International Journal of Law and Psychiatry最新文献

Adult safeguarding legislation is contentious because it seeks to protect ‘vulnerable’ adults who fall between the borderlands of social care, mental health and mental capacity law. As a new and complex area of law and practice, further research on adult safeguarding legislation is required, in particular to consider it efficacy and human rights implications. Utilising a narrative literature review approach this article explores current research evidence on the Adult Support and Protection (Scotland) Act 2007 to consider whether safeguarding powers and duties can achieve a proportionate balance between individual autonomy and the state's duties to protect adults at risk of harm and, if so, how. The findings demonstrate there is a wide range of people who can fall into these borderland areas. For a majority, the use of the Act has made significant positive differences to their lives. However, while supported decision-making was identified it was not found to be consistently applied. In addition, concerns emerged around the adequacy of some professionals' legal knowledge, the consistent upholding of adults' will and preferences, and the commitment to and resourcing of supported decision-making. Notwithstanding these drawbacks, it is concluded that this Act provides vital functions but amendments would enhance alignment with the CRPD.

When an alleged victim has a pre-existing psychopathological diagnosis, this can affect the rating of their version of the abuse in terms of credibility. The objective of this work is to analyze the relationship between the assessment of the credibility of the testimony of a CSA victim, the psychological problems that the child may have presented prior to sexual abuse and the possible psychological sequelae that she may present as a result of the abuse. 109 cases were selected in which the credibility of the testimony could be determined. Through forensic interviews and the study of the corresponding professional reports, the following were obtained: sociodemographic data, data on their previous psychological state and data on their psychological state after the reported events. The psychological state of the child after the reported events shows no relation to the forensic evaluation of the credibility of her testimony. The existence of a relationship between the absence of previous psychopathology and the fact that the victim's testimony is valued as a credible account is confirmed. This study reveals that children who presented psychological manifestations prior to their experience of abuse receive a lower credibility rating than those without previous psychopathological symptoms or diagnoses.

A psychotically motivated act or an act committed under impaired insight and control of action in the midst of an acute psychosis is the standard for lack of criminal responsibility. There is now increasing evidence that positive symptoms, particularly in the form of hallucinations and delusions, in trauma-related disorders and borderline personality disorder (BPD) are comparable to positive symptoms in psychotic disorders, posing a challenge for differential diagnosis and forensic assessment of the relevance of positive symptoms to insight and self-control. Due to the indistinguishability of the phenomena, there is both a risk of misdiagnosis of a psychotic disorder and also trivialization with the use of pseudo-hallucinations or quasi-psychotic labels. Essential phenomenological differences that may be helpful in forensic assessments are the usually preserved reality testing in trauma-related disorders and BPD, as well as differences in psychopathological symptom constellations. Because of these differences relevant to forensic assessments, it seems useful to distinguish trauma-related disorders and BPD with positive symptoms from psychotic disorders.

This article explores how the European Court of Human Rights has applied the norms of the UN Convention on the Rights of Persons with Disabilities (CRPD) in the area of mental health law. The European Court was initially receptive to the CRPD, including the UN Committee on the Rights of Persons with Disabilities' call for a repeal of legislation permitting involuntary psychiatric hospitalisation, but later distanced itself from it. The CRPD has nevertheless influenced how the European Court approached (a) involuntary hospitalisation, (b) separating detention from treatment, (c) restraints and other forms of ill-treatment in institutions, and (d) disability-neutral detention based on disability. Despite the two treaty bodies' different jurisprudential methodology and their different assumptions about the role of medical and legal professionals, the CRPD can continue to influence the European Court in areas such as less restrictive alternatives to coercive treatment, the relevance of capacity, and the importance of personal integrity for mental health treatment.

Objective

To systematically review the literature on methods for the standardized and objective assessment of Testamentary Capacity (TC), to identify the best evidence-based and clinically pragmatic method to assess TC. Doubts concerning TC can have far-reaching legal and financial implications.

Method

A systematic search of the literature was conducted, using PRISMA guidelines, to identify studies which describe methods or tools for the assessment of TC.

Results

The Testamentary Definition Scale (TDS); the Testamentary Capacity Assessment Tool (TCAT); and the Testamentary Capacity Instrument (TCI) all have good psychometric properties, but TDS only partially assesses TC, and the TCI is designed for research rather than day-to-day clinical practice.

Conclusion

The TCAT could usefully supplement the clinical assessment of TC, coupled with a standardized examination of cognition. There is room to develop an all-encompassing TC assessment tool. Currently, the clinical judgement of a medical professional, taking account of the medical, legal, ethical issues informing a capacity or competency decision, remains the gold standard for assessing TC.

Background

The relationship between schizophrenia spectrum disorders (SSD) and criminal behaviour is a central issue in forensic psychiatry. People with mental illness face some of the same types of criminogenic factors as people without mental illness, albeit more frequently. The research question of this study is the extent to which a framework of early and late offender typology can be empirically reconstructed in a forensic psychiatric population, and whether there are any practical implications.

Method

For N = 733 patients in six different forensic hospitals in Germany, the age at first psychiatric admission and the age at first registered offence were documented, as well as a number of other patient-related characteristics. Two clustering procedures were used to investigate whether forensic psychiatric patients could be classified according to these characteristics.

Results

A k-means cluster analysis using age at first psychiatric admission, age at first recorded offence, sociodemographic, clinical and criminological characteristics supported a 4-cluster solution. MANOVA analyses revealed further differences between the identified types.

Conclusion

This study empirically confirms some of the sub-groups of the early and late starter typology described in the literature. In particular, the "early starters", "late starters" and "first presenters" were identified, but cluster four comprises individuals not previously described in the scientific literature. Each of these classes has group-specific characteristics that may have implications for forensic treatment, post-release aftercare, and the legal system.

The Convention on the Rights of Persons with Disabilities (CRPD) sets out a new vision for mental health care with equality and self-determination as its core standards. The CRPD fundamentally challenges long-standing practices in Sweden including the use of involuntary hospitalization, treatment without consent, and the use of restraints. This article discusses the impact of this new vision on Swedish mental health law and policy. An examination of mental health law inquiries from 2008 to 2023 reveals a notable lack of attention from policymakers towards the CRPD. Nevertheless, the Convention has emerged as a vital advocacy instrument for disability organizations and others opposing proposals that seek to broaden doctors' authority to employ coercion. In addition, the many efforts undertaken to reduce the use of coercion and to enhance the involvement of individuals with psychosocial disabilities in policy development align seamlessly with the principles of the Convention. This article concludes with a reflection on why the CRPD has not assumed a more prominent role in shaping mental health law in Sweden and calls on the government to seriously consider the CRPD's call for equality.

This article examines the reasons behind the limited impact of China's mental health law reform in 2013 on reducing the use of restrictive measures in mental health services, focusing on the analysis of case law from Chinese courts. The analysis of collected rulings from the official database indicates that Chinese courts have adopted a lenient approach in scrutinizing the application of restrictive measures. Furthermore, the interpretation and application of the provisions related to restrictive measures in the law have led to service providers being held liable in numerous cases for not implementing such measures. Based on these findings, the article offers policy recommendations.

Self-directed violence (SDV), including both suicide and non-suicidal self-injury, represents a major challenge for carceral systems. Persistent self-injury (PSI) is an understudied SDV subtype, especially within the carceral context. The present study addressed three research questions: (a) do naturally occurring SDV subgroups occur within a carceral population (e.g., PSI versus other classes); (b) how SDV groups may be differentiated by verbal or behavioral SDV; and (c) whether demographic, mental health, and incarceration-related factors are associated with SDV subgroups. We conducted a secondary analysis of existing data from a statewide carceral electronic medical record (N = 3527). Latent class analysis supports two SDV subtypes: episodic and persistent self-injury. The PSI class was characterized by significantly greater verbal expressions and behavioral acts of SDV compared to the episodic group. Correlates of the PSI subtype included older age, male sex, prior SDV, and lower depressive symptoms. Findings are discussed with respect to the proposed Diagnostic and Statistical Manual self-injury focused disorder, influential factors on SDV in carceral settings, and recommendations for future research and practice.

There is a need to maximize understanding of conditions under which officers are most likely to use lethal force when interacting with persons with severe mental illness (SMI) and whether utilization of a mental health professional (MHP) serves to reduce use of force (UoF) severity. Using a mixed methods concurrent triangulation design framework, this exploratory study examined UoF with individuals exhibiting signs of psychosis and whether police-MHP partnerships decrease UoF severity. Findings indicate officers use more severe forms of force with armed individuals displaying signs of psychosis and that MHP presence did not reduce force severity in such cases. Qualitative themes provide context for these findings and include (1) concerns for MHP safety, (2) planned collaborations support safety, and (3) MHPs support de-escalation. Discussion highlights a need for increased officer education on SMI, appropriate de-escalation strategies, co-created engagement/disengagement protocols for MHPs, and defined standards of practice for police-mental health collaborations.