October 19, 2009

Spokane case illustrates sensationalism in coverage of insanity defense

Alarmist misinformation predominates

"Criminally Insane are often released." That's the headline on an AP story that ran in major U.S. dailies -- including the New York Times -- over the weekend. The case, involving the escape of a forensic patient from a state hospital in Spokane, Washington, has the Washington citizenry in a state of frenzied outrage. The CEO of the hospital has been forced to resign, and ever-opportunistic politicians are calling for abolition of the insanity defense.

In the spotlight is Phillip Paul, a schizophrenic man who killed an elderly woman in 1987, allegedly because voices in his head told him she was a witch. Found not guilty by reason of insanity, he was hospitalized at Eastern State Hospital in Spokane, Washington. Twenty-two years later, on Sept. 17, he walked away while he and 30 other forensic patients were on a supervised jaunt to the county fair. He was captured about three days later after a highly publicized manhunt.

Sunday's report is a classic example of the sensationalism and misinformation swirling around the insanity defense. Unfortunately, instead of critical inquiry, many reporters leap onto the bandwagon of misplaced public hysteria, and many editors likewise fail to think before grabbing a juicy-looking story to fill a news hole.

The AP article, by reporter Nicholas Geranos, amps up both public alarm and indignation:
"Instead of being straitjacketed and locked away as might be depicted by film or fiction, Paul has spent time living and working in downtown Spokane, fathered a child, created music videos and racked up $85,000 in credit card bills…. His escape … exposed a little known truth: The criminally insane often live among us, with little or no supervision."
Eek! Lock your doors! Not only are bogeyman sex offenders getting ready to snatch your kids on Halloween, but now we've got the "homicidal maniacs" (in the words of one newspaper columnist) loose among us.

Downplaying the facts

Contrary to the article's implications, Paul was not "living among us, with little or no supervision." Not at all. He was locked up in a state hospital. Escapes are rare, but they do happen. And rarely does any violence ensue.

The alarmist news coverage downplays facts that could reassure the public and reduce rather than amp up hysteria. First of all, Paul was captured uneventfully after about three days. And, during his brief foray into freedom, he did not commit any new crimes as far as we know.

Paul's risk for violence is not high. The homicide for which he was found Not Guilty by Reason of Insanity (NGRI) occurred 22 years ago. He has not exhibited any violent behavior in years, according to hospital spokespersons. Indeed, he is described as a "model patient."

If Paul was mentally unstable or at high risk of violence, he would not have been allowed out on the field trip. Such excursions were routine at the hospital (and its larger sister facility, Western State Hospital outside of Tacoma, Washington), rewards and incentives for stability and good behavior. Now, they have been entirely suspended.

Paul's low risk for violence in the community is substantiated by the fact that, over the past couple of decades, he has been released from the hospital several times. Once, he lived with his family; another time, he stayed at an assisted living center.

Media coverage accuses the staff of lax supervision. Certainly, it was a mistake to let Paul walk away; the staff who accompanied him reportedly let him take a backpack, which may not have been searched and may have contained food. However, during periods when he was conditionally released into the community, he was monitored and rehospitalized whenever he was noncompliant with medications or his symptoms worsened. That sounds like good supervision, not bad.

Successful insanity defenses rare

It is ludicrous to make generalizations about the dangers posed to the public by the criminally insane based on a very rare event such as this, involving a model patient who hurt not a single hair on anyone's head.

But the current frenzy, and in particular the politicians who are using the incident to bolster their popularity, are distorting the larger nature of the insanity defense as well.

In Washington, as in the majority of U.S. states, the standard for legal insanity is the M'Naghten test, which requires that a defendant be unable to tell the difference between right and wrong. The insanity defense is rarely invoked as a defense. One eight-state study found that the defense was used in less than 1% of cases.

There are many reasons for the rarity of the defense. Strategically, defense attorneys often do not pursue it because a defendant risks serving more time -- especially in less serious cases -- than if he or she pled guilty. Also, the standard is hard to meet. Contrary to public opinion, forensic psychologists and psychiatrists who evaluate a defendant's mental state are most likely to conclude he or she does not meet the legal threshold for insanity.

A survey of the general public indicated that people think the defense is successful about 35% of the time. Although success rates vary by jurisdiction, it is probably more accurate to say the defense is successful only about one-fourth of the time. In the broad majority of successful cases, the offender had a previously documented psychiatric disorder and the insanity disposition results from a plea bargain. In other words, contrary to the public's image of dueling experts in court, the defendant was so obviously crazy at the time of the offense that prosecutors agree to hospitalization rather than conviction and imprisonment, and no trial ensues.

One reason for the enduring controversy over the insanity defense is the misperception that the defense is a way to beat the rap. In reality, acquittees are sent to locked state hospitals that look very much like prisons. They get out only if they are found to no longer suffer from a mental disorder that makes them dangerous. Studies suggest the average length of hospitalization varies from around 4 years (in California) to more than 10 years (in Missouri). Longer hospitalizations are especially likely in serious or high-profile cases.

Even when a patient is released, there are usually strings attached. Under "conditional releases," patients are monitored for treatment compliance. If they violate terms of their release, such as by using drugs or not taking prescribed medications, they are immediately rehospitalized. Such revocations occur in an estimated 35% to 50% of releases, according to a California study. Phillip Paul, indeed, had been rehospitalized under just such circumstances in the past.

The implication of the news coverage is that insanity acquittees are dangerous to the public. But studies suggest that, as a group, people found NGRI are less likely to recidivate than the average felon released from prison. And the best predictor of subsequent violence is not mental illness, but the quantity and nature of prior crimes.

Moreover, the most feared type of crime by schizophrenics -- homicides of strangers -- "are exceptionally rare events," according to a large-scale international study from Australia, Canada, Finland, and the Netherlands that was just released in Schizophrenia Bulletin.

"What the [research] shows, more than anything else, is that the public fear of the mentally ill is completely misplaced," said Dr. Matthew Large, one of the researchers from the University of New South Wales, Australia. "These events are so rare that they are almost impossible to study, yet the fear of serious violence by the mentally ill is a major cause of stigma.”

Ultimately, the public's rage in this case focalizes on the fateful field trip: "How dare those inept government bureaucrats let a homicidal maniac out for fun? Let him suffer!" This venting of pent-up rage has the same punitive tone directed against prison officials in the past for letting prisoners have television sets or make phone calls.

In these tough economic times, public anger against the government is high. But punitive policies toward either forensic mental patients or prisoners will not increase public safety. Quite the contrary. Ultra-punitive policies only produce more embittered citizens who, just like the critics, are too quick to rage.

Hat tip: KK

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