PubMed · 8088746
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W A Smalley. 1994. Toward semantic precision.. https://doi.org/10.1176/ps.45.6.609
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The mental health service system has undergone continuous change for more than three decades. Undoubtedly, some of its problems are related to economic, social and political factors. This contribution discusses problems of deinstitutionalization, homelessness and criminalization of the mentally ill persons. To conclude, it proposes a number of ways by which better services could be rendered to the mentally disordered persons, particularly in areas that interface with the criminal justice system.
Using Missouri's insanity acquittee system as a case study, this analysis explores the extent to which legislation can structure the implementation of mental health policy. It found that Missouri's insanity acquittee legislation substantially structured policy implementation toward its primary goal of public safety. It did so (a) by including actors from both the criminal justice and mental health systems in the insanity acquittee release process, (b) by specifying procedures and criteria for the commitment and release of insanity acquittees, and (c) by requiring monthly monitoring of insanity acquittees released into the community and funding the staff positions to conduct the monitoring. The ability of legislation to structure policy implementation highlights the need for active involvement by mental health policy makers in the legislative process to shape policy goals and to structure implementation to support the interests of the mental health community. Without this involvement, implementation options available to mental health administrators may be severely limited.
This paper examines complications of sleepwalking disorder (DSM-IV 307.46), an arousal disorder or parasomnia, in relationship to mens rea, or culpable mental state necessary to a finding of criminal responsibility. The legal history of criminal intent and insanity is reviewed. A case of indecent exposure is discussed in a man with a history of closed head injuries and sleepwalking disorder who was found standing naked in the middle of a busy urban thoroughfare in the wee hours of the morning and arrested. On psychiatric evaluation, the defendant was found to have a long-standing sleepwalking disorder. At trial, scientific literature and psychiatric expert testimony concerning sleepwalking disorder was presented. The psychiatrist opined that the defendant was probably sleepwalking at the time of the alleged offense. No rebuttal testimony was offered by the prosecution. The jury found the man not guilty. The author surveys the legal history of sleepwalking disorder and compares this example with others in which uncontrolled behavior during sleep has resulted in harm to the patient or to others. Clinical and forensic implications of the disorder are reviewed. The parasomnias' impact on forensic practice should be systematically studied. Intervention strategies should be refined and implemented.