International Journal of Law and Psychiatry最新文献_第2页

Ethical, clinical, and legal challenges of mental health care in prisons: between constraints and clinical integrity 监狱精神卫生保健的伦理、临床和法律挑战：在约束与临床诚信之间。

IF 1.3 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2026-03-01 Epub Date: 2025-12-08 DOI: 10.1016/j.ijlp.2025.102165

Bruna Paulino Alves , Mariana Pinto da Costa , Thomas Pollmächer , Meryam Schouler-Ocak , Luis Madeira

Background

Prison populations experience disproportionately high rates of mental disorders and suicidality, often receiving inadequate care in settings primarily designed for punishment rather than treatment. Prisons, increasingly serving as de facto psychiatric institutions, present distinct ethical, legal, and clinical challenges for mental health professionals.

Objectives

This paper explores the ethical dilemmas in correctional mental health care, focusing on confidentiality, the principle of equivalence of care, and the dual role of clinicians. It critically examines clinical practices such as suicide prevention, psychopharmacological treatment, management of violence, and end-of-life decisions, and offers recommendations for ethical care in prison environments.

Methods

A comprehensive literature review was conducted using PubMed and major journals in psychiatry and bioethics, supplemented by policy documents from WHO, UN, and WPA. Guided by expert consultation, the thematic analysis included 97 articles and 6 book chapters. Expert feedback from the EPA ethics committee informed the final recommendations.

Results

Key findings highlight tensions between institutional control and therapeutic ethics, especially regarding confidentiality breaches, consent, and coercive practices. Structural factors—Overcrowding, under-resourcing, and stigmatization—Compromise the feasibility of equivalence of care. Ethical concerns intensify around suicide, substance use, neurocorrections, solitary confinement, and the death penalty.

Conclusion

Correctional mental health care requires ethically robust, rights-based approaches responsive to both clinical needs and institutional constraints. Implementing context-sensitive guidelines, improving training, ensuring continuity of care, and upholding patient autonomy are critical for safeguarding dignity and therapeutic integrity within prisons.

背景：监狱人口的精神障碍和自杀率高得不成比例，在主要用于惩罚而不是治疗的环境中，往往得不到适当的照顾。监狱越来越多地成为事实上的精神病院，给精神卫生专业人员带来了明显的道德、法律和临床挑战。目的：探讨惩教精神卫生保健中的伦理困境，重点关注保密、护理对等原则和临床医生的双重角色。它严格审查临床实践，如自杀预防、精神药物治疗、暴力管理和临终决定，并为监狱环境中的道德护理提供建议。方法：采用PubMed和主要的精神病学和生物伦理学期刊，辅以WHO、UN和WPA的政策文件，进行全面的文献综述。在专家咨询的指导下，专题分析包括97篇文章和6本书章节。来自EPA伦理委员会的专家反馈为最终建议提供了依据。结果：主要发现强调了机构控制和治疗伦理之间的紧张关系，特别是在违反保密规定、同意和强制做法方面。结构性因素——过度拥挤、资源不足和污名化——损害了同等护理的可行性。关于自杀、药物使用、神经矫正、单独监禁和死刑的伦理担忧加剧。结论：惩教精神卫生保健需要道德健全、基于权利的方法，以应对临床需求和体制限制。实施对具体情况敏感的指导方针、改进培训、确保护理的连续性和维护病人的自主权，对于维护监狱内的尊严和治疗的完整性至关重要。

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引用次数: 0

An integrative review exploring decision-making processes in forensic psychopathology investigations 综合审查探索决策过程在法医精神病理学调查

IF 1.3 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2026-03-01 Epub Date: 2025-11-26 DOI: 10.1016/j.ijlp.2025.102170

Barchielli Benedetta , Cricenti Clarissa , Giantesani Mario , Parmigiani Giovanna , Ferracuti Stefano , Scarpazza Cristina

Forensic psychopathology assessments play a critical role in legal decisions, particularly those related to criminal responsibility. However, despite their influence, the decision-making processes behind these assessments remain largely underexplored and inconsistently supported by empirical evidence. Emerging literature suggests that these decisions are shaped by multiple factors, including individual reasoning styles, team dynamics, and the influence of cognitive biases.

Aim

To explore the factors that influence expert decision-making in forensic psychopathology evaluations, with a focus on cognitive bias, procedural complexity, and the use of structured tools.

Method

An integrative review guided by Cooper's framework was conducted. Eight studies meeting inclusion criteria were analyzed using narrative synthesis and thematic coding.

Results

Three key themes were identified: (1) cognitive bias as a pervasive influence on expert judgment, (2) the iterative and context-dependent nature of forensic decision-making, and (3) inconsistencies between subjective clinical reasoning and structured assessment tools. While structured professional judgment tools and validated instruments showed potential for increasing accuracy and inter-rater reliability, their use remained uneven. Additionally, experienced clinicians often favored subjective judgment over formalized methods, which may limit transparency and reproducibility. The review highlights the need to reframe forensic evaluation as a reflective, evidence-informed process grounded in transparency and standardization. Integrating structured methods and debiasing strategies from other medical disciplines may enhance the validity and fairness of forensic judgments. These findings have implications for clinical training, interdisciplinary collaboration, and legal policy, and underscore the urgency of further research in this underdeveloped area of forensic mental health.

法医精神病理学评估在法律决定中发挥着关键作用，特别是那些与刑事责任有关的决定。然而，尽管它们有影响，但这些评估背后的决策过程在很大程度上仍未得到充分探索，也没有得到经验证据的一致支持。新兴文献表明，这些决策受到多种因素的影响，包括个人推理风格、团队动态和认知偏见的影响。目的探讨影响法医精神病理学评估专家决策的因素，重点关注认知偏差、程序复杂性和结构化工具的使用。方法在Cooper的框架指导下进行综合评价。采用叙事综合和主题编码对符合纳入标准的8项研究进行了分析。结果确定了三个关键主题：(1)认知偏见对专家判断的普遍影响；(2)法医决策的迭代性和情境依赖性；(3)主观临床推理与结构化评估工具之间的不一致性。虽然结构化的专业判断工具和经过验证的仪器显示出提高准确性和评估者之间可靠性的潜力，但它们的使用仍然不均衡。此外，经验丰富的临床医生往往倾向于主观判断，而不是正式的方法，这可能会限制透明度和可重复性。审查强调需要将法医评估重新定义为基于透明度和标准化的反思性、循证过程。整合其他医学学科的结构化方法和消除偏见的策略可以提高法医判断的有效性和公平性。这些发现对临床培训、跨学科合作和法律政策具有启示意义，并强调了在法医精神卫生这一不发达领域进一步研究的紧迫性。

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引用次数: 0

Is anti-ligature an automatic requirement for suicide prevention?: Assessing legal obligations in alternative mental health crisis services 反结扎是预防自杀的必然要求吗？评估替代性心理健康危机服务中的法律义务

IF 1.3 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2026-03-01 Epub Date: 2026-01-07 DOI: 10.1016/j.ijlp.2025.102182

Joshua Finn , Piers Gooding , Lisa Brophy , Deb Carlon , Chris Maylea

Around the world, peer-run, bed-based services that offer voluntary support to people experiencing mental health crisis are emerging as alternatives to hospital-based mental healthcare. In Victoria, Australia, where these ‘alternative crisis services’ are expanding, a key legal question has arisen: must non-coercive settings adopt the suicide prevention architectural design (or ‘anti-ligature design’) mandated in psychiatric wards under negligence and occupational health and safety laws?

This article answers that question through a three-stage study: (1) a doctrinal analysis of Victorian case law and statutes that shape duties to prevent suicide; (2) a narrative review of evidence on anti-ligature measures in hospital environments; and (3) thematic analysis of interviews with clinicians, designers, peer leaders and legal experts (n = 12).

The findings indicate that empirical evidence only associates anti-ligature design with reduced suicide rates when paired with search, detention and close observation powers, which are absent from alternative crisis services. There was no evidence identified that anti-ligature design will reduce suicide in settings which do not also implement these practices.

This absence of data does not justify retreat to institutional templates, especially considering key differences in the care models that differentiate alternative crisis services from traditional hospital-based offerings. Interviewees warned that conspicuous anti-ligature hardware can undermine the therapeutic value of alternative crisis services, and merely displace, rather than prevent, suicidal behaviour. Wholesale transplantation of hospital anti-ligature standards into alternative crisis services is therefore unlikely to satisfy the ‘reasonableness’ test and may contravene the therapeutic mandate of services. Instead, this study calls for regulators to endorse context-specific standards for mental health service design, some of which may require further empirical research on rights-based, peer-led safety strategies.

在世界各地，为经历精神健康危机的人提供自愿支持的同行经营的床位服务正在成为医院精神保健的替代方案。在澳大利亚的维多利亚州，这些“另类危机服务”正在扩大，一个关键的法律问题出现了：非强制性环境是否必须采用疏忽和职业健康安全法规定的精神病院的自杀预防建筑设计（或“反捆绑设计”）？本文通过三个阶段的研究来回答这个问题：(1)对维多利亚判例法和制定防止自杀责任的法规进行理论分析；(2)对医院环境中抗结扎措施的证据进行述评；(3)对临床医生、设计师、同行领导和法律专家的访谈进行专题分析（n = 12）。研究结果表明，经验证据表明，只有在与搜查、拘留和密切观察权力相结合的情况下，反捆绑设计才能降低自杀率，而这些在其他危机服务中是不存在的。没有证据表明，在没有实施这些做法的环境中，反捆绑设计将减少自杀。数据的缺乏并不能成为退回到机构模板的理由，特别是考虑到区分替代性危机服务与传统医院服务的护理模式的关键差异。受访者警告说，引人注目的反捆绑硬件会破坏替代性危机服务的治疗价值，而且只会取代而不是预防自杀行为。因此，将医院反结扎标准大规模移植到替代危机服务中不太可能满足“合理性”测试，并可能违反服务的治疗任务。相反，这项研究呼吁监管机构认可心理健康服务设计的具体环境标准，其中一些标准可能需要对基于权利的、同行主导的安全策略进行进一步的实证研究。

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引用次数: 0

Involuntary patients awareness of their entitlement to appeal an admission and existence of the mental health review board in South Africa 非自愿病人意识到他们有权对南非精神健康审查委员会的接纳和存在提出上诉。

IF 1.3 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2026-03-01 Epub Date: 2025-12-02 DOI: 10.1016/j.ijlp.2025.102184

Shamima Saloojee, Zinhle Shozi, Vuyokazi Ntlantsana, Sibongile Mashapu

Background

South Africa's mental health law is person-centred, has a strong human rights emphasis, and includes the appointment of mental health review boards (MHRB) to provide oversight and consider appeals against involuntary admissions. Owing to the low number of appeals, this study aimed to determine the proportion of involuntary patients who were aware of their right to appeal at two public sector psychiatric hospitals in KwaZulu Natal Province.

Method

A group of conveniently selected involuntary patients was interviewed in a descriptive study that entailed the collection of quantitative data through the administration of a study-specific questionnaire, and the Birchwood Insight Scale from June 2020 to December 2020.

Results

Of the 131 participants, most were unemployed (72.5 %) and had at least a high school level of education (61.06 %). The majority were diagnosed with a psychotic disorder (79.4 %), with a median duration of admission of 17.00 days (IQR 9.00, 69.00), and 63.4 % had good insight into their illness. Not a single patient appealed the current involuntary admission, and only one patient appealed a previous admission.

Only 11.5 % of the participants were aware that they had the right to appeal their admission, and 8.4 % were aware of the existence of the MHRB.

Conclusion

Most patients were unaware of their legal right to appeal and of the MHRB, highlighting the challenges in implementing the letter and practice of the law in underresourced settings without the necessary pre-conditions to fully realise its spirit.

背景：南非的精神卫生法以人为本，非常强调人权，其中包括任命精神健康审查委员会（MHRB）监督和审议针对非自愿收容的上诉。由于上诉数量少，这项研究旨在确定在夸祖鲁-纳塔尔省两家公立精神病医院了解自己有权上诉的非自愿病人的比例。方法：在一项描述性研究中，对一组方便选择的非自愿患者进行访谈，该研究需要通过管理研究特定问卷和Birchwood Insight Scale收集定量数据，时间为2020年6月至2020年12月。结果：在131名参与者中，大多数人失业（72.5%），至少有高中教育水平（61.06%）。大多数被诊断为精神障碍（79.4%），中位住院时间为17.00天（IQR 9.00, 69.00）， 63.4%对自己的疾病有很好的了解。没有一个病人对目前的非自愿入院提出上诉，只有一个病人对以前的入院提出上诉。只有11.5%的参与者知道他们有权对自己的录取提出上诉，8.4%的参与者知道MHRB的存在。结论：大多数患者不知道他们的合法上诉权利和MHRB，突出了在资源不足的环境中实施法律条文和实践的挑战，没有必要的先决条件来充分实现其精神。

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引用次数: 0

Between expertise and judgment: Discordance between forensic psychiatric reports and judicial decisions in Brazilian litigation 在专业知识和判断之间：巴西诉讼中法医精神病学报告和司法判决之间的不一致

IF 1.3 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2026-03-01 Epub Date: 2026-01-29 DOI: 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.

本研究调查巴西民事和行政诉讼中法医精神病学报告与司法判决之间的不一致。采用回顾性文献设计，我们分析了来自巴西电子司法程序（PJe）的200个案例（每个领域50个）的随机样本，涉及四个领域：社会保障（INSS）、公共服务考试、获得药物和所谓的医疗差错。总体一致性较高（87.5%），但有12.5%的案件存在不一致性，其中公务考试（20%）和医疗差错纠纷（20%）集中在一起，社会保障案件不存在不一致性。定性分析表明，司法分歧往往源于通过“剩余能力”或“尽职责任”等规范性构式对临床发现的重新解释，并由结构标准化程度较低的报告促成。多变量分析表明，指数事件和评估之间的时间滞后较长，以及缺乏结构化工具，与不一致的可能性较高相关。研究结果突出表明，巴西需要标准化的报告协议和跨学科培训，以加强法医精神病学与法律之间的联系。

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引用次数: 0

Prescription patterns of benzodiazepines and Z-drugs in Berlin prisons 柏林监狱苯二氮卓类药物和z型药物的处方模式。

IF 1.3 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2026-03-01 Epub Date: 2026-01-21 DOI: 10.1016/j.ijlp.2026.102189

Nicolas Schwarzer , Julia Krebs , Norbert Konrad , Marc Lehmann , Annette Opitz-Welke

Background

Benzodiazepines and Z-drugs are commonly prescribed medications in psychiatric treatment. Prisoners are a unique patient population due to their elevated prevalence of substance abuse and psychiatric morbidity. Given the limited data about the medical treatment for prisoners, this study aims to provide an initial exploratory overview of the prescription patterns of benzodiazepines and Z-drugs in Berlin prisons.

Materials and methods

A data set was compiled by extracting information from the documentation systems of all seven Berlin prisons. All inmates with a prescription for benzodiazepines or Z-drugs as of the cut-off date were included. Demographic characteristics, arrest circumstances, and medical histories were considered. Supplementary information on the overall prison population was obtained from officially published sources.

Results

As of August 31, 2022, the point prevalence of benzodiazepine and Z-drug prescriptions among Berlin prisoners was 3.9% (n = 136). The duration of 46 (33.8%) prescriptions exceeded six weeks. The prescription rate in female prisoners (6.8%, n = 13/190) was significantly higher than in male prisoners (4.1%, n = 123/3299). The prescription rate in default imprisoned individuals (16.5%, n = 62/376) was significantly higher compared to in convicted and remand detainees (2.1%, n = 71/3095).

Conclusion

Benzodiazepines and Z-drugs were prescribed less frequently in Berlin prisons than in general outpatient care. Approximately 1/3 of all prescriptions exceeded the recommended maximum duration. Prescription rates in prison were higher among female inmates. Rates among remand detainees did not exceed those of convicted prisoners. Default imprisonment was identified as a factor influencing prescription practices, likely due to its strong association with homelessness and alcohol abuse.

背景：苯二氮卓类药物和z -药物是精神病治疗中常用的处方药。囚犯是一个独特的病人群体，因为他们滥用药物和精神疾病的发病率很高。鉴于囚犯医疗数据有限，本研究旨在对柏林监狱苯二氮卓类药物和z型药物的处方模式进行初步探索性概述。材料和方法：通过从柏林所有七所监狱的文件系统中提取资料汇编了一套数据。截至截止日期，所有持有苯二氮卓类药物或z类药物处方的囚犯都包括在内。考虑了人口特征、逮捕情况和病史。关于监狱人口总数的补充资料来自正式公布的来源。结果：截至2022年8月31日，柏林囚犯苯二氮卓类药物和z -药物处方的点患病率为3.9% （n = 136）。处方持续时间超过6周的有46张（33.8%）。女性囚犯的处方率（6.8%,n = 13/190）显著高于男性囚犯（4.1%,n = 123/3299）。违约在押人员的处方率（16.5%,n = 62/376）显著高于已定罪和还押在押人员的处方率（2.1%,n = 71/3095）。结论：柏林监狱使用苯二氮卓类药物和z类药物的频率低于普通门诊。大约三分之一的处方超过了建议的最大持续时间。监狱中女性囚犯的处方率更高。还押囚犯的比率并不超过已定罪囚犯。默认监禁被确定为影响处方做法的一个因素，可能是因为它与无家可归和酗酒密切相关。

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引用次数: 0

Distinctive and common risk factors contributing to violent offending in patients with schizophrenia compared to people without a mental illness 与没有精神疾病的人相比，导致精神分裂症患者暴力犯罪的独特和共同风险因素

IF 1.3 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2026-03-01 Epub Date: 2026-01-27 DOI: 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.

研究表明，在精神分裂症患者和一般人群中存在共同的暴力危险因素，比较这两个不同群体的特征可以更好地理解。方法回顾2015年1月至2019年12月中国某司法鉴定中心刑事案件的法医档案。将男性罪犯分为四组：①有精神分裂症的暴力和非暴力罪犯；③无精神疾病的暴力和非暴力罪犯。从档案中提取社会人口学、犯罪学和临床资料，并采用简易精神病评定量表、社会残疾筛查量表和改良的显性攻击量表对精神症状、社会功能和攻击行为进行量化。对四组数据进行比较，并对暴力的影响因素进行研究。结果共纳入精神分裂症男性罪犯321人（暴力234人，非暴力87人）和无精神疾病男性罪犯186人。结果表明，精神分裂症患者暴力犯罪的对象多为家庭成员和亲属，多发生在农村和公共场所，作案前争吵较少。思想障碍和敌对猜忌是精神分裂症患者的暴力危险因素。言语攻击是精神分裂症患者和非精神疾病患者共同的暴力危险因素。结论精神分裂症患者的暴力预防与干预应重点关注言语攻击、思维障碍和敌对-怀疑行为。

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引用次数: 0

Restraint in health and social care settings 卫生和社会保健环境中的限制

IF 1.3 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2026-03-01 Epub Date: 2026-01-29 DOI: 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.

在保健和社会护理环境中，特别是对缺乏能力的个人使用约束，仍然是一个复杂和有争议的法律和道德问题。约束包括一系列干预措施，包括但不限于物理、化学、机械和心理方法，每种方法都需要严格的保障措施，以防止滥用并确保遵守人权标准。2016年《精神能力法》（北爱尔兰）的分阶段实施，特别是第12条，特别关注约束，标志着朝着更加基于权利的方法的重大转变，使法律和政策框架与自主和尊严的道德原则保持一致。本文以关键立法、卫生部（2023年）《关于在卫生和社会护理环境中使用限制性做法的区域政策》和相关判例法为依据，批判性地分析了制约约束的不断变化的监管格局。它进一步探讨了道德困境和业务挑战，包括工作人员培训、文件和监督机制，这些都是合法和适度使用约束所必需的。最后，本文通过以人为本的护理方法考察了预防策略，倡导向最小化限制性干预措施和促进人权驱动实践的文化转变。

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引用次数: 0

Forensic mental health research: The potential of Danish national registers 法医心理健康研究：丹麦国家登记册的潜力

IF 1.3 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2026-03-01 Epub Date: 2026-01-08 DOI: 10.1016/j.ijlp.2026.102188

Christian Jentz , Harry Kennedy , Lisbeth Uhrskov Sørensen

Forensic psychiatric research faces persistent methodological and ethical challenges, limiting the development of robust evidence to inform practice and policy. This article examines these barriers in the Danish context, highlighting the underutilized potential of national register data to overcome current limitations. Despite Denmark having a relatively large forensic psychiatric patient population and comprehensive national health registers, critical obstacles remain, including inconsistent patient identifiers, fragmented service delivery, and restrictive ethical frameworks that impede patient inclusion in research. The authors argue for greater methodological rigor, improved identification strategies, and clearer ethical guidelines, proposing that leveraging existing register-based data could significantly enhance the scope and quality of forensic mental health research. Addressing these barriers would help fill crucial knowledge gaps and support more evidence-based interventions for this vulnerable population.

法医精神病学研究面临着持续的方法和伦理挑战，限制了为实践和政策提供有力证据的发展。本文在丹麦的背景下考察了这些障碍，强调了未充分利用国家登记数据的潜力，以克服目前的限制。尽管丹麦拥有相对较大的法医精神病患者人口和全面的国家健康登记，但仍然存在重大障碍，包括患者标识不一致、服务提供不完整以及限制性伦理框架阻碍患者参与研究。作者主张更严格的方法、改进的识别策略和更明确的伦理准则，并提出利用现有的基于登记册的数据可以显著提高法医心理健康研究的范围和质量。解决这些障碍将有助于填补关键的知识空白，并支持为这一弱势群体提供更多基于证据的干预措施。

引用次数: 0

Lack of challenge to substantive criteria at mental health tribunals: Amplifying the medical perspective? 精神健康法庭缺乏对实质性标准的挑战：放大医学视角？

IF 1.3 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2026-03-01 Epub Date: 2025-11-25 DOI: 10.1016/j.ijlp.2025.102166

Sam Boyle , Fiona Jager , Jean-Laurent Domingue , Amélie Perron

Mental health tribunals provide legal safeguards for compulsory treatment for mental illness. Despite one of these tribunals' purposes being to give people subject to compulsory treatment a “day in court”, research has shown that individuals' experience of mental health tribunals is highly negative. To understand these negative experiences, we conducted a multi-stakeholder study of the Consent and Capacity Board, a mental health tribunal in Ontario, Canada. Our research revealed that disputes in the hearings tended to focus on procedural requirements of the compulsory treatment orders, and although substantive legal criteria were addressed, the medical conclusions underlying those criteria were not directly challenged. Further, in cases where a client “wins” and the treatment order is revoked, our analysis shows the medical perspective remained authoritative. Finally, although people subject to treatment orders were given a chance to speak at hearings, in most cases theirs was the only voice challenging the psychiatrist's medical conclusions, and their contribution would usually only lessen the chance of the order being revoked. Therefore, we argue that rather than challenging medical decision-making, as may be expected, tribunal hearings unintentionally amplify the medical perspective in a manner that is likely to be upsetting for people subject to the treatment orders. We acknowledge that this effect is ingrained in the current system and will be challenging to ameliorate. Nonetheless, it is an important consideration for those in legal and clinical practice, and policy makers. We give some suggestions about how these experiences could be improved and for further research opportunities.

精神卫生法庭为精神疾病强制治疗提供法律保障。尽管这些法庭的目的之一是让接受强制治疗的人“在法庭上呆上一天”，但研究表明，个人在精神健康法庭上的经历非常消极。为了了解这些负面经历，我们对加拿大安大略省的一个心理健康法庭——同意和能力委员会——进行了一项多方利益攸关方研究。我们的研究表明，听证会上的争端往往集中在强制治疗令的程序要求上，虽然讨论了实质性的法律标准，但这些标准所依据的医学结论没有受到直接质疑。此外，在客户“获胜”而治疗命令被撤销的情况下，我们的分析显示医学观点仍然是权威的。最后，虽然接受治疗命令的人有机会在听证会上发言，但在大多数情况下，他们是唯一质疑精神科医生医学结论的声音，他们的贡献通常只会减少取消治疗命令的机会。因此，我们认为，法庭听证会并没有像预期的那样挑战医疗决策，而是无意中放大了医疗视角，这可能会让接受治疗命令的人感到不安。我们承认，这种影响在现行制度中根深蒂固，要加以改善将具有挑战性。尽管如此，对于法律和临床实践以及政策制定者来说，这是一个重要的考虑因素。我们就如何改进这些经验和进一步的研究机会提出了一些建议。

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