People With Mental Illness and the Law Revision Notes for HSC SSCE Legal Studies

People With Mental Illness and the Law

Introduction

Mental health awareness in Australia has grown significantly in recent years, leading to greater understanding and acceptance of mental illness in society. This increased awareness has helped reveal the true scale of mental health issues affecting Australians. According to Australia's Health 2014 report, approximately $45\%$ of Australians aged $16$ - $85$ (around $7.3$ million people) will experience a common mental health condition at some point in their lives. Mental illness represents one of the leading causes of disability in Australia, affecting people's ability to function physically, emotionally, and psychologically.

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The intersection between mental illness and the legal system is particularly significant. In $2012$ , $38\%$ of prison entrants reported having been diagnosed with a mental health disorder (including drug and alcohol abuse) by a medical professional during their lifetime. This statistic highlights how individuals experiencing mental health issues frequently encounter legal action and potential incarceration, making it essential to understand how the law responds to people with mental illness.

Key terms:

Mental illness: An illness of the mind that affects the psychological, emotional and behavioural state of a person
Disability: Mental or physical impairment which can limit a person physically, emotionally and psychologically
Incarceration: Being detained or imprisoned as punishment for a crime

Changing attitudes to mental health

Historical context and social progress

Over the past $20$ years, Australian society has developed a much deeper understanding of mental illness. Historically, people showing signs of mental illness were often locked away or hidden from public view, reflecting widespread fear and misunderstanding. However, community attitudes and behaviours have transformed dramatically as awareness of different types of mental illnesses has increased and access to support services has improved.

Deinstitutionalisation and community-based care

The modern approach to mental health care emphasises treating individuals within their domestic environment (the household where they live) rather than in long-term institutional settings. This process, known as deinstitutionalisation, involves removing people from long-stay psychiatric hospitals and providing outpatient mental health care within their communities. Under this model, individuals visit health professionals for treatment and then return home, rather than remaining in hospital.

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While most Australians express support for community-based care when asked about it in principle, many still demonstrate a 'not in my backyard' attitude when facilities or services are proposed for their own neighbourhoods. This contradiction between stated values and actual behaviour creates challenges for implementing effective community mental health programs.

Current challenges in mental health support

The deinstitutionalisation approach faces significant obstacles, particularly regarding funding and resources. Limited financial support for disability services in Australia means that some people with mental health issues do not receive adequate assistance to help them cope effectively in society.

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This gap between policy intentions and practical support can leave vulnerable individuals without the care they need, potentially increasing their risk of encountering legal problems.

Definitions of mental illness

Understanding mental illness within the legal framework requires examining two distinct definitions that serve different purposes. The tension between these definitions has significant implications for how individuals with mental health issues are treated by the criminal justice system.

Legal definition of mental illness

In New South Wales, the Mental Health Act 2007 (NSW) provides the authoritative legal definition of mental illness. According to this Act, mental illness means:

"A condition that seriously impairs, either temporarily or permanently, the mental functioning of a person and is characterised by the presence in the person of any one or more of the following symptoms:

(a) delusions
(b) hallucinations
(c) serious disorder of thought form
(d) a severe disturbance of mood
(e) sustained or repeated irrational behaviour indicating the presence of any one or more of the symptoms referred to in paragraphs (a)–(d)"

This legal definition is deliberately narrow and requires clear evidence of serious impairment to mental functioning. The person must display at least one of the specified symptoms, which are observable and diagnosable conditions. The definition uses the word "serious" to indicate that minor or temporary difficulties do not meet the threshold for legal recognition as mental illness.

Medical definition of mental illness

The medical profession uses a significantly broader definition of mental illness based on the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Under the medical approach, a person may be diagnosed as mentally ill if their behaviour cannot be considered an 'expectable' (normal or anticipated) response to a particular situation or event. When behaviour falls outside expected norms, it is assessed as potentially representing a behavioural, psychological, or biological dysfunction.

This medical definition encompasses a much wider range of conditions and symptoms than the legal definition. Medical professionals can diagnose mental illness based on patterns of behaviour, emotional responses, and psychological states that may not meet the stricter legal criteria. Some individuals experience long-term, chronic mental illness, while others may have a single episode. It is statistically likely that most people either know someone with mental illness or will encounter such individuals during their lives.

Legal versus medical definition: a critical distinction

The fundamental difference between legal and medical definitions of mental illness creates significant challenges when criminal cases involve defendants with mental health issues. When a crime has been committed, courts must determine whether the defendant (the person accused of the crime) suffers from a mental illness according to the legal definition, not the medical one.

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The Burden of Proof

Critically, the burden of proof lies with the defendant to establish that they meet the legal definition of mental illness. This means the accused person and their legal team must provide sufficient evidence to satisfy the court's rigorous test. A person may have a documented medical diagnosis of mental illness but still fail to meet the stricter legal criteria required by the Mental Health Act 2007 (NSW).

This distinction often creates what can be described as a conundrum in criminal proceedings. A defendant may be receiving ongoing psychiatric treatment and have a clear medical diagnosis, yet still be found legally responsible for their actions because their condition does not satisfy the narrow legal definition at the time of the offence.

Case study: R v Bolas (2015)

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Case Study: R v Bolas (2015) - The Legal vs Medical Definition in Practice

Background and Facts

The case of Nicholas Bolas, heard in Sydney's Central Local Court in June $2015$ , illustrates the practical tension between legal and medical definitions of mental illness. Bolas, a $28$ -year-old homeless man, was charged with assault occasioning actual bodily harm after allegedly punching a $16$ -month-old baby girl who was sitting in her pram at a café near Central Station.

Medical History

The case revealed significant medical evidence of mental illness:

Bolas had been involuntarily admitted to St Vincent's Hospital for acute psychosis between May $5$ and May $11$ , $2015$
He was discharged on May $13$ , $2015$
An arrest warrant had been issued in Queensland after Bolas left a mental health unit there without permission
When questioned by the magistrate, Bolas could not recall when he had last taken medication for his psychosis
During the court appearance, Bolas appeared topless and refused to wear a shirt

Legal Arguments

Bolas's solicitor argued that he should be dealt with under the Mental Health Act, implying that his mental illness should be the primary consideration in determining how to proceed with the case. However, the prosecutor took a different position, arguing that Bolas did not satisfy the definition of a mentally ill person as specified in the Mental Health Act 2007 (NSW).

This disagreement demonstrates the practical application of the distinction between medical and legal definitions. Despite clear evidence of psychiatric hospitalisation and ongoing psychosis, the prosecution maintained that Bolas did not meet the legal threshold required for mental illness to be considered in determining criminal responsibility.

Court Decision

Magistrate Les Mabbutt ordered Bolas to be admitted to St Vincent's Hospital for a psychiatric assessment, recognising the need for expert evaluation. The magistrate indicated that Bolas would return to the court system if he was found to be mentally fit to stand trial. This outcome represents a compromise position: acknowledging the mental health concerns while preserving the possibility of criminal prosecution if Bolas is determined to meet the standard for fitness to plead.

Legal implications

The Bolas case demonstrates several important principles:

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Key Legal Principles from R v Bolas

Medical evidence alone is insufficient: Previous psychiatric hospitalisations and diagnoses do not automatically satisfy the legal definition of mental illness for court purposes
The burden remains on the defendant: Despite obvious indicators of mental health issues, the defendant must prove they meet the strict legal criteria
Assessment is ongoing: Courts can order psychiatric evaluations to bridge the gap between medical and legal understandings
Fitness to stand trial is separate from mental illness: Even if someone has a mental illness, they may still be considered fit to participate in legal proceedings

Exam guidance

Analyse command word

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When asked to analyse the difference between legal and medical definitions of mental illness:

Identify the key features of each definition
Explain why the legal definition is narrower (need for certainty in criminal law)
Discuss the implications for defendants with mental health issues
Use the Bolas case or similar examples to illustrate practical consequences

Evaluate command word

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When evaluating the effectiveness of the law in responding to people with mental illness:

Consider whether the strict legal definition provides adequate protection for vulnerable individuals
Assess the impact of the burden of proof being on the defendant
Examine whether deinstitutionalisation has been successful given funding limitations
Weigh the need for public safety against the rights of people with mental illness
Refer to statistics about prison populations with mental health issues

Assess command word

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When assessing societal attitudes toward mental illness:

Identify changes over time (from institutionalisation to community care)
Evaluate the gap between stated attitudes and actual behaviour ("not in my backyard")
Consider the role of funding and resources in determining outcomes
Link changing attitudes to legal reforms and policy developments

Remember!

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Key Points to Remember:

Mental illness affects approximately $45\%$ of Australians aged $16$ - $85$ at some point in their lives, making it a major public health issue
$38\%$ of prison entrants report having been diagnosed with a mental health disorder, highlighting the strong connection between mental illness and the criminal justice system
The legal definition of mental illness (Mental Health Act 2007 NSW) is narrower than the medical definition (DSM-IV), requiring serious impairment with specific observable symptoms
Defendants bear the burden of proof to establish they meet the legal definition of mental illness, even if they have medical diagnoses
Modern policy emphasises deinstitutionalisation and community-based care, though implementation faces challenges including funding limitations and community resistance

Key Terms to Remember:

Mental illness, disability, incarceration, deinstitutionalisation, domestic environment, burden of proof, defendant

Critical Legal Framework:

Mental Health Act 2007 (NSW) provides the binding legal definition in criminal proceedings
Legal definition requires: (a) delusions, (b) hallucinations, (c) serious disorder of thought form, (d) severe disturbance of mood, or (e) sustained irrational behaviour

People With Mental Illness and the Law (HSC SSCE Legal Studies): Revision Notes