International Journal of Law and Psychiatry最新文献_第6页

Swinging the pendulum from ‘a necessary evil’ to ‘the dignity of risk’: Can new UN legislative guidance help to end psychiatric coercion? 将钟摆从“必要之恶”转向“风险的尊严”：新的联合国立法指导能帮助结束精神胁迫吗？

IF 1.4 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-07-03 DOI: 10.1016/j.ijlp.2025.102102

Laura Davidson

The Convention on the Rights of Persons with Disabilities (CRPD) came into force almost two decades ago. Prohibitive of disability discrimination, Article 1 includes “long-term…mental…[and] intellectual impairments”. Thus, psychiatric coercion and the detention and forced medical treatment of persons with permanent cognitive impairment are unlawful acts. Due to non-compliance with the CRPD, the World Health Organization (WHO) withdrew its legislative mental health guidance several years ago. It has since conducted lengthy consultations with stakeholders, including many with lived experience of psychosocial disability.¹ This has led to new guidance compiled jointly with the UN Office of the High Commissioner for Human Rights (OHCHR), Mental Health, Human Rights and Legislation: Guidance and Practice (2023). The publication is described as a useful resource for states and decision-makers, and a “call to action” to realise the CRPD's vision of a shift from coercive care to equality and non-discrimination. It offers suggestions for legislative provisions that promote human rights and dignity in mental health systems to comply with international human rights norms and standards. Furthermore, it exhorts states to ensure that legislation recognises the “dignity of risk” for service users, which runs contrary to the current dominant biomedical model. This article considers the Guidance's take on key CRPD provisions and reflects on its logic and the legislative solutions it offers to various legal and ethical questions surrounding “hard cases”. The article also discusses some of the likely implications arising from compliance with the Guidance and the CRPD on which it is based, with particular reference to the law of England and Wales.

《残疾人权利公约》（CRPD）于近20年前生效。第1条禁止残疾歧视，包括“长期……精神……[和]智力缺陷”。因此，精神胁迫以及对有永久性认知障碍的人的拘留和强迫治疗是非法行为。由于不遵守《残疾人权利公约》，世界卫生组织（世卫组织）几年前撤回了其精神卫生立法指导。此后，它与利益攸关方进行了长时间的磋商，其中包括许多有过心理社会残疾经历的人为此，与联合国人权事务高级专员办事处（人权高专办）《精神卫生、人权与立法：指南与实践（2023年）》联合编写了新的指南。该出版物被描述为国家和决策者的有用资源，以及实现《残疾人权利公约》从强制护理转向平等和非歧视的愿景的“行动呼吁”。它为促进精神卫生系统中的人权和尊严的立法规定提出建议，以符合国际人权规范和标准。此外，它敦促各国确保立法承认服务使用者的“风险尊严”，这与目前占主导地位的生物医学模式背道而驰。本文考虑《指引》对《残疾人权利公约》主要条款的看法，并反思其逻辑和它为围绕“疑难案件”的各种法律和道德问题提供的立法解决方案。本文还讨论了遵守《指引》及其所依据的《残疾人权利公约》可能产生的一些影响，特别提到了英格兰和威尔士的法律。

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引用次数: 0

Evaluation of the sensitivity of the Health Screening of People in Police Custody (HELP-PC) tool in Northumbria Police, UK 英国诺森比亚警察局在押人员健康筛查（HELP-PC）工具敏感性评估

IF 1.4 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-06-23 DOI: 10.1016/j.ijlp.2025.102101

Thomas Cranshaw , Helena Austin , John Moore , Evelyn Evans , Salma Rauf , Faye Groom , Ellie Mannix , Ellen Whitehouse , Iain McKinnon

This paper presents an evaluation of a novel health screening tool implemented in 2016 by Northumbria Police, in the North East of England, United Kingdom. The aim of the study was to determine the sensitivity of the tool in detecting physical and mental health conditions. Secondary aims were to produce useful data on the prevalence of these conditions and onward referrals within custody. The tool was compared to a clinical interview carried out within the custody suite by research psychiatrists. Researchers spent a total of 64 days within the custody suite and interviewed 177 participants. The tool performed variably, with 100 % sensitivity for diabetes, epilepsy and psychosis, however in other areas the sensitivity was lower such as for opioid dependency (18 %). When compared to the pilot study of the tool there is a non-significant trend towards improved sensitivity, with no areas in which sensitivity has reduced. In comparison to a previous evaluation of an alternative tool, this tool has improved sensitivity for asthma (92 vs 49 %, p < 0.001), cardiovascular complaints (38 vs 2 %, p < 0.0001), head injury (72 vs 17 %, p = 0.004) and intellectual disability (82 vs 25 %, p = 0.016).

本文介绍了2016年由英国英格兰东北部诺森比亚警察局实施的一种新型健康筛查工具的评估。该研究的目的是确定该工具在检测身体和精神健康状况方面的敏感性。次要目的是就这些情况的普遍程度和在拘留期间的后续转诊提供有用的数据。研究人员将该工具与精神病学家在监护病房内进行的临床访谈进行了比较。研究人员在拘留室里呆了64天，采访了177名参与者。该工具的表现各不相同，对糖尿病、癫痫和精神病的敏感性为100%，但在其他领域的敏感性较低，如阿片类药物依赖（18%）。与该工具的初步研究相比，灵敏度提高的趋势并不显著，没有任何灵敏度降低的区域。与之前对替代工具的评估相比，该工具提高了对哮喘的敏感性(92% vs 49%, p <；0.001)，心血管疾病(38 vs 2%, p <；0.0001)，头部损伤（72% vs 17%, p = 0.004）和智力残疾（82% vs 25%, p = 0.016）。

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引用次数: 0

A repertoire and critical review of international resources relevant to medical assistance in dying where a mental disorder is the sole underlying medical condition 对与精神失常是唯一潜在医疗状况的死亡医疗援助有关的国际资源的汇编和批判性审查

IF 1.4 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-06-23 DOI: 10.1016/j.ijlp.2025.102114

Caroline Favron-Godbout , Izadora Foster , Eric Racine

Background

The possibility of asking for help in ending one's life is at the heart of some of the most enduring debates in medicine and bioethics. As a growing number of countries open to the practice, many concerns are emerging internationally about medical assistance in dying where a mental disorder is the sole underlying medical condition (MAiD-MD). It is paramount to understand what academic literature and resources are available to support different stakeholders in the context of MAiD-MD.

Objectives

This review aims to specifically identify various resources related to MAiD-MD and to initiate a process of compiling international resources to raise awareness about certain resources and support stakeholders to develop new resources.

Methods

This review of resources adopted a methodology inspired by the work of Arksey and O'Malley (2005) and Levac et al. (2010)’s scoping studies, as well as more structured forms of thematic literature reviews for content extraction.

Results

165 resources related directly or indirectly to MAiD-MD were identified and grouped according to the following six categories: 1) Laws, judgments, decisions, and reports from the operationalization of laws; 2) Ethical and clinical guidelines, protocols, practice guides, and information for healthcare professionals; 3) Resource directories; 4) Resources for sharing experiences, discussions, support or training; 5) Written resources for MAiD applicants, their relatives or the population; 6) Resources to support reflections and guide the development of practices. Twenty main relevant themes were identified through the thematic analysis. These themes are addressed and explored in varying degrees of depth throughout different resources.

Discussion

A diversity of relevant resources is developed internationally, but these are sometimes dispersed, little known, or inaccessible to the public. Numerous resources are developed to inform the various stakeholders and train healthcare professionals, but there seems to be a need to develop advanced support resources to help the various stakeholders in the context of MAiD-MD.

寻求帮助结束生命的可能性是医学和生物伦理学中一些最持久的争论的核心。随着越来越多的国家对这种做法开放，国际上出现了许多关于以精神障碍为唯一潜在医疗状况的死亡医疗援助的担忧（MAiD-MD）。了解哪些学术文献和资源可用于支持mad - md背景下的不同利益相关者是至关重要的。本综述旨在明确确定与mad - md相关的各种资源，并启动汇编国际资源的过程，以提高对某些资源的认识，并支持利益相关者开发新资源。方法本次资源综述采用的方法受到Arksey和O' malley（2005）以及Levac等人（2010）的范围界定研究的启发，以及内容提取的更结构化的主题文献综述形式。结果将165个直接或间接与mad - md相关的资源按以下6类进行分类：1)法律、判决、决定和法律实施报告；2)卫生保健专业人员的伦理和临床指南、协议、实践指南和信息；3)资源目录；4)分享经验、讨论、支持或培训的资源；5)为MAiD申请人、其亲属或人口提供的书面资源；6)支持反思和指导实践发展的资源。通过专题分析确定了20个主要的相关主题。这些主题在不同的资源中以不同程度的深度进行处理和探索。国际上开发了多种相关资源，但这些资源有时分散、鲜为人知或公众无法获得。已经开发了许多资源来通知各种利益相关者并培训医疗保健专业人员，但似乎需要开发先进的支持资源来帮助MAiD-MD背景下的各种利益相关者。

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引用次数: 0

Hoarding disorder, therapeutic jurisprudence and residential tenancy law: A complex relationship and opportunities for reform 囤积症、治疗法学与住宅租赁法：复杂关系与改革机遇

IF 1.4 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-06-13 DOI: 10.1016/j.ijlp.2025.102125

Adam Finkelstein, Marie Bismark, Rebecca Bentley, Erika Martino

For many, home represents comfort and security. However, for renters living with hoarding disorder, stable housing is often at risk. Hoarding disorder is a chronic mental illness associated with significant public health risks to both communities and individuals across jurisdictions. Internationally, residential tenancy laws often address hoarding using blunt legal measures at odds with the treatment needs of people living with the condition, which can negatively impact their health and wellbeing and potential recovery.

Leveraging a therapeutic jurisprudence framework to consider biopsychosocial outcomes, this paper examines residential tenancy laws in Victoria, Australia to consider how tenancy laws affect tenure security and the extent to which they hinder the promotion of health and wellbeing among renters living with hoarding disorder. A rapid review of international academic and grey literature, Victorian case-law and relevant parts of the Residential Tenancies Act 1997 (Vic) was conducted.

Analysis showed that, in the case of Victoria, the legal framework does not fully align with therapeutic jurisprudence principles, instead relying on impersonal task-centred approaches to address hoarding related issues in rental properties. Consequently, renters living with hoarding disorder are at increased risk of psychological distress, homelessness, and a reluctance to engage with supports. Recommendations with international relevance and applicability are discussed, including sector coordination and capacity building, and common avenues for legislative reform. Future research should prioritise lived experience perspectives, along with generating improved evidence through robust data collection that can inform reform in the rental sector.

对许多人来说，家代表着舒适和安全。然而，对于患有囤积症的租房者来说，稳定的住房往往存在风险。囤积障碍是一种慢性精神疾病，对各个司法管辖区的社区和个人都有重大的公共卫生风险。在国际上，住房租赁法经常使用与患有这种疾病的人的治疗需求不一致的生硬法律措施来解决囤积问题，这可能对他们的健康和福祉以及潜在的康复产生负面影响。利用治疗法学框架来考虑生物心理社会结果，本文研究了澳大利亚维多利亚州的住宅租赁法，以考虑租赁法如何影响租赁权安全，以及它们在多大程度上阻碍了患有囤积症的租房者促进健康和福祉。对国际学术和灰色文献、维多利亚州判例法和1997年《住宅租赁法》（维多利亚州）的相关部分进行了快速审查。分析表明，在维多利亚州的情况下，法律框架并不完全符合治疗法学原则，而是依靠客观的以任务为中心的方法来解决租赁物业中囤积相关问题。因此，患有囤积症的租房者面临更大的心理困扰、无家可归和不愿接受支持的风险。讨论了具有国际相关性和适用性的建议，包括部门协调和能力建设，以及立法改革的共同途径。未来的研究应优先考虑生活体验的观点，同时通过可靠的数据收集产生改进的证据，为租赁行业的改革提供信息。

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引用次数: 0

A case study of forensic psychiatry experts' reports analysis through large language models 通过大型语言模型分析法医精神病学专家报告的案例研究

IF 1.4 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-06-13 DOI: 10.1016/j.ijlp.2025.102122

Giulia Petroni , Salvatore Alaimo , Gabriele Mandarelli , Roberto Catanesi , Cinzia Niolu , Alberto Siracusano , Alfredo Pulvirenti

The integration of artificial intelligence (AI) technologies in forensic psychiatry has gained significant attention due to their potential to enhance tasks such as outcome prediction and decision-making. In this study, we explored the feasibility and performance of a large language model (LLM-GPT) in extracting both clinical and non-clinical variables from authentic forensic psychiatric reports concerning defendants' criminal responsibility and social dangerousness. We employed GPT-4o to extract relevant data using a set of custom queries, which we applied to two forensic psychiatric expert reports. The results of the study demonstrated that the system was capable of extracting information from the forensic psychiatric reports and generating a summarized version. Identifying the most important parts to construct a meaningful synthesis in a highly specialized application domain is currently a challenge. This study highlights the potential of AI in forensic psychiatry and suggests that this approach could be valuable for collecting semi-automated or automated data from reports, enabling the creation of a large dataset that could be used for further research and analysis.

人工智能（AI）技术在法医精神病学中的整合已经引起了极大的关注，因为它们有可能增强结果预测和决策等任务。在这项研究中，我们探索了一个大语言模型（LLM-GPT）在从真实的法医精神病学报告中提取有关被告刑事责任和社会危险的临床和非临床变量的可行性和性能。我们使用gpt - 40使用一组自定义查询提取相关数据，我们将其应用于两份法医精神病学专家报告。研究结果表明，该系统能够从法医精神病学报告中提取信息并生成摘要版本。在高度专门化的应用领域中，确定最重要的部分来构建有意义的合成是当前的一个挑战。这项研究强调了人工智能在法医精神病学中的潜力，并表明这种方法对于从报告中收集半自动或自动化数据可能很有价值，从而创建一个可用于进一步研究和分析的大型数据集。

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引用次数: 0

Conflicting purposes: Guardianship law, mental health law and involuntary detentions 相互冲突的目的：监护法、精神卫生法和非自愿拘留

IF 1.4 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-06-10 DOI: 10.1016/j.ijlp.2025.102111

Joan Braun

Part 3 of British Columbia's Adult Guardianship Act provides a statutory framework for protecting adults who are abused or neglected and unable to seek support and assistance on their own. The legislation aligns with modern approaches to guardianship with its focus on providing support to vulnerable adults. This statute's philosophy is captured in guiding principles, which affirm the presumption of capability and stipulate that support and assistance must be provided in a minimally intrusive manner. However, there is a gap between the statute's guiding principles and the legislation's application in practice. This is exemplified by using involuntary detentions as a mechanism to protect vulnerable adults from harm. Currently, British Columbia's health authorities rely on sections 22 of the Mental Health Act and 59 of the Adult Guardianship Act for authority to involuntarily detain older adults with dementia without their consent. This article argues that this practice raises serious rights concerns and that the resulting gap between the statute's philosophy and its implementation is due to inadequate procedural protections and overlap between the Adult Guardianship Act and the Mental Health Act. The article examines these issues through an analysis of the legislation, a discussion of relevant literature and judicial consideration of the issues, and identification of relevant rights concerns. Recommendations are made about how to address the gap between the intended purpose of the legislation and current practice.

不列颠哥伦比亚省《成人监护法》第3部分提供了一个法律框架，以保护受虐待或被忽视且无法自行寻求支持和帮助的成年人。该立法与现代监护方法相一致，其重点是为弱势成年人提供支持。该规约的理念体现在指导原则中，这些原则肯定了对能力的假定，并规定必须以最低限度的侵入方式提供支助和援助。然而，规约的指导原则与立法在实践中的应用之间存在着差距。使用非自愿拘留作为保护弱势成年人免受伤害的机制就是一个例子。目前，不列颠哥伦比亚省卫生当局根据《精神卫生法》第22条和《成人监护法》第59条的规定，有权在未经老年人同意的情况下非自愿地拘留患有痴呆症的老年人。这篇文章认为，这种做法引起了严重的权利问题，规约的理念与其执行之间的差距是由于程序性保护不足以及《成人监护法》与《精神卫生法》之间的重叠。本文通过对这些问题的立法分析、对相关文献的讨论和对这些问题的司法考虑，以及对相关权利问题的识别来探讨这些问题。就如何解决立法的预期目的与现行做法之间的差距提出了建议。

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引用次数: 0

The Dutch Compulsory Care Act: Possible effects on emergency involuntary admissions, treatment, and length of stay 荷兰强制护理法：对紧急非自愿入院、治疗和住院时间可能产生的影响

IF 1.4 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-06-10 DOI: 10.1016/j.ijlp.2025.102113

S. Gemsa , E.O. Noorthoorn , P. Lepping , H.A. de Haan , G.J.M. Hutschemaekers

Purpose

The Special admissions Act (1994) was replaced in 2020 by the Dutch Compulsory Care Act (2018). Whereas the former law focused mainly on involuntary treatment during an inpatient admission, the Compulsory Care Act (2018) aims to reduce involuntary care and allows involuntary care in in- and outpatient settings if unavoidable. The main aim of this study is to assess the observed impact of the change in legislation on admission duration and the use of involuntary care options with a focus on medication and seclusion during acute admissions.

Methods

Data were collected from a large Mental Health Trust in the east of the Netherlands. We compared health care monitoring data from the years 2016 and 2017 and 2020 and 2021. The data cover involuntary treatment and the short-term law articles warranting these in both inpatient and outpatient settings.

Results

In the years studied the number of patients treated involuntarily and the number of short-term involuntary emergency articles were fully comparable. Involuntary medication was used more often in 2020–2021 than in 2016–17; however, seclusion was used much less. The total duration of admissions started within a short-term emergency article decreased significantly from 96 days before the change in the law to 71 days after the law change (Effect size = 0.225, p = 0.012). Days of involuntary inpatient stay within a short-term emergency authorization remained the same. Inpatient involuntary medication almost doubled. Involuntary outpatient care by means of medication was mainly used during and after discharge, seldom before or without admission.

Conclusions

After the change in the law, compulsory care was used with similar frequency and for a similar number of patients. In this study an increase in the use of medication was associated with a significant reduction in the length of inpatient admissions. Involuntary medication was used less frequently in an outpatient than in an inpatient setting, despite being possible as a means to avoid involuntary emergency admissions.

目的《特别录取法》（1994年）于2020年被《荷兰义务医疗法》（2018年）所取代。之前的法律主要侧重于住院期间的非自愿治疗，而《强制医疗法》（2018年）旨在减少非自愿治疗，并允许在不可避免的情况下在住院和门诊环境中进行非自愿治疗。本研究的主要目的是评估观察到的立法变化对住院时间和非自愿护理选择的影响，重点是在急性入院期间进行药物治疗和隔离。方法数据从荷兰东部的一家大型精神健康信托基金收集。我们比较了2016年和2017年以及2020年和2021年的卫生保健监测数据。这些数据涵盖了非自愿治疗和住院和门诊条件下的短期法律条款。结果研究年份非自愿住院患者数与短期非自愿急诊病例数具有完全可比性。与2016 - 2017年相比，2020-2021年非自愿用药的使用频率更高；然而，隔离的使用要少得多。在短期紧急条目内开始的入院总时间从法律变更前的96天显著减少到法律变更后的71天（效应值= 0.225,p = 0.012）。短期紧急许可的非自愿住院天数保持不变。住院病人非自愿用药几乎翻了一番。非自愿门诊以药物治疗为主，主要在出院期间和出院后进行，很少在入院前或入院后进行。结论法律变更后，强制医疗的使用频率和患者数量相似。在这项研究中，药物使用的增加与住院时间的显著减少有关。非自愿用药在门诊的使用频率低于住院，尽管这可能是避免非自愿急诊入院的一种手段。

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引用次数: 0

The Mental Health Bill 2024 in the Republic of Ireland: Potential implications for adults with intellectual disabilities 爱尔兰共和国《2024年精神健康法案》：对智力残疾成年人的潜在影响

IF 1.4 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-05-29 DOI: 10.1016/j.ijlp.2025.102112

Dr Bláithín O'Shea

The Mental Health Bill 2024 aims to amend provisions relating to involuntary admission, detention, and treatment of persons with ‘mental disorder’ in mental health centres in the Republic of Ireland. This article critically analyses proposals under the Mental Health Bill 2024 which are most relevant to persons with intellectual disabilities (PWID). In particular, it examines the proposals to remove “significant intellectual disability” from the definition of “mental disorder”, and to prohibit the involuntary detention of a person solely on the basis that they have an intellectual disability. It explores the reasoning behind these proposals and identifies potential gaps and challenges which may be created by the proposed reforms, including the issues which remain for PWID who have co-occurring mental illness; the possibility that PWID who exhibit challenging behaviour – but who are not accused of a crime – may be funnelled into the criminal justice system due to a lack of alternative and appropriate measures and services; and possible contradictions which may exist for persons with intellectual disabilities subject to the Criminal Law (Insanity) Act 2006.

《2024年精神卫生法》旨在修订与爱尔兰共和国精神健康中心非自愿接纳、拘留和治疗“精神障碍”患者有关的条款。本文批判性地分析了《2024年精神健康法案》下与智力残疾者最相关的建议。它特别审查了从“精神障碍”的定义中删除“严重智力残疾”的建议，以及禁止仅以智力残疾为理由对一个人进行非自愿拘留的建议。它探讨了这些建议背后的原因，并确定了拟议改革可能产生的潜在差距和挑战，包括对患有共同发生的精神疾病的PWID患者仍然存在的问题；由于缺乏替代和适当的措施和服务，表现出具有挑战性行为但未被指控犯罪的PWID可能会被输送到刑事司法系统；以及受《2006年刑法（精神错乱）法》约束的智障人士可能存在的矛盾。

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引用次数: 0

RIGHTCARE-PR: Reporting guidelines for human rights in child and adolescent psychiatry RIGHTCARE-PR：儿童和青少年精神病学人权报告指南

IF 1.4 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-05-29 DOI: 10.1016/j.ijlp.2025.102110

Elvira Pértega , Christopher Holmberg

Background

Historically, global mental health has struggled between an evidence based biomedical model and a rights-based approach focusing on user perspectives. A particularly problematic global mental health challenge is the use of restraints in psychiatry, highly regulated but controversial and risky, often deemed incompatible with human rights. Despite calls for an absolute ban, inconsistent terms, definitions, and reporting requirements complicate an accurate understanding. Effective research reporting in light of human rights is crucial for knowledge dissemination and ethical integrity.

Aim

This paper aims to provide reporting guidance for the neglected area of restraints in child inpatient psychiatric care, integrating scientific evidence and human rights to enhance mental health service quality.

Methods

This study builds upon a previous literature review by Pértega and Holmberg (2023) on child restraints in psychiatric settings that found a lack of human rights considerations in scientific literature in four domains: study context, stakeholders, restraint phenomena, and regulations. Relevance for reporting on these items were consulted through a Delphi process involving international experts from law, psychiatry, and social sciences, providing a comparative perspective on legal and psychiatric practices to refine the guidelines.

Results

To ensure evidence-based mental health interventions align with human rights principles, this paper proposes reporting standards that integrate human rights into research on child psychiatric care restraints. The RIGHTCARE-PR guidelines consist of 14 items across four domains, enhancing the clarity and comprehensiveness of research reporting.

These guidelines provide a robust and practical tool for researchers to improve the quality and ethical integrity of psychiatric research, benefiting authors, editors, reviewers, and readers.

历史上，全球精神卫生一直在以证据为基础的生物医学模式和以用户观点为重点的基于权利的方法之间挣扎。一个特别成问题的全球精神卫生挑战是在精神病学中使用限制，这种限制受到严格管制，但存在争议和风险，往往被认为与人权不相容。尽管呼吁绝对禁止，但不一致的术语、定义和报告要求使准确理解复杂化。基于人权的有效研究报告对于知识传播和道德操守至关重要。目的针对儿童住院精神科监护中束缚行为被忽视的领域提供报告指导，将科学证据与人权相结合，提高精神卫生服务质量。方法：本研究建立在p rtega和Holmberg（2023）先前关于精神病院儿童约束的文献综述的基础上，该文献发现在四个领域的科学文献中缺乏对人权的考虑：研究背景、利益相关者、约束现象和法规。通过涉及法律、精神病学和社会科学的国际专家的德尔菲程序，对这些项目报告的相关性进行了咨询，提供了法律和精神病学实践的比较观点，以完善指南。为了确保基于证据的心理健康干预措施与人权原则保持一致，本文提出了将人权纳入儿童精神病护理限制研究的报告标准。RIGHTCARE-PR指南包括四个领域的14个项目，提高了研究报告的清晰度和全面性。这些指南为研究人员提供了一个强大而实用的工具，以提高精神病学研究的质量和道德完整性，使作者、编辑、审稿人和读者受益。

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引用次数: 0

Subject injury and police use of force in mental health crises 心理健康危机中的主体伤害和警察使用武力

IF 1.4 4区医学 Q1 LAW

International Journal of Law and Psychiatry

Pub Date : 2025-05-26 DOI: 10.1016/j.ijlp.2025.102104

H.L. Joseph , W. Liu , K. Petersen , J. Sheridan-Johnson , B.G. Taylor

This study examines the relative likelihood of police officer firearm use and severity of subject injury in officer encounters with subjects in mental health crises (MHC) and those not in mental health crises (nMHC). The study sample is from a dataset of officer involved shootings (OIS) and officer use of force (UOF) incidents from 26 large law enforcement agencies (LEAs) in the U.S. Logistic and ordinal regressions were used to assess whether subject UOF, resisting arrest, weapon use, intoxication or sociodemographic factors were related to officer firearm use and severity of subject injury, comparing cases involving MHC (N = 1334) and nMHC (N = 2848). Though the risk of officer firearm use and severity of subject injury were significantly positively correlated with being in MHC, there was no significant difference in either outcome between individuals in MHC and nMHC after controlling for the other predictors in the regressions. Compared to those in nMHC at the time of their encounter with the police, those in MHC were found to be more likely to resist arrest, use a weapon, and be intoxicated during encounters with police. People of color were at uniquely high risk for more severe injury in nMHC but not those in MHC. Additionally, the subject being intoxicated was associated with increased risk of officer firearm use in MHC but not in nMHC. This study identified specific populations (e.g., people of color, those with comorbid mental illness and substance use) and specific subject behaviors (e.g., weapon use) associated with increased risk of officer firearm use and subject injury that are more likely in MHC and warrant further protection during police encounters. Study findings highlight the critical importance that officers receive training in best practices in identifying when a subject is in MHC, implement appropriate de-escalation strategies, and partner with mental health professionals to increase mental health care utilization and decrease risk of harm.

本研究考察了警察在遭遇心理健康危机（MHC）和非心理健康危机（nMHC）时使用枪支的相对可能性和受试者受伤的严重程度。研究样本来自美国26个大型执法机构（LEAs）的警员涉事枪击（OIS）和警员使用武力（UOF）事件数据集，使用Logistic和序数回归来评估受试者涉事枪击、拒捕、武器使用、醉酒或社会人口因素是否与警员使用枪支和受伤严重程度有关，并比较涉及MHC （N = 1334）和nMHC （N = 2848）的案件。尽管警员使用枪支的风险和受试者受伤的严重程度与MHC呈显著正相关，但在回归中控制了其他预测因子后，MHC和nMHC个体之间的任何结果都没有显著差异。与nMHC的人相比，MHC的人在遇到警察时更有可能拒捕，使用武器，在遇到警察时喝醉酒。有色人种在nMHC中遭受更严重伤害的风险特别高，而在MHC中则不然。此外，醉酒的受试者与MHC中警察使用枪支的风险增加有关，但与nMHC无关。该研究确定了特定人群（如有色人种、患有精神疾病和药物使用共病的人）和特定主体行为（如武器使用）与警察使用枪支和主体受伤的风险增加有关，这些行为在MHC中更有可能发生，因此在警察遭遇时需要进一步保护。研究结果强调，官员接受最佳做法培训至关重要，以确定受试者何时处于MHC状态，实施适当的降级战略，并与精神卫生专业人员合作，以增加精神卫生保健的利用并降低伤害风险。

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