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

The experience of burnout in forensic psychiatrists has not been well studied, with most studies focusing on the experiences of forensic nurses, the impact of vicarious trauma and compassion fatigue in forensic mental health professionals, and the risk of posttraumatic stress disorder related to workplace exposures. This study reports on a national survey (34% response rate) conducted with forensic psychiatrists across Canada to understand the rate of, and contributors to, burnout and professional fulfillment. Just over half of the physician respondents reported experiencing burnout, which is in line with other recent surveys in Canada that have indicated elevated levels of burnout since the onset of the pandemic. The highest rates were found among early-career psychiatrists and those whose values did not align with their workplace. Intellectual stimulation, the interface with the legal system, and flexibility in one's job were all strongly linked with professional fulfillment. The goal of this survey was not only to identify rates and variables affecting burnout and wellness in this population but also to expand the dialogue on potential interventions at institutional and systems levels that can reduce burnout, promote professional fulfillment, and enhance recruitment and retention in the field of forensic psychiatry.

Multisystemic therapy (MST) is an intense, family-focused, community-based treatment designed for youth with criminal behaviors. Literature on its usefulness among juvenile sexual offenders (JSOs) remains limited. We conducted a systematic review of published studies assessing effectiveness of MST among JSOs. A comprehensive search of published studies, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was undertaken using multiple databases. Search terms included "multisystemic therapy" or "multisystemic family therapy." A total of 542 articles were obtained on initial search. After excluding duplicates, 297 articles were included in further analysis that yielded 48 articles for full-text analysis. Six randomized controlled trials of MST, comprising 231 juvenile sex-offenders, were assessed for final review. MST performed favorably relative to alternative treatments among juvenile sex offenders while also demonstrating lasting treatment effect on sustained follow-up.

Forensic evaluators may have little experience and knowledge of the political context of Myanmar, the Burmese people, and the refugee crisis. Oppression of several ethnic minority groups has marked Burmese military rule of Myanmar for several decades. Protracted trauma exposure, both pre- and post-migration, among refugee populations increases the risk for mental health disorders, particularly depression, anxiety, alcohol abuse, and posttraumatic stress disorder. These experiences may result in anger and psychiatric manifestations that bring Burmese refugees in conflict with the law in their host country. Culture influences how mental distress is experienced and reported, and it can influence a forensic evaluator's assessment of psychological-legal matters, such as competency to stand trial and asylum evaluations. The salience of cultural competence becomes particularly pressing given the small number of those of Burmese background in the United States. Most evaluations will be performed by forensic mental health professionals who are not Burmese in ethnicity, nor familiar with Burmese culture. In this article, we provide a backdrop of the military suppression of ethnic minorities prior to discussing the integration of cultural matters in forensic assessments of competency to stand trial, competency for extradition, and asylum seekers in Burmese refugees.

Despite the importance of independent medical examinations (IMEs), there is virtually no literature on the risks to the IME assessor nor the learning needs of psychiatrists in this area. To address this deficit, a retrospective chart review of nearly 38,000 cases from the Canadian Medical Protective Association (CMPA) identified 108 files involving complaints or legal actions against psychiatrists performing IMEs. Most complaints identified by the CMPA were to regulatory bodies, including biased opinion, inadequate assessment, inappropriately relying on a requester's information without independent evaluation, nonadherence to regulatory body policies, cursory documentation lacking relevant details, and communication breakdowns. A survey by the Canadian Academy of Psychiatry and the Law (CAPL) and the Canadian Psychiatric Association (CPA) had 306 Canadian psychiatrist respondents. About 37 percent of psychiatrists completing IMEs reported medico-legal consequences, including complaints to regulatory authorities. Only 40 percent of those doing IMEs and 20 percent of all psychiatrists had formal training in doing IMEs. The studies confirm that despite a low but important risk of medico-legal consequences, many psychiatrists performing IMEs do not have formalized training. Using the new CAPL Canadian Guidelines for Forensic Psychiatry Assessment and Report Writing is a step to reduce the risk of such evaluations.

The notion of human dignity remains a relatively complex concept that has roots in classical Greek and Roman antiquity and links to religious teachings and Kantian philosophical notions. From the Latin dignitas, human dignity means worth and implies excellence and distinction. Human dignity, also found in 20^th century constitutions and international declarations, has been considered in bioethics, general medicine, and psychiatry. The application of dignity to forensic psychiatry practice has received less attention. Through a review of texts in medicine and related fields, such as philosophy and anthropology, we aim to clarify the concept of human dignity and its application in forensic psychiatry practice. We first outline the historical origins of the term. We then consider several varieties of human dignity applied in medical ethics and psychiatry. We review individuals' lived experiences of indignity and dignity's place in forensic practice in different loci. We present recent scholarship related to human dignity and highlight the importance of dignity in forensic practice. Focusing on dignity in evaluator-evaluee and doctor-patient relationships should improve forensic work. Training in dignity-imbued forensic practice should remind us of the human dimensions of those we serve in the forensic arena.

Male sexual trauma presents multiple clinical challenges. Although the topic has received increased attention in the last couple decades, male sexual trauma continues to be underreported and underrecognized. This study aimed to investigate the long-term effects of sexual trauma for men who were victimized within an institutional environment by a person in a position of power. This study included data from 47 adult men who were victims of sexual abuse or misconduct by an assigned physician at a higher education academic institution between 1966 and 2003. A primary finding was elevated rates of intimacy and sexual problems and erectile dysfunction, which started shortly after the abuse and persisted over time. We found that there was an association between intimacy and sexual problems and difficulty maintaining employment, drug addiction, erectile dysfunction, and loss of meaningful and romantic relationships. Levels of potential psychopathology were prominently linked to loss of sexual interest or pleasure, intimacy concerns, and loss of intimate and other personal relationships. Men who experienced sexual abuse as adults within an institutional environment developed long-standing patterns of interpersonal and professional problems. This study emphasizes the need for nuanced screening, evaluation, and treatment for male sexual trauma.

During the COVID-19 pandemic, problem-solving courts adopted virtual hearings. We conducted an online nationwide survey with a convenience sample of court staff to elicit their perceptions of court participants' attendance, engagement, willingness to talk, and ability to form connection with judges during in-person versus virtual hearings. Sign tests compared ordinal ratings for perceptions of court participant outcomes during in-person versus virtual hearing modalities, and for audiovisual technology versus audio-only technology. The final analysis included 146 staff. Staff felt that during in-person hearings judges could form closer relationships with participants, quality of information exchanged was higher, and participants were more willing to talk. Staff rated attendance as high regardless of the modality. Staff felt participant engagement was higher with audiovisual technology than audio-only technology. Our results suggest that staff have concerns about effects of virtual hearings on court participant engagement and ability to form relationships with judges. Courts should address these potential negative effects of virtual hearings. We are concerned that staff perceived participants more negatively when participants used audio-only versus audiovisual technology, because technology access could be associated with participant demographic characteristics. Further research is needed to examine court participant perceptions and outcomes.

The practice of forensic psychiatry requires balance; the forensic psychiatrist encounters the need for balance routinely and in a variety of areas. Balance is necessary for sound judgment and objectivity when striving for excellence in the field. It is also necessary to effectively balance a career in forensic psychiatry with one's personal life. The American Academy of Psychiatry and the Law (AAPL) has stressed the virtue of balance in the preamble of its ethics guidelines, noting the importance of balancing competing obligations to the individual and society. Keeping in mind the importance of balance will assist forensic psychiatry with the many challenges of a postinternet era, such as rapidly changing technology, culture, and society. A substantial challenge for forensic psychiatry, now and in the future, involves data overflow and the so-called big data explosion. Information now flows too fast and in such vast amounts that a single individual can no longer keep pace. Balance may be pursued by adapting and leveraging certain skills to confront these challenges more effectively. The current inflection point of rapid technological, social, and cultural change, stresses the importance of balance through teamwork, technology, and prioritizing civil discourse.