Bruce H. Gross

Mentally Ill Persons in the Criminal Justice System: Some Perspectives

There is an increasing number of severely mentally ill persons in the criminal justice system. This article first discusses the criminalization of persons with severe mental illness and its causes, the role of the police and mental health, and the treatment of mentally ill offenders and its difficulties. The authors then offer recommendations to reduce criminalization by increased coordination between police and mental health professionals, to increase mental health training for police officers, to enhance mental health services after arrest, and to develop more and better community treatment of mentally ill offenders. The necessary components of such treatment are having a treatment philosophy of both theory and practice; having clear goals of treatment; establishing a close liaison between treatment staff and the justice system; understanding the need for structure; having a focus on managing violence; and appreciating the crucial role of case management, appropriate living arrangements, and the role of family members.

Developing Issues in the Classification of Mental and Physical Disabilities

In this analysis, the authors explore the implications of changing classifications and definitional criteria for mental disability and physical disability. Much of this discussion is set against the background of the ideas that have come out of the social and political movements organized by individuals with disabilities. The first part of the article focuses on issues that may develop from increasing implementation of the “social model” of disability. The second part centers on the problems produced by the development of measures based on contrasting definitions. Finally, the authors examine the factors that might contribute to evaluations of the satisfaction of and opportunities for adults with disabilities living in the community.

Psychological Factors in the Determination of Suicide in Self-Inflicted Gunshot Head Wounds

Self-inflicted contact gunshot wounds to the head have usually been considered presumptive of suicide. This study evaluates whether sufficient psychological data are gathered in such cases to support a manner of death determination of suicide. We suggest that law enforcement agencies and coroners departments do not fully explore the decedents state of mind at the time of death. We studied the first 50 consecutive deaths in 1993 in a major metropolitan county due to self-inflicted gunshot wounds to the head. The sample consists primarily of unmarried, white males, with a median age of 35 years, who displayed psychiatric disturbance, primarily depression, before their death. Younger individuals were often under the influence of alcohol and/or drugs at the time of death. Stressors, such as the loss of a loved one, are common among young and middle-aged persons, while serious health problems are found among the majority of middle-aged and elderly individuals. Many of the findings of this study are consistent with the literature regarding individuals who commit suicide. Although data on many important psychological risk factors are missing in most cases, sufficient psychological material is gathered about the decedents mental condition at the time of death to support a suicide determination.

Evolution of the psychological autopsy: fifty years of experience at the Los Angeles County Chief Medical Examiner-Coroner's Office.

The origin of the psychological autopsy was in the late 1950s and the result of a collaboration between the Los Angeles County Chief Medical Examiner‐Coroners Office and the Los Angeles Suicide Prevention Center. It was conceptualized as a thorough retrospective analysis of the decedents state of mind and intention at the time of death. It was used initially in “equivocal” deaths where the manner of death was possibly either suicide or accident. Later, it was used in cases where a party (primarily family members) protested the Medical Examiner‐Coroners suicide determination. Over the past 25 years, the University of Southern California Institute of Psychiatry, Law, and Behavioral Science has served as the psychiatric/psychological consultants to the Coroners Department. Research findings, the use of this approach in high‐profile cases, and the most recent manner in which the psychological autopsy is conducted are discussed.

Developmental Incompetence to Stand Trial in Juvenile Courts

Abstract:  Juveniles’ competency to participate in delinquency proceedings has received increased attention in recent years. Developmental incompetence, whereby juveniles’ incompetency is based upon their immaturity, as opposed to a mental disorder or developmental disability, is an evolving and important aspect of this area of law. The following paper reviews theories used to support the notion of developmental incompetence, as well as the extant empirical research on juveniles’ competency‐related abilities. Using a LexisNexis search, statutory and case laws pertaining to juvenile competency were identified across the 50 states and the District of Columbia. Only six states clearly allow developmental incompetence, whereas 17 have laws that do not include developmental immaturity as an acceptable basis of incompetence in juvenile courts. Developmental incompetence is likely to affect a relatively small proportion of juvenile cases, but has important implications for juvenile forensic practice. Recommendations are offered for forensic practitioners conducting this type of evaluation.

A Proposed Exception to the AIDS Confidentiality Laws for Psychiatric Patients

The authors offer psychotherapists a proposed exception to strict acquired immune deficiency syndrome (AIDS)-related confidentiality laws. The proposal is based on previously established exceptions to the psychotherapist-patient privilege. The recommended breach of confidentiality applies only to cases that meet all of the following criteria: (1) A patient knows that he or she has a human immunodeficiency virus (HIV) positive blood test and has been informed of AIDS-related safety precautions, (2) the HIV-positive patient has a mental disorder, and (3) it is reasonable to believe that the mental disorder has significantly impaired or may significantly impair the patients ability and behavior to follow AIDS-related safety precautions.

Psychological Autopsy: Consultative Tool for Suicide Determination

Abstract The psychological autopsy has become an essential part of the evaluation of manner of death in difficult forensic cases. Through careful assessment of scene investigation, autopsy findings, the decedent’s psychological background, presence or absence of risk factors for suicide, and other information, mental health professionals can provide significant insight into the decedent’s state of mind at the time of death. In a “contested” case, the medical examiner has determined that the manner of death is suicide and the psychological autopsy determines whether there is enough evidence to overcome this presumption. In an “equivocal” or “undetermined” case, the medical examiner does not have enough information to determine the manner of death. The purpose of the psychological autopsy in this situation is to look for information that either supports or contradicts a mental condition consistent with suicide.

The Fitness of Juvenile Court

Within juvenile courts, ever younger Violent offenders are being transferred to adult criminal courts. This article reviews legislation surrounding transfer of jurisdiction and the evaluation of juvenile amenability by a forensic examiner. Specific areas of focus for the evaluation of juvenile offenders are offered in consideration of the pivotal opportunity this area of juvenile justice poses the minor, the courts, and society at large. Language: en

The mental health expert witness

The mental health professional is called upon to apply his technical material to legal issues. In order for the mental health professionals involvement to be of benefit to the legal system, he must understand the legal issues posed and know how to answer them.