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Mental Health & Experts Manual

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Mental Health & Experts Manual 8th Edition © Kentucky Department of Public Advocacy – 2005 100 Fair Oaks Lane, Suite 302 Frankfort, Kentucky 40601 http://dpa.ky.gov/ Table of Contents CHAPTER 1 Mental Health Issues: The Heart of the Matter - Dick Burr 2 Competency to Stand Trial, Criminal Responsibility, Mental Retardation, Extreme Emotional Disturbance, Guilty but Mentally Ill, Ethical Considerations When Representing Mentally Ill Clients - Leo Smith 3 Mental Health Problems: Competency to Stand Trial; Criminal Responsibility; Mental Retar- dation; EED; GBMI - Roger Gibbs 4 Updating Approaches to Client Competence: Understanding the Pertinent Law and Standards of Practice - John T. Phiipsborn, The Champion, January/February 2005 5 Mental Health Issues in Criminal Cases The Elements of a Competent and Reliable Mental Health Examination - John Blume 6 Principles of Developing and Presenting Mental Health Evidence in Criminal Cases - John H. Blume and Pamela Blume Leonard 7 Avoiding or Challenging a Diagnosis of Antisocial Personality Disorder - John H. Blume and David P. Voisin 8 The Use of “Generators” in Brainstorming: An Interactive-Environmental Approach to Case Conceptualization - ©Eric Drogin, Ph.D. 9 Decision Rules for Integrating the Expert Into the Case: An 8 Step Process - © Jim Clark, Ph.D. & Ed Monahan 10 The Fiend Unmasked; Developing the mental health dimensions of the defense - © Jim Clark, Ph.D., Lane Veltkamp, MSW, LCSW & Ed Monahan 11 Social Histories and Forensic Mental Health Evaluations in Forensic Cases - © Robert Walker, MSW, LCSW 12 The Goals of Mitigation Interviews - © Lee Norton, Ph.D. 13 In Search of Psychology: A Jurisprudent Therapy Perspective on Sexual Offender Risk Assess- ment – ©Eric Drogin, Ph.D. 14 Pre-Trial Evaluation Program (Kentucky Correctional Psychiatric Center) - Gregory S. Taylor 15 Competency to Stand Trial - Assessment Instrument - Sample Questions i CHAPTER 16 Neuropsychological Evidence in Criminal Defense - Marilyn Wagner, Ph.D.© 17 PTSD in the Forensic Setting - Douglas Ruth, M.D. 18 Checklist of Client Behavior Evidencing Mental Impairments 19 Learning to Observe Signs of Mental Impairment - Deana Dorman Logan 20 Top Ten Tips for Interviewing Emotionally Disturbed Persons - Lynn Geurin, MSW, CSW 21 Comprehensive Textbook of Psychiatry VI - Book Review by Douglas Ruth, M.D. 22 Diagnostic and Statistical Manual of Mental Disorders, DSM-IV - Book Review by William Weitzel, M.D. 23 DSM-IV Classification Summary - Lynn Geurin, MSW, CSW 24 Global Assessment of Functioning (GAF) Scale - Lynn Geurin, MSW, CSW 25 “But Doctor, Isn’t That Just Your Opinion?” Contributing to the Decision-Making Process of the Forensic Psychologist as Expert Witness - © Eric Drogin, Ph.D. & Curtis Barrett, Ph.D. 26 Cross-Examining the Prosecution’s Mental Health Expert - Kelly Gleason & Robert Harp 27 Some of the Nitty Gritty: Examples of Changes in the DSM-IV - Kathleen Wayland 28 Working Effectively with Capital Defendants: Identifying and Managing Barriers to Commu- nication - Lee Norton, Ph.D. 29 Understanding Severe Traumatization - Lizabeth Roemer and Leslie Lebowitz, Ph.D. 30 Breaking Through: Communicating And Collaborating with the Mentally Ill Defendant – ©Eric Drogin, Ph.D. SAMPLE TESTIMONY 31 Sample Testimony of Forensic Social Worker 32 Social History Timeline 33 Sample Testimony of Psychologist & Psychiatrist ii Chapter 1: Mental Health Issues: The Heart of the Matter by Dick Burr Thinking Comprehensively and Consistently What We Need to Know and Do To About Mental Health Issues Consider and Utilize Mental Health Issues 1. Prior to and independent of current offense 1. We need to know something about relevant mental • Prior convictions impairments • Prior aggravating acts • Prior attempts to obtain services 2. Those that compromise intellectual functioning • mental retardation 2. Prior to and related to current offense • brain damage • Crime derives from mental illness • mental illness – psychosis, dissociation, physical illness • Crime occurs while client’s behavior structured by illness 3. Those that produce loss of contact with reality • 3. During current crime psychosis – schizophrenia, depression, mania, bipolar, • Ability to form specific or general intent, premeditate, schizoaffective, PTSD • implement a plan, have malice dissociation – PTSD • • NGRI/Sanity physical illness – fevers, diabetes, stroke, tumors • Affirmative defenses (coercion, duress, domination by 4. Those that produce a multitude of intellectual, emotional, others) and physical problems • Self-defense and imperfect self-defense • trauma – PTSD 4. Immediately following current crime • chronic maltreatment and neglect • Waivers of rights, consent to search • Behavior alleged to be inculpatory, including state- 5. We need to know the major risk factors that can produce ments or admissions to non-law enforcement mental illness and disorder • Multigenerational mental illness and disorder 5. Interrogations • Multigenerational exposure to trauma, maltreatment, • Waiver of right to counsel and neglect • Voluntariness of confessions or statements • Exposure to trauma, maltreatment, and neglect • Reliability (8th amendment right) of confessions or • Closed head injuries statements • Prenatal conditions – exposure to alcohol and drugs, maternal malnutrition and disease, maternal injury 6. Custodial Behaviors • Perinatal conditions – loss of oxygen in birth process, • Medication head trauma from delivery process • Custodial adjustment • Exposure to environmental toxins 7. Working with defense counsel/defense team • Serious physical illness • Competence to assist counsel • Ability to assist in defense 6. We need to be attentive and perceptive in interactions and • Ability to understand communications with the client 8. Entering plea 7. We need to investigate sufficiently to determine whether • Competence to enter a plea mental health assessment is warranted • medical history and records 9. Behaviors in court during trial • mental health history and records • What jury/judge sees • social welfare agency records • Responding to witness testimony • employment/military records • Client’s Testimony • school records • Keep pace with courtroom proceedings • prior criminal, prison, juvenile records • 10. During sentencing history of family mental illness • Allocution – multigenerational genetic history – diagnosed and undiagnosed illness and disorders 11. Post-conviction – family dynamics • interviews with family historian(s) Mental Health & Experts Manual Chapter 1 - 1 It Is Our Duty to Assure Reliable Assessment 5. Children’s responses to trauma depend on • Source, nature and duration of the trauma 1. Understanding the elements of reliable forensic • Age when the trauma occurs mental health assessment • How much social support is available • psychosocial history, obtained from and independent • How many other problems the child faces of client • The presence of wise, caring adult • medical examination • Presence of mental illness in family • mental status evaluation • Educational level of caretakers • additional diagnostic procedures • Supportive educational climate • Early intervention 2. Undertaking the investigation necessary for reliable • Intelligence assessment • Good self esteem 3. Obtaining necessary investigative assistance 4. Obtaining necessary expert assistance Presenting and Defending Mental Health Issues 5. Working with investigators and experts Mental health as mitigation: The Common Pathway: In what manner did the client’s mental and emotional Maltreatment and Neglect functioning influence him in the commission of the crime? 1. Maltreatment deprives child of Goals of the presentation • Important relationships • To describe the experiences and disorders of the • Raw materials of self esteem client that are relevant • Socialization necessary to become competent work- • To use these experiences and disorders to explain why ers, parents, and citizens the crime was purposeful for the client – why, from the client’s perspective, it happened 2. Abuse and neglect impair the child • To describe what could have prevented the crime • Cognitively from happening • Emotionally • Socially Direct Examination of the Defense Expert • Physiologically 1. Credentials and experience – highlight those things that explain why this person’s expertise will provide helpful in- 3. Maltreatment causes children to formation • Be helpless • Have no sense of self 2. Method of forensic evaluation and how followed here • Be dominated by negative feelings • Focus of the evaluation • Develop self defeating styles of relating to others • Did you follow a particular methodology in conduct- • Devote energy to managing danger rather than ing the evaluation? learning through love and play • What are the steps that you followed? • Have arrested and stunted development • Why did you … [take each step]? • Develop either-or perspective • How did you reach your conclusion? • Have difficulty concentrating • Not understand the motives of others Did you reach a conclusion concerning the effect of the • Have depressed verbal abilities client’s emotional and mental functioning on the commis- • Show increased arousal and insecurity sion of the crime? 4. Lack of attachment due to chronic neglect 3. What is your conclusion … • Prevents child from developing a safe base from • Concerning the client’s mental and emotional function- which to grow ing? • Dysregulates physiological and emotional states • And its effect on him at the time of the crime? • Causes child to
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