9/1/2015

What is abnormal behavior?

Abnormal Behavior and the Law
General criteria:

(Nevid, Rathus, & Greene)

unusualness
Raymond W. Novaco
University of California, Irvine
Abnormal Behavior
P102, summer 2015

social deviance
faulty perceptions or interpretations of reality
significant personal distress
maladaptive or self-defeating behavior
dangerousness

Dangerousness: A Dilemma

dangerousness

What should we do?

violence and self-harm

determination of dangerousness to self or others
involves clinical or expert judgment
non-clinical factors come into play
social, institutional, legal, economic

Larry Hogue, the Wild Man of West 96th Street

violent behavior
crack cocaine abuse
repeated hospitalizations
Joyce Brown, homeless on NY Streets
gravely disabled
accepted social help but refused treatment
sued for release from hospital
What course of action: Clinically? Social Policy?

Nathaniel Ayers The Soloist

LA Times Steve Lopez

James Holmes Aurora CO Theater massacre

July 20, 2012

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Seal Beach Salon Shooting, 10-12-11 mental disorder defense?

Scott Dekraai kills 7 in salon & 1 outside; + 1 seriously wounded

Adam Lanza & mother

Newtown, CN
12-14-12

custody dispute with his ex-wife Michelle,

who worked in the salon

Itzcoatl Ocampo
homeless killing series 2011-12

Kipland Kinkel

May 21, 1998

Springfield, Oregon

15-year-old went into his high school,

opened fire with a .22 rifle & several handguns
killed 2 and wounded 20 more
like Luke Woodham (Pearl, Miss., 10-1-97) killed his parents the
night before, and was very angry.
John Berry

his father, Refugio, was homeless

Iraq War vet; honorable discharge from Marines in 2010
was never in combat -- did transport; wanted to be a killer
confessed to murders shortly after arrest
also killed mother & brother of high school friend, prior to hml series

Jon Venables, age 10, who with Robert Thompson

abducted, tortured, and killed James Bulger, age 2
(12 February 1993, Liverpool)

He told his friend Dusty Saul, If I ever get really mad, Im going to
hit the cafeteria with my .22
history of mental illness in family; made statements of being
tormented by voices inside my head; told him to hurt people

Insanity Defense - Evolution

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Some Landmarks of the Insanity Defense

The first major legal test of the insanity defense is referred to as the
MNaghten rule, based on a case in England in 1843 of a Scotsman,
Daniel MNaghten, who had intended to assassinate the Prime
Minister of England, Sir Robert Peel.
In the US in 1844, a Massachusetts Chief Justice concluded that the
mind of a prisoner, Abner Rodgers, was in a diseased and unsound
state when he murdered a prison warden, due to an irresistible and
in controllable impulse, thus not the act of a voluntary agent.
The another major case that helped lay the foundation for the
modern insanity defense was Durham v. United States of 1954. The
criminal act was a product of the mental disease or defect.

Competency to Stand Trial

Competency to stand trial - The ability of criminal defendants to
understand the charges and proceedings brought against them and to
participate in their own defense.
Far more people are confined to mental institutions on the basis of a
determination that they lack the mental competence to stand trial
than on the basis of the insanity verdict.
Many more people are committed under the mental competency to
stand trial criteria for every one committed following a verdict of
not guilty by reason of insanity.

Insanity Defense cont.

By 1972, the Durham rule was replaced in many jurisdictions by legal
guidelines formulated by the American Law Institute (ALI, 1962) to
define the legal basis of insanity. These guidelines, which
essentially combine the MNaghten principle with the irresistible
impulse principle, include the following provisions:
1.

A person is not responsible for criminal conduct if at the time

of such conduct as a result of mental disease or defect he lacks
substantial capacity either to appreciate the criminality
(wrongfulness) of his conduct or to conform his conduct to the
requirements of law.

. . . . the terms mental disease or defect do not include

an abnormality manifested only by repeated criminal or
otherwise antisocial conduct. (American Law Institute,
1962, p. 66)
Insanity Defense Reform Act (1984) modified the criteria to place
emphasis on understanding, removing volition (capacity to
conform), and placing burden of proof on the defense.

Predicting Dangerousness
actual
no

yes

predicted
no

true negative

false negative

yes

false positive

true positive

California Penal Code for Incompetent to Stand Trial is PC 1370

base rate problem

Predicting Dangerousness: Base Rate Problem

Very few people are violent, and those who are violent are not
that way very often. In comparison to kindness, gratitude,
inquisitiveness, problem-solving, rule-following, etc., the
occurrence of violence is low in probability. It is thus hard to
predict accurately; but violence is a very consequential
phenomenon its end product has lasting effects.

The low base rate is thereby a double-edged sword with

regard to need for intervention: on the one hand, it does not
take very many more new people being violent to have a
serious social problem; on the other hand, violence
prevention might be applied to a large number of people who
would not be violent and might thus have their freedom
constrained.

Base Rate Problem and False Positives

100,000 people in community
100 are truly violent
dangerousness test is 95% accurate
95 violent people correctly identified
however, the test is 5% inaccurate
100,000 100 = 99,900 x .05 =
4995 false positives (and 5 false negatives)
differential consequences associated with false positives
versus false negatives

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False Positives, Why?

Public Perceptions of the Insanity Defense

What are the differential consequences associated with

false positives versus false negatives?
for the person receiving the designation?
for the person making the designation?
for the community or society?

Abnormal Behavior and the Legal System

critical junctures of public protection and mental health care

Incarceration and Mental Illness

In USA, over 2 million people confined in prisons and jails
Within 3 years of release, 2/3 are re-arrested

civil commitment
incompetence to stand trial; unfit to plead
insanity defense; not guilt by reason of insanity
guilty but mentally disordered; mitigated sentence severity
prison transfers to the mental hospitals
- mentally disordered prisoner
- hospital commitment as condition of parole
- civil commitment of sexually violent predator
community placement parole revocation

Severe Mental Illness (NA, Europe, Aust/NZ)

5-15% in jails have severe MI

10-15% in prisons have severe MI
3-5% schizophrenia (conservative estimate across studies)
female rate higher for SMI, including schizophrenia

Why high MI in CJ population?

deinstitutionaliztion
more strict criteria for civil commitment
lack of adequate community resources for MI
offenders w/ MI have difficulty getting MH services

Severe Mental Illness in LA County Jail (TT)

Baillargeon et al. (American J. Psychiatry, 2009)

Psychiatric Disorders & Repeat Incarcerations: Revolving Prison Door

Lamb, Weinberger, Marsh, and Gross (2007) Psychiatric Services.

random sample of 106 inmates March 2002 August 2002
(after mental health screening)

Psychiatric Diagnoses -- 75% severe MI

biploar disorder
MDD with psychotic features
schizophrenia
schizoaffective disorders
MDD w/o psychotic features

23%
5%
32%
15%
6%

Texas Department of Criminal Justice

79,211 inmates (2006-2007); 116 facilities
standard medical and psychiatric exams during intake
7,878 with psychiatric disorder; 2,324 with psychosis

95 % had prior arrests (72% of these were for violent crimes)

92% had history of non-compliance with psych medications
28% homeless 76% history of SA
95% had presence of overt psychotic symptoms in the jail

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solitary confinement & therapy in cages

Civil Commitment - involuntary hospitalization

Lanterman-Petris-Short Act (LPS) signed 1967 by RR
occurred during period of deinstitutionalization
goal: to end inappropriate lifetime commitment for MI
California Welfare and Institutions Code 5000 covering
treatment, patients rights, confidentiality, & conservatorship
Section 5150 allows for involuntary hospitalization for a
72-hour period for evaluation and treatment

Conditions for Civil Commitment - 5150

the person has a mental disorder
as a result of that disorder, the person is:
a danger to himself or herself
a danger to others
gravely disabled (unable to care for basic needs)

neither mental disorder nor danger defined by law

danger to others
due to a mental disorder, person intends to cause
harm to someone or to engage in dangerous acts
with gross disregard for safety of others
threats of physical harm against particular people
attempts to harm certain individuals
means available to carry out threats or attempts
(e,g, firearms or other weapons)

allows 72 hrs of hospitalization in a designated facility

Continuation of Civil Commitment - 5250

if person is still dangerous or gravely disabled after
the initial 72-hour period
allows certification for an additional 14-day
period of involuntary hospitalization
prior to 5250 certification, person must first be
given the opportunity to accept treatment on a
voluntary basis
Certification Review Hearing (at facility) by 4 days
post-certification holds
if person remains dangerous or gravely disabld
additional extensions can occur, but requires
stronger showing of dangerousness

Certification Review Hearing Probable Cause

occurs at the hospital facility
hearing officer (appointed by Superior Court)
hospital representative
patient advocate (prv. attorney or appt rights advocate)
hearing officer decides on whether criteria for
continued involuntary hospitalization are met
if patient disagrees, can file writ of habeas corpus
(available from hospital staff; filed by social worker)

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Habeas Corpus Writ

habeas corpus is Latin for produce the body
legal request for release from a facility/institution
writ entitles person to Superior Court hearing

Conservatorship -- LPS
someone gravely disabled, after the 5250 is upheld by
probable cause hearing, may be placed on a temporary
conservatorship (deputy public guardian is assigned
and must approve discharge plan)
30 day investigative process (public defender)

court date set within 2 working days from filing

own attorney or Public Defender assigned
patient chart review by investigator (Pub Def)
judge makes decision for patients release or
continued involuntary hospitalization

conservator appointed by a judge

patient may nominate the conservator
public guardian may be appointed
patient has the right to placement in the least
restrictive setting appropriate
pt. may request hearing to oppose conservatorship

Medical Refusal and Riese Hearing

Tarasoff Case: UC Berkeley, 1968-69

Section 5250 provides for detention and treatment, but

grad student, Prosenjit Poddar, became enamored with

Tatiana Tarasoff; he interpreted new years eve kiss as an act of
engagement (consistent with traditions of his India caste)

medication may not be given to involuntarily hospitalized

person who refuses it, except in an emergency situation
necessary for the preservation of life or prevention of
serious bodily harm to the patient or others
it is impractical to obtain consent
the treating physician must petition the court to have the
patient declared unable to consent psychotropic medication
after petition is filed, a Riese or capacity hearing is held, at
which psychiatrist presents evidence for patients incapacity
patient is represented by an advocate (public defender) who
argues for patients capacity to consent
court-appointed hearing officer determines patients capacity

when she rebuffed him, he became depressed and went for

treatment at student health center; when TT returned from
summer vacation in Brazil, he discontinued therapy
psychologist notified campus police, because PP had stated his
intention to purchase a gun; he stated that PP was dangerous
and required psychiatric commitment; police interviewed PP but
did not detain him; supervising psychiatrist decided that cc not
needed and that letter to police and therapy records be destroyed
PP went to TTs home with pellet gun and knife; when she
refused to speak to him, she shot her; she ran from house but he
caught her, stabbed her repeatedly, and killed her

Tarasoff: Duty to Warn

Tarasoff v. Regents of the University of California
1976 California Supreme Court ruling:
Once a therapist does in fact determine, or under
reasonable professional standards should have
determined, that a patient poses a serious danger of
violence to others, he bears the duty to exercise
reasonable care to protect the foreseeable victims of
that danger.

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Right to Treatment

Bryce State Hospital

(founded 1852)

Wyatt v. Stickney (1971-2) Federal Court, Montgomery AL

Lawsuit filed against Bryce State Hospital (had over 5,000 patients)
(lawsuit enlarged to include two other hospitals)
Established certain patient rights, including not to be required to
perform work that is performed for the sake of maintaining the
facility. [employee layoffs prompted lawsuit; case dismissed 2003]
The court-ordered agreements held that mental hospitals must, at a
minimum, provide the following:
1. A humane psychological and physical environment,
2. Qualified staff in numbers sufficient to provide adequate treatmt
3. Individualized treatment plans

Kenneth Donaldson.

Donaldson points to the U.S. Supreme Court decision that ruled that
people who are considered mentally ill but not dangerous cannot be
confined against their will if they can be maintained safely in the
community.

OConnor v. Donaldson (1975)

A former patient at a Florida state hospital (Chattahoochee),
Kenneth Donaldson sued two hospital doctors on the grounds
of being involuntarily confined without receiving treatment for
14 years, despite the fact that he posed no serious threat to
himself or others.
Donaldson was originally committed on the basis of a petition
filed by his father, concerned about his paranoid delusional.
Donaldson received no treatment during his confinement (he
refused it) and was denied grounds privileges and occupational
training, yet his repeated requests for discharge were denied.
Won case in US District Court; upheld by US Supreme Court.