Survival of the Sanest: Order and Disorder in a Pre-trial Psychiatric Clinic

In this study of pre-trial clinical assessment, Robert Menzies examines a key element in our system of criminal justice and finds is wanting. His book calls into question the entire process by which the state determines that defendants are or are not mentally fit to stand trial. The Metropolitan Toronto Forensic Service (METFORS) is a multi-disciplinary assessment agency which opened in 1978. During its first year of operation METFORS practitioners evaluated 592 defendants. Meznies has reconstructed medical and correctional records to trace the institutional careers of those men and women from their initial arrest, through their assessment of METFORS and the decision of the court, and finally through the two years following the initial assessment. What emerges is an illuminating analysis of the character and outcome of forensic psychiatric decision-making; the relationship between clinicians and other criminal justice officials such as police, prosecutors, and judges; the ability of medical experts to shape judicial judgements about accused persons; and the long-term implications of these assessments for the psychiatric and carceral experiences of forensic patients. Menzies presents a critical portrayal of pre-trial psychiatric assessment as an exercise in justifying, and even extending, the ambit of legal and therapeutic control over accused persons suspected of mental illness. He concludes that these remands can no longer be justified on medical, legal, or moral grounds.