Psychiatry and the Law II

Presented by Leonard William Mulbry, Jr., M.D.
South Carolina Forensic Psychiatry

Covering the topics of:

Competency to Stand Trial

The Dusky Standard
Whether the defendant "has sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding and whether he has a rational as well as a factual understanding of the proceedings against him."
[Dusky vs. U.S. (U.S. 1960)]

This standard applies in all states and D.C.

Criminal Responsibility

In order for an act to be criminal, there must be both a guilty act and guilty intent

Criminal Responsibility or Not Guilty by Reason of Insanity is based on the fact that "some acts are carried out by those who are not moral agents due to their mental state."

Voluntary Intoxication is usually not a basis for an insanity defense although it may provide the basis for diminished capacity.

M'Naghten Test (England, 1843) "To establish a defense on the ground of insanity, it must be clearly proved that, at the time of the committing of the act, the party accused was laboring under such a defect of reason from disease of the mind, as not to know the nature and quality of the act he was doing or, if he did know it, that he did not know he was doing what was wrong."

Guilty but Mentally III (GBMI)

An individual found GBMI is acknowledged to have been mentally ill at the time of the act, but lacked sufficient capacity to conform his conduct to the requirements of the law. GBMI may be offered to the trier as an alternative to NGRI.

Diminished Capacity

Diminished Capacity can be raised where an individual suffers from a mental illness or cognitive deficit that does not meet the requirements of the insanity defense, but nevertheless provides a basis for not holding the person fully responsible for the behavior. South Carolina does not allow diminished capacity but does allow Mitigation in sentencing.

Insanity Defense

Insanity defenses account for about one-tenth of one percent of felony trials, or two insanity pleas per one thousand arrests.

The success rate of the insanity defense varies from state to state.


Psychiatrists have an obligation to keep matters revealed by patients in the course of treatment confidential.


Privilege is the right to have information revealed to the psychiatrist or psychotherapist held in confidence and not revealed against his will except in certain circumstances. The right that belongs to the patient that must be raised by the patient before it comes into play.


Malpractice is an instance of negligence or incompetence on the part of a professional. It usually requires that the following "4D's" be demonstrated

Dereliction: The doctor departed from or ignored standard of care.

Duty: The doctor had an obligation to the patient

Direct: "but for" proximate cause

Damage: Harm must be done


This information is designed for general information only. The information presented at this site
should not be construed to be formal legal advice nor the formation of a doctor/client relationship.

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