Police officers' ability or inability to identify suspects' cognitive disabilities may directly influence how those suspects are treated and progress through the criminal justice process. Through qualitative interviews with police employees - including both frontline officers and investigators from six districts - this article explores the police's strategies for assessment and identification of cognitive disabilities. Findings show that police officers demonstrate varying levels of understanding of cognitive disabilities and that they base their assessments primarily on personal experience and instinct rather than on formal training and research-based practice. The article further explores legal protection implications by using two international human rights standards: the Convention on the Rights of Persons with Disabilities (CRPD) and the European Convention on Human Rights (ECHR). Findings underscore the importance of structural adaptations and training to ensure that individuals with cognitive disabilities receive fair treatment in the criminal justice system.
{"title":"\"Gut feeling and subtle signals\": Norwegian police officers' strategies for identifying cognitive disabilities in suspects during the initial stages of the legal process.","authors":"Nina Christine Dahl, Veerle Garrels, Kristina Kepinska Jakobsen","doi":"10.1016/j.ijlp.2026.102204","DOIUrl":"https://doi.org/10.1016/j.ijlp.2026.102204","url":null,"abstract":"<p><p>Police officers' ability or inability to identify suspects' cognitive disabilities may directly influence how those suspects are treated and progress through the criminal justice process. Through qualitative interviews with police employees - including both frontline officers and investigators from six districts - this article explores the police's strategies for assessment and identification of cognitive disabilities. Findings show that police officers demonstrate varying levels of understanding of cognitive disabilities and that they base their assessments primarily on personal experience and instinct rather than on formal training and research-based practice. The article further explores legal protection implications by using two international human rights standards: the Convention on the Rights of Persons with Disabilities (CRPD) and the European Convention on Human Rights (ECHR). Findings underscore the importance of structural adaptations and training to ensure that individuals with cognitive disabilities receive fair treatment in the criminal justice system.</p>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"106 ","pages":"102204"},"PeriodicalIF":1.3,"publicationDate":"2026-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-07DOI: 10.1016/j.ijlp.2026.102196
Gareth S Owen, Maria Koniarz, Alex Ruck Keene
This paper focuses on the nature of the assisted dying (AD) decision including the object of the mental capacity test. Specifically, we inquire into whether AD is a treatment decision. In Part I, we analyse how the AD decision is characterised in all international AD statutes also analysing what government guidance says when the primary legislation is ambiguous. In Part II, we address the question normatively: firstly, from the perspective of clinical ethics and secondly from the perspective of legal rules (the doctrine of informed consent and the duties of governments in states with socialised healthcare laws). We found that the nature of AD is variably characterised across international laws with a significant number (10/32) framing AD as a healthcare or treatment decision. In laws where the characterisation is ambiguous (14/32) government guidance tends toward a treatment characterisation. We argue in Part II that AD should not be classified as a treatment for reasons of clinical intelligibility, legal coherence and unintended policy consequences. We conclude with some recommendations, notwithstanding complexities, on a better characterisation of the decision to inform future AD policy research.
{"title":"Is assisted dying a treatment?","authors":"Gareth S Owen, Maria Koniarz, Alex Ruck Keene","doi":"10.1016/j.ijlp.2026.102196","DOIUrl":"https://doi.org/10.1016/j.ijlp.2026.102196","url":null,"abstract":"<p><p>This paper focuses on the nature of the assisted dying (AD) decision including the object of the mental capacity test. Specifically, we inquire into whether AD is a treatment decision. In Part I, we analyse how the AD decision is characterised in all international AD statutes also analysing what government guidance says when the primary legislation is ambiguous. In Part II, we address the question normatively: firstly, from the perspective of clinical ethics and secondly from the perspective of legal rules (the doctrine of informed consent and the duties of governments in states with socialised healthcare laws). We found that the nature of AD is variably characterised across international laws with a significant number (10/32) framing AD as a healthcare or treatment decision. In laws where the characterisation is ambiguous (14/32) government guidance tends toward a treatment characterisation. We argue in Part II that AD should not be classified as a treatment for reasons of clinical intelligibility, legal coherence and unintended policy consequences. We conclude with some recommendations, notwithstanding complexities, on a better characterisation of the decision to inform future AD policy research.</p>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"106 ","pages":"102196"},"PeriodicalIF":1.3,"publicationDate":"2026-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-06DOI: 10.1016/j.ijlp.2026.102193
Eimear Dunne, Art Malone, Alex Ruck Keene, Brian O'Donoghue, Nuala Kane
Anorexia Nervosa is an eating disorder typified by low body weight, restrictive eating behaviours, and body image distortion. It is associated with significant risk of medical complications, with one of the highest mortality rates of any mental illness. While the majority of patients receive treatment on a voluntary basis, a small proportion of severely ill patients refuse treatment and are treated involuntarily. The legal mechanisms used for involuntary treatment vary between jurisdictions, including mental health law, capacity-based law, guardianship, and use of inherent jurisdiction, the power of a superior court to rule on matters not included in statute. In Ireland, involuntary treatment of anorexia nervosa occurs within a legislative lacuna, not regulated by either the Mental Health Act 2001, or the Assisted Decision Making (Capacity) Act, 2015. Instead, treatment occurs under the Inherent Jurisdiction of the High Court, resulting in reliance on judicial discretion for decision-making. In this article, we explore the gaps in Ireland's current legal framework as applicable to care and treatment of anorexia nervosa, with reference to case law in England and Wales as a comparison. This includes an examination of the potential impact of the proposed changes to legislation as set out in the Mental Health Bill, 2024. We argue that these gaps mean that legislation governing the involuntary treatment of anorexia nervosa is urgently needed to safeguard the rights of this potentially vulnerable patient cohort, and ensure justice, transparency and consistency in legal approach.
{"title":"Involuntary treatment of anorexia nervosa in Ireland: Challenges and changes in the legal framework.","authors":"Eimear Dunne, Art Malone, Alex Ruck Keene, Brian O'Donoghue, Nuala Kane","doi":"10.1016/j.ijlp.2026.102193","DOIUrl":"https://doi.org/10.1016/j.ijlp.2026.102193","url":null,"abstract":"<p><p>Anorexia Nervosa is an eating disorder typified by low body weight, restrictive eating behaviours, and body image distortion. It is associated with significant risk of medical complications, with one of the highest mortality rates of any mental illness. While the majority of patients receive treatment on a voluntary basis, a small proportion of severely ill patients refuse treatment and are treated involuntarily. The legal mechanisms used for involuntary treatment vary between jurisdictions, including mental health law, capacity-based law, guardianship, and use of inherent jurisdiction, the power of a superior court to rule on matters not included in statute. In Ireland, involuntary treatment of anorexia nervosa occurs within a legislative lacuna, not regulated by either the Mental Health Act 2001, or the Assisted Decision Making (Capacity) Act, 2015. Instead, treatment occurs under the Inherent Jurisdiction of the High Court, resulting in reliance on judicial discretion for decision-making. In this article, we explore the gaps in Ireland's current legal framework as applicable to care and treatment of anorexia nervosa, with reference to case law in England and Wales as a comparison. This includes an examination of the potential impact of the proposed changes to legislation as set out in the Mental Health Bill, 2024. We argue that these gaps mean that legislation governing the involuntary treatment of anorexia nervosa is urgently needed to safeguard the rights of this potentially vulnerable patient cohort, and ensure justice, transparency and consistency in legal approach.</p>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"106 ","pages":"102193"},"PeriodicalIF":1.3,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1016/j.ijlp.2026.102197
Rachel Metcalfe-Hulme , Cliodhna O’Leary , Gavin Nobes , Ian Edwards , Peter Beazley
There has been limited research considering how different types of mental health information can influence juror decisions of guilt. The present study adopted an experimental methodology in which the amount of mental health information presented to contextualise an alleged offence of Criminal Damage was varied. Participants (n = 243) were randomly assigned to one of three conditions (‘control’: a mental health explanation could be reasonably inferred but was not directly stated; ‘symptoms only’: clear mental health symptoms were described but no diagnosis was provided; ‘symptoms + diagnosis’: which only differed from the ‘symptoms’ condition by additionally describing the condition as ‘paranoid schizophrenia’). Participants watched a series of videos depicting a fictional criminal trial and were asked to make judgements of guilt. Baseline stigma towards mental health conditions and mental health literacy (MHL) were measured using standardised scales. Guilt ratings were measured as the dependent variable. Regression analyses identified that mental health information, stigma, and MHL were all important predictors of guilt, however interaction effects indicated that people with higher MHL were particularly influenced by increasing mental health information (with guilt judgements decreasing more for those with higher MHL). A particularly notable finding was that the addition of a diagnosis of paranoid schizophrenia was associated with a reduction in guilt ratings, even after controlling for all other factors. The results are relevant to the way in which mental health conditions are described in the courtroom, and suggestions are made for future research.
{"title":"Juror decision making: Does juror stigma, mental health literacy, or the description of a defendant's mental health status, impact decision-making in a mock criminal trial?","authors":"Rachel Metcalfe-Hulme , Cliodhna O’Leary , Gavin Nobes , Ian Edwards , Peter Beazley","doi":"10.1016/j.ijlp.2026.102197","DOIUrl":"10.1016/j.ijlp.2026.102197","url":null,"abstract":"<div><div>There has been limited research considering how different types of mental health information can influence juror decisions of guilt. The present study adopted an experimental methodology in which the amount of mental health information presented to contextualise an alleged offence of Criminal Damage was varied. Participants (<em>n</em> = 243) were randomly assigned to one of three conditions (‘control’: a mental health explanation could be reasonably inferred but was not directly stated; ‘symptoms only’: clear mental health symptoms were described but no diagnosis was provided; ‘symptoms + diagnosis’: which only differed from the ‘symptoms’ condition by additionally describing the condition as ‘paranoid schizophrenia’). Participants watched a series of videos depicting a fictional criminal trial and were asked to make judgements of guilt. Baseline stigma towards mental health conditions and mental health literacy (MHL) were measured using standardised scales. Guilt ratings were measured as the dependent variable. Regression analyses identified that mental health information, stigma, and MHL were all important predictors of guilt, however interaction effects indicated that people with higher MHL were particularly influenced by increasing mental health information (with guilt judgements decreasing more for those with higher MHL). A particularly notable finding was that the addition of a diagnosis of paranoid schizophrenia was associated with a reduction in guilt ratings, even after controlling for all other factors. The results are relevant to the way in which mental health conditions are described in the courtroom, and suggestions are made for future research.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"106 ","pages":"Article 102197"},"PeriodicalIF":1.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146116600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Decision-making is part of our daily lives. However, for those who lack mental capacity to make specific decisions, such as where to live, the decision-making process may require others to make the decision in their Best Interests. The aim of this research study was to explore how decisions were made for individuals with a learning disability when they lacked the mental capacity to make a specific decision. The research focused on those whose decision-making may be impaired and so has not excluded people if they lack the capacity to understand the research. Instead, facilitated by the partial implementation of the Mental Capacity Act (NI) 2016, and underpinned by ethical approval and procedural safeguards, those individuals with a learning disability who did not have capacity to understand this study, were recruited and permitted to participate. Using a mixed methods approach the results demonstrate the value of including the voices of individuals with a learning disability who have had direct experience of Best Interests decisions. Furthermore, including professionals highlighted their perspectives of the Best Interests decision-making process. The findings reinforce the importance of involving the individual and their carers / supporters throughout the decision-making process including making them aware of the options available and how the individual's preferences are captured. The research suggests the need for a regionally agreed approach to Best Interests decision-making processes in Northern Ireland. A three-stage model to support decision-making has been developed by the research team and is currently being piloted by the Department of Health in Northern Ireland. Further research is required to explore the experiences of carers / supporters of individuals who are subject to Best Interests decisions.
{"title":"Best Interests decision-making processes in learning disability services in Northern Ireland","authors":"Danielle McIlroy, Lorna Montgomery, Gavin Davidson","doi":"10.1016/j.ijlp.2025.102185","DOIUrl":"10.1016/j.ijlp.2025.102185","url":null,"abstract":"<div><div>Decision-making is part of our daily lives. However, for those who lack mental capacity to make specific decisions, such as where to live, the decision-making process may require others to make the decision in their Best Interests. The aim of this research study was to explore how decisions were made for individuals with a learning disability when they lacked the mental capacity to make a specific decision. The research focused on those whose decision-making may be impaired and so has not excluded people if they lack the capacity to understand the research. Instead, facilitated by the partial implementation of the Mental Capacity Act (NI) 2016, and underpinned by ethical approval and procedural safeguards, those individuals with a learning disability who did not have capacity to understand this study, were recruited and permitted to participate. Using a mixed methods approach the results demonstrate the value of including the voices of individuals with a learning disability who have had direct experience of Best Interests decisions. Furthermore, including professionals highlighted their perspectives of the Best Interests decision-making process. The findings reinforce the importance of involving the individual and their carers / supporters throughout the decision-making process including making them aware of the options available and how the individual's preferences are captured. The research suggests the need for a regionally agreed approach to Best Interests decision-making processes in Northern Ireland. A three-stage model to support decision-making has been developed by the research team and is currently being piloted by the Department of Health in Northern Ireland. Further research is required to explore the experiences of carers / supporters of individuals who are subject to Best Interests decisions.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"105 ","pages":"Article 102185"},"PeriodicalIF":1.3,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1016/j.ijlp.2026.102190
Felipe Rodrigues De Queiroz , Natalia Vieira Souza Jordão
This study investigates the discordance between forensic psychiatric reports and judicial decisions in Brazilian civil and administrative litigation. Using a retrospective documentary design, we analyzed a random sample of 200 cases (50 per domain) from the Brazilian Electronic Judicial Process (PJe) across four areas: social security (INSS), public service examinations, access to medications, and alleged medical error. Overall concordance was high (87.5%), but 12.5% of cases showed discordance, which clustered significantly in public service examinations (20%) and medical error disputes (20%), with no discordance in social security cases. Qualitative analysis revealed that judicial divergence often stems from the reinterpretation of clinical findings through normative constructs such as “residual capacity” or “duty of diligence,” and is facilitated by reports with low structural standardization. Multivariable analysis indicated that longer time lags between the index event and evaluation, along with the absence of structured instruments, were associated with higher odds of discordance. The findings highlight the need for standardized reporting protocols and interdisciplinary training to strengthen the interface between forensic psychiatry and the law in Brazil.
{"title":"Between expertise and judgment: Discordance between forensic psychiatric reports and judicial decisions in Brazilian litigation","authors":"Felipe Rodrigues De Queiroz , Natalia Vieira Souza Jordão","doi":"10.1016/j.ijlp.2026.102190","DOIUrl":"10.1016/j.ijlp.2026.102190","url":null,"abstract":"<div><div>This study investigates the discordance between forensic psychiatric reports and judicial decisions in Brazilian civil and administrative litigation. Using a retrospective documentary design, we analyzed a random sample of 200 cases (50 per domain) from the Brazilian Electronic Judicial Process (PJe) across four areas: social security (INSS), public service examinations, access to medications, and alleged medical error. Overall concordance was high (87.5%), but 12.5% of cases showed discordance, which clustered significantly in public service examinations (20%) and medical error disputes (20%), with no discordance in social security cases. Qualitative analysis revealed that judicial divergence often stems from the reinterpretation of clinical findings through normative constructs such as “residual capacity” or “duty of diligence,” and is facilitated by reports with low structural standardization. Multivariable analysis indicated that longer time lags between the index event and evaluation, along with the absence of structured instruments, were associated with higher odds of discordance. The findings highlight the need for standardized reporting protocols and interdisciplinary training to strengthen the interface between forensic psychiatry and the law in Brazil.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"105 ","pages":"Article 102190"},"PeriodicalIF":1.3,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1016/j.ijlp.2026.102195
Steph Kerr , Danielle McIlroy , Gavin Davidson
The use of restraint in health and social care settings, particularly for individuals who lack capacity, remains a complex and contentious legal and ethical issue. Restraint encompasses a range of interventions, including but not limited to physical, chemical, mechanical, and psychological methods, each requiring stringent safeguards to prevent misuse and ensure compliance with human rights standards. The phased implementation of the Mental Capacity Act (Northern Ireland) 2016, particularly Section 12 which focuses specifically on restraint, marks a significant shift towards a more rights-based approach, aligning legal and policy frameworks with ethical principles of autonomy and dignity. This article critically analyses the evolving regulatory landscape governing restraint, drawing on key legislation, the Department of Health's (2023) Regional Policy on the use of Restrictive Practices in Health and Social Care Settings and relevant case law. It further explores ethical dilemmas and operational challenges, including staff training, documentation, and oversight mechanisms necessary for lawful and proportionate restraint use. Finally, the article examines preventative strategies through person-centred care approaches, advocating for a cultural shift towards minimising restrictive interventions and promoting human rights-driven practice.
{"title":"Restraint in health and social care settings","authors":"Steph Kerr , Danielle McIlroy , Gavin Davidson","doi":"10.1016/j.ijlp.2026.102195","DOIUrl":"10.1016/j.ijlp.2026.102195","url":null,"abstract":"<div><div>The use of restraint in health and social care settings, particularly for individuals who lack capacity, remains a complex and contentious legal and ethical issue. Restraint encompasses a range of interventions, including but not limited to physical, chemical, mechanical, and psychological methods, each requiring stringent safeguards to prevent misuse and ensure compliance with human rights standards. The phased implementation of the Mental Capacity Act (Northern Ireland) 2016, particularly Section 12 which focuses specifically on restraint, marks a significant shift towards a more rights-based approach, aligning legal and policy frameworks with ethical principles of autonomy and dignity. This article critically analyses the evolving regulatory landscape governing restraint, drawing on key legislation, the <span><span>Department of Health's (2023)</span></span> Regional Policy on the use of Restrictive Practices in Health and Social Care Settings and relevant case law. It further explores ethical dilemmas and operational challenges, including staff training, documentation, and oversight mechanisms necessary for lawful and proportionate restraint use. Finally, the article examines preventative strategies through person-centred care approaches, advocating for a cultural shift towards minimising restrictive interventions and promoting human rights-driven practice.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"105 ","pages":"Article 102195"},"PeriodicalIF":1.3,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-27DOI: 10.1016/j.ijlp.2026.102192
Yan Gu , Yong He , Yingying Xie , Wenqian Lu , Hao Liu , Yan Li , Gangqin Li
Background
Studies have suggested that there are common violence risk factors in both patients with schizophrenia and the general population, a comparison of the characteristics of these two distinct groups could allow for a better understanding.
Methods
Forensic archives of criminal cases in a Chinese Forensic Centre from January 2015 to December 2019 were reviewed. The male criminal offenders were included and divided into four groups: ① violent and ② non-violent offenders with schizophrenia, and ③ violent and ④ non-violent offenders without mental illness. The sociodemographic, criminological, and clinical information were extracted from the archives, and the psychiatric symptoms, social function, and aggressive behaviors were quantified using the brief psychiatric rating scale, the social disability screening schedule, and the modified overt aggression scale. Data were compared between the four groups and the influencing factors for violence were examined.
Results
Three hundred and twenty-one male offenders with schizophrenia (234 violent, 87 non-violent) and 186 male offenders without mental illness were included. Results showed that the violent offenses committed by patients with schizophrenia were more likely to target family members and relatives, occur in rural and public areas, and have fewer quarrels before the offense. Thought disorders and hostility-suspiciousness were identified as the violence risk factors for the patients with schizophrenia. Verbal aggression was a common violence risk factor in both patients with schizophrenia and the people without mental illness.
Conclusions
Violence prevention and intervention for patients with schizophrenia need to focus more on verbal aggression, thought disorders, and hostility-suspiciousness.
{"title":"Distinctive and common risk factors contributing to violent offending in patients with schizophrenia compared to people without a mental illness","authors":"Yan Gu , Yong He , Yingying Xie , Wenqian Lu , Hao Liu , Yan Li , Gangqin Li","doi":"10.1016/j.ijlp.2026.102192","DOIUrl":"10.1016/j.ijlp.2026.102192","url":null,"abstract":"<div><h3>Background</h3><div>Studies have suggested that there are common violence risk factors in both patients with schizophrenia and the general population, a comparison of the characteristics of these two distinct groups could allow for a better understanding.</div></div><div><h3>Methods</h3><div>Forensic archives of criminal cases in a Chinese Forensic Centre from January 2015 to December 2019 were reviewed. The male criminal offenders were included and divided into four groups: ① violent and ② non-violent offenders with schizophrenia, and ③ violent and ④ non-violent offenders without mental illness. The sociodemographic, criminological, and clinical information were extracted from the archives, and the psychiatric symptoms, social function, and aggressive behaviors were quantified using the brief psychiatric rating scale, the social disability screening schedule, and the modified overt aggression scale. Data were compared between the four groups and the influencing factors for violence were examined.</div></div><div><h3>Results</h3><div>Three hundred and twenty-one male offenders with schizophrenia (234 violent, 87 non-violent) and 186 male offenders without mental illness were included. Results showed that the violent offenses committed by patients with schizophrenia were more likely to target family members and relatives, occur in rural and public areas, and have fewer quarrels before the offense. Thought disorders and hostility-suspiciousness were identified as the violence risk factors for the patients with schizophrenia. Verbal aggression was a common violence risk factor in both patients with schizophrenia and the people without mental illness.</div></div><div><h3>Conclusions</h3><div>Violence prevention and intervention for patients with schizophrenia need to focus more on verbal aggression, thought disorders, and hostility-suspiciousness.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"105 ","pages":"Article 102192"},"PeriodicalIF":1.3,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-23DOI: 10.1016/j.ijlp.2026.102194
Anthony S. David
Background
Insight is an important facet of psychosis which can predict many clinical outcomes. Recently, the construct has come under scrutiny, particularly in medicolegal settings where lack of insight is given as a justification for involuntary treatment.
Objectives
This article reviews the arguments around the use of insight in evidence in cases of involuntary treatment and admission to hospital, and capacity to make healthcare-related decisions. It aims to clarify the place of insight and how it might be used beneficially in such discussions for clinicians and legal practitioners.
Methods
This is a narrative review of the insight construct in clinical psychiatry and medicolegal settings. The article draws on case material and in particular a recent case brought before the England and Wales Court of Protection (CoP).
Results
The insight concept is most often used to explain non-compliance with treatment and rejection of or disbelief in a mental illness diagnosis, where it has been faulted on grounds of circular reasoning. Its invocation in legal settings has been criticised, not least by the National Institute of Health and Care Excellence (NICE) since insight is often poorly defined and is not part of the criteria for, for example, mental incapacity. Nevertheless, a deeper understanding of what psychiatrists mean by insight can help in understanding how a patient's psychotic illness might seriously impair their capacity and lead to them to require care without their consent. The case discussed in the CoP exemplifies how insight can be misunderstood and misused by parties in a dispute.
Discussion
Insight remains a commonly discussed aspect of psychopathology and frequently arises in medicolegal arguments. Mental health practitioners giving clinical accounts and expert testimony should be aware of the strict definition of mental capacity and criteria for involuntary treatment. If they wish to refer to the patient's insight, they should take care to define what they mean but crucially they should carefully explain how insight can shed light on aspects of capacity, as advised by NICE. However, poor insight is a core aspect of psychosis and is closely related to lack of capacity and (contra NICE) should not be treated as a distinct concept.
{"title":"Insight, the law and psychiatry: Going round in circles or playing nice?","authors":"Anthony S. David","doi":"10.1016/j.ijlp.2026.102194","DOIUrl":"10.1016/j.ijlp.2026.102194","url":null,"abstract":"<div><h3>Background</h3><div>Insight is an important facet of psychosis which can predict many clinical outcomes. Recently, the construct has come under scrutiny, particularly in medicolegal settings where lack of insight is given as a justification for involuntary treatment.</div></div><div><h3>Objectives</h3><div>This article reviews the arguments around the use of insight in evidence in cases of involuntary treatment and admission to hospital, and capacity to make healthcare-related decisions. It aims to clarify the place of insight and how it might be used beneficially in such discussions for clinicians and legal practitioners.</div></div><div><h3>Methods</h3><div>This is a narrative review of the insight construct in clinical psychiatry and medicolegal settings. The article draws on case material and in particular a recent case brought before the England and Wales Court of Protection (CoP).</div></div><div><h3>Results</h3><div>The insight concept is most often used to explain non-compliance with treatment and rejection of or disbelief in a mental illness diagnosis, where it has been faulted on grounds of circular reasoning. Its invocation in legal settings has been criticised, not least by the National Institute of Health and Care Excellence (NICE) since insight is often poorly defined and is not part of the criteria for, for example, mental incapacity. Nevertheless, a deeper understanding of what psychiatrists mean by insight can help in understanding how a patient's psychotic illness might seriously impair their capacity and lead to them to require care without their consent. The case discussed in the CoP exemplifies how insight can be misunderstood and misused by parties in a dispute.</div></div><div><h3>Discussion</h3><div>Insight remains a commonly discussed aspect of psychopathology and frequently arises in medicolegal arguments. Mental health practitioners giving clinical accounts and expert testimony should be aware of the strict definition of mental capacity and criteria for involuntary treatment. If they wish to refer to the patient's insight, they should take care to define what they mean but crucially they should carefully explain how insight can shed light on aspects of capacity, as advised by NICE. However, poor insight is a core aspect of psychosis and is closely related to lack of capacity and (<em>contra</em> NICE) should not be treated as a distinct concept.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"105 ","pages":"Article 102194"},"PeriodicalIF":1.3,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-23DOI: 10.1016/j.ijlp.2026.102191
Jona Carlet, Florian Hotzy, Anke Maatz, Philipp Homan, Mario Müller
Background
Involuntary admission (IA) is a contentious practice in mental healthcare, justified only to prevent harm to self or others. Previous studies have identified individual sociodemographic characteristics as risk factors for IA. Intersectional theories argue that such approaches overlook the complexities of social identities and related health inequalities. Intersectionality stresses the interconnected nature of social identities, such as race or class, and analyses how these overlapping factors create unique experiences of marginalisation and discrimination. This study aimed to adopt an intersectional framework to identify subgroups with specific sociodemographic characteristics and assess their risk for IA. We hypothesized that groups facing multiple forms of marginalisation would be strongly associated with higher risk for IA.
Methods
We analysed data from 16,024 cases at the Psychiatric University Clinic Zurich, Switzerland, between 2017 and 2020 using Latent Class Analysis to identify subgroups with distinct sociodemographic characteristics. Variables included sex, age, nationality, residence status, educational attainment, employment status, and language proficiency. Classes were validated against clinical factors including IA.
Results
Four distinct classes emerged. The class most strongly associated with IA was characterized by unemployment, social welfare dependency, non-European citizenship, temporary residency or refugee status, and low educational attainment. In contrast, classes with Swiss nationality, permanent residency, and employment were significantly less likely to experience IA.
Conclusion
Adopting an intersectional framework, our findings suggest that individuals facing multiple marginalised identities are at higher risk for IA, indicating possible barriers to voluntary and early treatment. Further research is needed to explore and address these barriers.
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