ENG 112: Dual Enrollment: College Composition II (Woodgrove HS-Loudoun)

The challenge of a society to find the appropriate balance between accountability of one's criminal acts and allowance for mental illness is centuries old. Early tests of criminal responsibility are, in their core functional elements, not much different than today's, and tests in different countries are remarkably similar. Criminal responsibility requires the commission of a criminal act and a corresponding mental state or intent. Diminished or absent cognitive ability concerning the criminality of the act, or in some cases ability to control one's behavior, can be argued to reduce or eliminate the defendant's culpability and derivatively punishment. The stability and endurance of these underlying principles is really quite remarkable.

Of all of the matters that psychiatrists, psychologists, and social workers undertake, support of accused criminals', and particularly killers', pleas of "not guilty by reason of insanity" or, in some states, "not criminally responsible," is perhaps the most outrageously invalid. Many of their clients or patients are voluntary. Whatever debates exist concerning the prescribing of psychoactive drugs, such activities usually are desired by the recipients. Whatever role mental health practitioners play in adjudicating interpersonal legal disputes, at least they theoretically can bring the concept of "the reasonable man" (now, perhaps, the reasonable person) to hear without resorting to creating exculpatory bases for others' derelictions of responsibility in decision making. Even when testifying in court regarding the penalty phase after a verdict has been rendered, the mental health personage usually argues for mitigation, not elimination, of punishment.

Noncompliance with medication therapy and mental health care is prevalent among the mentally ill. Its multifactorial dynamics can include aspects of the illness itself such as anosognosia. Noncompliance with medication can increase risk of violent or other criminal behavior, but the law currently does not recognize it as a factor in determining culpability. The legal test of insanity that focuses on a "defect of reason from disease of the mind" presumes that the disease was not self-induced. Noncompliance with medication and voluntary intoxication can both be seen as self-induced incapacities, but their adjudication is often quite different. A psychotic condition may be the basis of an excuse, whereas simple intoxication is not. The distinction is not only the obvious one of acts of omission (medication noncompliance) and acts of commission (voluntary intoxication). There are other complicating factors, such as the knowledge of the effects of noncompliance, the mental state prior to the noncompliance, and the presence of any conditions that would excuse or justify it. These and other considerations render the assignment of criminal responsibility for the noncompliant psychiatric offender complex. A possible solution to this would be the application of therapeutic jurisprudence to the noncompliant mentally ill offender.

Criminal responsibility refers to the degree to which an individual is accountable for an illegal act that he or she committed given idiographic factors such as age, cognitive abilities, and psychological functioning (Packer, 2009). Thus, perception of criminal responsibility has the potential to greatly impact forensically involved individuals, and most often forensically involved individuals living with severe and persistent mental illness and/or cognitive limitations. This paper focuses on international and cross-cultural perspectives on criminal responsibility; the topic is of importance because mental health professionals may perform evaluations of criminal responsibility, and potentially testify in this regard, in jurisdictions with dissimilar perspectives and/or policies related to criminal responsibility. Specifically, this article discusses the similarities and differences between several geographic areas’ definitions of criminal responsibility, evolving legal standards, and the apparent relevance of formal diagnoses in determining criminal responsibility. Variation in perceptions of treatment to rehabilitate mentally ill offenders and the potential legal consequences of a finding of guilt or nonguilt by reason of insanity are also discussed. Findings emphasize that mental health experts who perform criminal responsibility evaluations must be attuned to the specific context in which a defendant is being tried, particularly if practicing in multiple jurisdictions, and that consumers of criminal responsibility research should attend to the broader social context(s) in which each research study is conducted and findings are interpreted.

The insanity defense has been the subject of debate as much in academia as in popular culture. Recently, the defense captured public attention when James Holmes, the man found guilty of the Aurora theater shooting, asserted the defense at trial, igniting popular debate about mental illness and criminal culpability. The debate centers on how we should punish individuals who have committed a crime, yet may not be criminally responsible on account of a mental health condition. Though very few individuals are found not guilty by reason of insanity (NGRI), the insanity defense has long been caught in a contentious balancing act; one that involves balancing individual liberty, public safety, and our belief that individuals with mental health conditions deserve treatment.

A growing body of research is helping to tease apart why some people with serious mental illness are prone to violence while others are not, and how clinicians and others can help through improved treatment and informed myth-busting.