Mad or bad? : Entry to the mental health system, from the courts
Degree GrantorUniversity of Canterbury
Degree NameDoctor of Philosophy
This thesis is concerned with criminal defendants who become psychiatrically hospitalised as the outcome of their court proceedings. There are four routes whereby criminal defendants can become hospitalised in New Zealand. These are to be found not guilty by reason of insanity, to found to be under disability, to be found guilty and mentally disordered and for charges to be dropped and proceedings initiated under the Mental Health (Compulsory Assessment and Treatment) Act, 1992. The background to each of these options is explored, with an emphasis on the insanity defence, and the empirical literature reviewed. There are some theoretical contradictions in whether these legal provisions are therapeutic or punitive. The aim of the current study was to describe criminal defendants who enter the mental health system and become psychiatrically hospitalised via the Court Liaison Service. The Court Liaison Service is a part of the Regional Forensic Psychiatric Service. As part of this service, a nurse screens criminal defendants at court for indications that mental health intervention may be warranted. A sample of defendants, who were seen by the Court Liaison Service at Christchurch, is described. Of these defendants some receive a full psychiatric evaluation and a report is prepared for the courts. The characteristics of those who receive a report are compared with those who do not receive a report. Defendants, who are hospitalised as an outcome of their court proceedings, are compared with those who are not. The findings are consistent with international research, in that most defendants were male, and socially disadvantaged in a number of ways. The mental status screening assessment was a useful discriminator between those who received a report and those who did not, and between defendants who were hospitalised and those that were not. Most defendants who were hospitalised showed clear signs of psychotic processes. Defendants who received a report but who were not hospitalised are particularly vulnerable in terms of their mental health needs. This group showed more evidence of depression, and was rated to be of higher suicide risk. They tended to have psychopathic traits, and were more frequently referred because of concerns about dangerousness. A considerable proportion of all defendants have difficulties with substance abuse. Report and hospitalisation status could be effectively predicted, using information collected at the time of the Court Liaison screening. For example, using diagnosis and mental status data as predictor variables, there was 86% correct classification of cases as hospitalised or not. In conclusion, it is argued that the insanity defence serves little current pragmatic use. Revision is recommended in the current admission criteria to psychiatric hospitals for criminal defendants, with an emphasis on effective treatment programmes. The victim's perspective is not frequently considered in deliberations about mentally disordered offenders, and this is seen as important. Finally, the Court Liaison Service serves an extremely valuable function at the interface between the criminal justice and mental health systems in New Zealand.