Providing Those with Mental Illness Full and Fair Treatment: Legislative Considerations in the Post-Clark Era

Abstract

Reforming legal treatment of individuals with mental illness has been a topic that periodically resurfaces only to quickly be replaced by the next emergent public policy issue. Decisions are generally made in a reactionary fashion instead of the more deliberative processes afforded other ongoing issues such as taxes, health care, budgets, and others. Now that the dust has settled from the Supreme Court’s decision in Clark v. Arizona, it is time that legislatures take another look, this time with a broader and perhaps more sober perspective, at how their legal system approaches such individuals. Generally speaking, the civil legal system deals with people with mental illness in terms of public services such as treatment facilities, mental health care provisions, and non-discrimination policies, among others. The criminal justice system, on the other hand, interfaces with people with mental illness through several mechanisms: diversion to alternative sentencing programs such as mental health courts, defendant competency requirements, and the availability, scope, and use of the insanity defense. Although the rise of the regulatory state has born some strict liability criminal statutes, actus reus, mens rea, justification, and excuse, together, form the basic fundament of criminal liability and the resultant ability of the government to deprive an individual of liberty and even life. When considering defendants with mental illness, Clark v. Arizona upheld extremely narrow policy choices with respect to mens rea and the insanity defense. Legislatures, of course, remain free to consider alternative strategies; indeed, the Supreme Court has demonstrated a remarkable deference to local formulations of the insanity defense. This Note will argue that narrow rules serve neither the public nor a prisoner’s interest in rehabilitation and that legislatures should broaden the insanity defense and fund policies that ensure early detection, provide adequate treatment, and enable people with mental illness to lead productive lives. The United States criminal justice system fails to serve adequately both the individual inmate and societal needs when dealing with defendants with mental illness. This problem is illustrated in cases involving persons with schizophrenia. For these individuals, incarceration based on either just desert or incapacitation functions as a way for society to ignore the underlying issues of treatment and post-release psychological care. Providing adequate treatment services before, during, and after confinement is necessary to meet the moral obligation we have to take care of the most vulnerable within our society. This is not to say that such individuals necessarily should be free from responsibility. Rather, people with mental illness present unique challenges to our judicial system and to the host of public services that the government provides its citizens. Addressing these issues – making the difficult policy choices – is incumbent upon legislatures, the courts, and the public at large. For individuals with mental illness, existing approaches provide a mechanism for the public to avoid the long-term problems of mental illness and the ability to either prevent such crimes from even occurring or to help reduce their recurrence after release from confinement. Specific social programs and services are needed, together with legal reforms, in order to address these issues. These changes are neither popular nor cheap in the short-term; however, a longer-horizon approach will show that such programs provide the public with lower incarceration rates and lower recidivism and give individuals with mental illness a chance at a more productive and healthy life. This Note will begin by examining the current understandings of both the pathology and effectiveness of treatment for individuals with schizophrenia and how the legal system interacts with individuals with mental illness. Then the historical progression of the law’s treatment of those with mental illness will be reviewed. A detailed accounting of the current status of the insanity defense will be discussed. This Note will conclude by proposing alternatives for legislatures to consider in the wake of the Clark v. Arizona decision.

Keywords: insanity defense, schizophrenia, mental illness, mental health courts

JEL Classification: K00, K14, K40, K42