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Forensic psychiatry is a sub-speciality of psychiatry and an auxiliar science of criminology. It encompasses the interface between law and psychiatry. A forensic psychiatrist provides services – such as determination of competency to stand trial – to a court of law to facilitate the adjudicative process.

Court work[link]

Forensic psychiatrists work with courts evaluating an individual's competency to stand trial, defences based on mental diseases or defects (e.g., the "insanity" defense), and sentencing recommendations. There are two major areas of criminal evaluations in forensic psychiatry. These are Competency to Stand trial (CST) and Mental State at the Time of the Offence (MSO).

Competency to stand trial (CST)[link]

This is the competency evaluation to determine that a defendant has the mental capacity to understand the charges and assist his attorney. This is seated in the Fifth Amendment to the US Constitution, which ensures the right to be present at your trial, to face your accusers, and to have help from an attorney.

In English and Welsh law a similar concept is that of "fitness to plead".

As an expert witness[link]

Forensic psychiatrists are often called to be expert witnesses in both criminal and civil proceedings. Expert witnesses give their opinion about a specific issue. Often the psychiatrist will have prepared a detailed report before testifying. The primary duty of the expert witness is to provide an independent opinion to the court. An expert is allowed to testify in court with respect to matters of opinion only when the matters in question are not ordinarily understandable to the finders of fact be they judge or jury. As such, prominent leaders in the field of forensic psychiatry, from Thomas Gutheil^[1] to Robert Simon and Lisa Gold^[2] and others^[3] have identified teaching as a critical dimension in the role of expert witness. The expert will be asked to form an opinion and to testify about that opinion, but in so doing will explain the basis for that opinion which will include important concepts, approaches and methods used in psychiatry.

Mental state opinion[link]

This gives the Court an opinion, and only an opinion, as to whether a defendant was able to understand what he was doing at the time of the crime. This is worded differently in many states, and has been rejected altogether in some, but in every setting, the intent to do a criminal act and the understanding that it was a criminal act bear on the final disposition of the case. Much of forensic psychiatry is guided by significant Court rulings or laws that bear on this area which include the following three standards^[4]:

• M'Naghten rules: Excuses a defendant who, by virtue of a defect of reason or disease of the mind, does not know the nature and quality of the act, or, if he does, does not know that the act is wrong.^[5]
• Durham rule: Excuses a defendant whose conduct is the product of mental disease or defect.^[6]
• ALI test: Excuses a defendant who, because of a mental disease or defect, lacks substantial capacity to appreciate the criminality (wrongfulness) of his conduct or to conform his conduct to the requirements of law.^[7]

"Not guilty by reason of insanity" (NGRI) is one potential outcome in this type of trial. It is important to note that insanity is a legal and not a medical term. Often there will be a psychiatrist(s) testifying for both the defense and the prosecution.

Forensic psychiatrists are also involved in the care of prisoners, both those in jails and those in prisons, and in the care of the mentally ill and dangerous (such as those who have been found not guilty by reason of insanity).

Risk management[link]

Many past offenders against other people, and suspected or potential future offenders with mental health problems or an intellectual or developmental disability, are supervised in the community by forensic psych teams containing a variety of professionals, including psychiatrists, psychologists, nurses and care workers. These teams have dual responsibilities, to promote both the welfare of their clients and the safety of the public. The aim is not so much to predict as to prevent violence, by means of risk management.

Risk assessment and management is a growth area in the forensic field, with much academic work being done in Ontario and British Columbia. This began with the attempt to predict the likelihood of a particular kind of offence being repeated, by combining "static" indicators from personal history and offence details in actuarial instruments such as the RRASOR and Static-99, which were shown to be more accurate than unaided professional judgment. More recently, use is being made also of "dynamic" risk factors, such as attitudes, impulsivity, mental state, family and social circumstances, substance use, availability and acceptance of support, to make a "structured professional judgment." The aim of this is to move away from prediction to prevention, by identifying and then managing risk factors. This may entail monitoring, treatment, rehabilitation, supervision and victim safety planning and depends on the availability of funding and legal powers. These schemes may be based on published assessments such as the HCR-20 (which incorporates 10 Historical, 5 Clinical and 5 Risk Management factors) and the RSVP (Risk of Sexual Violence Protocol) from Simon Fraser University, BC.

Britain[link]

In Britain most forensic psychiatrists work for the National Health Service, in specialist secure units caring for mentally ill offenders (as well as people whose behaviour has made them impossible to manage in other hospitals). These can be either medium secure units (of which there are many throughout the country) or high secure hospitals (also known as Special Hospitals), of which there are three in England and one in Scotland (The State Hospital, Carstairs), the best known of which being Broadmoor Hospital. The other 'specials' are Ashworth hospital in Maghull, Liverpool and Rampton hospital in Nottinghamshire. There are also a number of private sector medium secure units, which sell their beds exclusively to the NHS, as there are not enough secure beds available in the NHS system. (There are no 'private' paying patients in Forensic Psychiatry!)^{[citation needed]}

Forensic psychiatrists often also do prison inreach work, in which they go into prisons and assess and treat people suspected of having mental disorders; much of the day to day work of these psychiatrists comprises care of very seriously mentally ill patients, especially those suffering from schizophrenia. Some units also treat people with severe personality disorder, learning disabilities. The areas of assessment for courts are also somewhat different in Britain, because of differing mental health law. Fitness to plead, and mental state at the time of the offence are indeed issues given consideration, but the mental state at the time of trial is also a major issue, and it is this assessment which most commonly leads to the use of mental health legislation to detain people in hospital, as opposed to their getting a prison sentence.^{[citation needed]}

Learning disabled offenders who are a continuing risk to others may be detained in learning disability hospitals (or specialised community-based units with a similar regime, as the hospitals have mostly been closed) as suffering from "Mental Impairment" in England and Wales, and without use of that term in Scotland. This includes those who commit serious crimes of violence, including sexual violence, and fire-setting. They would be cared for by learning disability psychiatrists and registered learning disability nurses (RNLD). Some psychiatrists doing this work have dual training in learning disability and forensic psychiatry or learning disability and adolescent psychiatry. Some nurses would have training in mental health also (RMN and RNLD).^{[citation needed]}

Many past offenders against other people, and suspected or potential future offenders with mental health problems or a learning disability, are supervised in the community by forensic teams containing a variety of professionals, including psychiatrists, psychologists, nurses and care workers. These teams have dual responsibilities, to promote both the welfare of their clients and the safety of the public. The aim is not so much to predict as to prevent violence, by means of risk management.^{[citation needed]}

Court work (medico-legal work) is generally undertaken as private work by psychiatrists (most often forensic psychiatrists) as well as forensic and clinical psychologists, who usually also work within the National Health Service (NHS). This work is generally funded by the Legal Services Commission (used to be called Legal Aid).^{[citation needed]}

Canada[link]

In Canada certain credentialed medical practitioners may, and apparently at their sole discretion, make state-sanctioned investigations into and diagnosis of "mental illness". These diagnoses appear to be based at least in part, and in some cases entirely upon, the investigator's expressed perception of the validity of the subject's thoughts and beliefs. This aspect of diagnosis is manifest in the Diagnostic and Statistical Manual of Mental Disorders IV Text Revision (DSM-IV-TR) glossary definition of "delusion" which begins; "A false belief based on...", and is found on page 821 of the DSM-IV-TR and, similarly, elsewhere. Significantly the presence of "delusions" seem to form a primary criterion for the diagnosis of the majority of DSM-IV-TR "psychotic" disorders including Schizophrenia and Schizoaffective Disorder (Criterion A1 in the case of Schizophrenia). The DSM-IV-TR also states that "No laboratory findings have been identified that are diagnostic of Schizophrenia". This statement is also applied to Major Depressive episodes and Manic episodes.

The application of DSM-IV-TR criteria to the various pieces of criminal as well as federal health and provincial mental health law in Canada seems still to occur in spite of their conflict in this respect with Section 2(b) of the Canadian Charter of Rights and Freedoms, [1] which guarantees the "fundamental" "freedom of thought, belief, opinion and expression". Part VII -- General, of the Canadian Constitution Act, 1982 states that "any law that is inconsistent with the provisions of the Constitution "...(which contains the Charter of Rights and Freedoms)..."is, to the extent of the inconsistency, of no force or effect".

The potential for state sanctioned involuntary detainment and treatment exists pursuant to the Criminal Code of Canada, [2] and these health acts. The Ontario Mental Health Act, [3] for example contains references to circumstances under which involuntary admission to psychiatric facilities can occur.

However, legal involvement and involuntary detainment and treatment is not fundamental to the DSM-IV-TR nor, again according to the DSM-IV-TR, are implications of violent behavior at frequencies exceeding that of the general population attributed to those diagnosed. To a significant degree courts are in fact cautioned against the use of DSM-IV-TR diagnosis in the DSM-IV-TR introduction itself in its section entitled Use of DSM-IV-TR in Forensic Settings.

In the Canadian criminal justice system, again, in spite of the Charter Freedoms, individuals continue to be subjected to discrimination based on DSM IV diagnosis within the context of part XX.1 of the Criminal Code of Canada, [4]. This part sets out provisions for, among other things, court ordered attempts at "treatment" before individuals receive a trial as described in section 672.58 of the Criminal Code. Also provided for are court ordered "psychiatric assessments".

Confidentiality
The position of the Canadian Psychiatric Association [5] itself, stated in The Confidentiality of Psychiatric Records and the Patient's Right to Privacy(2000-21S), and [6] holds that "in recent years, serious incursions have been made by governments, powerful commercial interests, law enforcement agencies, and the courts on the rights of persons to their privacy." It goes on to state that "breaches or potential breaches of confidentiality in the context of therapy seriously jeopardize the quality of the information communicated between patient and psychiatrist and also compromise the mutual trust and confidence necessary for effective therapy to occur."

An outline of the Forensic Psychiatric process as it occurs in the Canadian Province of Ontario is attempted in the publication The Forensic Mental Health System In Ontario published by the Centre for Addiction and Mental Health, [7] in Toronto. The Guide states; "Whatever you tell a forensic psychiatrist and the other professionals assessing you is not confidential". The Guide further states; "The forensic psychiatrist will report to the court using any available information, such as: police and hospital records, information given by your friends, family or co-workers, observations of you in the hospital"[8]. Also according to The Guide;"You have the right to refuse to take part in some or all of the assessment. Sometimes your friends or family members will be asked for information about you. They have the right to refuse to answer questions too."[9].

It is noteworthy that the emphasis in The Guide is on the right to refuse participation. The adversarial tone of The Guide may seem unusual given that a result of Not Criminally Responsible by reason of Mental Disorder (NCR) verdict is often portrayed as desirable to the defense. The Insanity defense is the language used to describe the equivalent process in the United States. The language here in Canada can be confusing. In the popular sense NCR is a "defense" (for example in this page from The Supreme Court of Canada website which refers to "mental illness defense" [10]). The Criminal Code of Canada describes "defense of mental disorder" in Part I General section 16. However it is a "defense" which can be imposed by the court or the crown, not one that is sought only through application by a defendant or "the defense" in the usual sense. This process is also described in section 672.12 of The Code. Essentially, the Crown (an adversarial entity in Canadian law) or the Court itself (a neutral entity) can make an application to "defend" the "defendant" against the wishes of "the defense".

Also noteworthy is that an accused placed in a hospital setting is there presumably due to a perception at some level that there are reasonable grounds to believe that that person is ill in the first place. It is difficult to imagine then that they or those around them would not need, or at very least feel a need, to divulge information to that hospital in order to secure appropriate treatment. Indeed information about allergies, medications, past diagnosis etc. may be fundamental to the safety of any stay in custody whether there is an actual "need" for hospitalization proper, or not.

This raises the reasonable possibility that if the information in the guide is correct, and that "any information" can be used for the purpose of reporting to the court, that a dynamic of torture is set up whereby the court is apprised of information gathered from accused persons, their families, and their doctors under the premise of its necessity for the purpose of ethical medical treatment.

Treatment/Assessment Conflict
In Ontario a court ordered inpatient forensic assessment for criminal responsibility will typically involve both treatment and assessment being performed with the accused in the custody of a single multi-disciplinary team over a thirty or sixty day period.^{[citation needed]} An accused may, as may any of the other potential sources mentioned, feel compelled on ethical, medical or legal grounds to divulge information, medical or otherwise, to "assessors" in an attempt to allow for and ensure safe and appropriate "treatment" during that period of custody. This to their own benefit and to that of other "patients" and the facility staff themselves. An accused placed in the custody of a forensic psychiatric practitioner or entity imbued with the dual, and conflicting, responsibilities of caregiver and assessor may be compromised for that reason. Involved parties may also be moved to provide information as a result of concern over how victims, the families on both sides, they themselves, or indeed "society" may be affected by perceived possible outcomes.

The author is at a loss to find an instance of reference to the occurrence of this dual assessment/treatment paradigm in an inpatient criminal setting without citing case law apparently covered by publication ban. The omission of statements ruling out the dynamic of assessment/treatment conflict in The Forensic Mental Health System in Ontario an Information Guide and in descriptions of various Forensic inpatient assessment units in Ontario; Whitby [11], CAMH [12], Royal Ottawa [13], Thunder Bay [14] is perhaps telling enough.

There are however abundant internet references to treatment/assessment conflict as it relates to various justice systems, particularly civil litigation in other jurisdictions including [15], [16], [17].

The American Academy Of Psychiatry and the Law does state in its ethics guidelines [18] that "when a treatment relationship exists, such as in correctional settings, the usual physician-patient duties apply." It is however not clear whether this statement refers to evaluation in a correctional setting or treatment of those living in a correctional setting independent of the involvement of the court system. Arguably the practice of psychiatry involving incarcerated persons independent of the court's interest is by definition not truly forensic psychiatry, but simply psychiatry, though it may be offered by a practitioner with forensic qualifications who happens to practice in a correctional institution.

The dynamic of assessment/treatment conflict, particularly in a court mandated inpatient setting, arguably constitutes "torture". The dangers reasonably perceived and associated with modern psychiatric treatment, and the potential dangers of non-treatment or mistreatment as a result of the lawful omission of information pertaining to an accused by the accused or by interested third parties cause an ethical dilemma. It is akin to placing a person with any dangerous illness or disease into custody, isolating them from outside treatment, and telling them, their families, their doctors, and anyone else with pertinent information, that if they give that information, which they may reasonably feel is vital to management of that disease, that that information can and will be used to produce a case against that person in a court of law.

Notably the experience of torture applies not only to an accused but potentially to third parties such as witnesses, families, friends, associates, doctors, caregivers, police, and even victims. Any party from which information relating to the accused or alleged crime may be collected is vulnerable to the dynamic. The process thus appears to allow these parties to suffer torture as described in section 269.1(1)(a)(i) of the Criminal Code of Canada which states "torture" means any act or omission by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person (a) for a purpose including (i) obtaining from the person or from a third person information or a statement. The United Nations Convention Against Torture [19] provides a similar set of criteria. The condition of being tortured set out in these texts seems also to extend to members of the forensic mental health and Justice community itself faced with the conflicting demands of ethical medical care and the precedent of court mandated assessment in an environment that does not separate these two roles.

Outcomes
With a finding of "Not Criminally Responsible on Account of Mental Disorder" as described in section 672.34 of the Criminal Code lifelong restrictions on freedom, mandatory "treatment", and indefinite detention subject to periodic non-judicial review appear possible well beyond the scope of set limits for detention of those found to be criminally responsible for the same or even much more serious offenses. Section 672.12 of the Criminal Code states "The court may make an assessment order at any stage of proceedings against the accused of its own motion, on application of the accused or, subject to subsections (2)and (3), on application of the prosecutor" implying that the test is not universally applied.

Training Standards[link]

Some practitioners of forensic psychiatry have taken extra training in that specific area. In the United States, one year fellowships are offered in this field to psychiatrists who have completed their general psychiatry training. Such psychiatrists may then be eligible to sit for a board certification examination in forensic psychiatry. In Britain one is required to complete a three-year sub-speciality training in forensic psychiatry, after completing one's general psychiatry training, before receiving a Certificate of Completion of Training as a forensic psychiatrist. In some countries general psychiatrists can practice forensic psychiatry as well. However, other countries, such as Japan, require a specific certification from the government to do this type of work.

See also[link]

• Daubert v. Merrell Dow Pharmaceuticals which established the Daubert standard delimiting the admissibility of scientific expert witness testimony
• Rennie v. Klein - right to refuse treatment
• Kansas v. Hendricks - involuntary civil commitment for sexual predators
• Settled insanity
• Ultimate issue
• Twinkie defense
• Bruneri-Canella case, an early landmark case which introduced new forensic techniques in juridic debate

References[link]

External links[link]

• Studies in Forensic Psychiatry, by Bernard Glueck, 1916, reprinted 1969, from Project Gutenberg
• The Role of a Forensic Psychiatrist in Legal Proceedings, by Harold J. Bursztajn, MD, 1993, from Journal of the Massachusetts Academy of Trial Attorneys with permission of Harold J. Bursztajn, MD.

Andrea Yates (born Andrea Pia Kennedy on July 2, 1964) is a former Houston, Texas resident who killed her five children on June 20, 2001 by drowning them in the bathtub in her house.^[1] She had been suffering for some time with very severe postpartum depression and postpartum psychosis. Her case placed the M'Naghten Rules, a legal test for sanity, under close public scrutiny in the United States.^[2] Yates's 2002 conviction of capital murder and sentence to life in prison with the possibility of parole after 40 years was later overturned on appeal. ^[3]

On July 26, 2006, a Texas jury found that Yates was not guilty by reason of insanity. She was consequently committed by the court to the North Texas State Hospital, Vernon Campus,^[4] a high-security mental health facility in Vernon, Texas, where she received medical treatment and was a roommate of Dena Schlosser, another woman who committed filicide by killing her infant daughter. In January 2007, Yates was moved to a low security state mental hospital in Kerrville, Texas.^[5]

Overview[link]

Andrea Yates was born in Houston, Texas. She is the youngest of five children to Jutta Karin Koehler, a German immigrant, and Andrew Emmett Kennedy, whose parents were born in Ireland. Yates was raised in a Catholic household.

She graduated from Milby High School, in Houston, Texas, in 1982. She was the class valedictorian, captain of the swim team, and an officer in the National Honor Society.^[6] Yates completed a two-year pre-nursing program at the University of Houston and graduated from the University of Texas School of Nursing. From 1986 until 1994, she worked as a registered nurse at the University of Texas M.D. Anderson Cancer Center. In the summer of 1989, she met Russell "Rusty" Yates at the Sunscape Apartments in Houston, Texas, two months her junior. They soon moved in together and were married on April 17, 1993,^[7] and they announced that they "would seek to have as many babies as nature allowed". Afterwards, they bought a four-bedroom house in the town of Friendswood. In February 1994, the couple's first child, a son named Noah, was born. Shortly thereafter, Rusty accepted a job offer in Florida, so the family relocated to a small trailer in Seminole. By the birth of their third son, Paul, they settled back to Houston and purchased a GMC motor home.^[7]

Following the birth of Luke, their fourth son, Andrea became depressed. The media alleged that her condition was brought on by the extremist sermons of Michael Peter Woroniecki, the preacher who sold them their bus. Her family was concerned by the way that she was so captivated by the minister’s words.^[7]

On June 16, 1999, Rusty found Andrea shaking and chewing her fingers. The next day, she attempted to commit suicide by overdosing on pills. She was admitted to the hospital, and prescribed antidepressants. Soon after her release, she begged her husband to let her die as she held a knife up to her neck. Once again hospitalized, she was given a mixture of medications including Haldol, an anti-psychotic drug. Her condition improved immediately, and she was prescribed it on her release. After that, Rusty moved the family into a small house for the sake of her health. Andrea appeared temporarily to stabilise.^[7] In July 1999, she succumbed to a nervous breakdown, which culminated in two suicide attempts and two psychiatric hospitalizations that summer. She was diagnosed with postpartum psychosis.^[8]

Her first psychiatrist, Dr. Eileen Starbranch, testified that she urged the couple not to have more children, as it would "guarantee future psychotic depression". They conceived their fifth and final child approximately 7 weeks after her discharge.^[9] She stopped taking the Haldol in March 2000 and gave birth to daughter Mary on November 30 of that year. She seemed to be coping well until the death of her father on March 12, 2001.^[10]

She then stopped taking medication, mutilated herself, and read the Bible feverishly. She also stopped feeding her youngest child, Mary.^[7] Yates became so incapacitated that she required immediate hospitalization. On April 1, 2001 she came under the care of Dr. Mohammed Saeed. She was treated and released. On May 3, 2001, she degenerated back into a "near catatonic" state and drew a bath in the middle of the day; she would later confess to police that she had planned to drown the children that day, but had decided against doing it then. She was hospitalized the next day after a scheduled doctor visit; her psychiatrist determined she was probably suicidal and had filled the tub to drown herself.^[11][10]

Yates continued under Dr. Saeed's care until June 20, 2001, when Rusty left for work, leaving her alone to watch the children against Dr. Saeed's instructions to supervise her around the clock.^[12] Rusty's mother, Dora Yates, had been scheduled by him to arrive an hour later to take over for her. In the space of that hour, she drowned all five children.^[13] She started with the youngest boys, and after drowning them in her bathtub, laid them in her bed. She then drowned Mary, whom she left floating in the tub. Her oldest son, Noah, came in and asked what was wrong with Mary. He then ran, but she soon caught up with him and drowned him. She then left him floating in the tub and laid Mary in her brothers' arms. Afterwards, she called the police. Then she called Rusty, saying only “It’s time” repeatedly. ^[7]

Trials[link]

Yates confessed to drowning her children. She told Dr. Michael Welner that she waited for Rusty to leave for work that morning before filling the bathtub because she knew he would have prevented her from harming the children.^[14] After the killings, police found the family dog locked up; Rusty advised Welner that it had normally been allowed to run free, and was so when he had left the house that morning, leading the psychiatrist to conclude that she locked it in a cage to prevent it from interfering with her killing the children one by one.

Although the defense's expert testimony agreed that Yates was psychotic, Texas law requires that, in order to successfully assert the insanity defense, the defendant must prove that he or she could not discern right from wrong at the time of the crime. In March 2002, a jury rejected the insanity defense and found her guilty. Although the prosecution had sought the death penalty, the jury refused that option. The trial court sentenced her to life imprisonment in the Texas Department of Criminal Justice with eligibility for parole in 40 years.^[15]

On January 6, 2005, a Texas Court of Appeals reversed the convictions, because California psychiatrist and prosecution witness Dr. Park Dietz admitted he had given materially false testimony during the trial. Dietz stated that shortly before the killings, an episode of Law & Order had aired featuring a woman who drowned her children and was acquitted of murder by reason of insanity. Author Suzanne O'Malley, who was covering the trial for Oprah magazine and had previously been a writer for Law & Order, immediately reported that no such episode existed;^[16][17] the appellate court held that the jury may have been influenced by his false testimony and that thus a new trial would be necessary.

On January 9, 2006, Yates again entered pleas of not guilty by reason of insanity. On February 1, 2006, she was granted release on bail on the condition that she be admitted to a mental health treatment facility.^[18]

On July 26, 2006, after three days of deliberations, Yates was found not guilty by reason of insanity, as defined by the state of Texas. She was thereafter committed to the North Texas State Hospital - Vernon Campus.^[19] In January 2007, Yates was moved to a low security state mental hospital in Kerrville, Texas.^[5] Although psychiatrists for both the Texas State prosecutors and Yates' defense lawyers agreed that she was severely mentally ill with one of several psychotic diseases at the time she killed her children,^[20] the state of Texas asserted that she was by legal definition aware enough to judge her actions as right or wrong despite her mental defect. The prosecution further implied spousal-revenge as motive for the killings, despite the conclusion of defense experts that there was no evidence to support such a motive.^[21] Although the original jury believed she was legally aware of her actions, they disagreed that her motive was spousal-revenge.^[22] The jury in 2006 completely disagreed with the prosecution's assertions and her earlier conviction from 2002 was overturned.

Andrea was bulimic during her teenage years. She also suffered from depression and, at the age of seventeen, spoke to a friend about suicide.^[23]

While in prison, Andrea stated she had considered killing the children for two years, adding that they thought she was not a good mother and claimed her sons were developing improperly. She told her jail psychiatrist: "It was the seventh deadly sin. My children weren't righteous. They stumbled because I was evil. The way I was raising them, they could never be saved. They were doomed to perish in the fires of hell."^[24] She also told her jail psychiatrist that Satan influenced her children and made them more disobedient.^[25]

Russell Yates[link]

According to trial testimony in 2006, Dr. Saeed advised Rusty, a former NASA engineer, not to leave his patient unattended. However, he began leaving her alone with the children in the weeks leading up to the drownings for short periods of time hoping to improve her independence.^[12] He had announced at a family gathering the weekend before the drownings that he had decided to leave her home alone for an hour each morning and evening, so that she would not become totally dependent on him and his mother for her maternal responsibilities.^[26] Her brother, Brian Kennedy, told Larry King on a broadcast of CNN's Larry King Live that Rusty expressed to him in 2001 while transporting her to Devereux treatment facility that all depressed people needed was a "swift kick in the pants" to get them motivated.^[27] Her mother, Jutta Karin Kennedy, expressed shock when she heard of Rusty's plan while at the gathering with them, saying that she wasn't stable enough to care for the children. She noted that her daughter demonstrated she wasn't in her right mind when she nearly choked her still-toothless infant daughter Mary by trying to feed her solid food.^[28] According to authors Suzy Spencer and Suzanne O'Malley, who investigated her story in great detail, it was during a phone call Dr. Saeed made to Rusty during the breaking news of the killings that he first learned that she was not being supervised full time.^[29]

Andrea's first psychiatrist, Dr. Eileen Starbranch, says she was shocked to disbelief when the Yateses expressed a desire to discontinue her medications so that she could become pregnant again during an office visit with them. She warned and counseled them against having more children, and noted in the medical record two days later, '"Apparently patient and husband plan to have as many babies as nature will allow! This will surely guarantee future psychotic depression."'^[30] Nevertheless, she became pregnant with her fifth child, Mary, only 7 weeks after being discharged from Dr. Starbranch's care on January 12, 2000.^[31] Despite Rusty's statements to the media that he was never told by psychiatrists that she was psychotic nor that she could harm her children, and that he would have never had more children had he known otherwise,^[32][33][34] She revealed to her jail psychiatrist, Dr. Melissa Ferguson, that prior to their last child, "she had told Rusty that she did not want to have sex because Dr. Starbranch had said she might hurt her children." Rusty, she said, simply asserted his procreative religious beliefs, complimented her as a good mother, and persuaded her that she could handle more children.^[35]

Author Suzanne O'Malley highlighted Russell Yates's continuing sense of unreality regarding having more children:

"During the trial, he'd successfully maintained the position that Andrea would be found innocent. He had fantasies of having more children with her after she was successfully treated in a mental health facility and released on the proper medication. He worked his way through various fixes for their damaged lives, such as a surrogate motherhood and adoption (horrifying Andrea's family, attorneys and Houston psychiatrists) before giving in to reality."^[36]

Medical community[link]

Rusty Yates contended that as a psychiatrist, Dr. Saeed was responsible for recognizing and properly treating his wife's psychosis, not a medically untrained person like himself.^[37] He also claimed that, despite his urgings to check her medical records for prior treatment, Dr. Saeed had refused to continue her regimen of the antipsychotic Haldol, the treatment that had worked for her during her first breakdown in 1999.^[38] He added that she was too sick to be released from her last stay in the hospital in May, 2001. He said he noticed the staff lower their heads as if in shame and embarrassment, turning away without saying a word. The hospital had no other choice due to the ten day psychiatric hospitalization insurance constraints of their provider, Blue Cross-Blue Shield, subcontracted by Magellan Health Services.^[39][40]

Anti-depressants and homicidal ideation[link]

Rusty and her birth family came to believe that a combination of antidepressants improperly prescribed by Dr. Saeed in the days before the tragedy was responsible for Andrea's violent, psychotic behavior.^[41][42] According to Dr. Moira Dolan, executive director of the Medical Accountability Network, "homicidal ideation" was added to the warning label of the antidepressant drug Effexor as a rare adverse event, in 2005. Yates, she said, had been taking 450 mg, twice the recommended maximum dose, for a month before killing her children. Dr. Dolan reviewed Yates's medical record at the request of Rusty.^[43]

Dr. Lucy Puyear, an expert witness hired by Yates's defense team, countered their contention regarding the administration of her antidepressants, saying the dosages prescribed by Dr. Saeed are not uncommon in practice and had nothing at all to do with her reemergent psychosis. She suggested rather that her psychosis returned as a result of the Haldol having been discontinued by her doctor two weeks earlier.^[41] The oral form of haloperidol (Haldol) takes 4–6 days after discontinuation to reach a terminal plasma level of under 1.5%—a medical standard for "complete" elimination of a drug from the body.^[44]

Religious influences[link]

Media outlets alleged that Michael Peter Woroniecki, a traveling preacher whom Rusty had met while attending Auburn University, bears some responsibility for the deaths due to his “fire and brimstone” message and certain teachings found in his newsletter “The Perilous Times” that they had received on occasion and which was entered into evidence at the trial.^{[45][46][47][48][49][50][51]} However, both Rusty and Michael Woroniecki reject these accusations.^[52][53][54] Rusty said that his family’s relationship with the Woronieckis was not that close and that Woroniecki did not cause her delusions.^[53][55] Woroniecki maintained that his correspondence with them was with the intention of helping them strengthen their marriage and find the love that he says his own family had found in Jesus.^{[45][54][54][56][57][58]} Both men agreed that the alleged connection between his message and her mental state was “nothing more than media created fiction”.^[53] The adherence of the Yates family to the principles of the Quiverfull lifestyle, which encourages couples to have many children, has been posited as a factor contributing to the mental and emotional stress that she experienced. Some sources have suggested the lack of community may have contributed to her isolation.^[59]

In Popular Culture[link]

• The ABC-TV show Desperate Housewives was partly inspired by the Yates drownings, according to creator Marc Cherry.^[60]
• The Law & Order: Criminal Intent episode "Magnificat" was based on the Yates case.
• The 2008 film Baby Blues (AKA Cradle may Fall in U.K.) is based on the killings,^{[citation needed]} although the story is largely changed from the true events.
• On his song "World Gone Crazy", rapper Aaron Yates (AKA "Tech N9ne") references his last name being the same, and also references a woman drowning her babies in the lyrics: "Sick mothers drowning they babies" & "Why I got the same last name as Andrea?"
• A song by the band Trivium, entitled "Entrance of the Conflagration", deals with the drownings, and is mostly based on Andrea Yates' testimony.
• The TV documentary series, American Justice, has an episode about the case.
• In 2009, the Andrea Yates incident and its aftermath was adapted by playwright Douglas M. Parker into the play Thicker Than Water.
• The TV show "Deadly Women" did a segment on Andrea Yates.

Footnotes[link]

References[link]

• Bienstock, Sheri L. Mothers Who Kill Their Children and Postpartum Psychosis, (2003) Vol. 32, No. 3 Southwestern University Law Review, 451.
• Keram, The Insanity Defense and Game Theory: Reflections on Texas v.Yates, (2002) Vol. 30, No. 4 Journal of the American Academy of Psychiatry and the Law, 470.
• O'Malley, Suzanne, "Are You There Alone?:" The Unspeakable Crime of Andrea Yates ISBN 0-7434-6629-2, See also author website
• Spencer, Breaking Point ISBN 0-312-93871-3, See also author website
• Vatz,R.E. “Will Justice Be Served on Andrea Yates?” (March, 2005) USA Today magazine

External links[link]

	Biography portal
	Houston portal

• Father's website for the family
• Father's Blog (formerly a fact gathering database concerning the incident)
• Are You There Alone? website for Edgar-nominated book and blog on the Yates case
• Timeline of Andrea Yates' Life and Trial (Archive)
• Who is Andrea Yates? A Short Story of Insanity, Deborah Denno
• CrimeLibrary review
• About.com profile
• Despite 'Not Guilty' Verdict, Doctor Who Examined Yates Is Unconvinced." ABC News.
• PowerPoint evidence presented by Dr. Michael Welner during trial.

David Powell (December 17, 1883 in Glasgow, Scotland - April 16, 1925 in New York City, New York) was a Scottish born stage and later film actor of the silent era. In his twenties Powell appeared in stage companies of Sir Herbert Beerbohm Tree, Ellen Terry and Johnston Forbes-Robertson. In 1907 he appeared with Terry on Broadway in the first American presentation of Shaw's Captain Brassbound's Conversion. He later appeared with Forbes-Robertson in the United States and decided to stay in that country.

In 1912 Powell started his film career in one to three reel shorts. Possessed of dark good looks and shiny dark eyes, he was often cast opposite or in support of well-known star actresses of the time. Many of these actresses include Mary Pickford, Clara Kimball Young, Billie Burke, Hazel Dawn, Ann Murdock, Alice Brady, Edna Goodrich, Elsie Ferguson, Mae Murray, Mary Glynne and Ann Forrest amongst others. At the beginning of the 1920s he starred in several Paramount produced English films. Alfred Hitchcock was the title card writer for several of these films. As with other silent screen performers Powell has a lot of his filmography missing. Extant films that feature Powell are The Dawn of A Tomorrow (1916), Less Than Dust (1916), Idols of Clay (1920), The Virtuous Liar (1924), The Green Goddess (1923 version), The Average Woman (1924). Several of these however are in film vaults and foreign archives.

Powell died of pneumonia in April 1925 at the age of 42. He has a star on the Hollywood Walk of Fame.

Powell is not related to William Powell, of The Thin Man fame even though the two actors appeared in one silent film together Outcast (1922). In February 1925 William Powell's son, William David Powell was born. It's not known if the boy's middle name, David, was in honour of actor David Powell who died two months later.

Selected filmography[link]

• The Dawn of a Tomorrow (1915)
• Gloria's Romance (1916)
• The Beautiful Adventure (1917)
• The Lie (1918)
• Counterfeit (1919)
• On with the Dance (1920)
• Right to Love (1920)
• Lady Rose's Daughter (1920)
• Idols of Clay (1920)
• Appearances (1921)
• The Mystery Road (1921)
• The Princess of New York (1921)
• Dangerous Lies (1921)
• Her Gilded Cage (1922)
• Love's Boomerang (1922)
• The Spanish Jade (1922)
• Outcast (1922)
• The Green Goddess (1923)
• Virtuous Liars (1924) (*Extant;Library of Congress)

External links[link]

• David Powell at the Internet Movie Database
• David Powell at IBDb.com
• Blue Book interview with David Powell
• On David Powell's mustache
• David Powell portrait
• still of a scene from Lady Rose's Daughter(1920) with Powell and Elsie Ferguson
• Powell with Billie Burke; in Gloria's Romance

Persondata
Name	Powell, David
Alternative names
Short description	Actor
Date of birth	December 17, 1883
Place of birth	Glasgow  Scotland
Date of death	April 16, 1925
Place of death	New York City, New York  United States

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