In Criminal Trials and Mental Disorders Thomas Hafemeister, a law professor and psychologist, provides a lengthy and detailed discussion on how defendants with mental health issues are viewed by, and treated in, the US criminal justice system. Given that the aim of the US legal system is to serve fairness and justice for all, this is an extremely important book because a defendant’s mental disorder can play a significant role in his being provided with a fair and just trial. This book is particularly relevant today when it is being increasingly acknowledged that mental disorders are pervasive and undertreated and are even more so within the criminal justice system.

Throughout the book, Hafemeister bases his discussion on cases that involved considerations of competency and criminal responsibility providing a very thorough historical overview of them. In doing so, Hafemeister tries to uncover the rationale behind the various decisions taken in such cases while also offering criticism where he thinks that the system can be improved. Through his insightful analysis he thus pinpoints the limitations of the current system; Hafemeister’s analysis and critique shows clearly that rules and procedures for such cases in the US, both historically and today, are neither well-articulated nor consistently applied and thus that a lot more work is needed in order to formulate legal procedures and rules that can serve justice in accordance with the principles of the US constitution

The book begins with an overview of the major mental disorders and a very useful description of how forensic mental health assessments are carried out in the US. This description highlights the difficulties of providing such assessments while also giving insight into the work of forensic mental health evaluators and how that differs from the role of clinicians.

The rest of the book is focused on the defendant’s right to be competent to stand trial (CST) and on the insanity defense. The first half of the book deals with the former, which, interestingly, is adjudicated more frequently than the latter and is the most important mental health inquiry in criminal justice proceeding. It is important to note that Hafemeister goes to great lengths to remind readers that the presence of a mental disorder is neither necessary nor sufficient for a defendant being found incompetent to stand trial and that the US Supreme Court’s CST test makes no reference to mental disorders. This is indicative of Hafemeister’s constant attempt throughout his book to correct stereotypes and misunderstandings associated with mental disorders.

Hafemeister critically discusses the major trials that established the CST and the historical process through which the United States Supreme Court and the courts of different US States have arrived at their current procedures and legislation. He offers a clear description of how CST is determined and also spends time discussing other criminal trial–dependent issues like the Miranda warning, the right to waiver of counsel and the guilty plea.

In the second half of the book, Hafemeister discusses in detail the insanity defense and takes time to distinguish it clearly from the CST and from other defenses like the Actus Reus and Mens Rea defense, the diminished capacity defense and the “temporary” insanity defense. As with the CST, he begins with a historical overview of the insanity defense and his discussion is based on the major trials in which this defense played a pivotal role. Hafemeister discusses at length the current state of the different tests for establishing mitigating factors in criminal trial proceedings and highlights the procedural aspects of the insanity defense.

Just like he did for the tests for establishing CST, Hafemeister tries to make clear the rationale for and against such procedures, and to clearly spell out how difficult risk assessments are in cases where defendants have a mental disorder. Through this, the book clearly brings to light how the complexity of mental disorders and the differences between disorders that can be many and vast, makes it very difficult to find one common way to deal with all of them. Hafemeister also places all this in a social context, incorporating the public’s attitude to mental disorders, the effects of stereotypes and the social stigma associated with them in his analysis and discussion. He also draws attention to the difficulties associated with limited resources (both of time and money) in the delivering of justice and fairness in such trials, including the various due process protections that defendants are entitled to. The book thus succeeds in showing how these difficulties translate in different approaches in different States and in the little consensus that there still is about the standards of the insanity defense and the competence to stand trial.

Being a psychologist and professor of law, Hafemeister is in the position to also explain the differences in how we understand mental disorders (such as antisocial personality disorder or substance use addiction) in medicine and in the law. As such, in this book Hafemeister does not only offer a legal analysis of cases and their outcomes but also incorporates clinical considerations in his analysis and raises philosophical questions about mental disorders such as important ethical questions about responsibility.

In general, the book is a plea for a better understanding of mental disorders and their impact on behavior that offers extensive legal, clinical and philosophical insights. Though it is thorough and requires attentive reading it is non-technical and can be read by the educated lay reader. This book clearly shows how complicated a question the relationship between defendants with mental health disorders and the criminal justice system is, and thus can be a valuable resource for achieving a greater understanding of the key issues involved in cases that involve criminal defendants with mental disorders and their ability to receive a fair and just trial. I recommend this book to scholars and students interested in (US) criminal law, social justice and mental illness.

© 2019 Elly Vintiadis

Elly Vintiadis, American College of Greece