Assessment of competency for execution? A guide for mental health professionals

Assessment of competency for execution presents two compelling ethical questions for mental health professionals: whether clinicians can ethically provide such assessment, and if so, how it should be done in order to maximize quality and minimize ethical conflict. In this article we address the issue of whether to participate and, if so, how. The question of whether to participate is discussed by summarizing the arguments for and against participation and offering guidelines for making a decision. The question of how to proceed is discussed in two contexts: preadjudication (before a formal decision about competency) and postadjudication (following a determination of "incompetent" and transfer of the offender to another facility for treatment and further assessment). Finally, recommendations are made regarding research that would improve the quality of execution competency assessments.     

Conducting Veteran Dependency and Indemnity Compensation Exams: Establishing a Nexus Between Mental Health and Death

Forms of financial compensation have been paid to the beneficiaries of deceased service members since the Revolutionary War. In its current version, Dependency and Indemnity Compensation (DIC) is a tax-free monetary benefit paid to eligible survivors of veterans whose death resulted from a service-related disability. Mental health professionals are called upon to provide medico-legal opinions in DIC claims involving questions of whether a veteran’s service-connected mental illness contributed substantially to their death. The U.S. Department of Veterans Affairs (VA) does not currently employ training programs, competency standards, or best practice recommendations for these specialized evaluations. This article seeks to fill this gap and provide a resource for mental health professionals providing medical opinions in DIC claims.     

The processing and disposition of incompetent mentally ill offenders

Pretrial hospitalization of mentally ill offenders has been increasing in recent years and a number of abuses have been noted with respect to competency to stand trial. This is a report on 431 male felony defendants who were found incompetent to stand trial, hospitalized, and returned to court for a final disposition. Approximately one-half of those brought back to the court gained release to the community, with one-half continuing to be held in a hospital or a prison, and with 70% continuing in treatment in one setting or another. Disposition was significantly related to race, criminal history, severity of charges, and the recommendations of mental health professionals. Offenders were found to have spent unnecessarily long periods of time in jail and in the hospital awaiting court processing, raising questions about the fairness and efficiency of current procedures.     

THE IMPACT OF STATE MENTAL HOSPITAL DEINSTITUTIONALIZATION ON COMMITMENTS FOR INCOMPETENCY TO STAND TRIAL*

Previous studies have reported that state mental hospital deinstitutional-ization has resulted in the criminalization of the mentally ill. Utilizing two samples of defendants found incompetent to stand trial (IST) pre- and post-deinstitutionalization, selected from three states, this study examines the correlation between the rate of deinstitutionalization and increases in the frequency of incompetency commitments, as well as changes in the characteristics of incompetent defendants. These data suggest that increases in IST commitments and the mental health histories of the post-deinstitutional cohort are positively related to deinstitutionalization. Contrary to the criminalization hypothesis, there is no evidence that incompetent defendants are now being arrested for less serious offenses.     

浅析我国民事行为能力欠缺宣告制度的不足与完善

我国民事法律对精神病人民事行为能力欠缺者设有宣告制度,该制度的实行对精神病人的权益保护存在诸多不利因素,建议借鉴大陆法系和英美法系当代的法律法规,完善国内相关法律规定。     

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.     

Courting Compliance: Case Managers as “Double Agents” in the Mental Health Court

An ethnographic study of four Midwest mental health courts was focused on how case managers influence the judicial response to offender noncompliance. Mental health courts, which bear little resemblance to traditional work group models, are staffed by teams of legal and social service professionals working collaboratively toward reducing recidivism and community reintegration for high‐risk offenders. Few studies, however, have explored how treatment providers practice their trade in this new court organization. I investigate how case management professionals, working at the intersections of the social welfare and criminal justice systems, leverage courtroom decision making that results in greater leniency or enhanced punishment. The findings suggest that mental‐health‐court case managers act as boundary spanners in terms of their strategic use of resources to facilitate treatment goals. I conclude that case managers act as “double agents” challenging the state to advocate for clemency while enforcing client rules to uphold the integrity of the court.     

THE (DE)CONSTRUCTION OF CONFLICT IN DIVORCE LITIGATION: A DISCURSIVE CRITIQUE OF “PARENTAL ALIENATION SYNDROME” AND “THE ALIENATED CHILD”

In high‐conflict divorce litigation involving custody and access, mental‐health professionals are often used to assess the case and make recommendations. Using Foucauldian theories of discourse, this article suggests that these assessments, which are intended to resolve the conflict or offer profitable information, often participate in the conflict by constructing assessments and diagnoses that fit with legal discourse, and thus with the outcomes of adversarial‐styled rulings and ideologically driven interests. This article suggests that so long as such professionals are driven by the privileged discourse of law and psychology/psychiatry, the best interests of those at the center of the conflict can have their experience co‐opted by the iatrogenic features of these discourses.     

Older women and intimate partner violence: effective interventions

Women above the age of 60 who have experienced intimate partner violence (IPV) have specific needs compared with younger victims. More research is emerging that assists counselors and other helping professionals with identification of these needs and aids to promote the mental health and well-being of this population. Professionals must consider the generational values held by older IPV victims and understand how values may impact decision making. Integrating safety planning and risk assessment into the counseling process is vital. Older IPV victims may seek counseling for posttraumatic stress or depressive symptoms as a result of the abuse. Others may participate in counseling for issues unrelated to IPV. Therefore, a thorough assessment process should include questions related to relationship dynamics so that the counselor has a complete understanding of all factors impacting the client's functioning. Helping professionals must also have an understanding of available community resources, as well as barriers that these clients face as they take steps toward recovery from trauma. This research uses qualitative analysis of case studies to assist helping professionals in understanding the most effective interventions when working with this population.We found that a contextual approach focusing on the restoration of self-confidence is a constructive means of initiating recovery from trauma.     

Violence against mental health care professionals: prevalence,nature and consequences

In this study, the prevalence, nature and consequences of violence against mental health care professionals are examined. Dutch mental health professionals working in clinical psychiatry were approached to fill in an online questionnaire on their personal experiences with physical violent incidents. It appeared that 67% of the 1534 respondents were victim of at least one physical violent incident in the past five years. In total, the 1534 respondents reported they had encountered 2648 physical violent incidents. In some cases, the consequences were very severe, not only for the victim but also for the employer. Some groups of professionals appear to have an increased risk of being victimized. The findings show that the violence that mental health professionals encounter is a substantial and severe problem that no longer should be disregarded.     

Understanding deliberate indifference to suicide in corrections facilities: A review of recent legal cases

The US corrections system is the largest provider of mental health care in the country. Suicide is a leading cause of death in corrections facilities with rates of inmate suicide being far higher than the national average. Suicide is an event that can lead to legal action against the facility, staff, and treating health-care providers. Some claims are based on medical malpractice. In this setting, claims may also be brought based on violations of the detainee's constitutional rights. Pretrial detainees and prisoners, alike, have a constitutional right to adequate medical and psychiatric care through the Fourteenth Amendment and Eighth Amendment, respectively. But, there is limited information on constitutional claims made against correctional health-care providers for cases of inmate suicide. To help bridge this gap, the authors conducted a search of federal legal case decisions involving claims against health-care providers for deliberate indifference to a detainee's serious illness or injury in the event of attempted suicide or death by suicide over a 5 year period from 2016 to 2021. Fifteen cases were identified. Five themes emerged from the cases, which could serve as bases for claims against health-care professionals: receiving screening, mental health assessment, treatment, documentation, and attention to facility policies. The cases and their clinical significance are summarized in this article. The materials provide an overview of the problems surrounding correctional suicides and can serve as practice pointers in the corporeal setting.     

An inmate’s right to die: legal and ethical considerations in death row volunteering

There is a considerable body of literature about the death penalty across a variety of disciplines. However, a newer body of literature has emerged examining the phenomenon of elected executions, also known as death row volunteering. To date, 138 (nearly 11%) of the 1300 death row executions have come from volunteers. This issue has been particularly controversial due to a number of legal and ethical considerations that have been raised by the scholarly, legal, and public communities. Such issues include a capital defendant’s competency to volunteer; ethical and moral dilemmas for capital defense attorneys, the states, and medical and mental health professionals; whether death row volunteering equates to ‘state-assisted suicide’; and finally, how these considerations impact the public’s support for capital punishment. This paper reviews the existing literature pertaining to death row volunteering through the lenses of these various considerations. Recommendations for future research in this area are also offered.     

Dilemmas in administering the death penalty

This article critiques ethical arguments against conducting forensic evaluations of capital defendants or condemned prisoners and against treating prisoners found incompetent for execution, and considers the impact of widespread professional abstention on the legal system. It concludes that arguments for abstention by forensic evaluators are grounded mainly in personal moral scruples against capital punishment, rather than in tenets of professional ethics, but that abstention would be ethically required if the evaluator's scruples preclude objectivity. It also concludes that treatment of incompetent prisoners known to want treatment is ethically permissible but that treatment for the sole purpose of readying the prisoner for execution is not.Editor's note: Adversary Forum is edited by Gary B. Melton. Stan Brodsky was asked to respond to Professor Bonnie's article, and Professor Bonnie was given an opportunity to reply.This article is based on a paper presented as the Keynote Address to the Annual Meeting of the     

Competency to be executed: Panetti v. Quarterman

The ABA has studied extensively the constitutionally minimum requirements for executing mentally ill offenders. That study has led the Association to conclude that execution of such an offender is constitutionally permissible only if the offender "not only ... [is] 'aware' of the nature and purpose of punishment but also ... 'appreciate[s]' its personal application in the offender's own case, that is, why it is being imposed on the offender." Report in Support of Resolution 122A (Aug. 2006) (emphasis in original). The court below held that a death row inmate who, due to a serious mental disability, suffers from the delusion that the actual reason he is to be executed has nothing to do with his crime is nevertheless competent to be executed. To survive constitutional scrutiny, however, capital punishment must serve the purpose of retribution. The Fifth Circuit's holding breaks that link because it does not require that the offender have any understanding of why he is being put to death--that is, of the retributive purpose of his execution.     

The differential impact of deinstitutionalization on white and nonwhite defendants found incompetent to stand trial

Previous studies have reported that state mental hospital deinstitutionalization has resulted in the processing of the mentally ill through the criminal justice system. Using pre- and postdeinstitutionalization samples of defendants found incompetent to stand trial (IST) selected from three states, this study examines changes in the mental health and arrest histories of white and nonwhite ISTs. These data reveal a significant increase in the number of nonwhite ISTs. Also, after deinstitutionalization, nonwhite ISTs had significantly more prior arrests and hospitalizations than white ISTs. There were, however, no differences in the offenses for which whites and nonwhites were arrested.     

Sex-symmetric effects of coercive behaviors on mental health? Not exactly

The present study tested a section of the model of coercion in intimate partner violence (IPV) by investigating the relationships among coercion, IPV and mental health symptoms. The study's sample consisted of 573 culturally diverse university students (age M = 21.4) who completed a survey that measured past IPV victimization, coercive behaviors, and mental health symptoms. Structural equation modeling analyses revealed that coercion was a stronger predictor of adverse mental health symptoms than was IPV victimization. In addition, the study found that the adverse effect of coercive behaviors on mental health symptoms was stronger among female victims of IPV than among male IPV victims. The results have implications for theory building, future research, and mental health professionals who work with female and male victims of IPV.     

Criminals' explanations of their criminal behavior, III: the effects of time and context

The authors looked at the explanations for their index of violent crimes as given by 69 incarcerated violent male offenders, respectively. We then examined the extent to which those explanations changed with the passing of time and with change in context. We found that explanations of impaired internal control increased with the passing of time, and that such explanation was given more often to mental health professionals rather than law enforcement professionals. Finally, we found that our subjects tended to give mental health professionals fewer explanations involving external control with the passing of time.     

A National Survey of Mental Health Services Available to Offenders with Mental Illness: Who Is Doing What?

The purpose of this study was to examine the national practices of psychotherapy services for male offenders with mental illness (OMI) in state correctional facilities. Participants consisted of 230 correctional mental health service providers from 165 state correctional facilities. Results indicated that mental health professionals provided a variety of services to OMI that can be conceptualized by six goals considered important in their work: mental illness recovery, emotions management, institutional functioning, re-entry, risk-need, and personal growth. Mental health professionals in this study generally viewed mental illness recovery, institutional functioning, and personal growth as significantly more important and spent more time focused on these goals than emotions management, re-entry, and risk-need. Mental health professionals tended to believe the services they provided were effective across four key treatment foci including mental illness, skill development, behavioral functioning, and criminogenic needs with more progress perceived in areas related to mental illness and skill development than their ability to effectively change behavioral functioning. Implications of these findings and directions for future research are discussed.     

我国台湾地区死刑控制及其对大陆死刑改革的启示

本文从立法和司法两个方面分析了我国台湾地区死刑立法模式、死刑适用条件、死刑适用范围、死刑规定方式的控制以及死刑案件程序、死刑赦免、死刑执行的控制,还分析了我国台湾地区死刑立法控制和司法控制的理念。通过这两个方面的分析发现,台湾地区死刑控制与我国大陆死刑的改革方向不谋而合,即对已满75周岁的老年人犯罪绝对不适用死刑。此外,台湾地区死刑控制对我国大陆死刑改革也有一定的启示,即将死刑适用的具体条件限定为危害生命或健康的严重犯罪;废除绝对死刑;提高无期徒刑的假释门槛、新增重罪累犯不得假释的规定、延长死刑追诉权期限;增设死刑案件强制上诉制度,等等。     

LAWYERS AND MENTAL HEALTH PROFESSIONALS WORKING TOGETHER: RECONCILING THE DUTIES OF CONFIDENTIALITY AND MANDATORY CHILD ABUSE REPORTING

Lawyers are increasingly finding themselves working in conjunction with a social worker and/or a psychologist. This dynamic can be found in organizations that take a multi‐disciplinary approach to the law, such as New York City's Legal Aid Society and Lawyers for Children. Collaborative law is another such example. Collaborative law is an increasing trend in family law; it provides a divorcing couple the opportunity to work with professionals from different disciplines, without being subject to the court system. While a multi‐disciplinary approach to the law has the ability to maximize the value of representation, it also can create tension when inconsistent duties are imposed by conflicting professional obligations. A major area of conflict is between the lawyer's duty to maintain client confidences and the mental health professional's duty to report child abuse. This Note discusses the important policies behind these opposing duties. The Note recommends amending state child abuse and neglect laws in order to eliminate the conflict between the professions' duties and allow lawyers and mental health professionals to work together more harmoniously. Amending state child abuse and neglect laws will allow for mental health professionals working with a lawyer who represents a client the same reporting duties as lawyers in the process.