Determining Mental Competence

July 01, 2009
By Dr. Edward Furukawa

Dr. Edward Furukawa
Psychiatrist

Interviewed By Melissa Moniz

How long have you been practicing?

I’d been in private practice full time since about 1963 until about 1992. I then went into part-time practice and have been spending most of my time with the courts in forensic psychology. We examine defendants who commit offenses and are considered to be mentally incompetent. So we need to examine them to determine whether they knew what they were doing or not.

What types of tests are done to determine a person’s sanity/mental competence at the time of a crime?

We don’t have any particular test. What we need to do is look at the history and evaluate their knowledge. The law requires that there has to be one psychiatrist and two psychologists to examine the defendant. The court locally appoints you, and therefore you have no vested interest in winning or losing the case. We’ll ask them about the offense and what they remember. Some of them don’t remember a thing, and some of them try to fake it.

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Is it difficult to determine whether someone is faking answers?

Not hard to do. Some of them think that being not competent means that when you ask them a question like, What is 100 minus 7? They’ll say something like 45. They think that insane people give an answer that is off. However, if you were really insane, then you would say something totally unrelated. Things like that. One time I asked a guy, ‘Who is the president of the United States?‘And he said, ‘Abraham Lincoln.’ That’s not insane.

For someone who has been diagnosed with a mental illness, how do you differentiate their sanity at the time of the crime and everyday behavior?

You can be mentally ill and commit a crime but still know what you are doing. If you know what you’re doing and the consequences, then you are responsible. If you say I was taking meth or I was drunk, then that doesn’t excuse you because you took those substances voluntarily. All it does is reduce the seriousness of the crime, but it doesn’t excuse you.

It seems quite common for defendants to claim insanity.

Yes, but that doesn’t prevail very often - less than 1 percent of the time. Insanity is not a psychiatric term, it’s a legal term. So, when someone claims insanity, it means that you’re not aware of what you are doing and you don’t know the consequences of your acts. In Hawaii, we go by two things: You need to be aware of what you’re doing and be able to control your behavior according to the requirements of the law.

What can bring someone to the point where they aren’t aware of what they’re doing, don’t know consequence and can’t control their behavior?

Sometimes they have voices telling them things. Or they’re paranoid because they think someone is out to destroy or hurt them. That kind of stuff.

But most of the time, even if you’re psychotic or schizophrenic or hallucinating, that doesn’t mean you’re going to commit a crime. In fact, mentally ill patients aren’t any more dangerous than ordinary people.

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Do you also work with the psychiatric hospitals?

Yes. Say someone is in the Kaneohe state hospital and they want to be discharged. Then we need to examine them to see if they’re fit to be discharged.

As far as treatments, what is available for those who are diagnosed with a mental illness?

Nowadays we have some pretty powerful drugs - anti-psychotic medications. Before 1953 we had none.

So in Kaneohe they used to have at least 3,000 patients and they were just locked up. The medications we have now are very effective. They will stop the hallucinating, hearing voices and so forth. But if you stop the medications, then it starts back up again.

You also are on REHAB’s medical executive committee. Can you talk about how long you’ve been serving and the changes that have happened through the years?

Since about 1980. I think the physical plant has increased and they’re much more active. The way it’s conducted is up to snuff. One of the guys who has also been there a long time is Gary Okamoto, who now serves as medical director.