howard zonana | Yale University (original) (raw)
Papers by howard zonana
PubMed, 1990
Thirty-one female insanity acquittess from Connecticut were matched to a group of 31 male NGRIs. ... more Thirty-one female insanity acquittess from Connecticut were matched to a group of 31 male NGRIs. The samples were compared with regard to demographic, criminal, and clinical characteristics. Logistic regression analyses were used to determine predictors of criminal recidivism for the sample. Results indicated that women NGRIs were older, more likely to be married, less likely to be substance abusers, had less extensive criminal records, and were released from hospitals sooner than the men. A significant racial difference was noted: white women had less extensive criminal records and were hospitalized for shorter periods than minority women. Results of the logistic regression analyses showed that the strongest independent predictors of criminal recidivism were race and having a diagnosis other than psychosis (schizophrenia, affective or organic disorders). Findings support recent APA policy guidelines on the insanity defense.
PubMed, 2008
and Development Process This document is intended to be a review of legal and psychiatric factors... more and Development Process This document is intended to be a review of legal and psychiatric factors and to give practical guidance and assistance in the performance of psychiatric disability evaluations. It was developed by forensic psychiatrists who routinely conduct disability evaluations and have expertise in this area. Some contributors are actively involved in related academic endeavors. The process of developing the Practice Guideline incorporated opportunities for review by members and integration of feedback and revisions into the final draft. The final draft of the Guideline was approved by the Council of the American Academy of Psychiatry and The Law in March, 2008. The contents thus reflect a consensus of opinion among members and experts about the principles and practice applicable to the conduct of psychiatric disability evaluations. As with any Practice Guideline, this one is not binding, nor should it be construed as setting a standard of care. The Guideline does not present all acceptable current ways of performing forensic evaluations of persons with psychiatric disability, and following it does not lead to a guaranteed outcome. Fact patterns, clinical factors, relevant statutes, administrative and case law, and the forensic psychiatrist's judgment determine how to proceed in a forensic evaluation. Although treating clinicians may find this Guideline useful, it is directed toward psychiatrists and other clinicians who work in a forensic role in conducting evaluations and providing opinions related to psychiatric disability. It is expected that any clinician who agrees to perform forensic evaluations in this domain has the appropriate qualifications.
PubMed, 2007
Competence to stand trial is a legal construct used to identify those criminal defendants who hav... more Competence to stand trial is a legal construct used to identify those criminal defendants who have the requisite mental capacity to understand the nature and objective of the proceedings against them and to participate rationally in preparing their defense. This Practice Guideline has described how psychiatrists should evaluate individuals concerning their competence to stand trial. The Guideline describes acceptable forensic psychiatric practice for such evaluations. Where possible, it specifies standards of practice and principles of ethics and also emphasizes the importance of analyzing an individual defendant's case in the context of statutes and case law applicable in the jurisdiction where the evaluation takes place. The recommendations in the Guideline both reflect and are limited by evolving case law, statutory requirements, legal publications, and the current state of psychiatric knowledge. The authors have taken note of nationally applicable case law, federal constitutional standards, statutory language, and federal and state interpretations of the rights or statutes, recognizing that jurisdictions may differ in their specific interpretation or application of statutes or general constitutional standards. The review of cases concerning specific psychiatric diagnoses illustrates general U.S. trends, and psychiatrists must remain cognizant of their jurisdictions' interpretations of statutes or constitutional requirements. By surveying a variety of practices and approaches to data gathering and case analysis, the authors believe that this Guideline will stimulate additional collegial discussion about what is necessary and sufficient for adequate evaluations of adjudicative competence. The notion that psychiatrists should apply expertise to competence assessments stems from the principal that, before allowing a defendant to face criminal prosecution and possible punishment, courts need reasonable assurance--based, if necessary, on a careful, individualized evaluation--that the defendant has adequate mental capacity to make a defense. At a minimum, a psychiatrist's opinion about adjudicative competence should reflect an understanding of the jurisdictional standard and of how the defendant's mental condition affects competence as defined with the jurisdiction. The psychiatrist's report should clearly describe the opinion and the reasoning that leads to it. Psychiatrists who provide mental health expertise concerning adjudicative competence give trial courts information needed to assure that defendants can appropriately protect themselves and that criminal proceedings will be accurate, dignified,and just.
Journal of the American Academy of Psychiatry and the Law, Dec 1, 2014
Academy of Psychiatry and the Law. AAPL practice guideline for forensic evaluation of defendants ... more Academy of Psychiatry and the Law. AAPL practice guideline for forensic evaluation of defendants raising the insanity defense.
Oxford Medicine Online
Witness testimony of the elderly is a topic of growing importance in U.S. courts. Because the num... more Witness testimony of the elderly is a topic of growing importance in U.S. courts. Because the number and proportion of older persons in the United States is growing, it is likely that more elderly people will be called on to provide witness testimony. This chapter examines the types of challenges specific to the geriatric witness in the courtroom. It reviews the elements of competency to serve as a witness in federal and state courts; challenges facing elderly witnesses, including neurocognitive disorders and sensory impairments; and the literature on perceptions of credibility and the geriatric witness and the ability of individuals with dementia to testify meaningfully. Case law pertaining to protection of elderly witnesses, specifically Crawford v. Washington and United States v. Campbell, are discussed as they relate to the geriatric witness. The 2011 New Jersey Supreme Court decision of State v. Henderson is examined as well. This decision addresses the science of memory as it ...
The Bulletin of the American Academy of Psychiatry and the Law, 1979
Journal of Forensic Sciences, 1992
The Bulletin of the American Academy of Psychiatry and the Law, 1983
In 1974 the Connecticut statute on competence to stand trial was revised to allow the court the o... more In 1974 the Connecticut statute on competence to stand trial was revised to allow the court the option of having competence evaluated by a clinical team consisting ofa psychiatrist, a psychologist, and a psychiatric social worker, rather than by a psychiatrist alone. l This article traces the history of the Connecticut statute on competence to stand trial and describes the factors leading to the adoption of this interdisciplinary approach. Some advantages and disadvantages of the team approach are noted, and the reaction of the courts is discussed. The interdisciplinary model for competence evaluation is viewed as an efficient and viable alternative to evaluation by an individual psychiatrist and may be applicable to other types of forensic evaluations.
Behavioral Sciences & the Law, 1990
The American Journal on Addictions, 1999
The objective of this retrospective study was to determine if a jail diversion program reduced da... more The objective of this retrospective study was to determine if a jail diversion program reduced days of incarceration over the year following arrest in a sample of detainees with substance abuse disorders who had been arrested for a minor (misdemeanor) crime (n = 252) compared to a group (n = 95) who were not diverted. Particular attention was paid to comparing those singly diagnosed to those dually diagnosed. Analyses indicated that 1) detainees with substance abuse alone were less likely to be diverted than those with a dual diagnosis; 2) jail diversion reduced incarceration time during the next year; and 3) the effect of diversion differed depending upon the level of criminal charge. Diversion significantly reduced jail time only among those who were arrested for the more serious of the minor offenses that are associated with longer jail sentences.
PubMed, 2002
The insanity defense is a legal construct that excuses certain mentally ill defendants from legal... more The insanity defense is a legal construct that excuses certain mentally ill defendants from legal responsibility for criminal behavior. This practice guideline has delineated the forensic psychiatric evaluation of defendants raising the insanity defense. The document describes acceptable forensic psychiatric practices. Where possible, standards of practice and ethical guidelines have been specified. And where appropriate, the practice guideline has emphasized the importance of analyzing the individual case, the jurisdictional case law and the state (or federal) statute. This practice guideline is limited by the evolving case law, statutory language and legal literature. The authors have emphasized the statutory language of current legal standards, as well as the state or federal courts' interpretation of those standards because the same statutory language has been interpreted differently in different jurisdictions. Similarly, this practice guideline has reviewed the state and federal trends that determine which diagnoses meet the criteria for mental disease or defect. These trends yield to jurisdictional court interpretations. Finally, the authors hope this practice guideline has begun the dialogue about formulating a forensic psychiatric opinion by surveying the various approaches used to analyze case data. The forensic psychiatrist's opinion in each case requires an understanding of the current jurisdictional legal standard and its application, as well as a thorough analysis of the individual case. The psychiatrist's analysis and opinion should be clearly stated in the forensic psychiatric report. It should be noted that the role of a psychiatric expert witness in the criminal justice system is predicated on the law's interest in individualizing the criteria of mitigation and exculpation. Forensic psychiatric analyses and formulations of opinions are, therefore, subject to change as the legal guidance changes.
The journal of the American Academy of Psychiatry and the Law, 2017
Correctional systems, already struggling to meet the basic and functional requirements of older p... more Correctional systems, already struggling to meet the basic and functional requirements of older prisoners, will be further challenged by the increasing medical and psychiatric needs of this population. Mental health and general medical care for older adults requires specific on-site or consultation expertise in geriatric medicine and psychiatry, as well as potential changes in infrastructure, both of which may be prohibitively expensive. However, compassionate and effective treatment of older prisoners requires that prison and legal systems facilitate this expert care. To address this situation, strategic revisions of the criminal justice system are needed to alleviate prison overcrowding and consequent inadequate medical care for inmates, especially the elder ones. The unique, age-related demands of this older population predict an increased need for forensic psychiatrists with a thorough knowledge and expertise in geriatrics, as more forensic psychiatric evaluations will be needed...
The journal of the American Academy of Psychiatry and the Law, 2016
Receiving feedback on one's work from colleagues is an essential part of clinical and forensi... more Receiving feedback on one's work from colleagues is an essential part of clinical and forensic psychiatric practice. Often the material on which feedback is sought concerns past cases. When the material relates to current cases, particular safeguards are needed to protect important interests. This paper lists the interests that must be protected when feedback is provided through clinical consultation and supervision meetings in a forensic psychiatric training program. These are the interests of the person being evaluated, the attorneys, the people providing feedback to the evaluator, and the employers of the people providing feedback. The principles that the training program applies in determining attendance at, and participation in, these meetings are described. Finally, scenarios are presented that illustrate the application of these principles. Such application has allowed trainees and others to receive the benefits of consultation and supervision in the course of developing ...
Psychiatric services (Washington, D.C.), Dec 3, 2016
September 28, 2016, marked the 50th anniversary of the Connecticut Mental Health Center, a state-... more September 28, 2016, marked the 50th anniversary of the Connecticut Mental Health Center, a state-owned and state-operated joint venture between the state and Yale University built and sustained with federal, state, and university funds. Collaboration across these entities has produced a wide array of clinical, educational, and research initiatives, a few of which are described in this column. The missions of clinical care, research, and education remain the foundation for an organization that serves 5,000 individuals each year who are poor and who experience serious mental illnesses and substance use disorders.
The American Journal of Geriatric Psychiatry, 2016
Psychiatric Services, 2016
Journal of the American Academy of Psychiatry and the Law Online, Feb 1, 1999
Psychiatric Services, Oct 8, 2014
Yale Textbook of Public Psychiatry, 2016
PubMed, 1990
Thirty-one female insanity acquittess from Connecticut were matched to a group of 31 male NGRIs. ... more Thirty-one female insanity acquittess from Connecticut were matched to a group of 31 male NGRIs. The samples were compared with regard to demographic, criminal, and clinical characteristics. Logistic regression analyses were used to determine predictors of criminal recidivism for the sample. Results indicated that women NGRIs were older, more likely to be married, less likely to be substance abusers, had less extensive criminal records, and were released from hospitals sooner than the men. A significant racial difference was noted: white women had less extensive criminal records and were hospitalized for shorter periods than minority women. Results of the logistic regression analyses showed that the strongest independent predictors of criminal recidivism were race and having a diagnosis other than psychosis (schizophrenia, affective or organic disorders). Findings support recent APA policy guidelines on the insanity defense.
PubMed, 2008
and Development Process This document is intended to be a review of legal and psychiatric factors... more and Development Process This document is intended to be a review of legal and psychiatric factors and to give practical guidance and assistance in the performance of psychiatric disability evaluations. It was developed by forensic psychiatrists who routinely conduct disability evaluations and have expertise in this area. Some contributors are actively involved in related academic endeavors. The process of developing the Practice Guideline incorporated opportunities for review by members and integration of feedback and revisions into the final draft. The final draft of the Guideline was approved by the Council of the American Academy of Psychiatry and The Law in March, 2008. The contents thus reflect a consensus of opinion among members and experts about the principles and practice applicable to the conduct of psychiatric disability evaluations. As with any Practice Guideline, this one is not binding, nor should it be construed as setting a standard of care. The Guideline does not present all acceptable current ways of performing forensic evaluations of persons with psychiatric disability, and following it does not lead to a guaranteed outcome. Fact patterns, clinical factors, relevant statutes, administrative and case law, and the forensic psychiatrist's judgment determine how to proceed in a forensic evaluation. Although treating clinicians may find this Guideline useful, it is directed toward psychiatrists and other clinicians who work in a forensic role in conducting evaluations and providing opinions related to psychiatric disability. It is expected that any clinician who agrees to perform forensic evaluations in this domain has the appropriate qualifications.
PubMed, 2007
Competence to stand trial is a legal construct used to identify those criminal defendants who hav... more Competence to stand trial is a legal construct used to identify those criminal defendants who have the requisite mental capacity to understand the nature and objective of the proceedings against them and to participate rationally in preparing their defense. This Practice Guideline has described how psychiatrists should evaluate individuals concerning their competence to stand trial. The Guideline describes acceptable forensic psychiatric practice for such evaluations. Where possible, it specifies standards of practice and principles of ethics and also emphasizes the importance of analyzing an individual defendant's case in the context of statutes and case law applicable in the jurisdiction where the evaluation takes place. The recommendations in the Guideline both reflect and are limited by evolving case law, statutory requirements, legal publications, and the current state of psychiatric knowledge. The authors have taken note of nationally applicable case law, federal constitutional standards, statutory language, and federal and state interpretations of the rights or statutes, recognizing that jurisdictions may differ in their specific interpretation or application of statutes or general constitutional standards. The review of cases concerning specific psychiatric diagnoses illustrates general U.S. trends, and psychiatrists must remain cognizant of their jurisdictions' interpretations of statutes or constitutional requirements. By surveying a variety of practices and approaches to data gathering and case analysis, the authors believe that this Guideline will stimulate additional collegial discussion about what is necessary and sufficient for adequate evaluations of adjudicative competence. The notion that psychiatrists should apply expertise to competence assessments stems from the principal that, before allowing a defendant to face criminal prosecution and possible punishment, courts need reasonable assurance--based, if necessary, on a careful, individualized evaluation--that the defendant has adequate mental capacity to make a defense. At a minimum, a psychiatrist's opinion about adjudicative competence should reflect an understanding of the jurisdictional standard and of how the defendant's mental condition affects competence as defined with the jurisdiction. The psychiatrist's report should clearly describe the opinion and the reasoning that leads to it. Psychiatrists who provide mental health expertise concerning adjudicative competence give trial courts information needed to assure that defendants can appropriately protect themselves and that criminal proceedings will be accurate, dignified,and just.
Journal of the American Academy of Psychiatry and the Law, Dec 1, 2014
Academy of Psychiatry and the Law. AAPL practice guideline for forensic evaluation of defendants ... more Academy of Psychiatry and the Law. AAPL practice guideline for forensic evaluation of defendants raising the insanity defense.
Oxford Medicine Online
Witness testimony of the elderly is a topic of growing importance in U.S. courts. Because the num... more Witness testimony of the elderly is a topic of growing importance in U.S. courts. Because the number and proportion of older persons in the United States is growing, it is likely that more elderly people will be called on to provide witness testimony. This chapter examines the types of challenges specific to the geriatric witness in the courtroom. It reviews the elements of competency to serve as a witness in federal and state courts; challenges facing elderly witnesses, including neurocognitive disorders and sensory impairments; and the literature on perceptions of credibility and the geriatric witness and the ability of individuals with dementia to testify meaningfully. Case law pertaining to protection of elderly witnesses, specifically Crawford v. Washington and United States v. Campbell, are discussed as they relate to the geriatric witness. The 2011 New Jersey Supreme Court decision of State v. Henderson is examined as well. This decision addresses the science of memory as it ...
The Bulletin of the American Academy of Psychiatry and the Law, 1979
Journal of Forensic Sciences, 1992
The Bulletin of the American Academy of Psychiatry and the Law, 1983
In 1974 the Connecticut statute on competence to stand trial was revised to allow the court the o... more In 1974 the Connecticut statute on competence to stand trial was revised to allow the court the option of having competence evaluated by a clinical team consisting ofa psychiatrist, a psychologist, and a psychiatric social worker, rather than by a psychiatrist alone. l This article traces the history of the Connecticut statute on competence to stand trial and describes the factors leading to the adoption of this interdisciplinary approach. Some advantages and disadvantages of the team approach are noted, and the reaction of the courts is discussed. The interdisciplinary model for competence evaluation is viewed as an efficient and viable alternative to evaluation by an individual psychiatrist and may be applicable to other types of forensic evaluations.
Behavioral Sciences & the Law, 1990
The American Journal on Addictions, 1999
The objective of this retrospective study was to determine if a jail diversion program reduced da... more The objective of this retrospective study was to determine if a jail diversion program reduced days of incarceration over the year following arrest in a sample of detainees with substance abuse disorders who had been arrested for a minor (misdemeanor) crime (n = 252) compared to a group (n = 95) who were not diverted. Particular attention was paid to comparing those singly diagnosed to those dually diagnosed. Analyses indicated that 1) detainees with substance abuse alone were less likely to be diverted than those with a dual diagnosis; 2) jail diversion reduced incarceration time during the next year; and 3) the effect of diversion differed depending upon the level of criminal charge. Diversion significantly reduced jail time only among those who were arrested for the more serious of the minor offenses that are associated with longer jail sentences.
PubMed, 2002
The insanity defense is a legal construct that excuses certain mentally ill defendants from legal... more The insanity defense is a legal construct that excuses certain mentally ill defendants from legal responsibility for criminal behavior. This practice guideline has delineated the forensic psychiatric evaluation of defendants raising the insanity defense. The document describes acceptable forensic psychiatric practices. Where possible, standards of practice and ethical guidelines have been specified. And where appropriate, the practice guideline has emphasized the importance of analyzing the individual case, the jurisdictional case law and the state (or federal) statute. This practice guideline is limited by the evolving case law, statutory language and legal literature. The authors have emphasized the statutory language of current legal standards, as well as the state or federal courts' interpretation of those standards because the same statutory language has been interpreted differently in different jurisdictions. Similarly, this practice guideline has reviewed the state and federal trends that determine which diagnoses meet the criteria for mental disease or defect. These trends yield to jurisdictional court interpretations. Finally, the authors hope this practice guideline has begun the dialogue about formulating a forensic psychiatric opinion by surveying the various approaches used to analyze case data. The forensic psychiatrist's opinion in each case requires an understanding of the current jurisdictional legal standard and its application, as well as a thorough analysis of the individual case. The psychiatrist's analysis and opinion should be clearly stated in the forensic psychiatric report. It should be noted that the role of a psychiatric expert witness in the criminal justice system is predicated on the law's interest in individualizing the criteria of mitigation and exculpation. Forensic psychiatric analyses and formulations of opinions are, therefore, subject to change as the legal guidance changes.
The journal of the American Academy of Psychiatry and the Law, 2017
Correctional systems, already struggling to meet the basic and functional requirements of older p... more Correctional systems, already struggling to meet the basic and functional requirements of older prisoners, will be further challenged by the increasing medical and psychiatric needs of this population. Mental health and general medical care for older adults requires specific on-site or consultation expertise in geriatric medicine and psychiatry, as well as potential changes in infrastructure, both of which may be prohibitively expensive. However, compassionate and effective treatment of older prisoners requires that prison and legal systems facilitate this expert care. To address this situation, strategic revisions of the criminal justice system are needed to alleviate prison overcrowding and consequent inadequate medical care for inmates, especially the elder ones. The unique, age-related demands of this older population predict an increased need for forensic psychiatrists with a thorough knowledge and expertise in geriatrics, as more forensic psychiatric evaluations will be needed...
The journal of the American Academy of Psychiatry and the Law, 2016
Receiving feedback on one's work from colleagues is an essential part of clinical and forensi... more Receiving feedback on one's work from colleagues is an essential part of clinical and forensic psychiatric practice. Often the material on which feedback is sought concerns past cases. When the material relates to current cases, particular safeguards are needed to protect important interests. This paper lists the interests that must be protected when feedback is provided through clinical consultation and supervision meetings in a forensic psychiatric training program. These are the interests of the person being evaluated, the attorneys, the people providing feedback to the evaluator, and the employers of the people providing feedback. The principles that the training program applies in determining attendance at, and participation in, these meetings are described. Finally, scenarios are presented that illustrate the application of these principles. Such application has allowed trainees and others to receive the benefits of consultation and supervision in the course of developing ...
Psychiatric services (Washington, D.C.), Dec 3, 2016
September 28, 2016, marked the 50th anniversary of the Connecticut Mental Health Center, a state-... more September 28, 2016, marked the 50th anniversary of the Connecticut Mental Health Center, a state-owned and state-operated joint venture between the state and Yale University built and sustained with federal, state, and university funds. Collaboration across these entities has produced a wide array of clinical, educational, and research initiatives, a few of which are described in this column. The missions of clinical care, research, and education remain the foundation for an organization that serves 5,000 individuals each year who are poor and who experience serious mental illnesses and substance use disorders.
The American Journal of Geriatric Psychiatry, 2016
Psychiatric Services, 2016
Journal of the American Academy of Psychiatry and the Law Online, Feb 1, 1999
Psychiatric Services, Oct 8, 2014
Yale Textbook of Public Psychiatry, 2016