Claire Dawson
Hospitals for the criminally insane, also known as forensic psychiatric hospitals, are facilities that provide treatment for individuals who have been deemed not criminally responsible due to mental illness. These hospitals aim to provide specialized care and treatment for patients with mental health disorders, preparing them to eventually return to court and enhancing their quality of life within the hospital. The 'insanity defence' is rarely used and is only successful in 26% of cases, with 90% of those individuals having been previously diagnosed with a mental illness. The Matteawan State Hospital for the Criminally Insane, which opened in 1892, is an example of one of these hospitals, where patients underwent treatments such as electric and insulin shock therapy, hypnosis, group therapy, and lobotomies. Another example is Broadmoor Hospital, a high-security psychiatric hospital in England, which was first known as the Broadmoor Criminal Lunatic Asylum when it opened in 1863.
| Characteristics | Values |
|---|---|
| Hospitals for the criminally insane | Matteawan State Hospital for the Criminally Insane, Broadmoor Hospital, Patton State Hospital, Atascadero State Hospital, Western State Hospital |
| Location | New York, Crowthorne, Berkshire, England, California, Washington |
| Year of establishment | Matteawan: 1892; Broadmoor: 1863 |
| Number of employees | Atascadero: 2,140; Patton: 349 |
| Security | Matteawan: medium; Broadmoor: high |
| Patient population | Matteawan: 1,500 men and 250 women; Broadmoor: 4 blocks for men and 1 for women |
| Treatment | Therapy groups, medication, electric and insulin shock treatments, hypnosis, group therapy, lobotomies |
| Accreditation | Patton and Atascadero: Joint Commission on Accreditation of Healthcare Organizations |
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What You'll Learn
Matteawan State Hospital for the Criminally Insane
The Matteawan State Hospital for the Criminally Insane was established by a commission created by a law of 1886 to address the need for additional accommodations for the inmates of the State Asylum for Insane Criminals at Auburn. The commission was authorised to select a site for the construction of a new asylum, which was completed in 1892, with the Asylum for Insane Criminals being relocated to the new site with 261 patients. The new asylum was officially named Matteawan State Hospital in 1893.
The hospital was designed by architect Isaac Perry, who was tasked with creating a space that could accommodate 550 patients and had "an abundance of light and ventilation". The hospital was to function similarly to the state's civil hospitals, with the exception of tighter security. Doctors prescribed a program of "moral treatment" that had been developed in the early 1800s.
In 1899, another prison mental hospital was built on the grounds of Clinton. Dannemora, as it was called, would hold male convicts who became insane while serving their sentences and could retain them if they remained insane after their sentences expired. Matteawan, on the other hand, would hold unconvicted males as well as females in both categories.
By the late 1940s, new procedures were introduced at Matteawan, including electric and insulin shock treatments, hypnosis, and group therapy sessions. Lobotomies were also performed on some patients. By 1949, the facility, which was originally built for 550 patients, was severely overcrowded, housing almost 1,500 men and 250 women. The Matteawan "colony farm", which provided farming training for patients, was closed in the mid-1960s as it was no longer considered relevant for a patient population drawn mainly from New York City.
Today, some buildings from the former Matteawan State Hospital for the Criminally Insane are part of the medium-security Fishkill Correctional Facility.
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Forensic psychiatric hospitals vs. prisons
Forensic psychiatric hospitals and prisons differ in many ways. Patients in forensic psychiatric hospitals are referred to as patients, not inmates, and they don't have numbers. They are allowed to wear ordinary clothes and are given treatment and therapy by doctors. They are also given medication, which sometimes they take against their will. They are treated, not punished, and have access to better food and more amenities. They can have visits from friends and family, and are gradually released into the community over a year or so. However, like prisons, these hospitals are surrounded by fences, patrolled by guards, and patients can be put in solitary confinement and given other punishments. Additionally, patients in these hospitals don't have sentences, and their release is dependent on their recovery.
Prisons, on the other hand, are primarily focused on punishment and incarceration. Inmates are given numbers and are often referred to as prisoners or inmates rather than patients. They typically wear uniforms and may not have access to the same level of medical treatment or therapy as those in forensic psychiatric hospitals. Prisons are also known for their strict security measures, including fences, guards, and solitary confinement. The length of an inmate's stay in prison is determined by their sentence, and they are usually released once their sentence is served, or in some cases, when they are eligible for parole.
Forensic psychiatric hospitals are designed to treat individuals with mental illnesses who have committed crimes. These hospitals aim to provide treatment and care to improve the mental health of patients while also ensuring the safety of society. The patients in these hospitals may have been found not guilty by reason of insanity or deemed unfit to stand trial due to their mental state. The goal is to provide treatment and potentially prepare them for reintegration into society.
Prisons, on the other hand, are designed for individuals who have been found guilty of committing crimes and are serving their sentences. The primary focus of prisons is on punishment, deterrence, and rehabilitation. Inmates in prisons may have access to some mental health services, but the primary goal is not psychiatric treatment. Prisons offer correctional programs and aim to rehabilitate inmates to facilitate their reintegration into society upon release.
The distinction between forensic psychiatric hospitals and prisons lies in their purpose, focus, and target population. Forensic psychiatric hospitals cater to individuals with mental illnesses who have committed crimes, focusing on treatment and care. Prisons, on the other hand, are for individuals serving sentences after being found guilty, with an emphasis on punishment, deterrence, and rehabilitation.
In conclusion, while both forensic psychiatric hospitals and prisons serve the purpose of housing individuals who have committed crimes, they differ significantly in their approach and objectives. Forensic psychiatric hospitals prioritize treatment and care for individuals with mental illnesses, while prisons focus on punishment, deterrence, and rehabilitation. The target populations and the nature of confinement also vary between the two institutions.
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$130
The 'insanity' defence
The insanity defence is a legal concept, not a medical one, and is primarily used in criminal prosecutions. It is based on the assumption that, at the time of the crime, the defendant was suffering from severe mental illness and was therefore incapable of understanding the nature of the crime or differentiating right from wrong, and hence should not be held legally accountable.
The insanity defence is rarely used and is not an easy way to avoid prison. An eight-state study found that it is used in less than 1% of all court cases and has a 26% success rate. In 90% of successful cases, the defendant had previously been diagnosed with a mental illness.
The first famous legal test for insanity came in 1843 in the M'Naghten case. Englishman Daniel M'Naghten shot and killed the secretary of the British Prime Minister, believing that the Prime Minister was conspiring against him. The court acquitted M'Naghten "by reason of insanity," and he was placed in a mental institution for the rest of his life. The M'Naghten rule was embraced with almost no modification by American courts and legislatures for over 100 years. It was first used in the US in the case of People v. Freeman in 1847, where an Afro-Native man from Auburn, New York was tried for a quadruple murder.
In 1984, the Comprehensive Crime Control Act was passed, which included the Insanity Defense Reform Act. The federal insanity defence now requires the defendant to prove, by "clear and convincing evidence", that "at the time of the commission of the acts constituting the offense, the defendant, as a result of a severe mental disease or defect, was unable to appreciate the nature and quality or the wrongfulness of his acts".
In Victoria, the current defence of mental impairment was introduced in the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997, which replaced the common-law defence of insanity. The accused must be suffering from a mental impairment that affects their ability to understand the nature and quality of their conduct or know that it was wrong.
Establishing legal competency to stand trial is an important corollary to the insanity defence. A criminal defendant cannot stand trial if they are deemed legally incompetent. A defendant may request a hearing to determine competency at any time, which involves the submission of supporting evidence and a psychological evaluation.
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Patient experiences
There are hospitals for the criminally insane, also known as forensic psychiatric hospitals, that provide psychiatric care and treatment for individuals who have been deemed not criminally responsible due to mental illness. These hospitals aim to provide treatment and help patients gain the skills and knowledge necessary to understand court proceedings and participate in their defence.
The experiences of patients in these hospitals can vary. One patient, Brian, initially attended therapy groups and received help. However, he conflicted with psychiatrists over medication, experiencing side effects that made him feel impotent and incontinent. As his feelings of recovery were not aligned with the assessments of his psychiatrists, he became increasingly desperate, leading to incidents of hostage-taking, escape attempts, and violence. Brian's prolonged stay, exceeding that of many doctors, has been marked by trauma, including witnessing patient-on-patient murders and the declaration of a doctor as criminally insane.
The case of Brian Bechtold, admitted to the Clifton T. Perkins Hospital Center in Maryland, further illustrates the patient experience. Bechtold, diagnosed with paranoid schizophrenia, was ruled not criminally responsible for the murder of his parents due to insanity. Despite his intelligence and articulateness, Bechtold remained in the hospital for 27 years, with Mikita Brottman, an author who volunteered at the hospital, questioning the prolonged duration of his confinement.
The history of Matteawan State Hospital for the Criminally Insane, now partially serving as a medium-security correctional facility, also sheds light on patient experiences. The hospital employed treatments such as electric and insulin shock, hypnosis, group therapy, and lobotomies. Overcrowding was an issue, with the facility housing nearly three times its capacity by the late 1940s, contributing to the challenging environment experienced by patients.
While popular perception often associates these hospitals with dangerous and unstable individuals, many patients are intelligent and articulate, sharing the same human needs, desires, and fears as anyone else. The "insanity" defence is rarely used, and even when successful, it results in indefinite stays in maximum-security hospitals, indicating that patients face a long and uncertain path towards recovery and potential release.
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Broadmoor Hospital
The hospital has a long history dating back over 150 years and is internationally recognised for its work in forensic mental healthcare. The original building, with its high walls and visible security features, has often been assumed to be a prison by the public. Many of its patients are referred from the criminal justice system, and its design and layout incorporate elements that address criminality in addition to mental illness. However, the daily routine and interior layout are intended to facilitate therapy rather than operate as a prison.
In 2003, the Victorian buildings at Broadmoor Hospital were deemed 'unfit for purpose' by the Commission for Healthcare Improvement. The hospital received an 'Inadequate' rating from the Care Quality Commission in 2015. After a comprehensive redevelopment, a new hospital opened in December 2019, offering modern facilities and an enhanced therapeutic environment. The new hospital was rated ''Good'' overall by the Care Quality Commission in 2018.
Broadmoor has had some notable incidents in its history, including the escape of John Straffen in 1952, which led to the implementation of a unique alarm system to alert the public in the surrounding areas. The hospital has also faced security concerns and management issues, as highlighted by the Peter Fallon QC inquiry into Ashworth Special Hospital in 1999.
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Frequently asked questions
Yes, there are hospitals for the criminally insane. In the US, these are known as forensic psychiatric hospitals. In the UK, Broadmoor Hospital in Crowthorne, Berkshire, England, is a high-security psychiatric hospital and the oldest of England's three high-security psychiatric hospitals.
Patients in hospitals for the criminally insane undergo therapy and are prescribed medication by psychiatrists. In the past, procedures included electric and insulin shock treatments, hypnosis, group therapy sessions, and lobotomies. Today, patients are offered a specialized program of treatment to help them gain the knowledge and skills necessary to return to court.
Contrary to popular opinion, the 'insanity' defense is rarely used. According to an eight-state study, it is used in less than 1% of all court cases and has a 26% success rate.
