International Journal of Law and Psychiatry最新文献

Introduction

For people with a serious mental disorder, a community treatment order (CTO) is a legal response that requires them to undergo psychiatric treatment unwillingly under certain conditions. Qualitative studies have explored the perspectives of individuals involved in CTOs, including persons with lived experiences of a CTO, family members and mental health care providers, who are directly involved in these procedures. However, few studies have integrated their different perspectives.

Method

This descriptive and qualitative study aimed to explore the experience associated with a CTO in hospital and community settings among individuals with a history of CTO, relatives, and mental health care providers. Using a participatory research approach, individual semi-structured interviews were conducted with 35 participants. The data were reviewed using content analysis.

Results

Three themes and seven sub-themes were identified: 1) differential positions as a function of meaning conferred to CTOs; 2) a risk management tool; and 3) coping strategies used to deal with CTOs. Overall, relatives' and mental health care providers' perspectives tended to be in opposition to those who went under a CTO.

Conclusions

In a context of recovery-oriented care, more research is needed to reconcile the seemingly contradictory positions of individual with experiential knowledge and the legal leverage that deprives them of their fundamental right to autonomy.

In recent years, political events have reignited contentious debates about psychiatry and democratic governance. This discourse has largely centred around the ethics and morality of public commentary, particularly in relation to the American Psychiatric Association's Goldwater Rule. Yet, few studies have examined the practical implications of health-related limitations due to mental illness in national leadership and the constitutional and legal provisions that surround these issues, including voluntary or involuntary proceedings. Accordingly, this theoretical paper analyses these topics in a German context using the position at the head of the executive: the chancellorship. Germany was selected as a case example as the biggest democracy in Europe with modern legal frameworks representative of the post-World War Two era in European constitutionalism, and for its economic and political influence within the European Union. Throughout this paper, we do not speculate on the mental health of any individual (past or present), but instead explore jurisdictional mechanisms around health-related limitations in German high office. Consequently, we outline relevant constitutional and legal scenarios, and how short- or long-term medical incapacity may determine requisite responses and contingent complexities. This underpins our discussion, where we consider legal ambiguities, functional capacity, and ethical concerns in psychiatric practice.

This paper provides a theoretical rationale for using the constructs of procedural justice, trust and self-determination as a framework to guide the evidence-based practice of therapeutic jurisprudence (TJ). The overarching purpose of TJ is to provide therapeutic outcomes to all participants in the legal system. This paper proposes that in legal decision-making, running a procedurally just process that generates trust amongst participants and allows the parties to experience self-determination, creates a dynamic akin to the therapeutic alliance, which, in therapy, is a reliable predictor of therapeutic outcomes. The paper argues that when a legal therapeutic alliance forms in a legal decision-making process then positive therapeutic outcomes are possible, and the process can be classified as one that accords with the philosophy of TJ. A subsequent argument is that a therapeutic court can be defined as one that enacts such a process. The paper concludes by explaining how the framework can provide both a guide to courts in designing TJ processes and an assessment framework to analyse legal decision-making processes for their therapeutic value.

The Italian mafia organizations represent a subculture with values, beliefs and goals that are antithetical to and undermining of the predominant society. The conduct of individual members includes such extreme violence for material gain, it may at least superficially suggest a severe personality disorder. Since the first edition of the DSM and into the 21st century, various terms have been used, sometimes interchangeably, but over time inconsistently, to designate the mentality and practices of mafia members. Only recently has the psychology of mafia members become a focus of serious scientific study. Following broader national multicenter research, the present study aimed at investigating the possible differences in psychopathy between those mafia associates who had been convicted only of mafia association (Group A, bosses), and those who were also convicted of violent crimes (Group B, soldiers). The Psychopathy Checklist-Revised (PCL-R) was administered to n = 48 male inmates convicted of mafia association (M_age 45.0 years, SD 10.9, range 20–80 years); Group A consisted of n = 26 (54%) subjects, Group B n = 22 (46%). Most of the sample (73%) did not manifest psychopathy (PCL-R ≥ 25) nor Mann-Whitney U test disclosed significant differences in the total PCL-R scores between the study groups. We found significantly higher scores of PCR-R factor 1 (interpersonal / affective) in the members of the mafia association also convicted of violent crimes (PCL-R F1, group A: 5.8 ± 3.7; group B: 7.9 ± 3.5; p < 0.05), this difference appeared explainable on the basis of a higher component of affective psychopathy. These initial results add to the limited literature on mafia and psychopathy and seem to suggest the existence of a specific component of psychopathy in the subgroup of mafiosi with overtly violent conduct.

The central question of this study is whether buffering, boosting and exacerbating effects of the Big Five personality factors extraversion, openness to experience, agreeableness, conscientiousness and neuroticism can be demonstrated in the relationship between two job demands (i.e., work pressure and working overtime) and both burnout and work engagement in 257 Dutch judges. It is important to better understand the interaction effects between various job demands (work pressure and working overtime) and personality on both burnout and work engagement in judges given their increased risk of burnout and lower work engagement due to cognitively and their emotionally demanding work. Three hypotheses were tested in a cross-sectional design study. Moderation analyses showed that, as expected, conscientiousness significantly boosted the relationship between working overtime and work engagement. Hence, high scorers on conscientiousness showed more work engagement when working overtime. Also, extraversion moderated the relation between working overtime and work engagement, but only at a low level of extraversion. Thus, contrary to expectations, introverts showed more work engagement when they work overtime. Also, significant main effects were found. Work pressure and neuroticism related positively to burnout, while extraversion and agreeableness related negatively to burnout. Moreover, extraversion, agreeableness and conscientiousness related positively to work engagement. In our study, conscientiousness, extraversion and agreeableness can be considered as personal resources for judges, in line with the Conservation of Resources (COR) theory. Especially conscientiousness can facilitate judges to cope with challenging working circumstances and introversion ensures that judges stay engaged despite working overtime.

Introduction

The number of older prisoners with mental health issues released from prisons and forensic psychiatric institutions is rising. Their successful integration is important due to its implications for the public's safety and the individual's health and well-being. However, reintegration efforts are hampered due to the double stigma attached to ‘mental illness’ and ‘incarceration history’. To alleviate the burden of such stigma, affected persons and their social networks employ stigma management strategies. This study sought to investigate the stigma management strategies of mental health professionals supporting older incarcerated adults with mental health issues in their reintegration process.

Methods

Semi-structured interviews with 63 mental health professionals from Canada and Switzerland were carried out as part of the overall project. To address the reintegration topic, data from 18 interviews were used. Data analysis followed the thematic analysis approach.

Results

Mental health professionals emphasized the double stigmatization of their patients which impaired their quest for housing. Lengthy searches for placement frequently resulted in patients' unnecessary long stays in forensic programs. Nevertheless, participants outlined that they were at times successful in finding appropriate housing for their patients due to the use of certain stigma management strategies. They stated that they, first, established initial contacts with outside institutions, second, educated them about stigmatizing labels and, third, provided ongoing collaboration with public institutions.

Discussion

Incarcerated persons with mental health issues face double stigmatization that affects their reentry process. Our findings are interesting as they illustrate ways in which stigma can be reduced, and how the reentry process can be streamlined. Future research should include the perspectives of incarcerated adults with mental health issues to shed more light on the various options that they seek for successful reintegration after imprisonment.

Objective

The aim of this study was to examine a sample (n = 150) of elderly offenders to analyse the psychiatric, medical, demographic, criminal and if available neuropsychological test characteristics and criminal responsibility.

Method

Data were gathered through a retrospective chart review of applicants aged 65 and over who were referred for determination of criminal responsibility from 2014 to 2019 at the Observation Department of Council of Forensic Medicine (Adli Tip Kurumu Baskanligi, Gözlem İhtisas Dairesi) who were evaluated under inpatient status by law.

Results

There were 150 forensic cases aged 65 and over. The majority of the crimes were homicide (25.3%), homicide attempt (10%), and sexual offence (26%). The majority of sexual offence victims were children (34 of 39 cases). The percentages of decisions on criminal liability were as follows: 76% (n = 114) had full criminal liability, 21.3% of them (n = 32) had no criminal liability, 2.7% of them (n = 4) had reduced criminal liability. For the reduced/no criminal liability group, diagnoses were as follows: 37.1% dementia syndromes, 31.4% schizophrenia, 11.5% delusional disorder and 2.8% bipolar disorder manic episode.

Conclusion

When the findings in our study and current literature data are examined, it is seen that certain crime groups such as murder and attempted murder, and sexual crimes against children are high in elderly forensic psychiatric evaluations.

The Buss-Durkee Hostility Inventory (BDHI) is an important assessment scale of hostility in forensic psychiatry. We analyzed the validity and reliability of a Papiamento translation of the BDHI in 134 pre-trial defendants in Curaçao using Exploratory Structural Equation Modeling (ESEM). The reliability of the Direct and Indirect Hostility BHDI-P subscales were good and the reliability of the Social Desirability poor. There was a negative correlation between Direct Hostility and Agreeableness and a positive correlation between Indirect Hostility and Anxiety. We conclude that the BDHI-P has an acceptable measurement quality when used in defendants.

In this research, we provide two important contributions to the psychiatric community. First, we offer the first valid and reliable cognitive test that measures forensic clinicians' ability to detect and avoid diagnostic biases in psychiatric assessments. Second, we also estimate the prevalence of clinical decision bias detection and prevention ability among psychiatrists and psychologists. A total of 1069 clinicians from different specialties (317 psychiatrists and 752 clinical psychologists, of which 286 were forensic clinicians) participated in this research. The Checklist of Biases for Clinicians (BIAS-31) was developed, and its psychometric properties were analyzed. The prevalence of bias detection and prevention was estimated using BIAS-31 scores. The BIAS-31 is valid and reliable for measuring clinicians' ability to avoid and detect clinical biases. Between 41.2% and 55.8% of clinicians try to avoid biased clinical judgments. Likewise, between 48.5% and 57.5% of clinicians were able to correctly detect the biases involved in the diagnostic assessment process. We did not expect to obtain these prevalences. Therefore, we discuss to what extent specific training in the prevention of diagnostic biases is necessary and propose several clinical strategies to prevent a priori the occurrence of biases in the psychiatric assessment.

The coronavirus disease 2019 (COVID-19) pandemic led to increased psychological distress and far-reaching restrictions of freedom. In March 2020, Austrian penal authorities enacted various safety and protection measures to mitigate the propagation of COVID-19. While infection rates in penal institutions were low, restrictive conditions of detention limited the forensic care of offenders. This retrospective longitudinal observational study aimed to evaluate the impact of the pandemic on the psychosocial rehabilitation in forensic psychiatry.

Administrative and clinical data obtained from 97 males treated at an inpatient forensic mental health institution were compared before (January 2019 – mid-March 2020) and after (mid-March 2020 – May 2021) the enactment of pandemic-related restrictive measures. The study outcomes related to rehabilitative activities, social contacts, psychopathological stability, and compliance with institutional regulations.

During the pandemic, a decrease in individual one-day temporary releases (64 vs. 3, p < .001) and one-day group excursions (103 vs. 10, p < .001) was observed. Likewise, visits by relatives (1440 vs. 429, p < .001) and legal guardians (286 vs. 130, p = .009) decreased. Regarding compliance with institutional regulations, illegal activities decreased from 27 to 8 after enactment of restrictive measures (p = .024). In contrast, long-term temporary releases (122 vs. 188 weeks, p = .131) and admissions to the acute ward (141 vs. 143, p = .712) remained unchanged. Overall, this study demonstrates the substantial impact of COVID-19 on the psychosocial care of forensic psychiatric patients and implies the necessity for guidelines to uphold an appropriate standard of forensic rehabilitation during future pandemics.