In providing the care and control of individuals found Not Criminally Responsible on Account of Mental Disorder (NCRMD), forensic psychiatry attempts to balance the protection of society with the treatment of mental illness. A new approach in mental health care is the recovery model, which centers on the understanding that there should be a ‘recovery in’, not a ‘recovery from’ serious mental illness. In clinical practice, this means that treatment decisions should be made in collaboration with patients and include their personal circumstances, such as criminality and aspirations. Concepts that intersect with these goals are elements like choice, hope, personal responsibility, and empowerment. This paper examines the implementation of the recovery model in forensic mental health settings and provides an in-depth exploration and evaluation of the model as it is practiced at a forensic psychiatric outpatient clinic with individuals found NCRMD. Ten participants, including both individuals found NCRMD and psychiatric professionals, took part in semi-structured interviews. The paper examines the experiences, perceptions and challenges of implementing the recovery model in a forensic psychiatric setting and compares its strategies to the predominant risk-based forensic practices. The analysis suggests that it is difficult to implement the recovery model in a forensic setting without compromising either the recovery model or the risk management approach. Keywords: NCRMD, recovery model, risk management, outpatient setting, qualitative, forensic mental health
{"title":"Examining the use of the recovery model with individuals found not criminally responsible on account of mental disorder","authors":"M. Gulayets, A. Sawyer","doi":"10.15173/IJRR.V3I1.4079","DOIUrl":"https://doi.org/10.15173/IJRR.V3I1.4079","url":null,"abstract":"In providing the care and control of individuals found Not Criminally Responsible on Account of Mental Disorder (NCRMD), forensic psychiatry attempts to balance the protection of society with the treatment of mental illness. A new approach in mental health care is the recovery model, which centers on the understanding that there should be a ‘recovery in’, not a ‘recovery from’ serious mental illness. In clinical practice, this means that treatment decisions should be made in collaboration with patients and include their personal circumstances, such as criminality and aspirations. Concepts that intersect with these goals are elements like choice, hope, personal responsibility, and empowerment. This paper examines the implementation of the recovery model in forensic mental health settings and provides an in-depth exploration and evaluation of the model as it is practiced at a forensic psychiatric outpatient clinic with individuals found NCRMD. Ten participants, including both individuals found NCRMD and psychiatric professionals, took part in semi-structured interviews. The paper examines the experiences, perceptions and challenges of implementing the recovery model in a forensic psychiatric setting and compares its strategies to the predominant risk-based forensic practices. The analysis suggests that it is difficult to implement the recovery model in a forensic setting without compromising either the recovery model or the risk management approach. \u0000Keywords: NCRMD, recovery model, risk management, outpatient setting, qualitative, forensic mental health","PeriodicalId":181328,"journal":{"name":"International Journal of Risk and Recovery","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114641753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The mental health care law in Saudi Arabia was passed in 2014. This article will focus on the articles related to psychiatric admissions both voluntary and involuntary. The mental health care law is similar to the laws in western countries. However, it will be discussed in the paper how these articles and subsections are curtailed to the limited health systems and to the local culture. As the mental health care system and culture evolves, the mental health care law will definitely be modified in the future.
{"title":"Psychiatric admissions","authors":"A. Alqahtani","doi":"10.15173/IJRR.V3I1.3774","DOIUrl":"https://doi.org/10.15173/IJRR.V3I1.3774","url":null,"abstract":"The mental health care law in Saudi Arabia was passed in 2014. This article will focus on the articles related to psychiatric admissions both voluntary and involuntary. The mental health care law is similar to the laws in western countries. However, it will be discussed in the paper how these articles and subsections are curtailed to the limited health systems and to the local culture. As the mental health care system and culture evolves, the mental health care law will definitely be modified in the future.","PeriodicalId":181328,"journal":{"name":"International Journal of Risk and Recovery","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120951198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This editorial deals with vicarious trauma in the context of forensic mental health assessment and care.
这篇社论涉及法医心理健康评估和护理背景下的间接创伤。
{"title":"Vicarious trauma and occupational hazard for forensic mental health professionals","authors":"J. Bradford, G. Chaimowitz","doi":"10.15173/IJRR.V3I1.4533","DOIUrl":"https://doi.org/10.15173/IJRR.V3I1.4533","url":null,"abstract":"This editorial deals with vicarious trauma in the context of forensic mental health assessment and care.","PeriodicalId":181328,"journal":{"name":"International Journal of Risk and Recovery","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121545602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Substance Use Disorder is a major concern for public health. Legal substances are often misused to get “high”. Beside the risk of developing subsequent mental health and physical conditions, one of major risk is related to behavioural changes leading to criminal behaviour. There is need for regulation on some of these substances to ensure public as well as individual safety. This article is a case report describing Mitragyna speciosa (Kratom) induced psychosis in a patient suffering from Schizophrenia. We hope this article can bring attention to regulating bodies about the risks associated with readily available “legal” drugs like Kratom.
{"title":"Kratom-induced Psychosis: case report and literature investigation","authors":"S. Prat, S. Rizvi, G. Chaimowitz","doi":"10.15173/ijrr.v3i2.4134","DOIUrl":"https://doi.org/10.15173/ijrr.v3i2.4134","url":null,"abstract":"Substance Use Disorder is a major concern for public health. Legal substances are often misused to get “high”. Beside the risk of developing subsequent mental health and physical conditions, one of major risk is related to behavioural changes leading to criminal behaviour. There is need for regulation on some of these substances to ensure public as well as individual safety. This article is a case report describing Mitragyna speciosa (Kratom) induced psychosis in a patient suffering from Schizophrenia. We hope this article can bring attention to regulating bodies about the risks associated with readily available “legal” drugs like Kratom. ","PeriodicalId":181328,"journal":{"name":"International Journal of Risk and Recovery","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122747395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tom Domjancic, Treena Wilkie, Shaheen A Darani, Brittney R. Williams, Bandhana Maheru, Z. Jamal
The Structured Assessment of PROtective Factors for Violence Risk (SAPROF) is an assessment tool that examines protective factors when assessing for violence risk. There is limited research on clinicians’ perceptions of the use and implementation of risk assessment tools, and this study aimed to examine the experiences of clinicians using the SAPROF in a low secure forensic rehabilitation inpatient unit in Canada. An exploratory research design was used, and five clinicians participated in semi-structured interviews. Data was analyzed using a thematic approach and three central themes were identified: understanding of the patient from a strengths-based point of view, providing clinicians with a focus on how to help the patient, and bringing in opportunities to collaborate as a team. The findings highlight the additional value of the SAPROF as tool in helping forensic teams to adopt strengths based approaches to risk assessment, enhancing treatment planning and inter-professional collaboration. Keywords: strengths, risk assessment, SAPROF, consensus scoring, recovery
{"title":"Clinicians’ Perceptions of the Implementation of the Structured Assessment of Protective Factors for Violence Risk (SAPROF) on an Inpatient Forensic Unit","authors":"Tom Domjancic, Treena Wilkie, Shaheen A Darani, Brittney R. Williams, Bandhana Maheru, Z. Jamal","doi":"10.15173/ijrr.v2i2.3966","DOIUrl":"https://doi.org/10.15173/ijrr.v2i2.3966","url":null,"abstract":"The Structured Assessment of PROtective Factors for Violence Risk (SAPROF) is an assessment tool that examines protective factors when assessing for violence risk. There is limited research on clinicians’ perceptions of the use and implementation of risk assessment tools, and this study aimed to examine the experiences of clinicians using the SAPROF in a low secure forensic rehabilitation inpatient unit in Canada. An exploratory research design was used, and five clinicians participated in semi-structured interviews. Data was analyzed using a thematic approach and three central themes were identified: understanding of the patient from a strengths-based point of view, providing clinicians with a focus on how to help the patient, and bringing in opportunities to collaborate as a team. The findings highlight the additional value of the SAPROF as tool in helping forensic teams to adopt strengths based approaches to risk assessment, enhancing treatment planning and inter-professional collaboration. \u0000 \u0000Keywords: strengths, risk assessment, SAPROF, consensus scoring, recovery","PeriodicalId":181328,"journal":{"name":"International Journal of Risk and Recovery","volume":"118 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124529865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Absconding from mental health units is referred to as a patient leaving without permission and can have significant consequences for the patient, family, community, and institution. The varying definitions of absconsion involve breaching security of an inpatient unit, accessing grounds or community without permission, gaining liberty during escorted leave or being absent for longer than permitted from authorized or trial leave. While considerable literature exists on absconsion from acute psychiatric units, there is a paucity of literature specific to forensic absconsions, despite inherent differences between patients and systems. Forensic patients are offenders who are found unfit to stand trial, or not criminally responsible on account of mental disorder. The literature indicates the absconding rate within the forensic population is expected to be low, based on the fact that the level of security in forensic units is higher than general psychiatric units. Despite the rates being considered low, the outcomes of absconding in this population can potentially be serious, thus the exploration of factors surrounding these incidents is essential. Purpose: To review the literature regarding absconsion from forensic psychiatric institutions. This review will identify potential risk factors and motivations of forensic patients that have absconded. Methods: Electronic database and hand searches were conducted to locate articles pertaining to absconding specific to forensic psychiatric institutions published from 1969-present. Search terms included “abscond”, “escape”, “AWOL”, “runaway”, “psychiatric inpatient”, “forensic institution”, & variants. All full-text articles meeting inclusion & exclusion criteria were appraised for qualitative themes, limitations, and assessed for risk of bias using appropriate CASP Checklists. The review is structured following the PRISMA checklist and framework. Results: A total of 19 articles meeting literature review criteria were identified. The majority of the articles were of retrospective case-control design (n=12). Three systematic reviews were found on absconsion that included analyses from both forensic and general psychiatric populations. Definitions for absconding were omitted or varied making comparisons between studies difficult. Much research compared demographic, static and dynamic factors. History of previous absconsion, scores on validated risk-of-violence assessment tools, substance-use disorder, acute mental state, and socio-environmental factors were consistently noted as risk-factors. Four distinct motivations for absconding emerged: goal-directed, frustration/boredom, symptomatic, and accidental. Overall, the literature suggested forensic absconsion was a rare event of short duration with low risk to the public and few re-offending incidents. Conclusions: There is a paucity of literature on forensic absconsions. A consistent definition of absconsion and use of standardized reporting protocols
{"title":"Absconsion from forensic psychiatric institutions: a review of the literature","authors":"Danielle Campagnolo, I. Furimsky, G. Chaimowitz","doi":"10.15173/ijrr.v2i2.3920","DOIUrl":"https://doi.org/10.15173/ijrr.v2i2.3920","url":null,"abstract":"Background: Absconding from mental health units is referred to as a patient leaving without permission and can have significant consequences for the patient, family, community, and institution. The varying definitions of absconsion involve breaching security of an inpatient unit, accessing grounds or community without permission, gaining liberty during escorted leave or being absent for longer than permitted from authorized or trial leave. While considerable literature exists on absconsion from acute psychiatric units, there is a paucity of literature specific to forensic absconsions, despite inherent differences between patients and systems. Forensic patients are offenders who are found unfit to stand trial, or not criminally responsible on account of mental disorder. The literature indicates the absconding rate within the forensic population is expected to be low, based on the fact that the level of security in forensic units is higher than general psychiatric units. Despite the rates being considered low, the outcomes of absconding in this population can potentially be serious, thus the exploration of factors surrounding these incidents is essential. Purpose: To review the literature regarding absconsion from forensic psychiatric institutions. This review will identify potential risk factors and motivations of forensic patients that have absconded. Methods: Electronic database and hand searches were conducted to locate articles pertaining to absconding specific to forensic psychiatric institutions published from 1969-present. Search terms included “abscond”, “escape”, “AWOL”, “runaway”, “psychiatric inpatient”, “forensic institution”, & variants. All full-text articles meeting inclusion & exclusion criteria were appraised for qualitative themes, limitations, and assessed for risk of bias using appropriate CASP Checklists. The review is structured following the PRISMA checklist and framework. Results: A total of 19 articles meeting literature review criteria were identified. The majority of the articles were of retrospective case-control design (n=12). Three systematic reviews were found on absconsion that included analyses from both forensic and general psychiatric populations. Definitions for absconding were omitted or varied making comparisons between studies difficult. Much research compared demographic, static and dynamic factors. History of previous absconsion, scores on validated risk-of-violence assessment tools, substance-use disorder, acute mental state, and socio-environmental factors were consistently noted as risk-factors. Four distinct motivations for absconding emerged: goal-directed, frustration/boredom, symptomatic, and accidental. Overall, the literature suggested forensic absconsion was a rare event of short duration with low risk to the public and few re-offending incidents. Conclusions: There is a paucity of literature on forensic absconsions. A consistent definition of absconsion and use of standardized reporting protocols","PeriodicalId":181328,"journal":{"name":"International Journal of Risk and Recovery","volume":"89 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124182433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim of this article is to examine the current state of the battered woman syndrome (BWS) defence in Canada and propose an update to the list of factors considered by experts evaluating the applicability of the defence to individual cases. The history and current legal definition of the defence are presented, and theories relating to BWS are summarized. Factors required of expert testimony in BWS cases are presented; cases relevant to the development of the defence that highlight these assessment factors are discussed. In a subsequent section, limitations of the defence and the role of the expert are explored. The PTSD Checklist (used in clinician diagnosis) is summarized before an updated, BWS-specific expert checklist is proposed. The updated checklist proposes six elements to be considered by an expert assessing a BWS case: 1. environmental factors, 2. attempts to leave or alter the situation, 3. risk factors of the abuser, 4. risk factors of the victim, 5. triggers for violence, and 6. contrary evidence. It is hoped that using this checklist will help experts to cover all the essential elements they must consider in order to conclude that a woman satisfies the criteria for BWS. In particular, this updated checklist will help experts to prepare comprehensive testimony that addresses the five issues defined by Justice Wilson as the expert’s duty to assess. In addition, this checklist will help experts present a firm foundation for a defence regarding the critical question of why the night of the offence was different from all other nights.
{"title":"Battered woman syndrome: updating the expert checklist","authors":"G. Glancy, Marissa Heintzman, Adam Wheeler","doi":"10.15173/ijrr.v2i2.3820","DOIUrl":"https://doi.org/10.15173/ijrr.v2i2.3820","url":null,"abstract":"The aim of this article is to examine the current state of the battered woman syndrome (BWS) defence in Canada and propose an update to the list of factors considered by experts evaluating the applicability of the defence to individual cases. The history and current legal definition of the defence are presented, and theories relating to BWS are summarized. Factors required of expert testimony in BWS cases are presented; cases relevant to the development of the defence that highlight these assessment factors are discussed. In a subsequent section, limitations of the defence and the role of the expert are explored. The PTSD Checklist (used in clinician diagnosis) is summarized before an updated, BWS-specific expert checklist is proposed. The updated checklist proposes six elements to be considered by an expert assessing a BWS case: 1. environmental factors, 2. attempts to leave or alter the situation, 3. risk factors of the abuser, 4. risk factors of the victim, 5. triggers for violence, and 6. contrary evidence. It is hoped that using this checklist will help experts to cover all the essential elements they must consider in order to conclude that a woman satisfies the criteria for BWS. In particular, this updated checklist will help experts to prepare comprehensive testimony that addresses the five issues defined by Justice Wilson as the expert’s duty to assess. In addition, this checklist will help experts present a firm foundation for a defence regarding the critical question of why the night of the offence was different from all other nights.","PeriodicalId":181328,"journal":{"name":"International Journal of Risk and Recovery","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123674522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this Letter to the Editor, the authors comment on the implementation of a cognitive behavioural therapy for psychosis program for individuals admitted to a forensic psychiatry program. They highlight their experience and how they adapted the sessions to fit the needs of the patient in this context.
{"title":"The Implementation of Cognitive Behavioural Therapy for Psychosis (CBTp) in a Forensic Setting","authors":"K. Grimes, P. Sheridan","doi":"10.15173/IJRR.V2I1.3703","DOIUrl":"https://doi.org/10.15173/IJRR.V2I1.3703","url":null,"abstract":"In this Letter to the Editor, the authors comment on the implementation of a cognitive behavioural therapy for psychosis program for individuals admitted to a forensic psychiatry program. They highlight their experience and how they adapted the sessions to fit the needs of the patient in this context. ","PeriodicalId":181328,"journal":{"name":"International Journal of Risk and Recovery","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126526315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Forensic Psychiatry is defined as the Psychiatry subspecialty in which the clinical and scientific knowledge is applied to legal aspects, both with regard to Civil and Criminal Law. Nowadays, the largest security ward is in Coimbra, at the University Hospital. It covers 110 patients, 90 males and 20 females. The aim of the security measure, in accordance with the penal code, is the protection of legal assets and the psychosocial rehabilitation. In our sample, the main most frequent diagnosis was schizophrenia (37.8%). Moderate intellectual disability (23.4%) and mild intellectual disability (14.4%) were the second and third most frequent diagnosis. The unlawful acts that generated the prevalent security measure were in first place domestic violence (19,8%) followed by attempted murder (16,2%) and theft (14,5%). The elaboration of a therapeutic and rehabilitation plan is essential and its aim is to diminish the person’s dangerousness. It is fundamental to think of the safety ward as a health production space and not as a place of mere disease management or “dangerous states”, thus trying to solve the patient’s problems.
{"title":"Forensic Psychiatry in the largest security ward in Portugal","authors":"T. Carvalhão, P. Jorge, P. Batalim","doi":"10.15173/IJRR.V2I1.3501","DOIUrl":"https://doi.org/10.15173/IJRR.V2I1.3501","url":null,"abstract":"Forensic Psychiatry is defined as the Psychiatry subspecialty in which the clinical and scientific knowledge is applied to legal aspects, both with regard to Civil and Criminal Law. Nowadays, the largest security ward is in Coimbra, at the University Hospital. It covers 110 patients, 90 males and 20 females. The aim of the security measure, in accordance with the penal code, is the protection of legal assets and the psychosocial rehabilitation. In our sample, the main most frequent diagnosis was schizophrenia (37.8%). Moderate intellectual disability (23.4%) and mild intellectual disability (14.4%) were the second and third most frequent diagnosis. The unlawful acts that generated the prevalent security measure were in first place domestic violence (19,8%) followed by attempted murder (16,2%) and theft (14,5%). The elaboration of a therapeutic and rehabilitation plan is essential and its aim is to diminish the person’s dangerousness. It is fundamental to think of the safety ward as a health production space and not as a place of mere disease management or “dangerous states”, thus trying to solve the patient’s problems.","PeriodicalId":181328,"journal":{"name":"International Journal of Risk and Recovery","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126932818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Born, Patrick Gehring, A. Rohner, B. Eusterschulte
As a result of a Federal Constitutional Court decision on coercive treatment, in its state Law the federal state of Hesse has newly regulated the possibility of coercive treatment (Section 7 Paragraph 2 of the Hesse Law on the Enforcement of Court-ordered Hospital Treatment) and expressly incorporated the observance of a patient’s advance directive as defined by Sections 1901a and 1901b of the German Civil Code (Bürgerliches Gesetzbuch [BGB]). Having been sentenced to hospital order treatment under section 63 of the German Criminal Code (Strafgesetzbuch [StGB]), in the Vitos Haina Forensic Psychiatric Hospital thirteen patients with schizophrenia stated in a patient’s advance directive that they wished to be treated with certain antipsychotic medication in case of a recurring psychotic episode. In particular, the patient’s advance directive stated that this treatment should be compulsory if necessary. Based on a case vignette this article delineates both the motivation of the patients for such a patient’s advance directive as well as the legal limitations and the enforceability of such a patient’s advance directive. There is no prevailing view in the jurisdiction or literature on the utilization of a patient’s advance directive to guarantee an explicitly desired treatment in case of incapacity for consent. This article wishes to highlight the perspectives of those directly affected and to encourage discussion. Being of special interest for forensic psychiatry, these considerations may also be of importance for treatment considerations in general psychiatry.
{"title":"Is the anticipated consent to treatment in advance directives a solution to coercive treatment in forensic psychiatry?","authors":"P. Born, Patrick Gehring, A. Rohner, B. Eusterschulte","doi":"10.15173/IJRR.V2I1.3680","DOIUrl":"https://doi.org/10.15173/IJRR.V2I1.3680","url":null,"abstract":"As a result of a Federal Constitutional Court decision on coercive treatment, in its state Law the federal state of Hesse has newly regulated the possibility of coercive treatment (Section 7 Paragraph 2 of the Hesse Law on the Enforcement of Court-ordered Hospital Treatment) and expressly incorporated the observance of a patient’s advance directive as defined by Sections 1901a and 1901b of the German Civil Code (Bürgerliches Gesetzbuch [BGB]). Having been sentenced to hospital order treatment under section 63 of the German Criminal Code (Strafgesetzbuch [StGB]), in the Vitos Haina Forensic Psychiatric Hospital thirteen patients with schizophrenia stated in a patient’s advance directive that they wished to be treated with certain antipsychotic medication in case of a recurring psychotic episode. In particular, the patient’s advance directive stated that this treatment should be compulsory if necessary. Based on a case vignette this article delineates both the motivation of the patients for such a patient’s advance directive as well as the legal limitations and the enforceability of such a patient’s advance directive. There is no prevailing view in the jurisdiction or literature on the utilization of a patient’s advance directive to guarantee an explicitly desired treatment in case of incapacity for consent. This article wishes to highlight the perspectives of those directly affected and to encourage discussion. Being of special interest for forensic psychiatry, these considerations may also be of importance for treatment considerations in general psychiatry.","PeriodicalId":181328,"journal":{"name":"International Journal of Risk and Recovery","volume":"163 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127526264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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