International Journal of Law and Psychiatry最新文献

In the era of on-going efforts to empower persons with mental illness to be independent decision makers as informed by the United Nations' Convention on the Rights of Persons with Disability (CRPD), family members acting as substitute decision makers (SDM) for people suffering from disabling serious mental illness (SMI) remain an integral part of the medical-legal system in psychiatric care in many parts of the world, including Canada; yet their experiences and perspectives are rarely studied. This explorative qualitative study examines the lived experiences and reflections of 14 family member SDMs in Toronto, Canada. Five key themes related to being SDM emerged: 1) Varied subjective understanding of the responsibility and authority of the SDM role; 2) Varied role demands and impact on SDMs' lives; 3) Challenges in dealing with the mental health system; 4) Leveraging decision making status to promote patient care; and 5) SDM role impact on family relationships. The need to improve SDM understanding of their role, acknowledging their value and care-taker burden, finding a balance for their involvement, and improving their support in efforts to enhance care for the patients are discussed.

On 25 June 2021, the Law on Euthanasia in Spain came into force, providing for two modes of helping an individual end their life: euthanasia and/or medically assisted suicide. Among the requisites that a request for euthanasia has to fulfil are that the individual must be suffering a severe, chronic and debilitating condition or a severe and incurable disease, at the same time as that person shows the necessary competence to decide. The possibility exists that a patient suffering mental health problems submits such a request; however, the specific characteristics of a mental health disorder make such a request considerably more complex. In this article, based on a narrative review of the law itself and the related literature, the requisites established under the law are analysed from an ethical-legal perspective with the aim of defining when a request for euthanasia from a person with a mental health disorder may be deemed legitimate and in line with legal provisions. This should help clinicians make rational, reasoned decisions when dealing with a request of this type.

The draft Mental Health Bill published by the UK Government in July 2022 aims to reform mental health legislation in England and Wales. One significant proposal is to remove intellectual disability and autism from the scope of the legislation in all but a limited number of circumstances. The basis for this proposed change is not clear and there are no plans to introduce alternatives to the current legislation for people with intellectual disabilities and autism whose behaviour is challenging and present significant risks to themselves or others. This paper examines the implications of these proposals for people with intellectual disabilities. It considers the New Zealand experience as the only other common-law jurisdiction to implement a similar legislative change. Links to the government's Transforming Care de-institutionalisation programme and associated policies are explored and calls for a review of this approach are set out.

While the ethics of involuntary admission for psychiatric inpatient care is widely contested, the practice is legally permissible across most jurisdictions. In many countries, laws governing the use of involuntary admission set out core criteria under which involuntary admission is permitted; these parameters broadly related to either risk of harm to self or others, need for treatment, or both. In South Africa, the use of involuntary admission is governed by the Mental Health Care Act no. 17 of 2002 (MHCA 2002), which sets out clear criteria to direct mental healthcare practitioners' decision-making and delineates a process by which decision-making should occur. However, recent research suggests that, in practice, the process of decision-making differs from the procedure prescribed in the MHCA 2002. To further explore how decision-making for involuntary admission occurs in practice, we interviewed 20 mental healthcare practitioners, all with extensive experience of making involuntary admission decisions, working in district, regional, and tertiary hospitals across five provinces. We also interviewed four mental health advocates to explore patient-centered insights. Our analysis suggests that the final decision to involuntarily admit individuals for a 72-h assessment period under the MHCA 2002 was preceded by a series of ‘micro-decisions’ made by a range of stakeholders: 1) the family's or police's decision to bring the individual into hospital, 2) a triage nurse's decision to prioritise the individual along a mental healthcare pathway in the emergency centre, and 3) a medical officer's decision to sedate the individual. Practitioners reported that the outcomes of each of these ‘micro-decisions’ informed aspects of their final decision to admit an individual involuntarily. Our analysis therefore suggests that the final decision to admit involuntarily cannot be understood in isolation because practitioners draw on a range of additional information, gleaned from these prior ‘micro-decisions’, to inform the final decision to admit.

Psychopathy remains a relatively unexplored concept in Latin America. The abbreviated Self-Report Psychopathy Scale (SRP-SF) seems promising in this under-resourced context. However, the SRP-SF should be tested for measurement invariance to achieve meaningful comparison across countries in Latin America. Therefore the aims of this study were to examine the underlying factor structure of the SRP-SF in incarcerated adult male offenders from Uruguay (n = 331) and Chile (n = 208), to examine the measurement invariance of the SRP-SF across countries, and to assess the utility of SRP-SF to classify first time offenders from offenders with criminal history. Findings showed a good fit for the four-factor model in Uruguay, and both Chile and Uruguay showed invariance. Conversely, the Interpersonal and Affective factors were not associated with criminal history in the Uruguayan sample. Therefore, more studies are needed before using the SRP-SF as screening tool to classify first-time offenders and reoffenders in different countries in Latin America.

Sexual violence is a significant public health problem and a devastating issue for mental health throughout the world. Clinicians and researchers have worked, over the last decades, to develop effective strategies aimed at reducing sexual abuse rates. Multiple treatment approaches for sex offenders have been developed, with Cognitive Behavioral Therapy (CBT) been the most widely used therapy model with recognized effectiveness. In this sense, the present study aimed to analyze and evaluate the effectiveness of CBT based interventions in the treatment of individuals convicted of sexual crimes. For this purpose, a systematic review of articles published between 2012 and 2022 was carried out in the databases Pubmed, Science Direct, APA PsycNet and Scielo, with the keywords “cognitive behavioral therapy”, “CBT”, “sexual offender”, “sexual crimes” and others. As a result, eight studies were selected that met the defined inclusion criteria. Cognitive-behavioral interventions have shown great promise in reducing sexual crime recidivism and improving self-control, emotional regulation, intra and interpersonal social skills, supporting the hypothesis that CBT may be a promising model of intervention in forensic settings with sex offenders.

When people of any age, despite all possible support being provided, are unable to make a necessary decision, then it is important to have a legal framework which promotes and protects their rights. There is ongoing debate about how this can be achieved, in a non-discriminatory way, for adults but it is also an important consideration for children and young people.

In Northern Ireland, the Mental Capacity Act (Northern Ireland) 2016, when fully implemented will provide a non-discriminatory framework for those aged 16 and over. Arguably this addresses discrimination based on disability but continues to discriminate based on age. This article explores some of the possible ways the rights of those aged under 16 could be further promoted and protected.

These approaches may include: retaining the current combination of statute law but developing new guidance to inform practice for those aged under 16; codifying Gillick to clarify under what circumstances those aged under 16 can accept, and possibly also refuse, interventions; amend the Children (Northern Ireland) Order 1995 to provide a more comprehensive framework for health and welfare decision making; amend and extend the Mental Capacity Act (Northern Ireland) 2016 to apply to those aged under 16; or develop a new law specifically focused on the emerging capacity of those aged under 16.

There are complex issues involved including how to consider emerging or developmental decision-making ability, and the role of those with parental responsibility, but the complexities involved should not prevent these issues being addressed.

This article raises the question of the prospect of a common approach to mentally ill offenders in Europe, through a comparative discussion of the criminal insanity rules and systems in Norway and Bulgaria. The underlying motivation is to fill a gap in current legal research where the insanity discourse is still to a certain extent nationally oriented. Bulgaria is to date not represented at all in the international discussion of criminal insanity. Starting out from recognizing the different history, rules, culture and welfare of Norway and Bulgaria, the authors argue that these countries have a similar practical understanding of insanity and how it is associated with mental disorders as well as common challenges in their forensic and legal systems. These insights can provide a basis for further comparative explorations concerning a possible harmonization of insanity law in Europe.

Background

Incarcerated persons rank themselves according to the crime they have committed. Due to which, those lower in this hierarchy (e.g., paedophiles) are bullied. The goal of this paper was to better knowledge on older incarcerated adults' experiences of crime and social hierarchy in prisons.

Methods

Our results comprise data from 50 semi-structured interviews with older incarcerated persons. Data was assessed following thematic analysis.

Results

Our research showed that crime hierarchy occurs in prison and is recognized by older incarcerated individuals. Also, a social hierarchy based on various characteristics (e.g., ethnicity, education, language, mental health) is established within detention centres. This hierarchy is put forth by all persons deprived of liberty, but mostly by the ones at the bottom of the crime hierarchy, thus using it to portray themselves as better human beings than other incarcerated adults. They use the social hierarchy to cope with bullying whilst exhibiting coping mechanisms, such as the narcissistic facade. A concept we put forth as a novel idea.

Discussion

Our results show that crime hierarchy prevails in prison. Also, we explain the social hierarchy based on ethnicity, education, and other characteristics. Hence, being a victim of bullies, make lower-ranked (on the crime hierarchy) persons resort to social hierarchy to portray themselves as better individuals. This should not be considered as a personality disorder, but rather a narcissistic facade.

Background

In China, police departments usually initiate assessment of criminal responsibility after patients with mental disorders commit crimes. However, the specific conditions demanding assessment are not clearly stipulated by law. Few studies have been conducted on the epidemiological characteristics and assessment of criminal responsibility in patients with mental disorders. This study aimed to analyze the features and identify influencing factors for assessment of criminal responsibility for patients with mental disorders in a single-center cohort.

Methods

Cases undergoing criminal responsibility assessment at the Center of Forensic Science, East China University of Political Science and Law in Shanghai (CFS, ECUPL) between 2010 and 2020 were retrospectively reviewed. Criminal responsibility was categorized as criminal irresponsibility, diminished criminal responsibility, and full criminal responsibility. Differences among the groups were then statistically analyzed.

Results

In the study period, 437 patients including 361 males (82.61%) were referred for criminal responsibility assessment. Their ages ranged from 15 years to 91 years. After assessment, the number of cases with criminal irresponsibility, diminished criminal responsibility, and full criminal responsibility were 196 (44.85%), 181 (41.42%), and 60 (13.73%), respectively. The Chi-square test and nominal regression analysis showed that influencing factors for assessment of criminal responsibility comprised crime in public places (OR = 14.734; 95% CI: 1.463–148.424), crime in victim's residence (OR = 10.852; 95% CI: 1.068–110.214), crime in suspect's residence (OR = 9.542; 95% CI: 1.046–87.092), forensic psychiatric diagnosis of F1X (OR = 0.014,0.011; 95%CI:0.001–0.261,0–0.5), F2X (OR = 5.75; 95%CI:1.315–23.145), F4X (OR = 0.077; 95%CI:0.016–0.38,) and F6X (OR = 0.112,0.075; 95% CI: 0.022–0.558,0.006–0.959), criminal object of property (OR = 9.989; 95% CI: 1.305–76.455), cases of theft (OR = 0.09, 0.087; 95% CI: 0.013–0.648,0.012–0.654), and cases of endangering public security (OR = 0.152, 0.205; 95% CI: 0.034–0.678, 0.045–0.931).

Conclusion

Crime in public places, suspect's residence and victim's residence, forensic psychiatric diagnosis of F1X, F2X, F4X and F6X, criminal object of property, case types of theft and endangering public security were influencing factors in assessment of criminal responsibility. Therefore, special attention should be paid to patients with mental disorders under such circumstances in order to avoid bias on assessment of criminal responsibility.