The use of neurobiological evidence in sentencing mitigation.

Neurobiological evidence has grown increasingly relevant in U.S. criminal proceedings, particularly during sentencing. Neuroimaging, such as functional Magnetic Resonance Imaging and Positron Emission Tomography scans, may be introduced by defense counsel to demonstrate brain abnormalities to argue for more lenient sentencing. This practice is common for penalty mitigation in cases eligible for capital punishment. This article reviews the history of the use of neuroscience in criminal cases from the early 20th Century to present, noting pertinent legal and ethical considerations for the use of such evidence. The authors review important empirical research conducted in recent years regarding the use of neurobiological evidence in legal proceedings (such as mock-juror studies) and guidance from the federal sentencing guidelines and the American Bar Association. The discussion also notes relevant case law in which neuroimaging, behavioral genetics, or other neurobiological data were introduced in criminal proceedings, particularly precedent-setting U.S. Supreme Court cases.

A Survey of Forensic Psychiatry Fellowship Program Directors on Selecting Fellowship Applicants.

In the 2019-2020 academic year, there were 48 accredited forensic psychiatry fellowship programs in the United States. Programs vary in application requirements and timeline. There are no published objective data on factors that fellowship program directors (PDs) use when selecting fellows. We created an electronic survey that was emailed to PDs via a list from the Association of Directors of Forensic Psychiatry Fellowships. The survey was open November 6, 2019 to December 31, 2019. Twenty-five PDs participated from programs ranging in size from one to six positions, receiving zero to 30 applications. The most important factors when selecting a candidate to interview were "perceived commitment to specialty" and "perceived interest in your program." The most important factors when offering a position were "interpersonal skills" and "interactions during interview." The least important factors in both categories were USMLE/COMLEX scores and honor society membership(s). "Lack of a set timeline" during the application process was the most frequently cited difficulty (via multiple choice) during the application and interview process. Our study is the first to provide quantitative data regarding factors that forensic psychiatry fellowship PDs use to evaluate applicants in decisions regarding offering interviews and positions.

Adjudicative Competence and the Criminalization of Intellectual Disability.

Wood and colleagues effectively argue that Title II of the Americans with Disabilities Act applies to securing accommodations for persons with intellectual/disability disorder so that such persons can meaningfully participate in the criminal adjudicative process. This invited commentary further discusses the challenges in identifying, assisting, and fully accommodating persons with intellectual/disability disorder in the criminal justice system. It also highlights ongoing problems with stereotypes within this population, which may affect the outcome of criminal proceedings. This commentary argues that persons with intellectual/disability disorder will likely continue to be treated unequally in the criminal justice system until better supports, treatments, and services are provided in community settings because treatment and placement options are often closely linked with case disposition.

AAPL Practice Resource for the Forensic Psychiatric Evaluation of Competence to Stand Trial.

Full Document: Wall BW, Ash P, Keram E, et al: AAPL Practice Resource for the Forensic Psychiatric Evaluation of Competence to Stand Trial Update 2018. Journal of the American Academy of Psychiatry and the Law Online Supplement 2018, 46 (3). Available at: http://www.jaapl.org/content/46/3_Supplement.

The Competency Paradox in Somatic Disease.

Westmoreland et al. have reviewed factors associated with provider reluctance to initiate and judicial reluctance to authorize civil commitment and involuntary treatment for persons with severe anorexia nervosa. Their analysis of the legal, medical, and psychiatric elements that affect treatment outcomes contributes to professional understanding of a complex topic. Although their proposal to create guidelines for involuntary treatment for persons with eating disorders may be of clinical utility, guidelines should not be promulgated for the purposes of reaching judicial findings of law.

Commentary: gender nonconformity within a conformist correctional culture.

In this era of increasing civil rights successes for gays and lesbians, transgender individuals are often overlooked. Simopoulos and Khin present guidance for correctional institutions in the comprehensive care of transgender inmates. Their analysis of the legal, medical, and psychiatric concerns for incarcerated transgender and gender-nonconforming people improves professional understanding of a complex subject.

A training program for defendants with intellectual disabilities who are found incompetent to stand trial.

In this study, we examined whether a specialized training program, the Slater Method, affects rates at which persons with intellectual disabilities attain competence to stand trial. We reviewed records of all 30 persons with Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) clinical diagnoses of mental retardation (in this article, intellectual disability) or borderline intellectual functioning whom courts sent to Eleanor Slater Hospital for competency restoration from 2001 through 2006. Significantly more persons exposed to the Slater Method attained clinical trial competence (61.1%) than did persons who received traditional treatment alone (16.7%). Discussion focuses on potential limitations of the study, ethics-related concerns regarding use of the Slater Method, and directions for future research.

Commentary: Causes and consequences of male adult sexual assault.

Bullock and Beckson add to a growing body of literature on the negative consequences of adult sexual assault on male victims. There are similarities as well as important differences between male sexual assault victims and their female counterparts. Their analyses of societal contributions and myths about adult male sexual assault and of the difficulties that male victims experience in accessing and interacting with the medical and legal systems improve professional understanding of this complex subject.

AAPL Practice Guideline for the forensic psychiatric evaluation of competence to stand trial.

Competence to stand trial is a legal construct used to identify those criminal defendants who have the requisite mental capacity to understand the nature and objective of the proceedings against them and to participate rationally in preparing their defense. This Practice Guideline has described how psychiatrists should evaluate individuals concerning their competence to stand trial. The Guideline describes acceptable forensic psychiatric practice for such evaluations. Where possible, it specifies standards of practice and principles of ethics and also emphasizes the importance of analyzing an individual defendant's case in the context of statutes and case law applicable in the jurisdiction where the evaluation takes place. The recommendations in the Guideline both reflect and are limited by evolving case law, statutory requirements, legal publications, and the current state of psychiatric knowledge. The authors have taken note of nationally applicable case law, federal constitutional standards, statutory language, and federal and state interpretations of the rights or statutes, recognizing that jurisdictions may differ in their specific interpretation or application of statutes or general constitutional standards. The review of cases concerning specific psychiatric diagnoses illustrates general U.S. trends, and psychiatrists must remain cognizant of their jurisdictions' interpretations of statutes or constitutional requirements. By surveying a variety of practices and approaches to data gathering and case analysis, the authors believe that this Guideline will stimulate additional collegial discussion about what is necessary and sufficient for adequate evaluations of adjudicative competence. The notion that psychiatrists should apply expertise to competence assessments stems from the principal that, before allowing a defendant to face criminal prosecution and possible punishment, courts need reasonable assurance--based, if necessary, on a careful, individualized evaluation--that the defendant has adequate mental capacity to make a defense. At a minimum, a psychiatrist's opinion about adjudicative competence should reflect an understanding of the jurisdictional standard and of how the defendant's mental condition affects competence as defined with the jurisdiction. The psychiatrist's report should clearly describe the opinion and the reasoning that leads to it. Psychiatrists who provide mental health expertise concerning adjudicative competence give trial courts information needed to assure that defendants can appropriately protect themselves and that criminal proceedings will be accurate, dignified,and just.

Psychiatric fitness-for-duty evaluations.

Fitness-for-duty examinations are a common type of psychiatric disability evaluation. These evaluations are typically best performed by the independent (nontreating) psychiatrist with forensic training or expertise in these examinations. A comprehensive evaluation requires careful definition of the referral questions and consideration of the terms of the referral; review of relevant job-specific documentation and medical records; the collection of collateral information from relevant third-party informants; a thorough clinical psychiatric examination; and possibly additional testing. The examination report needs to be comprehensive, address the specific questions in clear language understandable to the non-mental health clinician, and use all available data to substantiate the logical conclusions in a fair, accurate, and objective manner.

Restoration of competency to stand trial: a training program for persons with mental retardation.

This article describes the development and use of a formal training tool for restoration of competency in clients with mental retardation who are incompetent to stand trial. The program was developed at Eleanor Slater Hospital within the Rhode Island Department of Mental Health, Retardation and Hospitals. This article describes the development of The Slater Method, the training tool format, the procedure for use of the Slater Method, and the duration of treatment to restore competency to stand trial in clients with mental retardation. Although the developmentally disabled population is not limited to persons with mental retardation, we have used the phrase mental retardation instead of developmentally disabled because the judicial system more commonly uses mental retardation.