Pub Date : 2024-10-19DOI: 10.1016/j.ijlp.2024.102028
Barry Solaiman
This article argues that significant risks are being taken with using GenAI in mental health that should be assessed urgently. It recommends that guidelines for using generative artificial intelligence (GenAI) in mental health care must be established promptly. Currently, clinicians using chatbots without appropriate approval risk undermining legal protections for patients. This could harm the patient and undermine the standards of the profession, undermining trust in an area where human involvement in decision-making is critical. To explore these concerns, this paper is divided into three parts. First, it examines the needs of patients in mental health. Second, it explores the potential benefits of GenAI in mental health and highlights the risks of its use as it pertains to patient needs. Third, it notes the ethical and legal concerns around data use and medical liability that require careful attention. The impact of the European Union's (EU) Artificial Intelligence Act (AI-Act) is also considered. It will be seen that these laws are insufficient in the context of mental health. As such, the paper recommends that guidelines should be developed to help resolve the existing legal gaps until codified rules are established.
{"title":"Generative artificial intelligence (GenAI) and decision-making: Legal & ethical hurdles for implementation in mental health","authors":"Barry Solaiman","doi":"10.1016/j.ijlp.2024.102028","DOIUrl":"10.1016/j.ijlp.2024.102028","url":null,"abstract":"<div><div>This article argues that significant risks are being taken with using GenAI in mental health that should be assessed urgently. It recommends that guidelines for using generative artificial intelligence (GenAI) in mental health care must be established promptly. Currently, clinicians using chatbots without appropriate approval risk undermining legal protections for patients. This could harm the patient and undermine the standards of the profession, undermining trust in an area where human involvement in decision-making is critical. To explore these concerns, this paper is divided into three parts. First, it examines the needs of patients in mental health. Second, it explores the potential benefits of GenAI in mental health and highlights the risks of its use as it pertains to patient needs. Third, it notes the ethical and legal concerns around data use and medical liability that require careful attention. The impact of the European Union's (EU) Artificial Intelligence Act (AI-Act) is also considered. It will be seen that these laws are insufficient in the context of mental health. As such, the paper recommends that guidelines should be developed to help resolve the existing legal gaps until codified rules are established.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"97 ","pages":"Article 102028"},"PeriodicalIF":1.4,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Frequency of seclusion in acute psychiatric units varies greatly worldwide. In Switzerland, its use is authorised under strict conditions. However, this coercive measure is not implemented in every psychiatric hospital in the country. The use of coercion is associated with a number of patient characteristics as well as organisational, contextual and professional's aspects. Nevertheless, the role of these factors remain inconsistent across studies and different coercive measures are often studied together. Hence, the aim of this study was to assess mental health professionals' perceptions and attitudes towards seclusion according to their experience with this type of measure and their personal and professional background.
Method
Nurses and physicians working in acute adult and geriatric psychiatric units in the Swiss Cantons of Vaud and Valais were invited to participate to an online survey exploring their socio-demographic characteristics, professional background, current position and activity, as well as their perceptions and attitudes towards seclusion. Exploratory Structural Equation Modelling (ESEM) was then used to determine the structure of the participants perceptions and attitudes towards seclusion to identify which socio-demographic and professionals' aspects could predict their underlying dimensions.
Results
116 mental health professionals agreed to participate in the study. A majority considered that seclusion had a therapeutic impact, while believing that it could also have negative effects or be dangerous for the patient. The majority also thought that seclusion increased the general feeling of safety. Lastly, a substantial proportion felt that the Swiss legal framework regulating seclusion was not sufficiently clear. Mental health professionals' perceptions and attitudes towards seclusion could be described by four dimensions: “Negative consequences”, “Safety”, “Legitimacy/legal aspect of seclusion” and “Organisational aspects”. Analyses revealed a tendency to normalize seclusion as its use increases.
Conclusion
Seclusion poses complex challenges for mental health professionals. The competent authorities should therefore provide careful guidance to help them maintain a high level of quality of care in the use of this coercive measure.
{"title":"Mental health professionals' perceptions and attitudes towards seclusion: The ambivalent relationship between safety and therapeutic considerations","authors":"Grégory Yersin , Benedetta Silva , Philippe Golay , Stéphane Morandi","doi":"10.1016/j.ijlp.2024.102033","DOIUrl":"10.1016/j.ijlp.2024.102033","url":null,"abstract":"<div><h3>Background</h3><div>Frequency of seclusion in acute psychiatric units varies greatly worldwide. In Switzerland, its use is authorised under strict conditions. However, this coercive measure is not implemented in every psychiatric hospital in the country. The use of coercion is associated with a number of patient characteristics as well as organisational, contextual and professional's aspects. Nevertheless, the role of these factors remain inconsistent across studies and different coercive measures are often studied together. Hence, the aim of this study was to assess mental health professionals' perceptions and attitudes towards seclusion according to their experience with this type of measure and their personal and professional background.</div></div><div><h3>Method</h3><div>Nurses and physicians working in acute adult and geriatric psychiatric units in the Swiss Cantons of Vaud and Valais were invited to participate to an online survey exploring their socio-demographic characteristics, professional background, current position and activity, as well as their perceptions and attitudes towards seclusion. Exploratory Structural Equation Modelling (ESEM) was then used to determine the structure of the participants perceptions and attitudes towards seclusion to identify which socio-demographic and professionals' aspects could predict their underlying dimensions.</div></div><div><h3>Results</h3><div>116 mental health professionals agreed to participate in the study. A majority considered that seclusion had a therapeutic impact, while believing that it could also have negative effects or be dangerous for the patient. The majority also thought that seclusion increased the general feeling of safety. Lastly, a substantial proportion felt that the Swiss legal framework regulating seclusion was not sufficiently clear. Mental health professionals' perceptions and attitudes towards seclusion could be described by four dimensions: “Negative consequences”, “Safety”, “Legitimacy/legal aspect of seclusion” and “Organisational aspects”. Analyses revealed a tendency to normalize seclusion as its use increases.</div></div><div><h3>Conclusion</h3><div>Seclusion poses complex challenges for mental health professionals. The competent authorities should therefore provide careful guidance to help them maintain a high level of quality of care in the use of this coercive measure.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"97 ","pages":"Article 102033"},"PeriodicalIF":1.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142477709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1016/j.ijlp.2024.102029
Jerrod Brown , Danielle Schulte Lewis , Trisha Kivisalu , Anthony P. Wartnik , Megan N. Carter , Diane Harr , Amy Jozan , David J. Gilbert
Fetal Alcohol Spectrum Disorder (FASD) is a lifelong disorder caused by prenatal alcohol exposure (PAE) and is one of the most common causes of brain damage and developmental disability. FASD has been characterized by an array of symptoms that negatively affects cognitive, social, and adaptive functioning. Individuals living with FASD, relative to the general population, are more likely to become entangled in the legal system due to challenges associated with the disorder. Moreover, symptomology of FASD often contributes to these individuals struggling in successfully navigating various stages of the legal system, including arrest, interrogation, working with their defense counsel, and courtroom appearances. The difficulties faced by defendants living with FASD are exacerbated by systemic failure from legal professionals in recognizing and accommodating for the extent and complexities of this disorder. Consequently, defendants living with FASD often do not receive effective due process of law in comparison to their neurotypical peers. Moreover, attempts at punishment and deterrence through probation and jail terms are often ineffective for individuals living with FASD because of the effects of their disorder. This article is intended to provide valuable information and best practices for professionals in the legal system, particularly judges, prosecutors, defense attorneys, social workers/mitigation specialists, and psychologists, who are likely to encounter individuals living with FASD or suspected FASD early in the judicial process.
{"title":"Fetal alcohol spectrum disorder (FASD) and the criminal justice system: A guide for legal professionals","authors":"Jerrod Brown , Danielle Schulte Lewis , Trisha Kivisalu , Anthony P. Wartnik , Megan N. Carter , Diane Harr , Amy Jozan , David J. Gilbert","doi":"10.1016/j.ijlp.2024.102029","DOIUrl":"10.1016/j.ijlp.2024.102029","url":null,"abstract":"<div><div>Fetal Alcohol Spectrum Disorder (FASD) is a lifelong disorder caused by prenatal alcohol exposure (PAE) and is one of the most common causes of brain damage and developmental disability. FASD has been characterized by an array of symptoms that negatively affects cognitive, social, and adaptive functioning. Individuals living with FASD, relative to the general population, are more likely to become entangled in the legal system due to challenges associated with the disorder. Moreover, symptomology of FASD often contributes to these individuals struggling in successfully navigating various stages of the legal system, including arrest, interrogation, working with their defense counsel, and courtroom appearances. The difficulties faced by defendants living with FASD are exacerbated by systemic failure from legal professionals in recognizing and accommodating for the extent and complexities of this disorder. Consequently, defendants living with FASD often do not receive effective due process of law in comparison to their neurotypical peers. Moreover, attempts at punishment and deterrence through probation and jail terms are often ineffective for individuals living with FASD because of the effects of their disorder. This article is intended to provide valuable information and best practices for professionals in the legal system, particularly judges, prosecutors, defense attorneys, social workers/mitigation specialists, and psychologists, who are likely to encounter individuals living with FASD or suspected FASD early in the judicial process.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"97 ","pages":"Article 102029"},"PeriodicalIF":1.4,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441982","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 : 2024-10-16DOI: 10.1016/j.ijlp.2024.102032
Sophie C. Dahlenburg , Dianna R. Bartsch , Kimberley J. Gilson
The prevalence of borderline personality disorder (BPD) in the general population is estimated to be 1.8 % whereas the rates of BPD among people in prison have been reported between 9 and 30 %. To date, there are no published systematic reviews into the rates of BPD among adults in prison. Understanding the prevalence of BPD in this setting can help to inform prison-staff education, funding and intervention options, and adequate care for an already at-risk population. We aimed to explore the global prevalence of BPD diagnoses and self-reported symptomology among adults in prisons via systematic review and meta-analysis. We also aimed to explore gender differences between women and men in prison. Following the PRISMA guidelines, we conducted a systematic review and meta-analysis of papers where a BPD diagnosis or self-reported symptoms were reported within a prison population of male or female adult offenders (18+ years). Our search yielded 33 studies comprising diagnostic interviews, and 15 studies which included self-reported symptom measures. The results indicated that for women and men in prison, the prevalence of BPD was (27.4 % and 18.8 %, respectively) when assessed via diagnostic interview. Results were similar for both women and men in studies that used a self-report measure to assess a BPD diagnosis (29.1 % and 16.4 %). Findings suggest that the prevalence of BPD in prisons should be considered when making decisions about mental health and criminogenic interventions. Self-report measures could be a resource-efficient method for screening prisoners for personality pathology in prison settings. Contemporary, well-structured, large-scale studies are required to better understand the prevalence of personality disorder in prisons.
{"title":"Global prevalence of borderline personality disorder and self-reported symptoms of adults in prison: A systematic review and meta-analysis","authors":"Sophie C. Dahlenburg , Dianna R. Bartsch , Kimberley J. Gilson","doi":"10.1016/j.ijlp.2024.102032","DOIUrl":"10.1016/j.ijlp.2024.102032","url":null,"abstract":"<div><div>The prevalence of borderline personality disorder (BPD) in the general population is estimated to be 1.8 % whereas the rates of BPD among people in prison have been reported between 9 and 30 %. To date, there are no published systematic reviews into the rates of BPD among adults in prison. Understanding the prevalence of BPD in this setting can help to inform prison-staff education, funding and intervention options, and adequate care for an already at-risk population. We aimed to explore the global prevalence of BPD diagnoses and self-reported symptomology among adults in prisons via systematic review and meta-analysis. We also aimed to explore gender differences between women and men in prison. Following the PRISMA guidelines, we conducted a systematic review and meta-analysis of papers where a BPD diagnosis or self-reported symptoms were reported within a prison population of male or female adult offenders (18+ years). Our search yielded 33 studies comprising diagnostic interviews, and 15 studies which included self-reported symptom measures. The results indicated that for women and men in prison, the prevalence of BPD was (27.4 % and 18.8 %, respectively) when assessed via diagnostic interview. Results were similar for both women and men in studies that used a self-report measure to assess a BPD diagnosis (29.1 % and 16.4 %). Findings suggest that the prevalence of BPD in prisons should be considered when making decisions about mental health and criminogenic interventions. Self-report measures could be a resource-efficient method for screening prisoners for personality pathology in prison settings. Contemporary, well-structured, large-scale studies are required to better understand the prevalence of personality disorder in prisons.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"97 ","pages":"Article 102032"},"PeriodicalIF":1.4,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142441981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-15DOI: 10.1016/j.ijlp.2024.102030
Maria Redahan , Brendan D. Kelly , Tania Gergel
In recent years, bodies such as the United Nations and the World Health Organization have highlighted the need for mental healthcare and legislation to better conform to contemporary human rights principles. They place particular emphasis on the right of people with mental health conditions to make their own decisions in all areas of life, including mental health treatment. One of the challenges in this context is that a person can lose the capacity to make these decisions during episodes of severe mental illness. Advance Healthcare Directives (AHDs), also known as Advance Choice Documents (ACDs), can help to overcome this challenge and allow people to exercise more agency over their care choices. AHDs are statements about the type of treatment a person would or would not like to receive in future if they are in a situation where they require treatment but are unable to make or communicate their decision. Despite an expanding body of evidence that AHDs enhance autonomy and are supported by patients and staff alike, uptake of AHDs is extremely low across many jurisdictions. Legislative reform and educational initiatives to enhance knowledge and awareness are vital for advancing and enlivening this field in clinical practice. This paper explores one such legislative development (Ireland's Assisted Decision Making (Capacity) Act, 2015) and one such educational initiative (the www.advancechoice.org website and videos). We highlight the need for further developments in the realms of both legislative reform and outreach and accessibility, in addition to greater advocacy by clinicians for the use of AHDs in mental health care.
{"title":"Advance healthcare directives and advance choice documents in psychiatry: New resources, new legislation, new opportunities","authors":"Maria Redahan , Brendan D. Kelly , Tania Gergel","doi":"10.1016/j.ijlp.2024.102030","DOIUrl":"10.1016/j.ijlp.2024.102030","url":null,"abstract":"<div><div>In recent years, bodies such as the United Nations and the World Health Organization have highlighted the need for mental healthcare and legislation to better conform to contemporary human rights principles. They place particular emphasis on the right of people with mental health conditions to make their own decisions in all areas of life, including mental health treatment. One of the challenges in this context is that a person can lose the capacity to make these decisions during episodes of severe mental illness. Advance Healthcare Directives (AHDs), also known as Advance Choice Documents (ACDs), can help to overcome this challenge and allow people to exercise more agency over their care choices. AHDs are statements about the type of treatment a person would or would not like to receive in future if they are in a situation where they require treatment but are unable to make or communicate their decision. Despite an expanding body of evidence that AHDs enhance autonomy and are supported by patients and staff alike, uptake of AHDs is extremely low across many jurisdictions. Legislative reform and educational initiatives to enhance knowledge and awareness are vital for advancing and enlivening this field in clinical practice. This paper explores one such legislative development (Ireland's Assisted Decision Making (Capacity) Act, 2015) and one such educational initiative (the <span><span>www.advancechoice.org</span><svg><path></path></svg></span> website and videos). We highlight the need for further developments in the realms of both legislative reform and outreach and accessibility, in addition to greater advocacy by clinicians for the use of AHDs in mental health care.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"97 ","pages":"Article 102030"},"PeriodicalIF":1.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432083","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 : 2024-09-17DOI: 10.1016/j.ijlp.2024.102017
Meron Wondemaghen
This conceptual article examines the organisational crisis in England's National Health Service in light of the recently launched model of policing called Right Care Right Person introduced to reduce police hours spent dealing with mental health crisis calls. It is a move that has come with concerns for health services because these newly created gaps alongside the existing ones pose challenges around funding and timescales in implementing the new model. It is a curious case of organisational paradox that diverting mentally ill persons into health services and ‘decriminalising’ those whose health conditions bring them to the attention of the justice system, has raised concerns in the health sector about access to adequate mental health services unless an arm of the justice system is involved. Given the similarities in health and legal systems in the Anglo-Western world, this English model has international implications about organisational paradoxes in health systems.
这篇概念性文章从最近推出的名为 "正确护理正确的人"（Right Care Right Person）的警务模式出发，探讨了英格兰国民健康服务的组织危机，该模式旨在减少警方处理精神健康危机电话的时间。此举引起了医疗服务机构的担忧，因为这些新出现的缺口与现有的缺口一起，给新模式的实施带来了资金和时间上的挑战。将精神病患者转到医疗服务机构，并将那些因健康状况而被司法系统关注的人 "非刑罪化"，这是个奇怪的组织悖论案例，它引起了卫生部门对获得适当精神健康服务的担忧，除非司法系统的一个部门参与进来。鉴于盎格鲁-西方世界的医疗体系和法律体系的相似性，这种英国模式对医疗体系的组织悖论具有国际影响。
{"title":"Policing psychiatric illness: An organisational paradox for Health & Law","authors":"Meron Wondemaghen","doi":"10.1016/j.ijlp.2024.102017","DOIUrl":"10.1016/j.ijlp.2024.102017","url":null,"abstract":"<div><p>This conceptual article examines the organisational crisis in England's National Health Service in light of the recently launched model of policing called <em>Right Care Right Person</em> introduced to reduce police hours spent dealing with mental health crisis calls. It is a move that has come with concerns for health services because these newly created gaps alongside the existing ones pose challenges around funding and timescales in implementing the new model. It is a curious case of organisational paradox that diverting mentally ill persons into health services and ‘decriminalising’ those whose health conditions bring them to the attention of the justice system, has raised concerns in the health sector about access to adequate mental health services unless an arm of the justice system is involved. Given the similarities in health and legal systems in the Anglo-Western world, this English model has international implications about organisational paradoxes in health systems.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"97 ","pages":"Article 102017"},"PeriodicalIF":1.4,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0160252724000669/pdfft?md5=64f0242cd01e9d20cba9632b826b8e34&pid=1-s2.0-S0160252724000669-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Antisocial personality disorder (ASPD) is a common mental health condition with major public health consequences, affecting 0.2–3.3 % of the general population. ASPD has become increasingly common in correctional settings. Therefore, this study aimed to assess antisocial personality disorder and its determinants among prisoners in South Gondar zone correctional centers, which has a vital role in early intervention.
Methods
An institution-based cross-sectional study was conducted using the simple random sampling technique to recruit a total of 552 participants. Antisocial personality disorder was assessed by the Diagnostic and Statistical Manual of Mental Disorders 5th text revision (DSM-5) using an interviewer-administered questionnaire. We used binary and multivariate analyses to identify factors associated with ASPD. Statistical significance was declared at a 95 % confidence interval (CI) of p-value ˂0.05.
Results
A total of 552 participants took part with a response rate of 97.87 %. The prevalence of antisocial personality disorder among prisoners was found to be 27.5 %, with a 95 % CI (23.96, 31.42). The study revealed that male sex (AOR = 5.25, 95 % CI: 1.60, 17.31), being unemployed (AOR = 4.38, 95 % CI: 1.27, 15.08), family history of mental illness (AOR = 2.23, 95 % CI: 1.30, 3.81), and repeated incarceration (AOR = 2.04, 95 % CI: 1.28, 3.23) were factors significantly associated with antisocial personality disorder.
Conclusions
This study showed a higher prevalence of antisocial personality disorder among prisoners. Male sex, unemployment, family history of mental illness, and history of incarceration were significantly associated with antisocial personality disorder. Therefore, the findings of this study recommend that incarcerated people require more attention and early intervention for antisocial personality disorder in correctional centers.
{"title":"Antisocial personality disorder and determinants among prisoners in South Gondar zone correctional institutions, Northwest Ethiopia: An institution-based cross-sectional study","authors":"Setegn Fentahun , Agegnehu Amare , Gebresilassie Tadesse , Mesele Wondie , Mamaru Melkam , Getachew Tesfaw","doi":"10.1016/j.ijlp.2024.102018","DOIUrl":"10.1016/j.ijlp.2024.102018","url":null,"abstract":"<div><h3>Background</h3><p>Antisocial personality disorder (ASPD) is a common mental health condition with major public health consequences, affecting 0.2–3.3 % of the general population. ASPD has become increasingly common in correctional settings. Therefore, this study aimed to assess antisocial personality disorder and its determinants among prisoners in South Gondar zone correctional centers, which has a vital role in early intervention.</p></div><div><h3>Methods</h3><p>An institution-based cross-sectional study was conducted using the simple random sampling technique to recruit a total of 552 participants. Antisocial personality disorder was assessed by the Diagnostic and Statistical Manual of Mental Disorders 5th text revision (DSM-5) using an interviewer-administered questionnaire. We used binary and multivariate analyses to identify factors associated with ASPD. Statistical significance was declared at a 95 % confidence interval (CI) of <em>p</em>-value ˂0.05.</p></div><div><h3>Results</h3><p>A total of 552 participants took part with a response rate of 97.87 %. The prevalence of antisocial personality disorder among prisoners was found to be 27.5 %, with a 95 % CI (23.96, 31.42). The study revealed that male sex (AOR = 5.25, 95 % CI: 1.60, 17.31), being unemployed (AOR = 4.38, 95 % CI: 1.27, 15.08), family history of mental illness (AOR = 2.23, 95 % CI: 1.30, 3.81), and repeated incarceration (AOR = 2.04, 95 % CI: 1.28, 3.23) were factors significantly associated with antisocial personality disorder.</p></div><div><h3>Conclusions</h3><p>This study showed a higher prevalence of antisocial personality disorder among prisoners. Male sex, unemployment, family history of mental illness, and history of incarceration were significantly associated with antisocial personality disorder. Therefore, the findings of this study recommend that incarcerated people require more attention and early intervention for antisocial personality disorder in correctional centers.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"97 ","pages":"Article 102018"},"PeriodicalIF":1.4,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0160252724000670/pdfft?md5=8930303b12d7f63bf39e60e1945aee84&pid=1-s2.0-S0160252724000670-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142163917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.ijlp.2024.102016
Eleftherios Kipoulas , Ian Edwards , Ratko Radakovic , Peter Ilmari Beazley
Expert witness credentials and gender have independently been shown to influence jurors' perceptions of expert witness credibility and legal decision-making. This study examined how manipulations of expert witness gender (Male/Female) and profession (Consultant Clinical Psychologist/Consultant Psychiatrist) together affected mock jurors' perceptions of expert witness credibility, judgements, and decision-making. Mock jurors (N = 182; 80.9 % were White) were recruited from England and Wales and were randomly assigned to watch a video-recorded mock expert witness testimony. Participants rated the expert witness using the Witness Credibility Scale and reported the likelihood of assigning the defendant to a guilty verdict. Results showed significant interaction effects of expert witness gender and profession on jurors' perceptions of their likeability, trustworthiness, knowledge, and total credibility. Male psychiatrists, followed by female clinical psychologists, received the highest scores in most credibility variables. Varied main effects of expert witness gender and profession on credibility were also found. Overall, jurors' ratings of expert witness credibility, when controlled by the expert's gender and profession, predicted jurors' determination of guilt. This study provides evidence of a potential interaction effect between profession and gender in expert witness credibility and supports existing research linking credibility with ultimate decision-making. More research is needed to understand jurors' unconscious biases and cognitive processes in making legal decisions.
{"title":"Perceptions of bias and credibility of male and female clinical psychologist and psychiatrist expert witnesses presenting clinical information in the courtroom","authors":"Eleftherios Kipoulas , Ian Edwards , Ratko Radakovic , Peter Ilmari Beazley","doi":"10.1016/j.ijlp.2024.102016","DOIUrl":"10.1016/j.ijlp.2024.102016","url":null,"abstract":"<div><p>Expert witness credentials and gender have independently been shown to influence jurors' perceptions of expert witness credibility and legal decision-making. This study examined how manipulations of expert witness gender (Male/Female) and profession (Consultant Clinical Psychologist/Consultant Psychiatrist) together affected mock jurors' perceptions of expert witness credibility, judgements, and decision-making. Mock jurors (<em>N</em> = 182; 80.9 % were White) were recruited from England and Wales and were randomly assigned to watch a video-recorded mock expert witness testimony. Participants rated the expert witness using the Witness Credibility Scale and reported the likelihood of assigning the defendant to a guilty verdict. Results showed significant interaction effects of expert witness gender and profession on jurors' perceptions of their likeability, trustworthiness, knowledge, and total credibility. Male psychiatrists, followed by female clinical psychologists, received the highest scores in most credibility variables. Varied main effects of expert witness gender and profession on credibility were also found. Overall, jurors' ratings of expert witness credibility, when controlled by the expert's gender and profession, predicted jurors' determination of guilt. This study provides evidence of a potential interaction effect between profession and gender in expert witness credibility and supports existing research linking credibility with ultimate decision-making. More research is needed to understand jurors' unconscious biases and cognitive processes in making legal decisions.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"96 ","pages":"Article 102016"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0160252724000657/pdfft?md5=d513bed6054e8c1ec0330e144eab9f7b&pid=1-s2.0-S0160252724000657-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142097146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-20DOI: 10.1016/j.ijlp.2024.102003
Lizel Göranson , Olof Svensson , Peter Andiné , Sara Bromander , Karl Ask , Ann-Sophie Lindqvist Bagge , Malin Hildebrand Karlén
The decision-making process of experts in forensic psychiatric investigations (FPI) is complex and reasoning regarding psychiatric diagnosis and severe mental disorder (SMD, the judicial concept central to legal exemption in Swedish law) has severe ramifications. Nevertheless, the qualitative aspects of FPI experts' decision-making process have seldom been studied systematically. Method. The participants (N = 41) were FPI experts: forensic psychiatrists (n = 15), forensic psychologists (n = 15) and forensic social workers (n = 11). Using three case vignettes and qualitative content analysis, it was explored how case-specific characteristics could affect which hypotheses FPI experts generated regarding a) psychiatric diagnosis and b) severe mental disorder and c) which information sources they required. Each case vignette described a diagnostically ambiguous case but indicated emphasis on: psychotic symptoms (case 1); personality disorder symptoms (case 2) and neurodevelopmental disorder symptoms (case 3). Results. Experts reasoned in a similar manner regarding generating hypotheses and required information, but also in a case-adapted manner. Experts considered various diagnostic alternatives, and some (e.g. psychosis) were mentioned for all three cases. Other diagnoses were only suggested as hypotheses in certain cases (e.g. case 3: intellectual disability). Discussion. In Sweden, a core basis for SMD is psychotic-like functioning, and psychosis was suggested as a hypothesis for all three cases. Experts reasoned in similar ways regarding SMD in all cases, considering various perspectives for and against SMD. Some case-specific arguments for and against SMD adapted to the psychopathological circumstances were found. These could be related to aspects of the SMD concept that become important to ascertain when the type of psychopathology indicated in the case vignette was present; for example, ascertaining reality monitoring for a person with potential delusions of being followed by a criminal gang requires investigation of criminal history and related conflicts. Taken together, FPI-experts considered a broad range of psychiatric diagnoses in various cases. Their reasoning regarding SMD was both based on general and case-specific (or psychopathology-specific) factors.
{"title":"Which diagnoses and arguments regarding severe mental disorder do forensic psychiatric experts in Sweden consider in different cases? A qualitative vignette study","authors":"Lizel Göranson , Olof Svensson , Peter Andiné , Sara Bromander , Karl Ask , Ann-Sophie Lindqvist Bagge , Malin Hildebrand Karlén","doi":"10.1016/j.ijlp.2024.102003","DOIUrl":"10.1016/j.ijlp.2024.102003","url":null,"abstract":"<div><p>The decision-making process of experts in forensic psychiatric investigations (FPI) is complex and reasoning regarding psychiatric diagnosis and <em>severe mental disorder</em> (SMD, the judicial concept central to legal exemption in Swedish law) has severe ramifications. Nevertheless, the qualitative aspects of FPI experts' decision-making process have seldom been studied systematically. <em>Method.</em> The participants (<em>N</em> = 41) were FPI experts: forensic psychiatrists (<em>n</em> = 15), forensic psychologists (<em>n</em> = 15) and forensic social workers (<em>n</em> = 11). Using three case vignettes and qualitative content analysis, it was explored how case-specific characteristics could affect which hypotheses FPI experts generated regarding a) psychiatric diagnosis and b) <em>severe mental disorder</em> and c) which information sources they required. Each case vignette described a diagnostically ambiguous case but indicated emphasis on: psychotic symptoms (<span><span>case 1</span></span>); personality disorder symptoms (<span><span>case 2</span></span>) and neurodevelopmental disorder symptoms (<span><span>case 3</span></span>). <em>Results</em>. Experts reasoned in a similar manner regarding generating hypotheses and required information, but also in a case-adapted manner. Experts considered various diagnostic alternatives, and some (e.g. psychosis) were mentioned for all three cases. Other diagnoses were only suggested as hypotheses in certain cases (e.g. <span><span>case 3</span></span>: intellectual disability). <em>Discussion.</em> In Sweden, a core basis for SMD is psychotic-like functioning, and psychosis was suggested as a hypothesis for all three cases. Experts reasoned in similar ways regarding SMD in all cases, considering various perspectives for and against SMD. Some case-specific arguments for and against SMD adapted to the psychopathological circumstances were found. These could be related to aspects of the SMD concept that become important to ascertain when the type of psychopathology indicated in the case vignette was present; for example, ascertaining reality monitoring for a person with potential delusions of being followed by a criminal gang requires investigation of criminal history and related conflicts. Taken together, FPI-experts considered a broad range of psychiatric diagnoses in various cases. Their reasoning regarding SMD was both based on general and case-specific (or psychopathology-specific) factors.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"96 ","pages":"Article 102003"},"PeriodicalIF":1.4,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142012161","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 : 2024-08-09DOI: 10.1016/j.ijlp.2024.102015
Keren Semyonov-Tal
The paper contributes to the literature on legal consciousness in medical settings by focusing on psychiatric patients' understanding of rights during hospitalization in Israeli psychiatric wards. It asks whether hospital personnel act as agents who promote patients' legal consciousness and whether patients are aware of their legal and social rights during hospitalization.
The data for this study were derived from the Patient Experience Survey of Psychiatric Public Hospitals, a comprehensive survey conducted by the Israel Ministry of Health in 2017. The survey included two variables that were used to measure patients' legal consciousness: legal consciousness with hospitalization rights and legal consciousness with social rights. To predict legal consciousness and patient satisfaction, a logistic regression model was employed.
The analysis reveals low rates of patients' awareness of hospitalization and social rights, varying between 55 and 66%, respectively. Variations in awareness are not strongly associated with patients' socioeconomic and demographic attributes or with hospital characteristics but are somewhat associated with hospitalization conditions. The data also reveal that awareness of legal rights (whether hospitalization rights or social rights) is likely to increase satisfaction with the hospitalization experience.
The analysis underscores a significant finding. Patients' awareness of their legal rights during hospitalization is limited. Interestingly, this awareness is more influenced by the conditions of hospitalization than by the patients' socio-demographic attributes. This research also provides insights into the potential role of legal awareness in shaping patients' attitudes toward treatment and enhancing their satisfaction during hospitalization.
本文通过关注精神病患者在以色列精神病院住院期间对权利的理解，为有关医疗环境中法律意识的文献做出了贡献。本文探讨了医院工作人员是否充当了促进病人法律意识的代理人，以及病人在住院期间是否了解自己的法律和社会权利。本研究的数据来自以色列卫生部于 2017 年开展的精神病公立医院患者体验调查（Patient Experience Survey of Psychiatric Public Hospitals），这是一项综合性调查。该调查包括两个变量，用于衡量患者的法律意识：住院权利法律意识和社会权利法律意识。为预测法律意识和患者满意度，采用了逻辑回归模型。分析结果显示，患者对住院权利和社会权利的知晓率较低，分别在 55% 和 66% 之间。法律意识的变化与患者的社会经济和人口属性以及医院特征没有密切联系，但与住院条件有一定关系。数据还显示，对法律权利（无论是住院权利还是社会权利）的认识很可能会提高住院体验的满意度。分析强调了一个重要发现。患者在住院期间对自身法律权利的认识是有限的。有趣的是，这种意识更多地受到住院条件的影响，而不是患者社会人口属性的影响。这项研究还深入探讨了法律意识在塑造患者对治疗的态度和提高他们对住院期间的满意度方面的潜在作用。
{"title":"Legal consciousness of psychiatric patients in Israeli hospitals: Awareness and satisfaction","authors":"Keren Semyonov-Tal","doi":"10.1016/j.ijlp.2024.102015","DOIUrl":"10.1016/j.ijlp.2024.102015","url":null,"abstract":"<div><p>The paper contributes to the literature on legal consciousness in medical settings by focusing on psychiatric patients' understanding of rights during hospitalization in Israeli psychiatric wards. It asks whether hospital personnel act as agents who promote patients' legal consciousness and whether patients are aware of their legal and social rights during hospitalization.</p><p>The data for this study were derived from the Patient Experience Survey of Psychiatric Public Hospitals, a comprehensive survey conducted by the Israel Ministry of Health in 2017. The survey included two variables that were used to measure patients' legal consciousness: legal consciousness with hospitalization rights and legal consciousness with social rights. To predict legal consciousness and patient satisfaction, a logistic regression model was employed.</p><p>The analysis reveals low rates of patients' awareness of hospitalization and social rights, varying between 55 and 66%, respectively. Variations in awareness are not strongly associated with patients' socioeconomic and demographic attributes or with hospital characteristics but are somewhat associated with hospitalization conditions. The data also reveal that awareness of legal rights (whether hospitalization rights or social rights) is likely to increase satisfaction with the hospitalization experience.</p><p>The analysis underscores a significant finding. Patients' awareness of their legal rights during hospitalization is limited. Interestingly, this awareness is more influenced by the conditions of hospitalization than by the patients' socio-demographic attributes. This research also provides insights into the potential role of legal awareness in shaping patients' attitudes toward treatment and enhancing their satisfaction during hospitalization.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"96 ","pages":"Article 102015"},"PeriodicalIF":1.4,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914265","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}
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