Insanity defence

There has been a long-standing recognition in the criminal law that some defendants are so mentally ill when they commit criminal acts that they should not be held criminally responsible and liable to punishment. In the English courts the criteria for a finding of not guilty by reason of insanity were formulated following the case of Daniel McNaghten in 1843, and they remain applicable despite recurrent criticism and proposals for reform. (2 22)

The McNaghten Rules specify that to establish an insanity defence it must be proved that at the time of committing the act the accused was suffering from a defect of reason, from disease of the mind, such that he did not know the nature and quality of his act, or, if he did know it, that he did not know what he was doing was wrong (wrong in this context means contrary to law).

In practice, the application of these criteria can be difficult and unsatisfactory. Quite commonly, for example, people with severe and acute psychotic symptoms may carry out criminal acts under the influence of their symptoms but the McNaghten criteria will not be met because the individual, although influenced by psychotic symptoms, knew what he was doing and that it was illegal. When reports are requested on the issue of insanity defence, the clinician has to try and make a careful retrospective assessment of the defendant's mental state at the time of the offence in order to judge how his psychiatric condition affected his knowledge of what he was doing, and his knowledge of whether it was wrong. The options available to a court in the event of a successful insanity defence are the same as those that apply following a finding of unfitness to plead.

More general questions about intention can arise in criminal proceedings. There may be a dispute about whether a particular defendant had the intention to commit the criminal act for which he is charged, and psychiatrists may be asked to report on whether the individual lacked capacity to form the requisite intention. These are often difficult cases to report on because the concepts and legal tests employed by the courts may not fit easily with conventional psychiatric concepts and assumptions. Intoxication with drugs or alcohol is also a complex area. Usually, voluntary intoxication with drugs or alcohol will not amount to a defence. In all these cases it is important that a psychiatrist seeks clear guidance from the instructing lawyers about the relevant legal issues and criteria that apply.

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