Journal of the American Academy of Psychiatry and the Law最新文献

This article discusses the relevance of delusions for a finding of criminal insanity. The authors start from the recognition that the psychiatric notion of delusion is considered relevant to criminal insanity in most jurisdictions and therefore integrates psychiatric perspectives to define delusions. The key focus is on the differences regarding how and why delusions matter legally between the Anglo-American and the Norwegian approach to criminal insanity. The authors argue that Norwegian law provides a new point of entrance to clarify legal implications of delusions but also uncovers further challenges and targets for future research regarding how the law relies upon psychiatric constructs.

Hunger strikes are a common occurrence in carceral settings accompanied by serious health risks and intensive health care utilization. A 2017 study on hunger strikes within the New Jersey Department of Corrections found these events most often occurred in a disciplinary setting. We undertook this study after a new state law, the Isolated Confinement Restriction Act (ICRA), improved conditions of confinement in part by reducing the utilization, nature, and duration of disciplinary housing. We hypothesized that ICRA would reduce the frequency of hunger strikes. Although the frequency of strikes was unchanged, the mean hunger strike duration declined from 28.9 days to 9.7 days (p = .034). The typical strike was modestly briefer, with the median duration before ICRA being four days and after being three days. The rate of hunger strikes greater than three days declined (from 60.3% to 45.2%; p = .049). There was no difference in the rate of hunger striking in disciplinary housing before or after ICRA. Although hunger strikes remain a frequently used method of protest for incarcerated persons, reform to the conditions of confinement was associated with reducing the health-related dangers and associated health care costs of these phenomena and arguably was a factor in this reduction.

This practice resource seeks to describe salient problems within reproductive psychiatry (also known as women's mental health) for the practice of forensic psychiatry. Understanding is critical and can help combat gender bias in such evaluations. Forensic psychiatric evaluations in the criminal realm, including evaluations related to neonaticide, infanticide, filicide, child abuse, and kidnapping by cesarean, require an understanding of reproductive psychiatry. Civil forensic evaluations requiring knowledge about reproductive psychiatry include parenting evaluations and risk assessments in the postpartum. Similarly, forensic psychiatrists performing a treatment role within corrections or forensic hospitals recognize the importance of understanding mental illness in pregnancy and postpartum, lactation, mother-baby units, and forced separation or custody loss. In addition to menstruation, pregnancy, and postpartum, specific concerns that bear consideration within reproductive forensic psychiatry include the periods of girlhood and menstruation. Finally, eating disorders and substance misuse bear additional attention in this group.

Concerns about sexual misconduct by health care professionals have been highlighted by recent high-profile cases. Professional health monitoring programs (PHPs) offer an additional layer of protection when health care professionals with a history of unprofessional sexual behavior (USB) return to practice; however, little is known about the characteristics or outcomes of clinicians referred to a PHP because of USB. Data were extracted from over 35 years of PHP records involving USB-related referrals (N = 570). The majority of cases were deemed ineligible for PHP monitoring and handled by other entities (e.g., licensing board, legal system). Of the 232 monitored cases (46.84 ± 9.42 years; 95.7% male), most were physicians (n = 156, 67.2%), with 75.9 percent of monitored cases involving USB with at least one patient. Most (74.9%) PHP monitoring outcomes were classified as "successful" or "very successful." Only three individuals (1.3%) who completed their monitoring were rereferred to the PHP. Monitored professionals exhibited less severe USB and were less likely to experience legal or disciplinary consequences (57.3% versus 69.8%, Cramer's V = .174, p < .0001) compared with unmonitored professionals. Findings enhance transparency of the PHP process and highlight its utility in safely returning clinicians to practice. Results may inform policies to prevent USB by health care professionals.

Preliminary research shows the psychedelic psilocybin to be a promising potential treatment for psychiatric illnesses. Recent U.S. government legislation and policy indicate that access to psilocybin, which remains illegal on the federal level despite increasing efforts to decriminalize it at the state and local levels, will be expanded to enable further research into its treatment potential. It remains unclear how psilocybin will be regulated and who will have access to this new treatment, raising important legal and ethics questions psychiatrists must consider. This article reviews the current legal regulation of psilocybin and matters related to standard of care, right to effective treatment, and the respectable minority doctrine. It concludes with a discussion of the ethics matters surrounding the use of psilocybin as medicine, including provider bias, the interpersonal dynamic between providers and patients, informed consent, and equity and access.

Asylum seekers in the United States face complex legal processes that require the construction of coherent and credible narratives to establish eligibility for legal status or immigration relief. In this article, we review clinical and legal considerations involved in optimizing trauma narratives in forensic psychiatric evaluations for immigration courts. We highlight significant challenges faced by asylum seekers, including the emotional impact of trauma and cultural factors affecting their ability to disclose their experiences, including the roles of symptoms and cultural and situational elements in disclosure and narrative development. We emphasize the importance of creating a therapeutic and empathetic environment to facilitate disclosure and partnering with interpreters across multiple culturally sensitive evaluations. We address the roles of common traumatic stressors in narrative development, including cultural challenges related to histories of torture, abduction, sexual violence, and human trafficking prevalent among asylum seekers, providing insights and guidance on each. Further, we address specific potential challenges to the forensic psychiatric evaluator during the narrative development process, such as transference, countertransference, malingering, and vicarious traumatization. We aim to provide guidance on the development of trauma narratives of asylees developed for both therapeutic and medico-legal effectiveness.

In 1991, Canada introduced Bill C-30 to amend the Criminal Code (mental disorder). Bill C-30 codified accumulated law specifying the criteria for fitness to stand trial. This test was clarified in a landmark case, R v. Taylor, which appeared to accept the limited cognitive capacity test. This explanation has guided the assessment of fitness to stand trial in courts across Canada for three decades. It was recently tested in an Ontario Court of Appeal case, R v. Bharwani, which ruled that the common interpretation of Taylor was insufficient. The court ruled there is one test for fitness, which is contextual and nuanced, and this test is spelled out in the Criminal Code. This will likely change the test and manner for assessing fitness to stand trial in Canada from how it has evolved over the last three decades.