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Research ArticleRegular Articles

Mental Illness and Mental Health Defenses: Perceptions of the Criminal Bar

Richard L. Frierson, Mary S. Boyd and Angela Harper
Journal of the American Academy of Psychiatry and the Law Online December 2015, 43 (4) 483-491;
Richard L. Frierson
Dr. Frierson is Professor of Clinical Psychiatry, University of South Carolina School of Medicine, Columbia, SC. Dr. Boyd is Staff Psychiatrist, Dorn VA Medical Center, Columbia, SC. Dr. Harper is in private practice, Columbia Psychiatric Associates LLC, Columbia, SC. Dr. Boyd is currently in private practice, Vista Psychiatric Consultants, LLC, Columbia, SC.
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Mary S. Boyd
Dr. Frierson is Professor of Clinical Psychiatry, University of South Carolina School of Medicine, Columbia, SC. Dr. Boyd is Staff Psychiatrist, Dorn VA Medical Center, Columbia, SC. Dr. Harper is in private practice, Columbia Psychiatric Associates LLC, Columbia, SC. Dr. Boyd is currently in private practice, Vista Psychiatric Consultants, LLC, Columbia, SC.
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Angela Harper
Dr. Frierson is Professor of Clinical Psychiatry, University of South Carolina School of Medicine, Columbia, SC. Dr. Boyd is Staff Psychiatrist, Dorn VA Medical Center, Columbia, SC. Dr. Harper is in private practice, Columbia Psychiatric Associates LLC, Columbia, SC. Dr. Boyd is currently in private practice, Vista Psychiatric Consultants, LLC, Columbia, SC.
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    Table 1

    The Survey

    Please answer the following questions. In order to preserve research validity, please do not consult with texts, statutes, or colleagues prior to completing the survey. Please circle the best answer. If you do not know the answer, please guess.
    Which of the following most closely describes your occupation?
        1. Prosecuting attorney3. Judge
        2. Public defense attorney4. Private defense attorney
    How long have you been a prosecutor or defense attorney?
        1. 0–3 years3. 5–10 years
        2. 3–5 years4. >10 years
    How long have you been practicing law in general?
        1. 0–3 years3. 5–10 years
        2. 3–5 years4. >10 years
    Where did you attend law school?
        1. Southeast United States4. Southwest United States
        2. Northeast United States5. Western United States
        3. Midwest United States6. International degree
    Did you receive any instruction in law school about mental illness?
        1. Yes2. No
    Did you receive any instruction in law school about mental health law?
        1. Yes2. No
    Do you feel that your education about mental health issues was adequate?
        1. Yes2. No
    Have any of the following suffered from a severe mental illness, such as Schizophrenia, Bipolar Disorder (Manic Depression) or Major Depression?
        1. You3. Family member
        2. Friend4. None
    5. Other (neighbor, coworker, etc.)
    How prevalent is mental illness among criminal defendants?
        1. <5%3. 15–25%
        2. 5–15%4. >25%
    How many cases have you prosecuted or defended that have involved an individual with mental illness?
        1. No cases3. 6–15 cases
        2. 1–5 cases4. >15 cases
    How many cases have you prosecuted or defended that involved a Not Guilty by Reason of Insanity (NGRI) defense or outcome?
        1. No cases3. 6—5 cases
        2. 1–5 cases4. >15 cases
    How many cases have you prosecuted or defended that involved a Guilty but Mentally ill (GBMI) plea or outcome?
        1. No cases3. 6–15 cases
        2. 1–5 cases4. >15 cases
    Which of the following is the correct definition of a delusion?
        1. A false belief firmly held by the patient despite evidence to the contrary
        2. A false sensory perception, such as seeing or hearing things that are not present
        3. Impairment of thinking where a patient becomes disoriented to time, place, or events
        4. A rapid succession of fragmentary thoughts or speech in which content changes abruptly
    Which of the following is the correct definition of psychosis?
        1. A loss of contact with reality
        2. Rapidly shifting mood states
        3. Repetitive behaviors such as counting or hand washing
        4. A loss of contact with reality; persistent and extreme elevation in mood
    Which of the following is the most severe and chronic mental illness?
        1. Major depression3. Schizophrenia
        2. Bipolar disorder4. Obsessive compulsive disorder
    South Carolina has two mental illness verdicts: Not Guilty By Reason Of Insanity (NGRI) and Guilty But Mentally Ill (GBMI). Please circle the best answer to the following questions involving these verdicts.
    What do you think the verdict Not Guilty by Reason of Insanity (NGRI) means?
        1. The defendant has a severe mental illness and cannot stand trial.
        2. The defendant had mental illness at the time of the crime.
        3. The defendant who committed the crime had a mental illness that prevented him from understanding that what he did was wrong.
        4. The defendant who committed the crime had a mental illness that prevented him from controlling his actions according to the law.
    What do you think the outcome of the Not Guilty By Reason Of Insanity (NGRI) verdict is for a serious felony such as murder, assault and battery with intent to kill, rape, etc?
        1. The defendant goes home.
        2. The defendant goes to prison.
        3. The defendant goes to a psychiatric hospital for treatment and then is transferred to a prison when stable enough to complete his sentence.
        4. The defendant goes to a psychiatric hospital for treatment and then is released to go home when determined not to be dangerous to self or others.
    What do you think the outcome of the Not Guilty by Reason of Insanity (NGRI) verdict should be for a serious felony such as murder, assault and battery with intent to kill, rape, etc?
        1. The defendant goes home.
        2. The defendant goes to prison.
        3. The defendant goes to a psychiatric hospital for treatment and is transferred to a prison when stable enough to complete the sentence.
        4. The defendant goes to a psychiatric hospital for treatment and is released to go home when determined not to be a danger to self or others.
    What do you think the verdict Guilty But Mentally Ill (GBMI) means?
        1. The defendant has a severe mental illness and cannot stand trial.
        2. The defendant had mental illness at the time of the crime.
        3. The defendant who committed the crime had a mental illness that prevented him from understanding that what he did was wrong.
        4. The defendant who committed the crime had a mental illness that prevented him from controlling his actions according to the law
    What do you think the outcome of the Guilty But Mentally Ill (GBMI) verdict is for a serious felony such as murder, assault and battery with intent to kill, rape, etc?
        1. The defendant goes home.
        2. The defendant goes to prison.
        3. The defendant goes to a psychiatric hospital for treatment and is transferred to a prison when stable enough to complete the sentence.
        4. The defendant goes to a psychiatric hospital for treatment and is released to go home when he is determined not to be a danger to self or others.
    What do you think the outcome of the Guilty But Mentally Ill (GBMI) verdict should be for a serious felony such as murder, assault and battery with intent to kill, rape, etc?
        1. The defendant goes home.
        2. The defendant goes to prison.
        3. The defendant goes to a psychiatric hospital for treatment and is transferred to a prison when stable enough to complete his sentence.
        4. The defendant goes to a psychiatric hospital for treatment and is released to go home when he is determined not to be a danger to themselves or others.
    Which of the following crimes/offenses would influence your decision to recommend an NGRI plea?
        1. Felony offense with a >10-year potential sentence
        2. Felony offense with a <10-year potential sentence
        3. Misdemeanor offense
        4. Makes no difference
        5. Would never recommend
    Which of the following crimes/offenses would influence your decision to recommend a GBMI plea?
        1. Felony offense with a >10-year potential sentence
        2. Felony offense with a <10-year potential sentence
        3. Misdemeanor offense
        4. Makes no difference
        5. Would never recommend
    In you opinion, should jurors be told the potential outcome of a verdicts such as Not Guilty By Reason of Insanity (NGRI) or Guilty But Mentally Ill (GBMI) before they have to decide the verdict in a case?
        1. Yes
        2. No
    Do you think that if jurors knew the outcome it would influence their decision?
        1. Yes
        2. No
    Do you think that a defendant found GBMI can receive the death penalty?
        1. Yes
        2. No
    Should the NGRI verdict be eliminated?
        1. Strongly agree4. Somewhat disagree
        2. Somewhat agree5. Strongly disagree
        3. Neutral
    Should the GBMI verdict be eliminated?
        1. Strongly agree4. Somewhat disagree
        2. Somewhat agree5. Strongly disagree
        3. Neutral
    I would rather defend or prosecute clients who do not have mental illness
        1. Strongly agree4. Somewhat disagree
        2. Somewhat agree5. Strongly disagree
        3. Neutral
    What is your age?
    What is your sex (circle one)?MaleFemale
    Are you married (circle one)?YesNo
    • View popup
    Table 2

    Demographic Variables and Experience

    VariableData
    Age, years26–73 (mean, 45.64)
    Gender
        Male80
        Female20
    Marital status
        Married76
        Unmarried24
    Current occupation
        Private defense attorney57
        Public defender23
        Prosecutor17
        Judge3
    Years in current job
        ≤310
        4–512
        6–1020
        >1058
    Mental illness instruction in law school
        Yes26
        No74
    Mental health law Instruction in law school
        Yes17
        No83
    Mental health instruction adequate
        Yes15
        No83
        Unknown2
    Personal experience with mental illness
        Self5.6
        Friend35.8
        Family29.9
        Other8.6
        None31
    • Data are percentage of analyzed responses, unless stated otherwise. N = 255.

    • View popup
    Table 3

    Experience With Defendants with Mental Illness and Mental Health Defenses

    ExperienceOccurrence
    Prevalence of mental illness among defendants
        <5%9
        5–15%29
        15–25%28
        >25%31
        No answer3
    Number of cases involving mental illness
        None4
        1–5 cases20
        6–15 cases18
        >15 cases58
    Number of NGRI cases
        None44
        1–5 cases44
        6–15 cases9
        >15 cases3
    Number of GBMI casesNone
        None42
        1–5 cases44
        6–15 cases10
        >15 cases4
    • Data are percentages of respondent groups. N = 255.

    • View popup
    Table 4

    Experience With Defendants with Mental Illness and Mental Health Defenses by Occupation

    ExperienceProsecutor (N = 43)Public Defender (N = 59)Private Defense Attorney (N = 144)Judge (N = 9)Total (N = 255)
    More than 15 cases with defendants with mental illness5283533359
    Has used the NGRI defense in a case6487443356
    Has tried or pleaded a case with a GBMI verdict6480511759
    • Data are percentages of respondent groups.

    • View popup
    Table 5

    Correct Responses by Occupation, Regarding Mental Illness, Mental Illness Verdicts, and Dispositional Outcomes

    Survey ItemProsecutor (N = 43)Public Defender (N = 59)Private Defense Attorney (N = 144)Judge (N = 9)Total (N = 255)
    Defined delusion7470715071
    Defined psychosis86898710088
    Identified schizophrenia as most severe mental illness6480718372
    Identified legal definition of NGRI8374749976
    Identified legal definition of GBMI6470505058
    Identified dispositional outcome of NGRI9893868388
    Identified dispositional outcome of GBMI720141714
    Identified that persons found GBMI could receive death sentence527856559
    • Data are percentages of respondent groups.

    • View popup
    Table 6

    Attitudes About Defendants with Mental Illness and Mental Illness Verdicts

    OpinionProsecutor (N = 43)Public Defender (N = 59)Private Defense Attorney (N = 144)Judge (N = 9)Total (N = 255)
    Would rather defend, prosecute, or judge defendants who do not have mental illness6943475050
    The NGRI verdict should be eliminated5011185023
    The GBMI verdict should be eliminated3833405038
    • Data are percentages of respondent groups.

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Journal of the American Academy of Psychiatry and the Law Online: 43 (4)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 43, Issue 4
1 Dec 2015
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Mental Illness and Mental Health Defenses: Perceptions of the Criminal Bar
Richard L. Frierson, Mary S. Boyd, Angela Harper
Journal of the American Academy of Psychiatry and the Law Online Dec 2015, 43 (4) 483-491;

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Richard L. Frierson, Mary S. Boyd, Angela Harper
Journal of the American Academy of Psychiatry and the Law Online Dec 2015, 43 (4) 483-491;
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