Legal narratives as significant news sources about mental illness and violent crime

Media coverage about people affected by mental illness is an area of research that is extensively examined. Many scholars argue that the media depicts people with mental illness as inherently violent and dangerous within sensational narratives. These depictions are criticized for reinforcing the social stigma and disadvantages many of the mentally ill face. The media does, however, require news sources and, in the context of crime and mental illness, the courts are a significant source. Through qualitative content analysis of Australian newspaper articles, this research examines an under-researched and incompletely theorized area. In doing so, it demonstrates that media depictions of some mentally ill offenders reflect and heavily draw upon legal narratives and what is argued in court about these offenders in the context of criminal responsibility and legal insanity.     

Dealing with mentally ill domestic violence perpetrators: A therapeutic jurisprudence judicial model

People suffering from mental illness are increasingly referred to the domestic violence court. Yet the typical diversion programs available, including batterer's intervention programs, are inappropriate for those with serious mental illness. As a result, the Miami-Dade Domestic Violence Court has developed a new approach for dealing with this population that applies mental health court techniques in domestic violence court. This article will describe and discuss this pioneering model. It also will situate this model within the context of other problem-solving courts and discuss how the court uses principles and approaches of therapeutic jurisprudence. The paper presents some preliminary data that describe the social and legal characteristics of 20 defendants in the Domestic Violence Mental Health Court followed over a two year period between 2005 and 2007.     

Law,psychology, and the "new sciences": rethinking mental illness and dangerousness

Clinical and legal research on the meaning of mental illness and on definitions (and predictions) of dangerousness continue to offer the mental health law arena mostly disappointing results. In this article, the authors argue that much of this failure is linked to the prevailing Newtonian paradigm of cause-effect relationships, linear logic, and absolute order. In its place, the authors draw attention to the "new sciences"; that is, advances generated from quantum physics and chaos theory. To situate the analysis, the authors explore how psycholegal decision making unfolds. Specifically, the authors examine what contributions the new sciences offer society on the nature and meaning of psychiatric disorder and on the forecasting of violence. Along the way, the authors suggest how the new sciences advance the regard for citizen justice within the domain of mental health law.     

A call for minds: the unknown extent of societal influence on the legal rights of involuntarily and voluntarily committed mental health patients

This article begins and ends with a call for more empirical research to understand the connection between societal views of mental illness and the legal system. The author asserts that changing social perceptions of mental illness certainly affect legal outcomes and commitment levels, but the degree remains unknown. This article explores the above two topics through the framework of the Circuit Court 'split' regarding the Constitutional rights of persons committed to state mental health institutions. A main facet of the 'split' is centered on the Circuits' disagreement about whether or not all mentally ill patients committed to institutions deserve the same Constitutional protections.     

Social disadvantage, mental illness and predictors of legal involvement

The following study evaluates the complex association between legal involvement and mental illness. It describes a population of consumers of community mental health programs, comparing those with legal involvement to those without legal involvement, on a number of demographic, clinical and social indicators. It is a secondary analysis of data collected in studies making up the Community Mental Health Evaluation Initiative (CMHEI) in the province of Ontario, Canada. Legal involvement was a significant issue among community mental health program consumers; about one in five consumers had at least some contact with the legal system in the preceding nine months. Legally involved consumers were more likely to be in receipt of social assistance and be unstably housed than those legally uninvolved. However, there were no significant differences between legally involved and uninvolved consumers with respect to severity of symptomatology, current medication use or number of hospitalization days in the past 9 months. A predictive model compared the differential impact of clinical and social determinants upon legal involvement. Analyses failed to uncover a significant relationship between severity of psychiatric symptomatology and legal involvement. Significant predictors of legal involvement included gender, race, drug use as well as housing instability, and receipt of social assistance. Legal involvement was attributable to factors other than the severity of mental illness; these results challenge assumptions that the most symptomatically severe consumers are most at risk of legal involvement. Accordingly, the rate of legal involvement in a sample of community mental health program users must be considered in a broad context, with particular emphasis on social disadvantage.     

Mental health courts: serving justice and promoting recovery

This article begins and ends with a call for more empirical research to understand the connection between societal views of mental illness and the legal system. The author asserts that changing social perceptions of mental illness certainly affect legal outcomes and commitment levels, but the degree remains unknown. This article explores the above two topics through the framework of the Circuit Court 'split' regarding the Constitutional rights of persons committed to state mental health institutions. A main facet of the 'split' is centered on the Circuits' disagreement about whether or not all mentally ill patients committed to institutions deserve the same Constitutional protections.     

Responding to Severe Parent–Child Rejection Cases Without a Parentectomy: A Blended Sequential Intervention Model and the Role of the Courts

There have been significant developments over the past two decades that have expanded our understanding of the dynamics of parent–child contact problems post‐separation, which have resulted in some changes in judicial processes to respond to these cases. One significant advancement is a more sophisticated differentiation of the nature and severity of contact problems, which better assists legal and mental health professionals to provide more suitable legal and clinical interventions. However, the issue of innovative court processes has received limited attention. The authors describe a subgroup of families within the “severe” category, for whom an expanded intervention model, referred to as a Blended Sequential Intervention is proposed. This approach involves a reversal of care with court mandated therapeutic support for the rejected parent and child, but also involves the favored parent in the therapeutic plan from the outset, and is intended to avoid a permanent “parentectomy” of the child from either parent. The authors discuss how the courts should respond to these cases, and posit that until all therapeutic treatments are exhausted, interim orders should be preferred to final determinations, and judges should maintain oversight. The authors discuss the critical role of judicial leadership in working with lawyers and mental health professionals to manage and address the issues in these high conflict cases.     

Of Eggshells and Thin-skulls: a consideration of racism-related mental illness impacting Black women

Recent research has indicated that the prevalence of mental disorders is estimated to be higher among Blacks than among Whites, most likely due to the nexus of race and socioeconomic disparity. Blacks are under-represented in in-patient populations and more likely than Whites to use the emergency rooms for mental health treatment. Numerous studies confirm that Blacks drop out of mental health services at a significantly higher rate than Whites and use fewer treatment sessions for mental health issues. Furthermore, Blacks enter mental health treatment at a later, more advanced stage than Whites, under-consume community mental health services of all kinds, are misdiagnosed more often than Whites, and are more often diagnosed with a severe mental illness than Whites. People from diverse ethnic backgrounds often are prevented from receiving adequate mental health treatment due to misdiagnoses and lack of access to the services they need. Factors contributing to this disparity include a general mistrust of medical health professionals, cultural barriers, co-occurring disorders, socioeconomic factors, and primary reliance on family and the religious community during times of distress. Unfortunately, the traditional institutions of racialized research largely ignore the disparate social and political exposures confronting people of color, such as residential and occupational segregation, racial profiling, tokenism, discrimination, racism, and the consequential physiological and psychological effects flowing from the macro and micro effects of such interactions and intersectionalities. This article explores these issues and proposes civil law legal frameworks for addressing these disparities. In particular, it is suggested that renewed consideration be made of the Thin-skull and Eggshell doctrines in the United States and comparable traditional international doctrine.     

Combining work and family in the Netherlands: Blessing or burden for one's mental health?

In this article we study which characteristics of combining work and family put people at risk for mental illness. Two alternative perspectives on the impact of multiple social roles on mental health are tested: the role accumulation perspective and the role strain perspective. Both perspectives are studied with data from a cross-sectional national survey held among a large, representative sample of Dutch people (N=1008). Multivariate analyses provided support for both perspectives. Having more social roles was related to better mental health. We also found a positive mental health effect of having a full-time job in combination with having children. However, having a partner who contributes less to household duties or having a job with low decision latitude or lower skill discretion was related to mental illness. So, certain aspects of social roles may also threaten people's mental health. Overall, our findings do not support the idea that combining work and family is necessarily a burden and harmful for people's mental health. Whether multiple social roles are a blessing or burden for people's mental health seems to depend on the characteristics of the social roles.     

What Would Mary Douglas Do? A Commentary on Kahan et al., “Cultural Cognition and Public Policy: The Case of Outpatient Commitment Laws”

Involuntary outpatient commitment is a highly controversial issue in mental health law. Strong supporters of outpatient commitment see it as a form of access to community-based mental health care and a less restrictive alternative to hospitalization for people with severe mental illness; vocal opponents see it as an instrument of social control and an unwarranted deprivation of individual liberty. Kahan and colleagues apply the theory of “cultural cognition” in an empirical study of how cultural worldviews influence support for outpatient commitment laws among the general public and shape perceptions of evidence for these laws’ effectiveness. This article critiques Kahan et al. and offers an alternative perspective on the controversy, emphasizing particular social facts underlying stakeholders’ positions on outpatient commitment laws.     

论《精神卫生法》的自愿原则

为了防止正常人"被精神病",更好地保护精神障碍患者的合法权益,《精神卫生法》确立了自愿原则。该原则渊源于私法领域的自愿原则而又与其不同,是在知情的条件下对精神卫生服务的单方接受自愿。它回应了要像人一样保护精神障碍患者,彰显了精神卫生法的福利法本质。它包涵自愿诊断、自愿治疗和自愿出院三个既相互区别又相互联系子原则。非自愿诊断、非自愿治疗、非自愿继续住院治疗只是自愿原则的补充,此种例外旨在寻求患者精神健康权与社会公众安全保护的平衡。     

Psychological Injuries and Legal Decision Making in Civil Cases: What We Know and What We Do not Know

Civil plaintiffs frequently seek monetary compensation for their psychological injuries. Despite the increased study of psychological injury within the legal system, there has been little empirical examination of how psychological injury evidence impacts legal decisions. To illuminate what is known (and not known) on this topic, this paper reviews legal and empirical research regarding how legal decision makers (judges and jurors) perceive and use psychological injury evidence to render civil judgments. A few themes emerged from this review: (1) Courts generally devalue psychological injury, often making it difficult for plaintiffs to pursue and succeed on these claims; (2) these difficulties are a likely byproduct of legal decision-makers’ misperceptions of mental illness; and (3) despite a recent surge in empirical research on how jurors perceive and use psychological injury evidence to render civil decisions, many unexplored areas remain. Specific recommendations for legal policy and suggestions for future research are highlighted throughout this review.     

Detention under the Mental Health Act: balancing rights,risks and needs for services

Mental health law has to balance considerations of both justice, and health and welfare. In the political climate of the 1990s mental health services have become targeted on those with serious mental illness, to address the objectives of containing risks and limiting service expenditure. This paper identifies that increasing rates of detention under the Mental Health Act through the 1990s in a particular region, disproportionately involve longer-term detentions (under section 3), men, and people with serious mental illnesses. Those detained are likely to experience social difficulties. Changes in legislation are imminent, and the paper concludes that thought should be given to the amount of statutory intervention in the lives of seriously mentally ill people, and to the principle of reciprocity in relation to those coerced for lesser periods. Services should seek to address the issues of social exclusion which are reflected in the circumstances of those detained.     

Mental disorder and criminality in Canada

This article examines the relationship between mental disorder and criminality in Canada from the colonial period to the landmark 1992 Mental Disorder Amendments that followed the passing of Bill C-30. The history of this relationship has been shaped by longstanding formal and informal systems of social regulation, by the contests of federal–provincial jurisdiction, by changing trends in the legal and psychiatric professions, and by amendments to the federal Criminal Code. A study of these longer-term features demonstrates that there has been no linear path of progress in Canada's response to mentally unwell offenders. Those caught in the web of crime and mental disorder have been cast and recast over the past 150 years by the changing dynamics of criminal law, psychiatry, and politics. A long historical perspective suggests how earlier and more contemporary struggles over mental disorder and criminality are connected, how these struggles are bound by historical circumstance, and how a few relatively progressive historical moments emerging from these struggles might be recovered, and theorized to advantage.     

Sexual offenders with serious mental illness: prevention, risk, and clinical concerns

Individuals with serious and persistent mental illness who have also engaged in illegal sexual behavior present a unique challenge for our legal and clinical systems. Frequently, these individuals may engage in problematic sexual behaviors which result in hospitalization rather than incarceration, and an overburdened and resource-deficient public community mental health system is ill-equipped to address the seriousness of these sexual behaviors. We have a rather limited understanding of how prevention programs, intervention strategies, and risk assessment would work with this population. Here we evaluate data from a sample of 245 inpatient psychiatric sexual offenders in a forensic mental health setting and compare these with what information has already been presented in some of the literature. Through an examination of seriously mentally ill sexual offenders and their clinical presentation, legal history, and risk management concerns, we illustrate a variety of tertiary prevention needs. Future directions in the area of prevention and risk management for seriously mentally ill sexual offenders are also discussed.     

美国精神病人强制住院治疗法律制度及其借鉴

精神病人强制住院治疗制度是美国一项重要的法律制度。该制度通过司法程序将具有危险性、无法自理的精神病人强制性地送入精神治疗机构治疗。这涉及精神病人的人身自由、名誉等基本权利,因此美国制定法和判例法中形成了强制治疗的实体标准和正当程序。该制度要求治疗机构根据实际情况对于治疗期限届满的精神病人作出合理的处理。这一制度为我国精神病人强制治疗法律制度的规范与完善提供了可资借鉴的经验。     

A Prescription for Violence: The Legacy of Colonization in Contemporary Forensic Mental Health and the Production of Difference

In this paper I will argue, through the example of the “treatment” of racialized minorities diagnosed with mental illness, that the mental health system (including its unique laws, production of different identity categories and ruling disciplines), with its dogmatic adherence to and reliance on alleged expert opinion and internal inquiry, allows for the erasure of subaltern voices. Often we hear about a tragic incident as reported by the media about someone diagnosed with a mental illness who has committed a crime. These representations routinely present the person as violent, aggressive, uncontrollable, and unpredictable. Repeatedly the voice of the accused is not represented; his or her social, historical, and political contexts are not considered relevant. The technologies of the criminal justice and mental health system’s use of physical or chemical restraint, coercive treatment, or practices such as deportation are also not reported, thus reproducing systems of harm. We don’t get to look inside the asylum. Patients’ voices are excluded from the discursive practices, disciplinary hegemony or dominant regimes of truth within the mental health system. This creates a system impermeable to criticism, where violence continues to prevail. Through a discussion of the disproportionate criminalization and deportation of the mentally ill, the false associations between mental illness and violence, the colonial ancestry of internal inquiry, and example cases from the media, this paper reviews how these particular technologies of violence owe their inheritance to the orientalising, discursive practices and disciplinary hegemony developed during colonization that when ignored, reproduce the dehumanizing outcomes upon which they were built.     

The law and the public's health: a study of infectious disease law in the United States

Law plays crucial roles in the field of public health, from defining the power and jurisdiction of health agencies, to influencing the social norms that shape individual behavior. Despite its importance, public health law has been neglected. Over a decade ago, the Institute of Medicine issued a report lamenting the state of public health administration, generally, and calling, in particular, for a revision of public health statutes. The Article examines the current state of public health law. To help create the conditions in which people can be healthy, public health law must reflect an understanding of how public health agencies work to promote health, as well as the political and social contexts in which these agencies operate. The authors first discuss three prevailing ways in which the determinants of health are conceptualized, and the political and social problems each model tends to create for public health efforts. The analysis then turns to the core functions of public health, emphasizing how law furthers public health work. The Article reports the results of a fifty-state survey of communicable disease control law, revealing that few states have systematically reformed their laws to reflect contemporary medical and legal developments. The Article concludes with specific guidelines for law reform.     

The MacArthur Treatment Competence Study. I

This is the first of three papers reporting the results of the MacArthur Treatment Competence Study, a project designed to develop reliable and valid information with which to address clinical and policy questions regarding the abilities of persons with mental illness to make decisions about psychiatric treatment. Four commonly applied legal standards for determining decision-making competence are described: abilities to communicate a choice, understand relevant information, appreciate the nature of the situation and its likely consequences, and rationally manipulate information. Previous research related to the capacities of persons with mental illness in relation to these standards is reviewed and critiqued. The principles underlying the design of the MacArthur Treatment Competence Study are described.This work was supported by the Research Network on Mental Health and the Law, John D. and Catherine T. MacArthur Foundation. The authors, are grateful to the members of the Network for their assistance in the conceptual development of this project and for their, comments on an earlier draft of this paper: Shirley Abrahamson, Richard Bonnie, Pamela Hyde, John Monahan, Stephen Morse, Ed Mulvey, Loren Roth, Paul Slovic, Henry Steadman, and David Wexler.