Mental health and law

Mental health and law 

In the diagnosis and treatment of mental disorders certain legal issues, responsibilities and rights of patients etc are involved. These all are part of forensic psychiatry. Psychiatrists have the professional, ethical and legal duties to provide a competent care to the patient.

The patients have the right to accept or to refuse treatment. Also the issues such as government legislations, laws and professional licence body’s directives are included in forensic psychiatry. This also includes professional body’s code of ethics and clinical practise guide lines.   

Who is a mentally disordered person? 

To define mental disorder is very difficult as there has been no consensus in defining what is normal mind?. In most cases the situation can be described as if “to find black cat in dark room, where the cat may not be there” So I will not try to get into the complex and contentious discussion of what is normal and what is abnormal mind.  

The usual practice in a family court, they look into the following facts to determine if the person is mentally disordered or not and if that person needs involuntary treatment:  

1)     Clinical presentation: This may include incidents or threats of violence, self harm or suicidal attempts, or neglect of self care that includes not eating or drinking, not taking essential medicines for physical illness.

2)     History of clinical presentation: How it started, the duration of the illness, if it is continuous or episodic in nature etc.

3)     Past history of any such episode of illness, and it’s treatment and outcome.

4)     Relevant drug, and alcohol use contributing the condition, relevant social and personal information pertaining to illness.

5)     For statutory definition of mental disorder the following are the manifestations:  

a)     Disorder of mood: depressed mood, angry or irritable mood, elevated mood, unpredictable in occurrence.

b)     Disorder of volition: impulsive, aggressive, unable to control impulse or urge etc, or mute, or diminished activity.

c)     Disorder of cognition: poor memory, poor attention, poor concentration, poor understanding of the surrounding.

d)     Disorder of thoughts or delusions: abnormal firm believes not shared by the his or her community;

e)     Disorder or perception or hallucinations: hearing voices or seeing things etc without any stimulus.

f)     Abnormal state of mind poses serious danger to self or others.  

In regard to initiating treatment against the will of the patient or the involuntary treatment the above factors are important.  A person may have all the features of disorder of mind but not dangerous to self or others and has adequate self care, and socially functioning, may not be put under involuntary treatment or compulsory treatment.  Or a parson who has been delusional, but self care is adequate and due to delusional thinking or due to hearing voices (such as voices telling him to kill somebody or kill himself or herself) may pose a danger to self or others, in that situation mental health act may be imposed on him to treat the condition.  

There are many grey areas in the act and this is decided by the family court judge and sometimes the decision one mental health act is delivered contrary to psychiatrist’s opinion.   

CRIMINAL LAW PERTAINING TO FORENSIC PSYCHIATRY

 Criminal Responsibility 

According to criminal law committing a harmful act is not enough whether a crime has been committed. It must have two important aspects such as: 1)     It must be committed voluntarily by the person (actus reus).2)     It must have an evil intent (mens rea).  So when a person who is suffering from a mental illness, and is so much disordered mind that the person may not have the capacity to understand the rational intent of the act.  To determine the criminal responsibility the two following rules are important in criminal law. The names of the rules were acquired by the historical cases in the past.  

M’Naghten Rule:

Persons are not guilty by reason of insanity if the persons laboured under mental disease such that they were unaware of the nature, the quality, and the consequences of their acts. Also they were incapable of understanding that their acts were wrong. So a person may have delusional belief and because of that if the person committed a crime then he or she would be held responsible for the act.

But if a person has been delusional but at the time of act were not labouring under delusion then the person would be held responsible. If a person knew what he or she was doing but due to mental illness not able to understand the consequences of it then he or she can claim diminished responsibility or may not be held responsible for the actions.  

Sometimes an individual have a delusional idea but the crime committed was not justified by the delusions, thus the individual may be held responsible or guilty or punishable.

There are verdicts when a person was found to be suffering from mental illness but convicted to be guilty of the act. In these cases the patients are sent to prisons for treatment for indefinite period of time. Anyway these persons remain in state custody for a much longer time than the prison sentence if he or she were convicted of the crime. 

To establish a defense on the ground of insanity the following is a must:

1)     It must be clearly proved that at the time of committing the act the accused was suffering from a defect of reason, due to disease of mind. Thus he or she did not know the nature and quality of act. Even if he or she knew what he or she was doing but he or she did not know that it was wrong.

2)     When a person suffers from partial delusions only and is not insane in other aspect and as a result commits an offense, he or she must be considered in the same situation regarding responsibility as if the facts with respect to which the delusion exists were real.

According to the rule, the question is not whether the defendant knows the difference between right and wrong, it is whether the defendant understood the nature and quality of the action and whether the defendant knew the difference between right and wrong with respect to the act.  

Irresistible impulse test: This is also a test of criminal responsibility and it is broadened to the above test or rule. The test states that when a person charged with criminal offense is not responsible for the act if the act was committed under an impulse that the person was unable to resist because of mental disease.  

This is interpreted by the court with a concept called “policeman-at–the-elbow-law”. This means if a person commits an offense due to poor impulse control even if a police man had been at the accused’s elbow.  Some psychiatrists believe the above interpretation only covers a small and special group of people with mental illness. 

There are other laws which are beyond the scope of this site and any specific question can be addressed as necessary