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

Some international jurisdictions route individuals for whom criminal responsibility is foreclosed because of mental disorder from the penal system into a forensic psychiatry regime. Such rerouting might be presumed preferable for such individuals, because it is intended to offer a humane alternative to incarceration and is often viewed by the public as an avenue for accused individuals to avoid accountability. Our clinical experience corroborates European findings that at least some individuals who have been placed into forensic psychiatric care would have preferred to remain in the penal system. We report on our preliminary qualitative investigation into the reasons why some forensic psychiatric inpatients in the Canadian province of Ontario would prefer to be incarcerated. Using a grounded theory methodology, we identify six thematic categories of reasons for this preference. Drawing on these themes, we propose that participants perceive inpatient forensic psychiatric detention as posing a greater threat to personal identity than incarceration as well as feel despair associated with the perceived futility of resisting identity-shaping pressures in this environment. Participants' concerns re-emphasize the clinical challenge, but also the importance, of providers' supporting patients to associate hope rather than harm with the aim of personal transformation through inpatient forensic psychiatric care.

Medications for opioid use disorder (MOUD), including buprenorphine, are effective for the treatment of incarcerated persons (IPs) with opioid use disorder (OUD). Racial disparities in such prescribing have been researched in both community and correctional settings. We describe a performance improvement (PI) project to reduce the disparities in prescribing buprenorphine in the New Jersey Department of Corrections that involved public-facing educational efforts directed toward both prescribers and potential patients. Using reports designed to collect baseline and follow-up summary data from the electronic medical record and institutional database, we showed that, from 2021 to 2024, for the entire NJDOC census, the rate of prescribing for Black IPs increased from 3.9 to 6.3 percent (p < .00001) and for Hispanic IPs from 6.6 to 9.6 percent (p = .0009), whereas prescribing for White IPs was unchanged (19.0-18.0%, p = .362). When considering interest in buprenorphine by persons with OUD (either expressing interest or receiving a prescription for it), we noted increases in Black (41.1-56.5%, p < .0001) and Hispanic (54.9-69.7%, p = 0) IPs, but not White (71.6-73.4%, p = .360) IPs. Compared with a study on MOUD prescribing in this setting in 2019, the proportion of IPs prescribed buprenorphine identifying as Black increased (17.0-41.1%, p < .00001). These results support educational efforts for improving access to treatment with MOUD in carceral settings.

This study evaluated legal prohibitions on firearm possession in a population of 128,090 adults in Virginia with a serious mental illness and record of at least one psychiatric hospitalization between 1998 and 2015. Approximately half the study population acquired a gun-disqualifying record of a mental health adjudication or felony criminal conviction. Among persons with a mental health disqualification, the annualized arrest rate for gun-involved violent crime subsequently declined by 35.9 percent during the prohibition period; no such decline was seen in the arrest rate for crimes not involving guns. The likelihood of arrest for a gun-involved violent crime was further reduced among people whose disqualifying record was reported to the background check database (odds ratio (OR) = .7; 95% confidence interval (CI) .6 - .8; p ≤ .0010). In a subgroup analysis of individuals (n = 261) who lost and regained firearm eligibility, 14.6 percent had a subsequent arrest for a violent crime, 1.5 percent for a gun-involved crime. Regarding suicide, 1.5 percent of the restored group died of intentional self-inflicted injuries, half of those involving a firearm. The study provides evidence that firearm prohibitions were partially effective, especially when disqualifying records were reported to the background check database. Study findings give cause for modest concern for the safety consequences of gun rights restoration as practiced in one state.

Judges generally make pretrial release decisions based on the risk that a defendant will miss court appearances or pose a danger to the community; for criminal cases initiated in state courts, this decision-making is guided by state bail statutes, with judicial discretion within statutory limits. Individuals with mental illnesses may be disproportionately exposed to pretrial detention, exposing them to the psychiatric, medical, and legal consequences of incarceration. The purpose of this literature review was to find out if and how mental illness is related to missed court appearances or rearrest while individuals are awaiting trial. This review identified a limited number of empirical studies examining the association between mental illness and these outcomes. The results of the studies were variable. Although some studies found that mental illness variables predicted failure to appear, the relationship was more prominent for women than men. Substance use and criminal history appear to be more consistent predictors than mental illness. The data on the relationship between mental illness-related variables and rearrest are also mixed. Further research is needed to understand if or how mental illness affects decisions on pretrial detention.

Hinduism is a global religion with over 1.2 billion adherents. Only about one percent of U.S. adults are Hindu, so forensic evaluators may have little experience with this population. Within the United States over the past decade, there has been a trend of Hindus filing workplace discrimination claims with emotional distress but without forensic psychiatric evaluations. Immigration challenges, unique patterns of discrimination, and intersectional identities in diverse Hindu communities may challenge evaluators who do not regularly work with Hindus. Even when Hindu evaluees see Hindu evaluators, they may not share caste, ethnic, racial, or regional affiliations, so evaluators benefit from investigating the evaluee's intersectional identity, the connection between identity and perceived discrimination, patterns of help seeking, and levels of functioning. This article introduces evaluators to diverse U.S. Hindu populations; psychiatric, forensic, and cultural problems in discrimination-based claims; and evaluation strategies based on analyzing recent cases.

The forensic assessment of transgender individuals is challenging because of evolving legal landscapes, sociopolitical tensions, gaps in the clinical literature, and lack of standardized assessments studied in this population. This article explores the complexities forensic psychiatrists encounter when evaluating transgender persons, with an emphasis on assessments of general and sexual violence risk, mitigating factors, sex discrimination, disability, emotional distress, and parenting. The article also addresses the importance of remaining vigilant in striving for objectivity in assessments of transgender individuals while acknowledging both the dearth of population-specific research and the vulnerabilities and risks faced by transgender individuals. Recommendations are made for ongoing research in this field.

Forensic mental health professionals (FMHPs) play a crucial role in shaping legal outcomes, necessitating a clear understanding of excellence in the field. Establishing criteria for excellence depends upon first addressing key controversies, including those related to the role for advocacy inside the legal process, the extent to which FHMPs should strive for social justice outside the courtroom, and the allocation of scarce forensics resources. Resolution of these debates will, in turn, determine whether excellence stems primarily from selection or treatment. Only once a clear consensus regarding the meaning of excellence develops can aspirational goals for the professional be established.