Pub Date : 2025-10-20DOI: 10.1016/j.ijlp.2025.102159
Carole Burrell, John L. Taylor
The First-tier Tribunal (Mental Health) was established in 2008 to deal with applications and references concerning people subject to the powers of the England and Wales Mental Health Act 1983. Substantive decisions in tribunal proceedings are made by a panel consisting of a legally qualified judge, a specialist member and a medical member. Applicants to the post of medical member must meet statutory and nonstatutory eligibility requirements including holding a consultant psychiatrist post for at least three years. In this paper, comparisons with other common law jurisdictions are drawn and it is argued that the medical member role in this tribunal is outdated and should be replaced by a newly established ‘clinical member’ role. Eligibility should be based on competence and skills rather than professional qualifications. The post would be open to consultant level mental health practitioners from multiprofessional backgrounds who demonstrate they are capable of meeting the specialist needs of the tribunal. Broadening the range of professionals eligible to be appointed to the clinical member post will help alleviate longstanding difficulties in medical member recruitment; will assist with tribunal efficiency; is in keeping with the extended roles introduced by the Mental Health Act 2007; and will encourage diversity in the range of persons available for selection for appointment.
{"title":"Replacing the medical member of the first-tier Tribunal (Mental health) with a clinical member for tribunal applications and references made under the Mental Health Act 1983 (England and Wales)","authors":"Carole Burrell, John L. Taylor","doi":"10.1016/j.ijlp.2025.102159","DOIUrl":"10.1016/j.ijlp.2025.102159","url":null,"abstract":"<div><div>The First-tier Tribunal (Mental Health) was established in 2008 to deal with applications and references concerning people subject to the powers of the England and Wales Mental Health Act 1983. Substantive decisions in tribunal proceedings are made by a panel consisting of a legally qualified judge, a specialist member and a medical member. Applicants to the post of medical member must meet statutory and nonstatutory eligibility requirements including holding a consultant psychiatrist post for at least three years. In this paper, comparisons with other common law jurisdictions are drawn and it is argued that the medical member role in this tribunal is outdated and should be replaced by a newly established ‘clinical member’ role. Eligibility should be based on competence and skills rather than professional qualifications. The post would be open to consultant level mental health practitioners from multiprofessional backgrounds who demonstrate they are capable of meeting the specialist needs of the tribunal. Broadening the range of professionals eligible to be appointed to the clinical member post will help alleviate longstanding difficulties in medical member recruitment; will assist with tribunal efficiency; is in keeping with the extended roles introduced by the Mental Health Act 2007; and will encourage diversity in the range of persons available for selection for appointment.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"104 ","pages":"Article 102159"},"PeriodicalIF":1.3,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Decision-making capacity (DMC) is a widely used criterion in health laws to balance respect for patient autonomy with protection from the potential consequences of treatment decisions. In 2017, lacking DMC was introduced as an additional criterion for involuntary care and treatment following comprehensive amendments to the Norwegian Mental Health Care Act. Despite the amendments aiming to reduce involuntary care and treatment rates, national health registry data indicate continued rising rates along the pre-2017 trajectory after an initial reduction in 2017. While previous studies suggesting varying DMC assessment quality, little is known about the potential factors influencing these variations.
Aims
To identify factors influencing DMC assessments after introducing a capacity-based mental health law governing involuntary care and treatment.
Methods
60 purposively sampled stakeholders, including patients, families, health professionals, and lawyers, participated in semi-structured interviews and focus groups in 2018, with 26 of these participating in follow-up interviews in 2022–23. The transcribed interviews were analysed using thematic analysis.
Results
Data analysis generated four themes: 1) available resources' influence on DMC assessments; 2) health professionals' values and practices regarding involuntary care; 3) legal interpretations by supervisory bodies regarding involuntary care; and 4) political signals from the health authorities regarding involuntary care.
Conclusion
DMC assessments appear to be influenced by several factors, including resource availability, health professionals' values and practices, legal interpretations by supervisory bodies, and political signals from health authorities. Combined with a lack of systematic training and validated tools, these factors may have raised the threshold for accessing mental healthcare beyond what systematic DMC assessments would suggest, contributing to increased illness severity among patients and rising involuntary care rates post-2017. Further research is needed to better understand the complex dynamics involved in DMC assessments and how to effectively implement capacity-based health laws.
{"title":"Factors influencing decision-making capacity assessments in involuntary care and treatment in Norway: A qualitative exploration of multi-stakeholder perspectives","authors":"Jacob Jorem , Reidun Førde , Tonje Lossius Husum , Jørgen Dahlberg , Reidar Pedersen","doi":"10.1016/j.ijlp.2025.102157","DOIUrl":"10.1016/j.ijlp.2025.102157","url":null,"abstract":"<div><h3>Background</h3><div>Decision-making capacity (DMC) is a widely used criterion in health laws to balance respect for patient autonomy with protection from the potential consequences of treatment decisions. In 2017, lacking DMC was introduced as an additional criterion for involuntary care and treatment following comprehensive amendments to the Norwegian Mental Health Care Act. Despite the amendments aiming to reduce involuntary care and treatment rates, national health registry data indicate continued rising rates along the pre-2017 trajectory after an initial reduction in 2017. While previous studies suggesting varying DMC assessment quality, little is known about the potential factors influencing these variations.</div></div><div><h3>Aims</h3><div>To identify factors influencing DMC assessments after introducing a capacity-based mental health law governing involuntary care and treatment.</div></div><div><h3>Methods</h3><div>60 purposively sampled stakeholders, including patients, families, health professionals, and lawyers, participated in semi-structured interviews and focus groups in 2018, with 26 of these participating in follow-up interviews in 2022–23. The transcribed interviews were analysed using thematic analysis.</div></div><div><h3>Results</h3><div>Data analysis generated four themes: 1) available resources' influence on DMC assessments; 2) health professionals' values and practices regarding involuntary care; 3) legal interpretations by supervisory bodies regarding involuntary care; and 4) political signals from the health authorities regarding involuntary care.</div></div><div><h3>Conclusion</h3><div>DMC assessments appear to be influenced by several factors, including resource availability, health professionals' values and practices, legal interpretations by supervisory bodies, and political signals from health authorities. Combined with a lack of systematic training and validated tools, these factors may have raised the threshold for accessing mental healthcare beyond what systematic DMC assessments would suggest, contributing to increased illness severity among patients and rising involuntary care rates post-2017. Further research is needed to better understand the complex dynamics involved in DMC assessments and how to effectively implement capacity-based health laws.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"104 ","pages":"Article 102157"},"PeriodicalIF":1.3,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267636","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 : 2025-10-06DOI: 10.1016/j.ijlp.2025.102158
Vladimir Zaichenko
The paper by Butenko et al., ‘Forensic psychiatry misuse in proceedings of administrative offenses’ (International Journal of Law and Psychiatry, 2023) focused on the ‘Case of Zaichenko v. Ukraine (No. 2)’ in the European Court of Human Rights (2015). As the applicant in that case, I wish to respond to the paper by adding further context and detail to the arguments presented. My concerns centre on four areas: findings of national courts, errors and gaps in the European Court of Human Rights judgment, the constitutional consequences of mistranslation, and the broader legal chain of events. Overall, my response to all these circumstances is that intellectuals fear judges as fire, while lawyers fear knowledge and intellectuals. To explain such mutual fear only deepens the horror. This explanation may be correct and precise, but it is also too general. A more concrete half-answer might be this: let us recall (a) the overall number of cases before the Court; (b) the number of judges; (c) the principles of European Court of Human Rights staff recruitment; (d) the frequent incompatibility of member states' normative systems; and (e) their linguistic, confessional, and cultural diversity. Add to this the contradictions of regulation itself, and ordinary human weaknesses. Regulation today has grown to a scale that no single mind can contain, and is produced, not by Solons or Pericles, but by lesser hands. In such conditions, the individual who turns to the Court is often lost behind the informational avalanche. Whom or what can one trust, if not the Court's final judgment? Here I will not appeal to Popper or Lakatos, but only to a much older Athenian, himself once persecuted by a court: ‘Question everything’.
{"title":"Forensic psychiatry assessment and human rights in Ukraine: response to Butenko et al's paper ‘Forensic psychiatry misuse in proceedings of administrative offenses’ (2023)Type of submission","authors":"Vladimir Zaichenko","doi":"10.1016/j.ijlp.2025.102158","DOIUrl":"10.1016/j.ijlp.2025.102158","url":null,"abstract":"<div><div>The paper by Butenko et al., ‘Forensic psychiatry misuse in proceedings of administrative offenses’ (<em>International Journal of Law and Psychiatry,</em> 2023) focused on the ‘Case of Zaichenko v. Ukraine (No. 2)’ in the European Court of Human Rights (2015). As the applicant in that case, I wish to respond to the paper by adding further context and detail to the arguments presented. My concerns centre on four areas: findings of national courts, errors and gaps in the European Court of Human Rights judgment, the constitutional consequences of mistranslation, and the broader legal chain of events. Overall, my response to all these circumstances is that intellectuals fear judges as fire, while lawyers fear knowledge and intellectuals. To explain such mutual fear only deepens the horror. This explanation may be correct and precise, but it is also too general. A more concrete half-answer might be this: let us recall (a) the overall number of cases before the Court; (b) the number of judges; (c) the principles of European Court of Human Rights staff recruitment; (d) the frequent incompatibility of member states' normative systems; and (e) their linguistic, confessional, and cultural diversity. Add to this the contradictions of regulation itself, and ordinary human weaknesses. Regulation today has grown to a scale that no single mind can contain, and is produced, not by Solons or Pericles, but by lesser hands. In such conditions, the individual who turns to the Court is often lost behind the informational avalanche. Whom or what can one trust, if not the Court's final judgment? Here I will not appeal to Popper or Lakatos, but only to a much older Athenian, himself once persecuted by a court: ‘Question everything’.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"104 ","pages":"Article 102158"},"PeriodicalIF":1.3,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245549","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}
The risk for general or criminal recidivism in forensic psychiatric patients has not been extensively investigated in the literature. The aim of this review is to evaluate criminal recidivism among forensic patients with mental disorders undergoing some type of outpatient treatment.
Methods
In this review, we utilized PubMed, Embase, Scopus, and the Cochrane Library to search for studies published from January 1990 up to July 2024. Eligible studies should i) evaluate forensic patients with mental health conditions, ii) evaluate patients undergoing outpatient treatment, and iii) evaluate criminal recidivism (general, sexual, or violent) as a primary outcome. Recidivism was also compared between groups when reported.
Results
Overall, 12 clinical studies including 3271 patients were evaluated. Of these, 3048 patients undergoing outpatient treatment were analyzed. The mean age of all patients was 23.4 years (SD = 6.3), and 79.7 %. were male. The mean follow-up was 33.82 months. Overall, the pooled proportion for general recidivism was 39.1 % (95 % CI: 25 %–54.3 %), and for violent recidivism was 21.7 % (95 % CI: 2.6 %–52.3 %; data from four studies). In group comparisons (data from five studies), there was no difference between patients under treatment and the control groups as far as general recidivism (OR = 0.489; 95 % CI [0.202–1.183]; P = 0.112), and violent recidivism (OR = 0.283; 95 % CI [0.056–1.416]; P = 0.124) were concerned.
Conclusion
The general and violent recidivism rates are high among forensic patients undergoing outpatient treatment for mental health disorders. There was no difference between outpatient treatment and control groups regarding their effect on recidivism. However, most of the studies reviewed did not provide information about drug treatment; more comparative studies focusing on pharmacotherapy are needed to verify any benefits of outpatient treatment.
文献中还没有对法医精神病患者的一般或刑事累犯风险进行广泛的调查。本综述的目的是评估在接受某种类型门诊治疗的精神障碍法医患者的犯罪累犯情况。方法：在本综述中，我们使用PubMed、Embase、Scopus和Cochrane Library检索1990年1月至2024年7月间发表的研究。符合条件的研究应i)评估有精神健康状况的法医患者，ii)评估接受门诊治疗的患者，以及iii)评估刑事累犯（一般、性或暴力）作为主要结果。在报告时，还比较了两组之间的累犯情况。结果：总共评估了12项临床研究，包括3271例患者。其中，3048例接受门诊治疗的患者被分析。所有患者的平均年龄为23.4岁（SD = 6.3），占79.7%。是男性。平均随访时间为33.82个月。总的来说，一般累犯的总比例为39.1% (95% CI: 25% - 54.3%)，暴力累犯的总比例为21.7% （95% CI: 2.6% - 52.3%；数据来自四项研究）。组间比较（数据来自5项研究），治疗组与对照组在一般累犯（OR = 0.489; 95% CI [0.202 ~ 1.183]; P = 0.112）和暴力累犯（OR = 0.283; 95% CI [0.056 ~ 1.416]; P = 0.124）方面无差异。结论：在门诊接受精神障碍治疗的法医患者中，一般再犯率和暴力再犯率较高。门诊治疗组与对照组对再犯的影响无差异。然而，大多数研究没有提供有关药物治疗的信息；需要对药物治疗进行更多的比较研究，以验证门诊治疗的任何益处。
{"title":"Recidivism among forensic psychiatric patients undergoing outpatient treatment for mental health disorders – A meta-analysis","authors":"Panagiota Bali , Fotios Chatzinikolaou , Evangelia Karachaliou , Jakub Lickiewicz , Tella Lantta , Konstantinos Tasios , Vasiliki Efstathiou , Athanasios Douzenis","doi":"10.1016/j.ijlp.2025.102155","DOIUrl":"10.1016/j.ijlp.2025.102155","url":null,"abstract":"<div><h3>Introduction</h3><div>The risk for general or criminal recidivism in forensic psychiatric patients has not been extensively investigated in the literature. The aim of this review is to evaluate criminal recidivism among forensic patients with mental disorders undergoing some type of outpatient treatment.</div></div><div><h3>Methods</h3><div>In this review, we utilized PubMed, Embase, Scopus, and the Cochrane Library to search for studies published from January 1990 up to July 2024. Eligible studies should i) evaluate forensic patients with mental health conditions, ii) evaluate patients undergoing outpatient treatment, and iii) evaluate criminal recidivism (general, sexual, or violent) as a primary outcome. Recidivism was also compared between groups when reported.</div></div><div><h3>Results</h3><div>Overall, 12 clinical studies including 3271 patients were evaluated. Of these, 3048 patients undergoing outpatient treatment were analyzed. The mean age of all patients was 23.4 years (SD = 6.3), and 79.7 %. were male. The mean follow-up was 33.82 months. Overall, the pooled proportion for general recidivism was 39.1 % (95 % CI: 25 %–54.3 %), and for violent recidivism was 21.7 % (95 % CI: 2.6 %–52.3 %; data from four studies). In group comparisons (data from five studies), there was no difference between patients under treatment and the control groups as far as general recidivism (OR = 0.489; 95 % CI [0.202–1.183]; <em>P</em> = 0.112), and violent recidivism (OR = 0.283; 95 % CI [0.056–1.416]; <em>P</em> = 0.124) were concerned.</div></div><div><h3>Conclusion</h3><div>The general and violent recidivism rates are high among forensic patients undergoing outpatient treatment for mental health disorders. There was no difference between outpatient treatment and control groups regarding their effect on recidivism. However, most of the studies reviewed did not provide information about drug treatment; more comparative studies focusing on pharmacotherapy are needed to verify any benefits of outpatient treatment.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"104 ","pages":"Article 102155"},"PeriodicalIF":1.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201803","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 : 2025-09-24DOI: 10.1016/j.ijlp.2025.102156
Yu-Ning Her , Ya-Hsuan Wang , Da-Yuan Ma , Chieh Chang , Fan-Jung Wan , Nian-Sheng Tzeng
Background
The aim of this study is to investigate the psychiatric evaluations for juvenile offenders.
Methods
A total of 166 juvenile offenders were enrolled in this study. After diagnostic psychiatric interviews for 166 juvenile offenders, three groups of academic achievement (normal, academically challenged, and those suspended/dropouts from school). Different offenses, including those were against people, property, related to illicit drugs, or related to sex and delinquency and mental illness were also recorded. The relationship among the mental illness, types of offenses, and academic achievement was analyzed.
Results
In this study, 89.76 % of juvenile offenders reported educational achievement problems and 89.76 % of them had psychiatric disorders. The educational achievement with regard to the types of offenses (p < 0.001) or specific mental illness (p < 0.001). Juvenile offenders who were lagged behind in school performance showed more offenses against property (56.48 %), and more ADHD and conduct disorder (ADHD only: 36.11 %. ADHD with conduct: 12.04 %. ADHD with mood disorder: 11.11 %. Conduct disorder: 14.81 %). Those who dropped out of school showed more offenses against people and more mood disorder (mood disorder only: 24.39 %. Mood disorder with ADHD: 24.39 %). For those without academic challenges, the most common offenses were related to sex.
Conclusions
These findings revealed that often times juvenile offenses are related to psychiatric disorders and school problems.
{"title":"Psychiatric evaluations for adolescent offenders with delinquency in Taiwan","authors":"Yu-Ning Her , Ya-Hsuan Wang , Da-Yuan Ma , Chieh Chang , Fan-Jung Wan , Nian-Sheng Tzeng","doi":"10.1016/j.ijlp.2025.102156","DOIUrl":"10.1016/j.ijlp.2025.102156","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study is to investigate the psychiatric evaluations for juvenile offenders.</div></div><div><h3>Methods</h3><div>A total of 166 juvenile offenders were enrolled in this study. After diagnostic psychiatric interviews for 166 juvenile offenders, three groups of academic achievement (normal, academically challenged, and those suspended/dropouts from school). Different offenses, including those were against people, property, related to illicit drugs, or related to sex and delinquency and mental illness were also recorded. The relationship among the mental illness, types of offenses, and academic achievement was analyzed.</div></div><div><h3>Results</h3><div>In this study, 89.76 % of juvenile offenders reported educational achievement problems and 89.76 % of them had psychiatric disorders. The educational achievement with regard to the types of offenses (<em>p</em> < 0.001) or specific mental illness (<em>p</em> < 0.001). Juvenile offenders who <del>were</del> lagged behind in school performance showed more offenses against property (56.48 %), and more ADHD and conduct disorder (ADHD only: 36.11 %. ADHD with conduct: 12.04 %. ADHD with mood disorder: 11.11 %. Conduct disorder: 14.81 %). Those who dropped out of school showed more offenses against people and more mood disorder (mood disorder only: 24.39 %. Mood disorder with ADHD: 24.39 %). For those without academic challenges, the most common offenses were related to sex.</div></div><div><h3>Conclusions</h3><div>These findings revealed that often times juvenile offenses are related to psychiatric disorders and school problems.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"104 ","pages":"Article 102156"},"PeriodicalIF":1.3,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151420","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 : 2025-09-22DOI: 10.1016/j.ijlp.2025.102154
Kari Eriksen Øverland , Kevin S. Douglas , Elisabeth Norman , A. Linda Gröning
Despite the international recognition of children's evolving capacities and the importance of incorporating these factors into forensic assessments, there is limited research on forensic practices specific to children above the minimum age of criminal responsibility (MACR). The current study is part of a larger project examining legal and forensic assessments related to children's criminal unaccountability (criminal insanity) in Norway. The aim of the current study was to examine how forensic assessments of children above the MACR are conducted in Norway, and to what extent developmental factors are considered in these assessments. Drawing on existing literature, we first propose a set of principles for developmentally informed forensic assessments of children. The principles address direct expert-child interaction; structured assessment procedures; collateral/contextual information; cultural responsiveness; and the qualifications of forensic experts. We then evaluated 122 forensic assessments of children aged 15 to 18 years according to the proposed principles. Our findings revealed significant gaps, including minimal direct engagement with the child, low usage of structured assessment tools, limited collateral information from caregivers and schools, lack of cultural considerations and a concerning lack of child-specific expertise among forensic experts. These shortcomings underscore the need for more rigorous and developmentally sensitive practices. Recommendations include enhanced training, incorporating developmental principles into curricula, and establishing standardized protocols integrating structured assessment tools and comprehensive contextual information. While conducted in a Norwegian context, our study calls for further research in other jurisdictions to develop international guidelines that accommodate the unique developmental needs of children in forensic settings.
{"title":"Developmental factors in forensic assessments of children over the minimum age of criminal responsibility: A study of forensic reports in Norway 2013–2024","authors":"Kari Eriksen Øverland , Kevin S. Douglas , Elisabeth Norman , A. Linda Gröning","doi":"10.1016/j.ijlp.2025.102154","DOIUrl":"10.1016/j.ijlp.2025.102154","url":null,"abstract":"<div><div>Despite the international recognition of children's evolving capacities and the importance of incorporating these factors into forensic assessments, there is limited research on forensic practices specific to children above the minimum age of criminal responsibility (MACR). The current study is part of a larger project examining legal and forensic assessments related to children's criminal unaccountability (criminal insanity) in Norway. The aim of the current study was to examine how forensic assessments of children above the MACR are conducted in Norway, and to what extent developmental factors are considered in these assessments. Drawing on existing literature, we first propose a set of principles for developmentally informed forensic assessments of children. The principles address direct expert-child interaction; structured assessment procedures; collateral/contextual information; cultural responsiveness; and the qualifications of forensic experts. We then evaluated 122 forensic assessments of children aged 15 to 18 years according to the proposed principles. Our findings revealed significant gaps, including minimal direct engagement with the child, low usage of structured assessment tools, limited collateral information from caregivers and schools, lack of cultural considerations and a concerning lack of child-specific expertise among forensic experts. These shortcomings underscore the need for more rigorous and developmentally sensitive practices. Recommendations include enhanced training, incorporating developmental principles into curricula, and establishing standardized protocols integrating structured assessment tools and comprehensive contextual information. While conducted in a Norwegian context, our study calls for further research in other jurisdictions to develop international guidelines that accommodate the unique developmental needs of children in forensic settings.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"104 ","pages":"Article 102154"},"PeriodicalIF":1.3,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145110034","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 : 2025-09-22DOI: 10.1016/j.ijlp.2025.102153
Ana Fresán , Ricardo-Arturo Saracco-Alvarez , J. Mónica Arienti-González , Rebeca Robles-García , Carlos-Alfonso Tovila-Zárate , J. Nicolás I. Martínez-López
Background
The MacArthur Competence Assessment Tool for Treatment (MacCAT-T), a semi-structured interview, is designed to evaluate patient decision-making capacity, a crucial aspect of patient-physician interaction.
Methods
A process study was undertaken of a sample of Mexicans diagnosed with schizophrenia aged between 18 and 50 years to determine the validity and reliability of the MacCAT-T in this population. A ROC curve was plotted to obtain discriminant validity, convergent validity was tested with the VAGUS scale and internal consistency was obtained as a measure of reliability.
Results
Adequate sensitivity (0.95) and specificity (0.75) were obtained with a cut-off point of seven. Significant correlations were observed between the MacCAT-T and the VAGUS scales (r = 0.54 and r = 0.76, p < 0.05), indicative of adequate convergent validity. Internal consistency values were 0.93 for the total score and over 0.80 for all its dimensions.
Conclusion
This study demonstrated that the MacCAT-T is a valid, reliable tool that can be used to assess decision-making capacity in Mexican patients with schizophrenia, which could have a heuristic value for promoting ethical clinical and research practices designed to achieve the crucial balance between patient autonomy and safeguarding.
麦克阿瑟治疗能力评估工具（MacCAT-T）是一种半结构化访谈，旨在评估患者的决策能力，这是医患互动的一个重要方面。方法对年龄在18岁至50岁之间的墨西哥精神分裂症患者进行了一项过程研究，以确定MacCAT-T在该人群中的有效性和可靠性。绘制ROC曲线获得判别效度，用VAGUS量表检验收敛效度，获得内部一致性作为信度的度量。结果灵敏度为0.95，特异度为0.75，分界点为7。MacCAT-T和VAGUS量表之间存在显著相关性（r = 0.54和r = 0.76, p < 0.05），表明具有足够的收敛效度。总分的内部一致性值为0.93，所有维度的内部一致性值均超过0.80。结论本研究表明，MacCAT-T是一种有效、可靠的工具，可用于评估墨西哥精神分裂症患者的决策能力，这对于促进临床和研究实践的道德规范具有启发式价值，旨在实现患者自主和保护之间的关键平衡。
{"title":"Validity and reliability of Mexican version of MacArthur competence assessment tool for treatment decision (MacCAT-T) in patients with schizophrenia","authors":"Ana Fresán , Ricardo-Arturo Saracco-Alvarez , J. Mónica Arienti-González , Rebeca Robles-García , Carlos-Alfonso Tovila-Zárate , J. Nicolás I. Martínez-López","doi":"10.1016/j.ijlp.2025.102153","DOIUrl":"10.1016/j.ijlp.2025.102153","url":null,"abstract":"<div><h3>Background</h3><div>The MacArthur Competence Assessment Tool for Treatment (MacCAT-T), a semi-structured interview, is designed to evaluate patient decision-making capacity, a crucial aspect of patient-physician interaction.</div></div><div><h3>Methods</h3><div>A process study was undertaken of a sample of Mexicans diagnosed with schizophrenia aged between 18 and 50 years to determine the validity and reliability of the MacCAT-T in this population. A ROC curve was plotted to obtain discriminant validity, convergent validity was tested with the VAGUS scale and internal consistency was obtained as a measure of reliability.</div></div><div><h3>Results</h3><div>Adequate sensitivity (0.95) and specificity (0.75) were obtained with a cut-off point of seven. Significant correlations were observed between the MacCAT-T and the VAGUS scales (<em>r</em> = 0.54 and <em>r</em> = 0.76, <em>p</em> < 0.05), indicative of adequate convergent validity. Internal consistency values were 0.93 for the total score and over 0.80 for all its dimensions.</div></div><div><h3>Conclusion</h3><div>This study demonstrated that the MacCAT-T is a valid, reliable tool that can be used to assess decision-making capacity in Mexican patients with schizophrenia, which could have a heuristic value for promoting ethical clinical and research practices designed to achieve the crucial balance between patient autonomy and safeguarding.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"104 ","pages":"Article 102153"},"PeriodicalIF":1.3,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145110033","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 : 2025-09-19DOI: 10.1016/j.ijlp.2025.102144
Paige Lerman , Penelope Weller , Frances Shawyer , Lisa Brophy , Bridget Hamilton , Chris Maylea , Elisabeth Wilson-Evered , Graham Meadows , Ellie Fossey
Psychiatric advance directives have been a prominent theme in mental health system reform. This study aimed to investigate psychiatrists' attitudes towards advance statements following their introduction in the Mental Health Act 2014 in Victoria, Australia (Mental Health Act 2014 (Vic) ss 19–22). Advance statements are non-binding legal documents that permit mental health consumers to outline their treatment preferences, should they become subject to compulsory treatment. The mixed methods design involved psychiatrists completing an online survey based on a clinical vignette (n = 18) followed by in-depth interviews (n = 4). Results showed that psychiatrists viewed insufficient support from their institutions and peers as primary barriers to the effective use of advance statements, suggesting the need for deliberate implementation strategies to ensure psychiatrists make reasonable efforts to give effect to advance statements.
精神病学事前指示已成为精神卫生体制改革的一个突出主题。本研究旨在调查在澳大利亚维多利亚州2014年《精神卫生法》（2014年《精神卫生法》（Vic） ss 19-22）中引入预先陈述后，精神科医生对预先陈述的态度。事先声明是不具约束力的法律文件，允许心理健康消费者在接受强制治疗时概述其治疗偏好。混合方法设计包括精神病学家完成一项基于临床小插曲的在线调查（n = 18），然后是深度访谈（n = 4）。结果显示，精神科医生认为来自机构和同行的支持不足是有效使用预陈述的主要障碍，这表明需要深思熟虑的实施策略，以确保精神科医生做出合理的努力，使预陈述生效。
{"title":"Psychiatrists’ engagement with advance statement in Victoria, Australia","authors":"Paige Lerman , Penelope Weller , Frances Shawyer , Lisa Brophy , Bridget Hamilton , Chris Maylea , Elisabeth Wilson-Evered , Graham Meadows , Ellie Fossey","doi":"10.1016/j.ijlp.2025.102144","DOIUrl":"10.1016/j.ijlp.2025.102144","url":null,"abstract":"<div><div>Psychiatric advance directives have been a prominent theme in mental health system reform. This study aimed to investigate psychiatrists' attitudes towards advance statements following their introduction in the <span><span>Mental Health Act 2014</span></span> in Victoria, Australia (<em>Mental Health Act 2014 (Vic)</em> ss 19–22). Advance statements are non-binding legal documents that permit mental health consumers to outline their treatment preferences, should they become subject to compulsory treatment. The mixed methods design involved psychiatrists completing an online survey based on a clinical vignette (<em>n</em> = 18) followed by in-depth interviews (<em>n</em> = 4). Results showed that psychiatrists viewed insufficient support from their institutions and peers as primary barriers to the effective use of advance statements, suggesting the need for deliberate implementation strategies to ensure psychiatrists make reasonable efforts to give effect to advance statements.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"104 ","pages":"Article 102144"},"PeriodicalIF":1.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103018","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 : 2025-09-09DOI: 10.1016/j.ijlp.2025.102143
Rannveig Íva Aspardóttir, Hannah Jones, Alan Underwood, Jennifer Hopton, Georgina Mathlin
Individuals with mental health difficulties in Iceland can be detained in police cells as a last resource place of safety when psychiatrists consider patients unsuitable for admission to a ward, for example, due to being under the influence of substances or being too violent. We aimed to investigate if detainment in a police cell affected symptoms of mental illnesses, and subsequently if police cells are an appropriate place of safety for patients in Iceland. We used a mixed methods approach utilising administrative records of detainees' visible symptoms of mental illnesses and ten semi-structured interviews with mental health professionals and police sergeants. Unpublished secondary data from the Reykjavik Metropolitan Police of detainees (n = 6874) and exceptional incidents in police cells from the 1st of January 2018 to the 18th of August 2022 was analysed. 72.1 % of all suicide attempts and 77.3 % of all self-harming behaviour took place in the initial four hours of detainment. Three themes generated from the interviews with professionals: 1) violent behaviour as a determining factor in using police cells as a place of safety, 2) the detrimental impact of detainment in police cells on mental health, and 3) the lack of support and resources for professionals to appropriately care for individuals with mental health difficulties. The study highlights police cells are not currently suitable places of safety in Iceland. New laws and regulations in Iceland should be developed to support police and mental health professionals to adequately provide safety for individuals with mental health difficulties.
{"title":"Symptoms of mental health difficulties in police cell detainees in Iceland: Is it an appropriate place of safety for patients? A mixed methods study","authors":"Rannveig Íva Aspardóttir, Hannah Jones, Alan Underwood, Jennifer Hopton, Georgina Mathlin","doi":"10.1016/j.ijlp.2025.102143","DOIUrl":"10.1016/j.ijlp.2025.102143","url":null,"abstract":"<div><div>Individuals with mental health difficulties in Iceland can be detained in police cells as a last resource place of safety when psychiatrists consider patients unsuitable for admission to a ward, for example, due to being under the influence of substances or being too violent. We aimed to investigate if detainment in a police cell affected symptoms of mental illnesses, and subsequently if police cells are an appropriate place of safety for patients in Iceland. We used a mixed methods approach utilising administrative records of detainees' visible symptoms of mental illnesses and ten semi-structured interviews with mental health professionals and police sergeants. Unpublished secondary data from the Reykjavik Metropolitan Police of detainees (<em>n</em> = 6874) and exceptional incidents in police cells from the 1st of January 2018 to the 18th of August 2022 was analysed. 72.1 % of all suicide attempts and 77.3 % of all self-harming behaviour took place in the initial four hours of detainment. Three themes generated from the interviews with professionals: 1) violent behaviour as a determining factor in using police cells as a place of safety, 2) the detrimental impact of detainment in police cells on mental health, and 3) the lack of support and resources for professionals to appropriately care for individuals with mental health difficulties. The study highlights police cells are not currently suitable places of safety in Iceland. New laws and regulations in Iceland should be developed to support police and mental health professionals to adequately provide safety for individuals with mental health difficulties.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"104 ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145011220","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 : 2025-09-09DOI: 10.1016/j.ijlp.2025.102140
Kate Diesfeld , Greg Young
New Zealand, as well as other jurisdictions, are revisiting their decision-making capacity law regimes. Currently several strands of New Zealand capacity law are under review. Reforms could impact many people across many domains of decision-making. Focussing on adult decision-making, we describe features of New Zealand's approach to decision-making capacity law that resemble other jurisdictions. We then summarise unique features of New Zealand law and explain the urgency of reform, in light of our obligations under the United Nations Convention on the Rights of Persons with Disabilities, research funded by the Human Rights Commission and the findings of New Zealand's Royal Commission of Inquiry Abuse in Care. Analysis of New Zealand's capacity law is timely, given the current review of the two key statutes governing adult decision-making and mental health legislation.
{"title":"Decision-making capacity law developments in Aotearoa New Zealand","authors":"Kate Diesfeld , Greg Young","doi":"10.1016/j.ijlp.2025.102140","DOIUrl":"10.1016/j.ijlp.2025.102140","url":null,"abstract":"<div><div>New Zealand, as well as other jurisdictions, are revisiting their decision-making capacity law regimes. Currently several strands of New Zealand capacity law are under review. Reforms could impact many people across many domains of decision-making. Focussing on adult decision-making, we describe features of New Zealand's approach to decision-making capacity law that resemble other jurisdictions. We then summarise unique features of New Zealand law and explain the urgency of reform, in light of our obligations under the United Nations Convention on the Rights of Persons with Disabilities, research funded by the Human Rights Commission and the findings of New Zealand's Royal Commission of Inquiry Abuse in Care. Analysis of New Zealand's capacity law is timely, given the current review of the two key statutes governing adult decision-making and mental health legislation.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"104 ","pages":"Article 102140"},"PeriodicalIF":1.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145020698","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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