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Noffsinger HANDOUT Ohio Public Defenders 6.13.17

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Noffsinger HANDOUT Ohio Public Defenders 6.13.17 Criminal Law and Psychiatry June 21 & 23, 2017 Everything you always wanted to Agenda know about • Competence to • Involuntary Stand Trial Treatment Criminal Law and Psychiatry* • Other Criminal • Mental Health Competencies Courts • Insanity Defense • Assisted Outpatient *BUT WERE AFRAID TO ASK • Civil Commitment Treatment • Juvenile • Attacking Mental Stephen Noffsinger, M.D. Competency Health Expert • Mitigation Testimony Pre-Test 1 Pre-Test 2 A defendant who is Incompetent to A psychotic defendant who is Stand Trial for Aggravated Murder Incompetent to Stand Trial for may have the charges dropped, Aggravated Murder may refuse based on his incompetency. antipsychotic medication. A. True A. True B. False B. False Pre-Test 3 Pre-Test 4 A defendant who is Incompetent to Stand Trial and fails competency Defendants acquitted by reason of restoration may still proceed to a insanity for Murder are released into trial. society. A. True A.True B. False B.False Stephen Noffsinger, M.D. 1 Criminal Law and Psychiatry June 21 & 23, 2017 Pre-Test 6 Pre-Test 5 A defendant found NGRI on a Grand John was found NGRI twenty years Theft Motor Vehicle charge will ago on a Murder charge. John can remain under the jurisdiction of the only be committed if he is presently trial court for the remainder of his mentally ill and dangerous. life. A.True A.True B.False B.False Generic Definition of Competence Competence to Stand Trial • The capacity to understand a concept and rationally proceed through a decision- making process • Competence is the quality of the thought process involved, not just the eventual decision Generic Definition of United States Constitution Competence Competence to stand trial guaranteed by: • Competence is a present-state evaluation • Fourteenth Amendment – Substantive Due • Mental illness does not necessarily = Process Incompetence • Sixth Amendment Stephen Noffsinger, M.D. 2 Criminal Law and Psychiatry June 21 & 23, 2017 Sixth Amendment Dusky v. United States (1960) In all criminal prosecutions, the accused shall Test for Competence to Stand Trial is: enjoy the right to a speedy and public trial, by an impartial jury of the State and district where in the crime shall have been committed, which district “[W]hether defendant has sufficient present shall have been previously ascertained by law, and to be informed of the nature and cause of the ability to consult with his lawyer with a accusation; to be confronted with the witnesses reasonable degree of rational understanding against him; to have compulsory process for - and whether he has a rational as well as obtaining witnesses in his favor, and to have the factual understanding of the proceedings Assistance of Counsel for his defence. against him.” Ohio Revised Code Ohio Revised Code Summarized Section 2945.37 - “A defendant is presumed • Presumption of competence to stand trial competent to stand trial, unless it is proved • Incompetence to stand trial proven by by a preponderance of the evidence in a preponderance of the evidence hearing…that because of his present mental • Competence to stand trial addressed in condition he is incapable of understanding competence hearing the nature and objectives of the proceedings • Incompetence must be due to a present against him, or of presently assisting in his defense.” mental condition Ohio Revised Code Summarized Competency vs. Sanity Due to present mental condition, defendant Competency Sanity lacks capacity to: • present state • assessment at time of assessment offense 1. Understand the nature and objectives of proceedings, • triability • responsibility OR 2. Assist in defense Stephen Noffsinger, M.D. 3 Criminal Law and Psychiatry June 21 & 23, 2017 Progression of Competency to Evaluating Competence to Stand Stand Trial Evaluation Trial 1. Arrest/Arraignment • Record review 2. Competence issue raised • Discussion with referring attorney (possible) 3. Competence evaluation at local forensic – History of mental illness center (or inpatient evaluation) – Bizarre nature of offense – Difficulty working with client – Irrational refusal of plea bargain Evaluating Competence to Stand Evaluating Competence to Stand Trial Trial • Interview defendant – standard psychiatric interview with: • Formulate opinion on competence to stand – Chief complaint/history of present illness trial – Background histories – Past psychiatric history – Mental Status Examination • Written report/opinion • Diagnosis • Competence Evaluation • Competence to Stand Trial Assessment tool (optional) Nature and Objectives of Ohio Revised Code Summarized Proceedings Due to present mental condition, defendant • Charge lacks capacity: • Severity of charge • Appreciate situation as defendant 1. To understand the nature and objectives of • Possible sentence proceedings, • Pleas OR • Roles of courtroom personnel 2. To assist in defense • Adversarial nature of trial Stephen Noffsinger, M.D. 4 Criminal Law and Psychiatry June 21 & 23, 2017 Ability to Assist in Defense Ability to Assist in Defense • Ability to work with defense attorney • Sufficient memory and concentration to • Plea bargain understand events at trial • Ability to give rational/coherent account of • Understand appropriate courtroom behavior offense • Absence of self-defeating behavior • Testify relevantly on own behalf • Evaluate evidence • Willingness to consider mental illness • Estimate chances of conviction defense • Develop plan of defense • Make reasonable defense decisions Distrust of attorneys • 45% of pro se defendants: “Lawyers are more concerned with their own self-promotion than ’ ” What to do with a defendant who their client s best interest. is unable/unwilling • Many habitual offenders: to trust his attorney? – do not regard court appointed attorneys as trustworthy – view the system as unfair and stacked against them • Experience-based and not delusional Reasons for Incompetency Reasons for Incompetency • Low intelligence or dementia - impairs the • Mania - impairs the defendant’s ability to defendant’s factual understanding of the act appropriately in the courtroom. charge; pleas; trial process; etc. • Paranoid delusions - impair the defendant’s • Depression and self-defeating behavior - ability to work with their defense counsel. limit the defendant’s motivation for the best outcome at trial. • Disorganized thinking - impairs the defendant’s concentration and attention Stephen Noffsinger, M.D. 5 Criminal Law and Psychiatry June 21 & 23, 2017 Reasons for Incompetency Incompetency • Irrational decision-making about their • Incompetence: Males = females defense – due to delusions, disorganized thinking, low intellect or dementia. • Reason for Incompetence • Hallucinations - distract the defendant from – Elderly - dementia attending to the trial. – Young adults - psychosis, mood disorder, low IQ – Teens - low IQ Progression of Competency to Incompetency Stand Trial Evaluation • Psychotic Disorders – 45-65% found incompetent 1. Arrest/Arraignment • Mood Disorders – 23-41% found 2. Competence issue raised incompetent • Intellectual Disability– 12.5-36% found 3. Competence evaluation at local forensic incompetent center (or inpatient evaluation) Progression of Competency to Progression of Competency to Stand Stand Trial Evaluation Trial Evaluation 4. Competence hearing - if competent = trial 6. If Incompetent and Restorable - opinion on least restrictive treatment setting for 5. If incompetent - opinion on whether there is restoration to competence to stand trial. a substantial probability of Restoration to Competence within one year if treated. If Incompetent, Unrestorable, go to #10 Stephen Noffsinger, M.D. 6 Criminal Law and Psychiatry June 21 & 23, 2017 Progression of Competency to Restoration to Competence to Stand Trial Evaluation Stand Trial 7. Restoration to Competence program outpatient vs. inpatient (civil vs. max) • Treatment of mental illness 8. Updates to court due: a. when restored b. six month interval • Education c. expiration of statutory time limit for restoration Statutory Time Limits for Progression of Competency to Restoration to Competence Stand Trial Evaluation M3-M4: 30 days 9. If restored = trial 10. If unrestorable (Incompetent to Stand M1-M2 – 60 days Trial, Unrestorable) a. charges dropped - no criminal court F3, F4, F5: 6 months jurisdiction b. possible civil commitment - probate F1- F2: 12 months court c. possible reindictment Confidentiality and Competence Legal Regulation Evaluation • Evaluation shared with defense, prosecution of and court. Competence to Stand Trial • ORC - no information gathered in competence evaluation can be used to prove guilt. Stephen Noffsinger, M.D. 7 Criminal Law and Psychiatry June 21 & 23, 2017 Jackson v. Indiana Wilson v. United States • United States Supreme Court 1972 • US Court of Appeals, 1968 • “Due process requires that the nature and • Competence for amnestic defendants duration of commitment bear some decided on a case-by-case basis, based on reasonable relation to the purpose of the extent that: commitment.” 1. amnesia effected ability to consult/assist • Required “substantial probability” of attorney restoration to justify commitment 2. amnesia effected ability to testify Wilson v. United States Drope v. Missouri 3. evidence could be extrinsically • US Supreme Court 1975 reconstructed • Question – what events should trigger competency 4. government assisted in reconstruction evaluation? 5. strength of prosecution’s case • Holding: 6. any other facts regarding fairness of trial – Defense, prosecution or judge can raise competence
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