关系

目的探讨在进行法医精神病学鉴定中精神分裂症患者的智力状况及刑事责任能力的关系。方法采用韦氏成人智力量表中国版(WAIS-RC)对138例精神分裂症患者进行测试,并与其相应的刑事责任能力进行Pearson相关分析。结果精神分裂症患者的全量表智商为±s=74.59±14.716;言语智商为±s=80.89±14.077;操作智商为±s=70.27±15.427。经统计分析发现:言语智商和操作智商(F=26.786,P=0.000)有显著性差异;各项智力结果与刑事责任能力相关性均不存在统计学意义(P>0.05)。结论精神分裂症患者平均智力水平在正常范围之下,边缘状态与轻度损害之间,但在法医精神病学鉴定中,其刑事责任能力与智力状况不存在相关性。     

刑事诉讼中法医精神病鉴定争议的反思与理论诠释

法医精神病鉴定在一些重大刑事案件中持续成为舆论关注的焦点。不论法医精神病鉴定启动与否均会陷入被质疑的困境。这既存在制度安排的问题,也存在鉴定本身的问题,还存在凭直觉判断的问题,更存在理论误导的问题。这些问题叠加在一起衍生了较为复杂的中国性问题。这一复杂问题的解决,需要合理配置启动法医精神病鉴定程序的权力(利),科学对待法医精神病鉴定本质,尊重法医精神病鉴定的医学认定,正确使用法医精神病鉴定意见中的刑事责任能力判断,在正当程序中维护法医精神病鉴定的科学性。对于非制度问题需要正确的理论诠释,避免因实践难题与理论缺陷交织触发一些不具有实质意义的纷争和枉顾科学的呼吁。     

Forensic neuropsychology and the criminal law

This article explores theoretical and empirical issues in the application of clinical neuropsychological evidence to forensic issues in the criminal law. The nature of forensic neuropsychological evaluations is discussed with reference to issues of competency to stand trial, criminal responsibility, and other competencies in the criminal process. Examples of specific disorders relevant to criminal law standards are presented, together with data estimating the prevalence of brain dysfunction in criminal and forensic populations. Research is also reviewed on the role of neuropsychological brain dysfunction in the etiology of violence and criminally relevant behavior. Finally, empirical and ethical issues concerning the applicability and admissibility of forensic neuropsychological data in the criminal context are discussed.