Disclaimer: The views and opinions expressed in the articles contained in the Academy News are those of the identified authors and do not necessarily reflect the official policy or position of the Academy.
Source: Betty Layne DesPortes, JD, MS, AAFS President
Article by: William C. Darby, MD, and Christopher R. Thompson, MD
The United States Supreme Court ruled 5-4 in its 2017 McWilliams v. Dunn decision that Alabama failed to provide the adequate expert mental health assistance guaranteed by the Constitution as discussed in the 1985 case, Ake v. Oklahoma, 470 U.S. 68.
In Ake, the Court held that states must offer “access to a competent psychiatrist who will conduct an appropriate examination and assist in evaluation, preparation, and presentation of the defense” in certain situations. For the Ake standard to be applied, the criminal defendant must be: (1) indigent; and, (2) have a mental condition that is relevant to criminal culpability and to punishment or calls into question the defendant’s sanity at the time of the offense. This decision created ambiguity, however, about what is necessary to satisfy the “adequate mental health assistance” standard and, specifically, whether the expert must be neutral or, rather, a member of the defense team.
The petitioner, James McWilliams, Jr., was convicted of the rape and murder of a convenience store clerk. The prosecution sought a death sentence, which required both a jury recommendation and a later affirmation by the judge. The prosecution presented aggravating factors, reintroducing evidence from the guilt phase and emphasizing the defendant’s history of prior felony convictions. The prosecution also called two psychiatrists who testified that the defendant was not psychotic and had exaggerated or faked psychiatric symptoms during their court-ordered, pre-trial evaluation of McWilliams’ sanity.
The defense called McWilliams and his mother, who testified that he suffered multiple serious head traumas as a child and had a history of subsequent psychological problems. Although the defense subpoenaed additional mental health records from the state prison where McWilliams was being held, the records did not arrive in time for the hearing, and the jury recommended the death sentence with the minimum number of affirmative votes required to do so.
At the suggestion of a psychologist who “volunteered” to help counsel “in her spare time,” McWilliams’ defense team filed a motion to authorize neurological and neuropsychological testing to address potential mitigating circumstances regarding McWilliams’ reported history of head trauma and related psychiatric problems. Subsequently, a neuropsychologist, John Goff, PhD, filed his report two days prior to the judicial sentencing hearing. In his report, he diagnosed McWilliams with an “organic personality syndrome” with symptoms of “low frustration tolerance and impulsivity” that were “suggestive of a right hemisphere lesion” and “compatible with the injuries [McWilliams] sa[id] he sustained as a child.” Although Dr. Goff noted that McWilliams was “obviously attempting to appear emotionally disturbed” and “exaggerating his neuropsychological problems,” he also had “genuine neuropsychological problems.”
On the morning of the sentencing hearing, the defense finally received the prison medical records (which had been subpoenaed months prior). These records revealed that McWilliams was taking multiple psychotropic medications, including an antipsychotic medication. With the new mental health data, defense counsel requested a continuance of the sentencing hearing because the attorney was “not a psychologist or a psychiatrist,” and needed “to have someone else review these findings” and offer “a second opinion as to the severity of the organic problems discovered.” The trial judge denied multiple motions for a continuance, as well as a motion to withdraw, and sentenced the defendant to death on the basis of three aggravating circumstances and no mitigating circumstances. The judge further contended that he personally reviewed the records and found evidence of McWilliams faking symptoms, which negated any mitigating circumstances related to a mental health condition.
In the majority opinion delivered by Justice Stephen Breyer, the Supreme Court held that: (1) McWilliams met the necessary criteria to trigger the application of the Ake standard; (2) Alabama was not exempt from their responsibility to provide adequate mental health assistance because the defense had the temporary assistance of a psychologist who “volunteered” but was not available to assist during the judicial sentencing trial; and, (3) citing multiple attempts by counsel for a continuance refuted Alabama’s claim that McWilliams “never asked for more expert assistance” than he received, “even though the trial court gave him the opportunity to do so.” The Opinion of the Court underscored the attempts made by the defense to request a mental health expert that were rebuffed at the judicial sentencing hearing.
In the majority opinion, Justice Breyer determined that Ake requires that a defendant receive the assistance of a mental health expert who is sufficiently available to the defense and independent from the prosecution to effectively “conduct an appropriate  examination and assist in  evaluation,  preparation, and  presentation of the defense.” The majority opinion concluded that even if Alabama met the first prong “examination” component, it did not satisfy the other three prongs. That is, no mental health expert was made available to help the defense evaluate and interpret Dr. Goff’s report or McWilliams’ medical records and incorporate them into a meaningful, coherent legal strategy. For example, Justice Breyer emphasized that an independent expert could have “explained that McWilliams’ purported malingering was not necessarily inconsistent with mental illness,” thus countering the trial judge’s misguided interpretation that an individual’s faking or exaggerating psychiatric symptoms connotes the absence of legitimate mental illness, which subsequently would nullify any mitigating circumstances related to a mental health condition. Therefore, the majority opinion concluded that Alabama’s provision of mental health assistance was so drastically deficient as to be “contrary to, or involved an unreasonable application of, clearly established Federal law.”
The dissenting opinion, delivered by Justice Alito, focused primarily on the narrow legal question of whether Ake established the requirement that a defendant have access to a mental health expert who is a member of the defense team, as opposed to a neutral expert equally available to both the prosecution and defense. Justice Alito argued that Ake was purposely ambiguous about this point.
The dissenting opinion did not address a point emphasized by Justice Breyer in the majority opinion: that the presence of malingered or feigned symptoms does not negate the presence of legitimate mental illness – a fact that could have been presented by McWilliams’ defense if allowed adequate expert assistance (neutral or otherwise) as established in Ake. As the majority concluded, the trial judge cannot predict the future and is not be in a position to know whether relevant psychiatric expert testimony would alter the balance of aggravating versus mitigating circumstances without first hearing that testimony.
Although the majority did not rule on the broader constitutional question of whether Ake meant that indigent defendants have the right to “independent” expert assistance, the Court did note that “the simplest way for a State to meet the [Ake] standard may be to provide a qualified expert retained specifically for the defense team.”