Research on the Determination of the Capacity for Criminal Responsibility of Mentally Ill Patients: How to Implement the Mixed Standards of Medicine and Jurisprudence in Specific Cases to Determine the Capacity for Criminal Responsibility of Mentally Ill Patients

1. An overview of the number and types of literature

As for the topic of "the capacity of mental patients for criminal responsibility", foreign research is relatively scarce, and the existing domestic literature is relatively rich, and most of them are found in academic journals, but there is still no in-depth research. In general, there are many studies that focus on "the capacity of mental patients for criminal responsibility", and few studies that focus specifically on "the determination of the capacity for criminal responsibility of mental patients".

The author searched the subject of "criminal responsibility capacity of mental patients" by consulting CNKI, and the results were as follows: a total of 174 Chinese literature, including 128 academic journals, 28 dissertations, 11 conferences, 5 newspapers, and 2 achievements; There are a total of 4 foreign language literatures, all of which are academic journals.

The figure below shows the distribution of the main topics in Chinese literature.

The figure below shows the source distribution of Chinese literature and Chinese dedication. It can be seen that there are a wide range of sources, mainly Chinese forensic expertise (accounting for 14.29%).

At the same time, the search results showed that the number of documents in the core journals of Chinese literature was small.

2. Research consensus

(1) The understanding of "mentally ill" and "mentally ill" in the law

The term "mental illness" in China's current law is a very broad concept, which should be understood in a broad sense, which is equivalent to "mental illness" in the medical sense.

Article 18 of China's Criminal Law stipulates that mental illness is a medical determination of the pathological characteristics of the perpetrator, and medical standards are adopted; Whether a mentally ill person needs to bear criminal responsibility is to make a legal value judgment, and it is necessary to make a judicial judgment based on the degree of the mentally ill person's illness, and finally determine the circumstances in which the mentally ill person bears criminal responsibility.

Paragraph 1 of Article 18 of China's Criminal Law stipulates: "If a mentally ill person is unable to recognize and control his own behavior and causes harmful results, and it is confirmed by legal procedures, he shall not bear criminal responsibility", which means that he has no capacity for criminal responsibility. To find a mentally ill person incapacitated for criminal responsibility, two criteria must be met at the same time:

(1) Biological (medical) standards refer to the fact that, from a medical point of view, the perpetrator is a mentally ill person who commits a specific act harmful to society based on the effect of psychopathology. There is a direct causal relationship between the perpetrator's psychopathology and the commission of a specific harmful act.

(2) The psychological (jurisprudence) standard refers to the fact that, from the perspective of psychology and law, the harmful behavior of an actor with mental illness is due to the effect of psychopathology, which makes him lose the ability to recognize or control his or her own behavior in violation of the criminal law.

Paragraph 2 of Article 18 of China's Criminal Law stipulates: "An intermittent mentally ill person who commits a crime when he is mentally normal shall bear criminal responsibility," which is full capacity for criminal responsibility, and this paragraph stipulates that the perpetrator has been assessed to be intermittently mentally ill and was mentally normal at the time of the crime, and of course needs to bear criminal responsibility, and the mentally ill person and the need to bear criminal responsibility are two different concepts.

Paragraph 3 of Article 18 of the Criminal Law stipulates: "A mentally ill person who has not completely lost the ability to recognize or control his own conduct shall bear criminal responsibility, but the punishment may be mitigated or commuted," this is a limitation of criminal responsibility, that is, the perpetrator is mentally ill, but the ability to control and recognize the behavior has not been completely lost, and from the perspective of legal evaluation, it is necessary to bear criminal responsibility, after all, the ability to control and recognize the behavior is reduced, so the punishment can be mitigated or commuted at sentencing. Whether the specific punishment is mitigated or mitigated mainly depends on the specific circumstances of the crime and the harmful consequences caused.

A mentally ill person under criminal law is called a mentally ill person if he or she is assessed as a mentally ill person medically and has limited capacity for criminal responsibility in legal law, including both medical standards and legal standards. The reasons are as follows: Article 18, paragraph 1 of China's Criminal Law stipulates: "Where a mentally ill person causes harmful results when he is unable to recognize or control his own behavior, and it is confirmed through legal procedures, he shall not bear criminal responsibility, but his family or guardian shall be ordered to strictly supervise and provide medical treatment; When necessary, the government compulsorily treats them. "According to the provisions of China's Criminal Law, a mentally ill person refers to a person who cannot recognize or control his own behavior, because he cannot recognize and control his own behavior, even if he causes harmful consequences, he does not bear criminal responsibility, which is the subjective (subjective) inability to prevent the formation of a crime.

According to the Guidelines for the Assessment of the Criminal Responsibility Capacity of Persons with Mental Disorders issued by the Ministry of Justice, the criteria for assessing the criminal responsibility capacity of the mentally ill mainly include two aspects: on the one hand, mental illness and mental disorder; On the one hand, there is the capacity for criminal responsibility. Therefore, to determine that a person is legally mentally ill, it is not only necessary to determine that the perpetrator has a mental disorder in medicine, but also that the severity of the mental disorder has reached a high level of mental illness, and common mental illness syndromes are manifested in the following characteristics: hallucinatory delusional syndrome (such as schizophrenia), manic syndrome (such as organic mental disorder), depressive syndrome (such as depression), catatonic syndrome (such as schizophrenia, depressive episode and acute stress disorder, organic mental disorder, etc.), etc. Although these symptoms of mental disorders are collectively referred to as mental illness, due to the different manifestations of different symptoms, suffering from mental illness does not necessarily mean mental illness, let alone suffering from mental illness, and does not necessarily require criminal liability. According to the Review and Cross-examination of Criminal Psychiatric Appraisal Opinions issued by the Supreme People's Procuratorate in 2019, psychiatric appraisal opinions are divided into two parts: psychiatric medical appraisal and criminal responsibility capacity appraisal, the former is a medical assessment of whether a criminal suspect was mentally ill at the time of the crime and the extent of mental illness he suffers from from a medical perspective, and the latter is a legal assessment of whether the criminal suspect had the ability to recognize and control at the time of the crime and whether the ability to identify and control was weakened from a legal perspective.

(2) Evaluators must not judge the mental person's capacity for criminal responsibility

The research generally believes that the power to determine the capacity for responsibility should be held by the judicial organs; The research on the identification methods, judgment criteria and review procedures of the ability to identify, control and responsibility belongs to the interdisciplinary field of criminal law and forensic psychiatry. In practice, most of the current judgments on the capacity for criminal responsibility are monopolized by judicial psychiatric appraisal institutions, and only forensic doctors evaluate the capacity for criminal responsibility of persons with mental disorders. Judicial personnel directly adopt the judicial appraisal opinions made by the appraisal body. However, in practice, the judgment of mental disorder appraisal institutions on the ability to identify, control and criminal responsibility is mostly considered from the perspective of psychiatry, and they lack professional knowledge in criminal law, ethics and sociology. Most States consider that the expert may not make a judgment on the legal question of the existence of criminal liability of a person with a mental disorder. It has been pointed out that "the ability to identify, control and be responsible are both legal concepts, and in principle, they should not be determined by forensic psychiatric experts." "This is the consensus around the world.

(3) The determination of the criminal responsibility of mentally ill persons should be combined with the logic of conduct before and after the crime

The legal profession generally believes that the determination of criminal responsibility of a mentally ill person should be combined with the logic of behavior before and after the incident. For example, on May 23, 2025, the family of the victim of the criminal case of stabbing a person in Guangyang District, Langfang, Hebei Province, applied for a second psychiatric evaluation of the perpetrator Xie Moumou. In this case, Xie Moumou's behavior of changing clothes and disposing of the murder weapon after committing the crime may be interpreted as a "rational" manifestation with realistic motives, which in turn affects the determination of his "ability to control". However, the professional requirements of medical identification are in tension with the public's intuitive rejection of "psychiatric exoneration". Patients with schizophrenia do not completely lose their perception of reality, and their behavior may be a mixture of pathological impulses and partial rational choices. This complexity requires the judicial process to strike a balance between technical rationality and human experience, and the current system is still weak in dealing with appraisal objections – although re-appraisal is allowed, the intervention mechanism of cross-regional and third-party institutions is not yet perfect.

The determination of the criminal responsibility of a mentally ill person must meet the dual conditions of "medical standards" and "psychological standards".

The medical standard points to professional forensic expertise, while the psychological standard requires proof that the perpetrator was incapable of identifying or controlling the crime at the time of the crime.

3. The main concerns of the research

The existing research mainly focuses on the nature and application of the determination of the capacity for criminal responsibility of the mentally ill, and the supporting system for the determination of the capacity for criminal responsibility of the mentally ill.

(1) Essence

Focusing on the provisions of Article 18, Paragraph 1 of the Criminal Law of the People's Republic of China, there are three different views in the academic community on the nature of the determination of the capacity for criminal responsibility of mentally ill persons:

1. Medical judgment says

That is, if the perpetrator is judged to be incapable of criminal responsibility or has limited capacity for criminal responsibility, the only criterion is whether he or she suffers from mental illness as stipulated in the criminal law, which mainly exists in the field of psychiatric forensics, focusing on the judgment of facts. Medicine mainly judges whether the relevant subject suffers from mental illness from the pathological aspect and symptomatological aspect, that is, it is necessary to determine whether the relevant subject has organic lesions and corresponding symptoms. As a result, the medical profession also divides psychosis into two criteria: organic psychosis and functional psychosis. Patients with organic psychosis have corresponding psychotic symptoms due to problems with brain structure or nerves, while patients with functional psychosis do not have pathological lesions in brain structures and nerves, but patients still show corresponding symptoms. However, most scholars believe that there are many shortcomings in this criterion in determining the capacity of a mentally ill person to be criminally responsible: First, for example, an intermittent mentally ill person may not necessarily lose or reduce his ability to recognize or control his mental illness during the remission period of mental symptomsIt can be seen that medical standards cannot reflect the actual situation of the capacity of mentally ill patients for criminal responsibility; Second, it is difficult to determine the criminal responsibility of a mentally ill person based on medical standards alone, and it is difficult to define whether he is a person with complete or limited capacity for criminal responsibility, and it is difficult to practice in judicial practice； Third, according to the laws of our country, the perpetrator's capacity for criminal responsibility should be determined by a judge, if according to medical standardsPsychiatric evaluators have become the real manipulators of the mentally ill's capacity for criminal responsibility, and doubts about the legal basis will lead to loopholes in punishment in the criminal law.

According to Li Hong, a professor at Tsinghua University's Law School, China's so-called forcible evaluation of mental illness is not only a medical evaluation of mental illness, but also a legal evaluation of whether the perpetrator has the ability to identify and control the behavior at the time of his behavior. Because of this, in China's criminal trial practice, the acceptance rate of psychiatric forensic appraisals issued by psychiatrists is more than 90%, and the conclusion of forensic psychiatric appraisal, as one of the evidences, has a very critical and important position in China's criminal trials, and is by no means just a "for reference" opinion.

Jurisprudence Judgment

Legal judgment means that when judging the capacity of a mentally ill person for criminal responsibility, only the psychological state of the perpetrator is used as the criterion, regardless of the reason for the psychological state, that is, no psychiatric evaluation is required.

This doctrine is a point of view from the perspective of criminal law, with an emphasis on value judgments. Scholars believe that mental illness in criminal law has different evaluation mechanisms and evaluation targets from medical mental illness, and that medical mental patients can be treated as persons with full capacity for criminal responsibility in criminal law, while in legal science, the existence of criminal responsibility capacity depends very much on the judge's criminal law judgment process, and only judges have the ability to identify some mental pathologies, and the role of doctors is dispensable, and even psychiatric evaluations must be guided by judges, so the determination of the capacity for criminal responsibility of mental patients should break the dependence on psychiatric medical experts. Re-examine the criminal law effect of psychiatric evaluation.

Article 18 of the Criminal Law of the People's Republic of China focuses on whether the perpetrator bears criminal responsibility as "unable to recognize or control his own behavior", which affirms the legal judgment theory. Although the capacity for criminal responsibility is a criminal law judgment, in addition to age and important physiological functions, the factors that affect the actor's ability to recognize or control are only the mental elements of the actor. This will inevitably undermine the stability of the law, and the criminal law will become a dead letter. At the same time, judges do not necessarily have professional knowledge in psychiatry, and it is not scientific to determine the perpetrator's ability to bear criminal responsibility solely on the basis of judges' legal knowledge and common sense, which is not conducive to judicial fairness. Therefore, doctors play an indispensable role in determining the capacity of mentally ill persons for criminal responsibility. Proceeding from the provisions of China's current laws and relevant systems, the determination of the capacity for criminal responsibility of a mentally ill person is inseparable from the appraisal of a licensed physician.

Mixed Theory of Medical and Legal Judgment

When the mixed theory is used to determine the capacity for criminal responsibility of a mentally ill person, both the medical judgment theory and the legal judgment theory are adopted. The perpetrator suffers from "mental illness" as provided for in the Criminal Law and the "mental illness" must cause a legally prescribed state of mind before it can be found to be completely incapable of criminal responsibility or has limited capacity for criminal responsibility. According to the provisions of Article 18, Paragraph 1 of the Criminal Law of China, it can be seen that the determination of the capacity for criminal responsibility of mentally ill persons in China adopts mixed standards, and studies generally believe that this kind of determination standard is reasonable and legal. In the case of a combination of medical and legal standards, legal judgment should play a major role, after all, criminal cases are mainly judicial trials. Whether or not a mentally ill person is a mentally ill person should be judged by the judiciary, and the criteria for judging should be medical and legal standards.

(2) Application

1. Motivation says

This doctrine is based on the standpoint of "medical judgment theory". It advocates combining the long-held "motivation theory" of the psychiatric community with the provisions of Article 18 of the Criminal Law, so as to change the disconnect between the criminal law academic circles and the psychiatric circles in the determination of the criminal responsibility capacity of the mentally ill, and provide medical standards for the accurate determination of the criminal responsibility capacity of the mentally ill. According to the "motive theory", the more pathological components of the motive and the more serious the degree of impairment of the ability to recognize, the easier it is for the perpetrator to be found to be incapable of criminal responsibility; The less pathological motivation there is, the more consistent the actor's motivation is with the logic of real life, and the closer to the realistic motivation, the easier it is to be evaluated as fully responsible. A person with a mixed motive or an unclear motive in between the two is an abnormal motive and is evaluated as a person with limited capacity for responsibility.

2. Reasonable behavior theory

In recent years, the "theory of reasonable ability" has become popular in the United States and Japan in academic circles regarding the judgment of recognition ability in criminal law. From the standpoint of "legal judgment", this doctrine holds that the process of conduct is the most reliable basis for inferring the capacity for criminal responsibility, and that the criminal law effect of the expert opinion of psychiatrists should be gradually abolished. In criminal law, psychopathy evaluates the ability to recognize and control specific behaviors, and if it is separated from specific behaviors, mental illness in the abstract has no significance in criminal law. The "Theory of Reasonable Behavior" understands "ability to recognize" as the ability to make reasonable behavioral decisions, denies the core position of "ability to recognize illegality" in the connotation of ability to recognize, and replaces it with "ability to be reasonable", puts forward a somewhat operable view on the current situation of the identification of mental disorders in China, and reiterates the position that the judgment of criminal responsibility of the mentally ill is a legal judgment.

Fourth, the shortcomings of China's research on the capacity for criminal responsibility of mentally ill persons at this stage

However, there are still some weaknesses in the existing research, which are mainly manifested in the following aspects.

(1) Inaccurate psychiatric evaluation opinions

The psychiatric appraisal opinion is the initial corresponding appraisal result of a medical expert based on his or her own medical expertise, and the appraisal result itself has a certain degree of scientificity. However, in practice, the identification of mentally ill patients involves relevant knowledge such as medicine, sociology, psychology and law.

(2) The discussion of the specific determination plan for the responsibility capacity of mentally ill persons is still shallow

How to accurately determine the responsibility capacity of a mentally ill person is an extremely complex issue, because it is different from the formal judgment of the responsibility capacity of a minor based on age, and it requires a positive judgment of the ability of the mentally ill person to identify and control. Since the determination of the capacity for responsibility is a criminal law issue, the criminal law academic community must provide a specific judgment plan for the ability of the mentally ill to identify and control. However, this issue has always been a commonplace but unresolved topic in the field of criminal law in China, and there is a relative lack of discussion on the specific determination scheme of the responsibility capacity of the mentally ill, whether it is a criminal law textbook or a related monograph on the capacity for responsibility. The criminal law scholars only discuss the determination of the ability to identify and control in general, but do not actively discuss how to specifically determine the ability to identify and control the mentally ill as the judicial psychiatric circles do, which can easily lead to judges being at a loss in the face of appraisal opinions. While asserting that the determination of the responsibility capacity of a mentally ill person is a legal judgment, it is not possible to provide a set of feasible determination schemes, which may lead to judges being unable to determine the responsibility capacity of a mentally ill person, and finally falling into intuitive judgment or blindly following the appraisal opinions of judicial psychiatrists. It is precisely because of the lack of a set of specific identification plans for judging the perpetrator's ability to identify and control that although murderers such as Qiu Xinghua and Zhang Koukou have been executed, there are still endless debates about their ability to be responsible. Therefore, the issue of the specific determination scheme of the responsibility capacity of the mentally ill has become an urgent topic to be studied in the field of criminal law.

(2) The boundaries between medical evaluation and judicial judgment are unclear

The use of a combination of medical standards and legal standards in the evaluation of criminal responsibility capacity in China involves the complex interrelationship between the two and how to accurately grasp the relationship between mental disorders and illegal acts. Since the judgment of the capacity of persons with mental disorders for criminal responsibility first requires medical workers to judge their mental disorders from a medical point of view, which is highly professional and the judgment process is complex and delicate, it is generally believed in practice that forensic psychiatric appraisers have a greater say in the judgment of their capacity for criminal responsibility. [4] Therefore, most of the current judgments on the capacity for criminal responsibility are monopolized by forensic psychiatric appraisal institutions, and only forensic doctors evaluate the capacity for criminal responsibility of persons with mental disorders. However, judicial personnel often actively or passively evade the judgment of their ability to be held criminally responsible, and directly adopt the judicial appraisal opinions made by the appraisal agency. However, the judgment of the ability to identify, control and criminal responsibility of mental disorder evaluation institutions is mostly considered from the perspective of psychiatry, and they lack professional knowledge in criminal law, ethics and sociology. The capacity for criminal responsibility is precisely the concept of criminal law, which has its own logic and judgment standards, and should be left to professional judicial personnel for judgment.

5. Summary

Mental illness is not a "gold medal" for crimes, and justice needs to find a balance between protecting the rights and interests of patients and maintaining public safety. The verdict in the Chengdu Wang Mouya case may set a benchmark for the management of crimes against the mentally ill in China. The attribution and assistance of the mentally ill is not only related to judicial justice, but also tests the bottom line of civilization in a society—it requires the technical rationality of the law, and more importantly, a deep understanding of human nature. Only by translating individual tragedies into a thrust for institutional progress can we build a bridge of hope between security and dignity. As lawyers, we look forward to the realization of justice, and we also call for the improvement of the system - because every life deserves to be protected.

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