(25) Jiwa Prof Suwadi Forensic Psychiatry

7/29/2019 (25) Jiwa Prof Suwadi Forensic Psychiatry

1/54


2/54

PSYCHIATRY:

THE MEDICAL SPECIALTY CONCERNED WITH

THE STUDY, DIAGNOSIS, TREATMENT, AND

PREVENTION OF BEHAVIOR DISORDERS OR

MENTAL DISORDERS

PSYCHIATRIST IS :

A PHYSICIAN WHO HAS HAD ADVANCED

TRAINING IN THE DIAGNOSIS AND TREATMENTOF MENTAL DISORDERS


3/54


4/54

FORENSIC PSYCHIATRY

ABOUT 30 % OF MEN IN PRISON HAVEA PSYCHIATRIC DISORDER OF A SEVERITYREQUIRING TREATMENT

THE COMMONEST DIAGNOSES ARE

SOCIOPATHY AND ALCOHOLISM; THERE IS ALSO AN EXCESS OF MENTAL

SUBNORMALITY , FUNCTIONAL PSYCHOSIS,ORGANIC BRAIN DISEASE, AND EPILEPSYAMONG PRISONERS.

HOWEVER , SOCIAL AND CULTURAL FACTORSARE MORE IMPORTANT THAN PSYCHIATRICILLNESS IN CAUSING CRIME


5/54

FORENSIC PSYCHIATRY

MALE PRISONERS OUTNUMBER FEMALEONES 30-FOLDS

CULTURAL FACTORS PROBABLY ACCOUNT

FOR MOST OF THIS DISCREPANCY, BUT THEINCREASED FREQUENCY OF CRIMINALBEHAVIOUR AMONG MEN WITH THE XYYGENOTYPE SUGGESTS THAT BIOLOGICALFACTORS ALSO CONTRIBUTE

FEMALE PRISONERS HAVE MORE MENTAL ANDPHYSICAL DISEASE THAN MALE ONES


6/54


7/54

THE MAIN PSYCHIATRICCONDITIONS WHICH CAN LEAD TO

MURDER ARE :1. PSYCHOSES: A SEVERELY DERPESSED

PERSON MAY MURDER CHILDREN OR OTHERRELATIVES BECAUSE OF A DELUSION THATTHEY ARE GOING TO SUFFER A WORSE FATE.

2. SCHIZOPHRENICSMAY COMMIT MURDERUNDER THE INFLUENCES OF PARANOIDDELUSIONS.

3. PUERPERAL PSYCHOSISACCOUNTS FOR

SOME, BUT NOT ALL, CASES OF INFANTICIDE.4. SOCIOPATHICPERSONALITY DISORDER

5. DRUG-INDUCEDSTATES


8/54

THE MAIN PSYCHIATRICCONDITIONS WHICH CAN LEAD TO

MURDER ARE : MORBID JEALOUSY

MENTAL HANDICAP, IN WHICH

FRUSTRATION MAY BEEXPRESSED BY VIOLENCE

EPILEPTIC AUTOMATISM: THIS IS

A RARE CAUSE , AND THERE IS NOSIGNIFICANT ASSOCIATIONBETWEEN MURDER AND EPILEPSY


9/54


10/54


11/54

UNFIT TO PLEAD

THE GROUNDS FOR BEING UNFIT TOPLEAD, ARE : INABILITYTO INSTRUCT COUNSEL,

TO APPRECIATE THE SIGNIFICANCE OFPLEADING,

TO CHALLENGE A JUROR,

TO EXAMINE A WITNESS, OR

TO UNDERSTAND THE EVIDENCE ORCOURT PROCEDURE


12/54

PLEA IN MURDERA RARE PLEA IN MURDER

CASES IS NOT GUILTY BYREASON OF INSANITY, WHEN

THE OFFENDER FULFILS THEMCNAUGHTEN RULES , THAT ISHE EITHER DID NOT KNOW THENATURE AND QUALITY OF HISACT, OR DID NOT KNOW THAT ITWAS WRONG


13/54

PLEA IN MURDER

A DELUDED PATIENT IS ASSUMED TO BEUNDER THE SAME DEGREE OFRESPONSIBILITY AS HE WOULD BE IFTHE DELUSIONS WERE TRUE.

IF THIS PLEA IS SUCCESFUL, THEACCUSED IS SENT TO A SPECIALHOSPITAL

ABOUT HALF THOSE ACCUSED OF

MURDER CLAIM AMNESIA FOR THEEVENT, BUT THIS IS NOT AN ADEQUATEDEFENSE , NOR IS DRUNKENNESS


14/54

RAPE

Rape is sexual intercourse with

a woman without her consent

About 400 rapes are reportedannually in England and Wales ,

but most cases are probably not

reported


15/54

The following types or rapist

are described :1. Inhibited men who are unable to formnormal sexual relationship

2. Aggressive violent men with contempt

for women3. The psychiatrically ill or mentally

handicapped

4. Group rape, by gangs of youth whosemembers would probably not committhe crime individually


16/54

the aggressive type

Of those convicted, 90 % do not

repeat the crime , but the aggressive

type may do so as well ascommitting other violent crimes ,

and may required secure care and

anti libidinal drugs

Centres for counseling rape victims

have been set up in some cities


17/54

SHOPLIFTING

Women shoplift more often than men, andshoplifting is the most common crimeamong female prisoners

A minority of shoplifting episodes areorganized crimes

About two-thirds of female shoplifters aredepressed middle-aged women

In Londons West End, about a third areyoung foreign women without psychiatricdisturbance


18/54

SPECIAL HOSPITALS

Special hospitals exist for the treatment ofpsychotic, sociopathic, or mentallyhandicapped patients who havecommitted violent crimes

They include broadmoor , Rampton ,Moss Side and Park Lane in England , andCarstairs in Scotland

All patients are compulsorily admitted and

detained under the Mental Health Act, themajority from the courts, some fromprisons or psychiatric hospitals


19/54

Violence

Violence to others, violence to self ,

damage to property, and sex

offences are the most frequentreasons for admission

The length of stay is several years

but about half the patients areeventually fit for discharge or

transfer to conventional psychiatric

hospitals


20/54

other topics with

forensic implicationsSome other topics with forensic

implications are dealt with in

other parts of the book : sexual

deviations , juvenile delinquency

and baby battering , and the

Mental HealthAct


21/54

Criminal Responsibility

It is established principle of English law that manis responsible for his own actions-that is to saythat he intends their result

Therefore is follows that in the eyes of the law hemust bear the responsibility for them

In the case of serious offences, responsibility isthe more likely to be questioned

In the case of an individual suffering from mental

illness committing a crime, it has been for manyyears argued that the mans state of mind mustimpair his responsibility for his acts.


22/54

test of insanity

This has, however , not been easy to

establish in a court of law since the law

assumes everyone is sane , and insanity has

to be proven

Since the law assumes everyone is sane ,

and insanity has to be proven

Since 1843 the courts have used theMacNaughten Rules as a test of insanity .


23/54

MacNaughten rules

These rules arose following the trial formurder of Daniel MacNaughten whokilled Sir Robert Peels private secretary

MacNaughten had paranoid delusionsand was acquitted on the direction of thejudge

Subsequently judges formulated the rulesas they have been know ever since, as a

of answers to questions put to them bythe house of lords .


24/54

In practice the rules seek theanswer to the questions

1. Regarding the offence, did theaccused know the nature andquality of the act?

2. If he did, did he know he was doingwrong ?

3. If he knew the nature and quality of

the act, was he labouring under adelusion ?


25/54

responsibility

Despite their apparent simplicity, the rules

can be difficult to apply and make for only

a limited acknowledgement of impaired

responsibility

For years they have been the subject of

controversy, both here and in the USA .

Nevertheless they are still widely appliedas tests of insanity in capital cases


26/54

diminished responsibility

Since the homicide Act of 1959 thelaw in England and Wales hasacknowledged the concept of

diminished responsibility, which canbe invoked if an accused person isshown to be suffering from suchabnormality of mind ..as

substantially to impair hisresponsibility.


27/54

diminished responsibility

The concept of diminishedresponsibility has not been acceptedwithout reserve, and it has been

pointed out that once allowance ismade for diminished responsibilityone is calling into question the wholeidea of criminal responsibility at any

level. A question that remains unresolved


28/54

ARSON

About 40 % of serious fires are started deliberately.Types of arsonist include :

1. Those with a criminal motive , e.g. obtaininginsurance money or concealing evidence ofcrime . They usually have sociopathicpersonalities

2. Psychotic patients motivated by delusions

3. Those with abnormal personality or low

intelligence who start fires for excitement orrevenge. They often repeat the office and requiresecure detention


29/54

Testamentary capacity

The ability to make a valid will depends on

the possession of sound diposing mind .

This is not defined in law but the concept is

derived from the notion that the person

concerned should fulfill the following criteria :

he should understand the implications of the

act of making a will, have a good idea of theextent of the estate and know who are the

likely beneficiaries


30/54

Testamentary capacity

Mental illness, whether through psychosis or

organic cerebral disease, does not

automatically debar someone from making a

valid will, since even in chronic schizophreniaand in dementia there are often well-

preserved areas of lucidity and contact with

reality

A doctor should never witness a will

irrespective whether or not he is a beneficiary


31/54

THE PSYCHIATRIC EXPERT WITNESS

THERE ARE TWO KINDS OF PSYCHIATRIC/PHYSICIAN

TESTIMONY (EXPERT WITNESSES):

A PSYCHIATRIST/PHYSICIAN WHO HAS EXAMINED OR

TREATED A PATIENT MAY BE CALLED AS A WITNESS ANDASKED TO PROVIDE INFORMATION ABOUT THE PATIENTS

CONDITION AND TREATMENT, INCLUDING, AT TIMES,

OPINIONS ABOUT CAUSATION, AND PROGNOSIS

A DIFFERENT SITUATION EXISTS WHEN A

PSYCHIATRIST/PHYSICIAN IS ASKED TO PERFORM ANEXAMINATION OR TESTIFY AS AN EXPERT SPECIFICALLY

FOR LEGAL PURPOSES.


32/54

Psychiatrist/Physicianstestify The psychiatrist/Physician called on

to present clinical testimony should

be willing to testify if the patient

wishes the psychiatrist/physician to

do so, or if the privilege of

confidentiality has been waived by

the patient, or if the psychiatrist islegally required to testify.


33/54

Psychiatrist/Physicianstestify The psychiatrist should maintain adequate

records and properly prepare to give testimony.

Preparation should include close familiarity with

the details of the patients clinical condition andtreatment and some knowledge of the pertinent

legal issues.

A preliminary conference with the attorney acting

for the patient is often useful. The attorney may wish a written report before the

court appearance

COMMON REASONS FOR


34/54

COMMON REASONS FORINCOMPETENCE TO STANDTRIAL LOW INTELLIGENCE OR DEMENTIA THAT

IMPAIRS THE DEFENDANTS

UNDERSTANDING OF THE TRIAL

PROCESS

DEPRESSION AND SELF-DEFEATING

BEHAVIOR THAT LIMIT THE

DEFENDANTS MOTIVATION FOR THE

BEST OUTCOME AT TRIAL MANIA THAT IMPAIRS THE DEFENDANTS

ABILITY TO ACT APPROPRIATELY IN THE

COURTROOM

COMMON REASONS FOR


35/54

COMMON REASONS FORINCOMPETENCE TO STAND

TRIAL PARANOID DELUSIONS THAT IMPAIR THEDEFENDANTS ABILITY TO WORK WITH DEFENSE

COUNSEL

DISORGANIZED THINKING THAT IMPAIRS THE

DEFENDANTS CONCENTRATION AND

ATTENTION

IRRATIONAL DECISION MAKING ABOUT THE

DEFENSEAS THE RESULT OF DELUSIONS,

DISORGANIZED THINKING, LOW INTELLECT, ORDEMENTIA

HALLUCINATIONS THAT DISTRACT THE

DEFENDANT FROM ATTENDING TO THE TRIAL


36/54

COMPETENCY AND SANITYEVALUATIONS

EQUATING PSYCHOSIS WITH INCOMPETENCE TOSTAND TRIAL

CONFUSING COMPETENCY TO STANDTRIAL WITH

INSANITY

EQUATING PSYCHOSIS AT THE TIME OF THE ACTWITH INSANITY

CONCLUSORY REPORTS THAT FAIL TO STATE THE

BASIS FOR THE OPINION

PSYCHODYNAMIC EXPLANATION FOR THE OFFENSEGIVEN AS AN EXCUSE, RATHER THAN FOCUSING ON

THE LEGAL STANDARD FOR SANITY


37/54

COMMON ERRORS INCOMPETENCY AND SANITY

EVALUATIONS FAILURE TO READ RELEVANT MEDICAL RECORDS

FAILURE TO INTERVIEW THE DEFENDANT

DESIRE FOR JUST OUTCOME, INFLUENCING THE

ACCURACY OF THE REPORT

FAILURE TO ADDRESS THE CORRECT COMPETENCY OR

SANITY STANDARD IN THAT PARTICULAR JURISDICTION

EVALUATING COMPETENCY IN THE PAST RATHER THAN

THE PRESENT

EVALUATING SANITY IN THE PRESENT RATHER THAN AT

THE TIME OF THE CRIME


38/54

PRACTICE GUIDELINES

IN ASSESSING COMPETENCY TO STAND TRIAL,FOCUS ON DEFENDANTS PRESENT MENTAL

FUNCTIONING

IN EVALUATING SANITY, FOCUS ON THE

DEFENDANTS MENTAL STATE AT THE TIME OF

THE OFFENSE

ASSESS THE IMPACT OF THE DEFENDANTS

MENTAL ILLNESS ON THE AREAS OF

FUNCTIONING ADDRESSED BY THE COMPE-

TENCY AND SANITY STANDARDS


39/54

PRACTICE GUIDELINES

A DEFENDANT MAY BE SERIOUSLY

MENTALLY ILL BUT STILL BE

COMPETENT TO STAND TRIAL OR

LEGALLY SANE

THE CRITICAL ISSUE IS THE IMPACT OF

THE DEFENDANTS MENTAL ILLNESS ON

THE AREAS OF FUNCTIONINGADDRESSED BY THE COMPETENCY AND

SANITY STANDARDS.


40/54

PRACTICE GUIDELINES

GENERAL PSYCHIATRISTS WHO AGREE TO

PERFORM A COMPETENCY OR SANITY

EVALUATION MUST KEEP IN MIND THAT THEIR

OPINION WILL BE HIGHLY INFLUENTIAL WITHTHE COURT AND WILL CARRY SERIOUS CON-

SEQUENCES.

FORENSIC PSYCHIATRISTS ROUTINELY

PERFORM A COMPETENCY AND SANITY

EVALUATION

SUMMARY OF INSANITY


41/54

SUMMARY OF INSANITYSTANDARDS

WILD BEAST TEST (REX V. ARNOLD 1724)-- A MAN MUST BE TOTALLY DEPRIVED OF HISUNDERSTANDING AND ME- MORY SO AS NOT

TO KNOW WHAT HE IS DOING, NO MORE THAN

AN INFANT, A BRUTE, OR A WILD BEAST

IRRESISTIBLE IMPULSE TEST (REGINA V.

OXFORD 1840) - IF SOME CONTROLLINGDISEASE WAS, IN TRUTH, THE ACTING POWER

WITHIN HIM WHICH HE COULD NOT RESIST,

THEN HE WILL NOT BE HELD RESPONSIBLE


42/54

SUMMARY OF INSANITY STANDARDS

MNAGHTEN RULE (MCNAUGHTANS CASE

1843) -- A MEN TAL DISEASE OR DEFECT AT THE TIMEOF THE ACT WHICH CAUSED THE DEFENDANT NOT TO

KNOW THE NATURE AND QUALITY OR THE

WRONGFULNESS OF THE ACT

DURHAM RULE (DURHAM V. UNITED STATE

1954) -- THE ACCUSED IS NOT CRIMINALLYRESPONSIBLE IF HIS UNLAWFUL ACT IS THE PRODUCT

OF A MENTAL DISEASE OR DEFECT


43/54

SUMMARY OF INSANITYSTANDARDS

MODEL PENAL CODE (AMERICAN LAW

INSTITUTE 1955) --A PERSON IS NOTRESPONSIBLE FOR CRIMINAL CONDUCT IF AT

THE TIME OF SUCH CONDUCT, AS A RESULT OFMENTAL DISEASE OR DEFECT, HE LACKS

SUBSTANTIAL CAPACITY TO APPRECIATE THE

WRONGFULNESS OF HIS CONDUCT (COGNITIVE

ARM) OR TO CONFORM HIS CONDUCT TO THE

REQUIREMENTS OF THE LAW (VOLITIONAL

ARM)


44/54

A deposition

The psychiatrist may be required to give

testimony in the form of a deposition

a deposition is a device for taking sworn

testimony before trial for use at trial.

Its purpose is to preserve testimony for

later use in case where the witness might

not be available at trial for any reason.


45/54

A deposition

A deposition may take place in the

doctors own office or at any convenient

place.

Usually only the opposing attorney and acourt reporter are present.

Witness giving deposition testimony are

under oath just as if they were in court.


46/54

A subpoena

A subpoena is an order, backed by the

authority of a judge, for the witness to

appear at a deposition or in court.

It usually also requires that the physicianproduce the patients clinical records, or

that the records be made available to the

attorney, in which case a personal

appearance is not required.


47/54

A subpoena

Failure to comply with a subpoena is punishable as

contempt of court.

A subpoena to appear at a deposition or in court will

specify a particular time and place.

In the case of depositions, reasonable requests for changesin time and place of appearance will usually be granted by

the attorney for the requesting party.

The psychiatrist may not have to be subpoenaed if there is

an agreement to testify voluntarily.

The arrangements for time and place then be agreed onbetween the attorney and the doctor.


48/54

An Expert

Expert witnesses should be prepared to

give their professional qualifications. A

prepared resume is helpful, including

education, postgraduate training,licensing, specialty board certification,

membership in professional

organizations, publications, honors and

awards, and any other informationrelevant to establishing the psychiatrists

credentials as an expert.


49/54

An Expert

In providing forensic psychiatric

testimony, psychiatrist are in quite a

different role. They may or may not have

performed a clinical examination of thelitigant, or if they did, the examination was

performed solely for legal purposes.

Usually it is not the patient who seeks the

examination, and control over the findings

is not retained by either the psychiatrist or

the subject of the examination


50/54

Perform clinical examination

It is generally preferable to perform an

appropriate clinical examination whenever

possible.

A forensic doctor/psychiatrist may

sometimes be called on to provide

testimony on purely hypothetical issues or

to give opinions about scientific or clinicalissues relevant to the legal questions.


51/54

Perform clinical examination

Forensic expert testimony requires much more

legal knowledge than ordinary clinical testimony.

Difficult ethical problems may arise in the

practice of forensic psychiatry. A person beingexamined by a doctor may be confused about the

function of the forensic specialist and may

assume the existence of a traditional clinical

relationship, believing that the examination is

for the patients benefit or that what the patient

and specialist say is confidential.


52/54

Fee for testify

The psychiatrist who testifies as an expert

in court or in a deposition or who prepares

a report for any legal purpose is entitled to

a reasonable fee. In all cases it should be understood

clearly how much will be paid, when

payment will be made, and who is

responsible for payment.


53/54

Fee for testify

Although lawyers are permitted to take

most civil cases on a contingent fee basis,

it is not ethical for doctors to agree to a

contingent fee for professional servicesand testimony.

It is not improper, if circumstances

warrant, to request partial payment in

advance.


54/54

THANKS YOU

Date post:	14-Apr-2018
Category:	Documents
Upload:	drcinta
View:	219 times
Download:	0 times

(25) Jiwa Prof Suwadi Forensic Psychiatry

Documents