International Journal of Law and Psychiatry最新文献

This study aimed to investigate the double mediation effect of entrapment and anger, as well as the moderated mediation effect of psychological flexibility and self-compassion on the relationship between the forensic psychiatric hospital ward climate and reactive aggression perceived by patients. A self-reporting method was used to measure ward climate, entrapment, anger, reactive aggression, psychological flexibility, and self-compassion in a sample of 246 participants being treated at the National Forensic Psychiatric Hospital. The relational model was verified according to the structural equation model analysis, and the double mediation effect of the conditional process model was verified using a Process macro. The results showed that both the simple mediation effect and the double mediation effect of entrapment and anger were statistically significant. Psychological flexibility significantly moderated the relationship between ward climate and entrapment, ward climate and anger-in, and significantly influenced the reduction of reactive aggression. When psychological flexibility was higher, ward climate did not cause entrapment, and the intensity of anger-in and reactive aggression was reduced. Self-compassion significantly reduced entrapment, and the higher the self-compassion, the lesser the entrapment. Finally, psychological flexibility and self-compassion moderated the indirect effect through entrapment and the indirect effect through anger-in on the relationship between the ward climate and reactive aggression. Hence, the moderated mediation effect by psychological flexibility and self-compassion was confirmed. To conclude our study, its limitations are outlined, and practical therapeutic intervention for preventing reactive aggression in forensic hospital patients is discussed.

The number of women involved with forensic mental health systems internationally is rising, however, limited research has explored the characteristics of those assessed for criminal responsibility. We investigated the demographic, psychiatric, and criminological characteristics of women recommended as eligible or ineligible for the defence of Not Criminally Responsible (NCR) on account of mental disorder following a criminal responsibility assessment in Central Canada. Data were collected through retrospective chart reviews of court-ordered criminal responsibility assessments for 109 women referred for evaluations between 2003 and 2019. Accused were an average age of 34.55 years, predominately identified as Indigenous (37.7%) or Caucasian (20.8%), and had often been charged with assault (47.7%). Women identified in the reports as NCR-eligible were significantly more likely to be employed, experience delusions during the index offence, and have expert reports linking their mental health symptoms to NCR legal criteria. They were also significantly less likely to have a personality disorder, substance-related diagnosis, or have used substances during the index offence. Delusions during the index offence significantly predicted assessment recommendations when controlling for age at assessment order, current substance-related diagnosis, and whether the expert report linked mental health symptoms to NCR legal criteria. Findings indicate the key factors considered by forensic mental health professionals when conducting criminal responsibility assessments with women. Meaningful differences exist between women identified as NCR-eligible and ineligible, with findings illustrating who may be more likely to receive services within the Canadian forensic mental health system.

Background

In 2019, the Council of Europe agreed to urge member states to take steps toward total abolition of psychiatric coercive measures.

Aims

To test if this aspiration is perceived as realistic and what the alternative would be in the event of a total abolition, we surveyed members of the European FOSTREN network of mental health practitioners and researchers, which is specifically dedicated to exchanging knowledge on reducing psychiatric coercion to its minimum.

Methods

Web-based survey. Categorical responses were analyzed using frequencies, and free text responses were analyzed through thematic analysis.

Results

In total, out of 167 invitations to FOSTREN network members, 76 responded to the survey (Response Rate 45.5%). A minority (31%) of participating experts dedicated to the reduction of psychiatric coercive measures believed a total abolition to be an achievable goal. A commonly held belief was that total abolition is not achievable because mental health disorders are difficult to treat and may cause violence, necessitating coercion, and there is a need to protect the involved persons from harm. Those responding that complete abolition is achievable argued that the consequences of coercion outweigh any gains and indicated that use of advance directives are sufficient as alternatives to coercion.

Conclusion

Of a European group of experts specifically dedicated to the reduction of psychiatric coercion who participated in this questionnaire study, a minority believed a total abolition be an achievable goal. The study adds to the empirical evidence of the feasibility of the aspiration to totally abolish involuntary measures in the mental health services from the perspective of experts.

In the United States and elsewhere around the world, people with serious mental illness (SMI) are overrepresented in the criminal justice system. Clinical interventions to divert such individuals out of correctional settings, including Assertive Community Treatment (ACT), have been shown to reduce rates of criminal justice recidivism when modified to allow for the use of court sanctions to encourage treatment adherence. However, these interventions are noted to be underutilized as alternative to incarceration (ATI) programs.

This paper summarizes the results of a retrospective cohort study conducted in a New York State forensic psychiatric hospital of 87 pretrial detainees admitted after being found incompetent to stand trial between January 2019 and January 2022. Of these, 49 patients were referred to an ACT team that served as an ATI program. The study outcomes noted that patients referred to this ACT team were 20% less likely to remain in pretrial detention than those that were not. Moreover, patients referred to the ACT program were also 34% more likely to be granted an ATI plea bargain in the community that did not involve serving a prison term. These results suggest that pretrial detainees with SMI are more likely to be granted an ATI program that offers more intensive treatment services such as ACT, due to the capability of such programs to also provide more intensive outreach and community supervision than traditional outpatient mental health service providers.

Extended suicide, a specific type of homicide-suicide event, has severe social consequences yet remains lacking systematic research. This retrospective study investigated 51 cases of extended suicide involving mental disorders in central China with aim of better understanding risk factors for such events and guiding prevention strategies. Over an 8-year period from 2015 to 2022, cases were collected from forensic institutions, and demographic characteristics, case details, and psychiatric data were recorded. The 51 incidents involved 51 perpetrators and 79 victims, with more female perpetrators (58.8%) and more female victims (54.4%). The average age of the perpetrators was 36.1, and most were married (88.2%). Almost all of the victims were family members of the perpetrator, like the most numerous children (64.6%), followed by spouses (24.1%). The most common homicide mode of death was mechanical asphyxia (38.0%), followed by sharp devices (36.7%) and drug poisoning (16.5%). Depressive disorders (76.5%) were the most common diagnosis of mental disorder for perpetrators. The study analyzed the unique characteristics of extended suicide to enrich such data. These findings help strengthen the screening and identification of potential perpetrators and victims to prevent such cases from occurring.

Scotland's mental health and capacity legislation and its implementation is underpinned by European Convention on Human Rights (ECHR) informed principles, and such legislation and its implementation has remained largely ECHR compliant. It is designed to protect individuals' autonomy from inappropriate and disproportionate nonconsensual intrusions but its scope is largely limited to this. However, since the legislation was enacted at the start of the twenty first century the UK subsequently ratified the UN Convention on the Rights of Persons with Disabilities (CRPD) which requires the law and related practice to focus on giving effect to all the rights of persons with mental disabilities (people living with psychosocial, cognitive and intellectual disabilities) on an equal basis with others and to actively support such equality in rights enjoyment.

The Terms of Reference of the independent Scottish Mental Health Law Review (2019–2022) included considering and making recommendations to align Scotland's mental health and capacity legislation with the CRPD. After engaging widely with stakeholders its recommendations sought to strengthen the voice of persons who use services and of those who care for them, reduce the need for non-consensual measures and secure rights to the help and support necessary to live a good life. In order to achieve this, it recommended, amongst other things, a refocusing on mental health and capacity law together with a Human Rights Enablement, Supported Decision Making and Autonomous Decision Making framework.

Background

Verbal and physical violence in psychiatric hospitals can have harmful consequences for staff members, such as physical injury, traumatisation, and sick leave, and they often accompany involuntary admission. Harm to others may co-occur with self-harm, i.e., dual harm. However, little is known about the association between dual-harm and violent behaviour towards staff members and its clinical outcomes, such as seclusion and rapid tranquilisation after involuntary admission to a psychiatric inpatient unit.

Method

A convenience sample of patients admitted involuntarily (N = 384; mean age = 48.03, SD = 19.92) between January 2016 and December 2019 in Western Brabant, the Netherlands, was used to design a retrospective file audit. Distinct harm groups, marked by the presence/absence of self- and/or other-harm, were investigated using multivariate linear regression modelling on the seriousness of violent acts and the total length of admission. Logistic regression analyses were used to study the association between harm groups and the administration of rapid tranquilisation, seclusion, and extended involuntary admissions.

Results

Several harm groups were identified, including self-harm only, other-harm only, and dual-harm groups. Psychiatric patients admitted to the hospital because of (the risk of) violence towards others had a higher risk of violent incidents during admission and some restrictive measures. In a subgroup of patients with psychotic disorders, patients with dual harm committed the most serious violent incidents compared to those in the other harm groups.

Conclusion

Distinct harm groups were identified in a sample of involuntarily admitted patients. In a general adult psychiatric setting, patients at risk for violent behaviour, especially dual-harm patients, should be identified and monitored as part of the risk assessment. Future research is needed to explore more clinical correlates in the proposed distinction between harmful groups and to assess long-term prognosis.

Introduction

This study examined the impact of statutory revisions in 2016 which aimed to enhance procedural justice within the process of civil commitment for persons diagnosed with mental illnesses (PDMI) in South Korea. These changes included requiring that PDMI pose a threat of danger to self or others and the need for treatment simultaneously as criteria for petitioning civil commitment. Additionally, the revision established a public entity to oversee the legitimacy of petitions to involuntarily commit PDMI to inpatient treatment. Despite these statutory changes, families providing care for PDMI still appear to depend on civil commitment as a way to seek respite from care burden, not necessarily to respond to psychiatric emergencies involving dangerousness. This practice seems to be aided by processes within the public entity providing oversight. Due to such barriers we hypothesized that, even after the statutory revision in 2016, PDMI who had been civilly committed following petitions from families will not exhibit elevated dangerousness compared to PDMI who had never been hospitalized during the same period.

Methods

Trained interviewers recruited 331 participants self-identified as PDMI from psychiatric rehabilitation agencies in the community and aided them in completing a survey including measures of self-reported hospitalization history, suicidality, and aggression toward others. Participants were classified into four groups: Family-petition committed (FPC) group (n = 30, 9.1%), voluntarily hospitalized (VH) group (n = 34, 10.3%), public-petition committed (PPC) group (n = 31, 9.4%), and never hospitalized (NH) group (n = 236, 71.3%). We conducted logistic regression analyses to compare self-reported dangerousness between groups with the NH group as the reference group.

Results

In the past 12 months, 43.5% of PDMI participants had self-reported behaviors that may have met the dangerousness criteria for civil commitment. Controlling for confounding factors, the PPC group was 2.96 times and 3.02 times as likely to report suicidal ideation and physical aggression, respectively, compared to the NH group. However, as hypothesized, the FPC group did not differ from the NH group on any indicator of self-reported dangerousness.

Conclusion

The findings were based on cross-sectional correlational data and should not be viewed as conclusive evidence that the 2016 statutory revision is ineffective in preventing family-petitioned civil commitment in cases where dangerousness is not apparent. Nevertheless, these findings encourage further empirical studies that illuminate the etiology of procedural justice in civil commitments petitioned by family members and that assess factors and contexts that promote the consideration of least coercive treatments, rather than resorting to involuntary hospitalization when psychiatric emer