Case on Confidentiality in Mental Health

“Privacy Breach by Doctor: HC Seeks Status of Mental Health Boards for Legal Recourse.”

Hindustan Times, www.hindustantimes.com/cities/others/privacy-breach-by-doctor-hc-seeks-status-of-

The article discusses a recent privacy breach committed by a doctor in the Indian state of Punjab, who
reportedly disclosed confidential information about a patient's mental health to a third party without
the patient's consent. The patient, a college student, had sought treatment from the doctor but was
surprised and distressed to learn that her private information had been shared without her permission.

The High Court has now asked the government to provide information on the status of mental health
review boards that were supposed to be established to address such breaches of privacy. The court has
also requested an explanation from the hospital and the doctor involved in the incident.

The article highlights the importance of protecting patient confidentiality, particularly in cases related to
mental health, and notes that breaches of privacy can have serious consequences, including social
stigma and discrimination. The court's intervention is seen as a positive step towards ensuring that
patients' rights are protected and that those who violate them are held accountable.

Overall, the article raises important issues related to medical ethics and patient privacy and highlights
the need for robust systems and procedures to safeguard patients' rights and prevent breaches of
confidentiality.
 Case on Legal Issues in Mental Health

6.1 The Insanity Defense. Open Textbook Library - Criminal Law.

"6.1 The Insanity Defense" explains criminal defenses based on excuse, including the insanity defense.
Most states and the federal government recognize the insanity defense, but Montana, Utah, Kansas, and
Idaho do not. Legal insanity differs from medical insanity and is generally more difficult to establish. The
insanity defense is controversial as it excuses even the most evil and abhorrent conduct, but is rarely
used and hardly ever successful. The policy supporting the insanity defense is twofold: an insane
defendant does not have control over his or her conduct, and an insane defendant does not have the
ability to form criminal intent. Four variations of the insanity defense exist: M’Naghten, irresistible
impulse, substantial capacity, and Durham.

The M'Naghten insanity defense is the most common type of insanity defense in the US, created in
England in 1843. It requires that the defendant be suffering from a mental defect at the time of the
criminal act, and that the defendant did not know the nature and quality of the act or that the act was
wrong because of the mental defect. The level of awareness required for the defendant varies between
jurisdictions, and the definition of "wrong" also varies. The defendant cannot use this defense if there is
any evidence of a cover-up or an attempt to hide or escape. The defense is appropriate for cases where
the defendant suffers from a mental defect and does not know their conduct was wrong, while
inappropriate when the defendant knew their act was wrong, as in the case of Susan who killed her
children and then tried to mislead the police.

The irresistible impulse insanity defense is a variation of the insanity defense that supplements the
M’Naghten rule with the concept of volition or free choice. It is easier to prove than the M’Naghten rule
in some cases, and some jurisdictions recognize this defense. However, most states and the federal
government reject this defense. In order to use this defense, a defendant must suffer from a mental
defect or disease of the mind and be unable to control their conduct due to the defect or disease. Even
if the defendant is aware that their conduct is wrong, if they cannot control it, they may be excused.
However, the challenge is distinguishing between conduct that can be controlled and conduct that
cannot be controlled.

The example case of Jolene, who has been diagnosed with paranoia and attacked a sorority sister with a
stun gun and scissors, is not appropriate for the irresistible impulse insanity defense. Jolene was aware
that her conduct was wrong because she spared Agnes, and her choice not to attack Agnes indicates
that she had control over her conduct. Therefore, Jolene's claim of not guilty by reason of insanity would
not be successful in a jurisdiction that recognizes the irresistible impulse insanity defense.
The substantial capacity test is a type of insanity defense created by the Model Penal Code that
requires the defendant to lack substantial capacity to appreciate the criminality of their conduct or to
conform their conduct to the requirements of the law as a result of a mental disease or defect. It
combines cognitive and volitional elements and is easier to establish insanity under this test compared
to the M’Naghten standard. Unlike the M’Naghten and irresistible impulse insanity defenses, the
substantial capacity test does not require complete inability to understand the difference between right
and wrong, and it incorporates an emotional quality.

The example provided shows how Loreen, who has been diagnosed with psychosis and has a history of
mixing her meds together and putting them in other people’s food or drink, may be successful in
claiming insanity under the substantial capacity test for putting a "love potion" made of her
antidepressants in Aidan's coffee and causing him to become seriously ill. The statement she made to
Aidan shows that she lacks substantial capacity to appreciate the criminality of her conduct, and her
behavior in the mental hospital shows her lack of ability to conform or control her conduct.

The Durham insanity defense, used only in New Hampshire, has been established since the late 1800s.
It relies on the principles of proximate causation and has two elements: 1) the defendant must have a
mental disease or defect, and 2) if the criminal conduct is caused by the mental disease or defect, the
conduct should be excused under the circumstances. However, the defense is difficult to apply because
the court failed to give clear definitions for "product," "mental disease," or "mental defect."

An example is given of a person with paranoia who brings a gun to work and kills someone they believe
is trying to harm them. In New Hampshire, this person might be successful with a claim of not guilty by
reason of insanity under the Durham insanity defense, because they have a mental disease or defect
(paranoia) and can produce evidence that their mental illness caused their criminal conduct.

Presumption of sanity for criminal defendants, which means that they are considered sane unless
evidence is produced to prove otherwise. Defendants who claim insanity must produce evidence that
rebuts this presumption, and the burden of proof can vary depending on the state. Some states require
the prosecution to prove sanity beyond a reasonable doubt or to a preponderance of evidence, while
others require the defendant to prove insanity by clear and convincing evidence. The insanity defense
has been converted into an affirmative defense in many states, which means the defendant must prove
their insanity rather than the prosecution proving their sanity.

The concept of Diminished Capacity, which is a defense that can be used in some jurisdictions to reduce
a first-degree murder charge to a lesser offense such as second-degree murder or manslaughter.
Diminished capacity is distinct from the insanity defense, and in California, it was abolished as an
affirmative defense after a highly publicized trial in which a defendant used it successfully. The section
also mentions the syndrome defense, which is a failure of proof defense that some jurisdictions
recognize, and gives some examples of syndromes that may be used to negate criminal intent, such as
posttraumatic stress disorder, intermittent explosive disorder, and battered woman syndrome.
Difference between the insanity defense and mental competence to stand trial. Insanity defense
pertains to the defendant's mental state at the time the crime was committed, while mental
competence to stand trial is analyzed at the time of the trial. A defendant must be mentally competent
to understand the charges against him or her and be able to assist in his or her defense. If the defendant
is found mentally incompetent, the trial is delayed until the defendant regains competency. The Model
Penal Code prohibits trying, convicting, or sentencing a defendant who lacks the capacity to understand
the proceedings against him or to assist in his or her defense. Mentally incompetent defendants can
receive mental health treatment, including involuntary medication until they regain competence.

The concept of "Guilty but Mentally Ill" verdict is explained, where a defendant who is found guilty but
mentally ill is punished and treated for mental health simultaneously while in prison. The verdict is only
available when the defendant fails to prove legal insanity and requires the defendant to prove mental
illness at the time of the crime. An example is provided with Jolene, who has been diagnosed with
paranoia and may be an appropriate candidate for the guilty but mentally ill verdict if available in her
state.

This discusses the disposition of defendants who are found legally insane. The not guilty by reason of
insanity verdict means the defendant is not criminally responsible and has no criminal record, but does
not mean they are free to return to society. In some states and federally, the defendant is automatically
committed to a treatment facility until their mental health is restored. The Model Penal Code also
mandates this approach. In other states, there is a hearing on sanity after the verdict, and if the
defendant is deemed competent, they are released, and if not, they are committed to a treatment
facility.

Lastly is the concept of temporary insanity, which is recognized by many states and is similar to the
insanity defense except for the duration of the mental illness. If a defendant is found not guilty by
reason of insanity for a criminal offense but regains mental competence at the time of prosecution, they
will be released after the verdict is rendered. An example of temporary insanity is the case of Lorena
Bobbitt, who successfully established the irresistible impulse insanity defense and was released after the
jury returned a verdict of not guilty by reason of insanity.