Pub Date : 2023-05-01DOI: 10.1016/j.ijlp.2023.101892
S. Verhülsdonk , A.K. Folkerts , K. Dietrich , B. Höft , T. Supprian , M. Jänner , E. Kalbe
The number of elderly delinquent individuals living in prisons and forensic hospitals is increasing. For both settings, complex needs have been described for the elderly related to age-related changes and frequent somatic disorders as well as mental disorders, primarily depressive symptoms.. One of the biggest challenges are cognitive impairments which have been described for both groups, probably not least due to frequent risk factors (e.g., substance abuse, depressive symptoms). Given that the group of forensic patients has a manifest mental illness, which is usually treated with psychopharmaceuticals, the question arises as to what extent cognitive deficits are more frequent here. For both groups, the detection of cognitive deficits with regard to therapy and release planning is of relevance. In sum, studies on cognitive function in both populations are rare, and the results are hard to compare due to different instruments to assess cognition.
Sociodemographic, health-, and incarceration-related data were collected as well as neuropsychological functions using established instruments to evaluate global cognitive functioning (Mini-Mental State Examination [MMSE], DemTect), executive function (Frontal Assessment Battery [FAB], and Trail Making Test [TMT]).
In the final sample, 57 prisoners and 34 forensic inpatients from North Rhine Westphalia, Germany being 60 years and older were included. The groups were comparable in age (prisoners: M = 66.5 years, SD ± 5.3; forensic inpatients: M = 66.8 years, SD ± 7.5) and education (prisoners: M = 11.47, SD ± 2.91; forensic inpatients: M = 11.39, SD ± 3.64), but the offenders in forensic psychiatry had spent significantly more time in the correctional setting than prisoners (prisoners: M = 8.6, SD ± 10.8; forensic inpatients: M = 15.6 years, SD ± 11.9). In both groups cognitive deficits were frequent. Depending on the tests and population, between 42% and 64% showed impairments in global cognition, and between 22% and 70% were classified with impaired executive functioning. We found no significant differences in global cognition or executive functions assessed with the TMT between the two groups. However, forensic inpatients were significantly more impaired in the FAB compared to the prisoners.
The results emphasize the high frequency of cognitive dysfunction in both settings and a possibly higher frequency of “frontal” dysfunction in forensic inpatients, and, thus, indicate the relevance of routine neuropsychological diagnostic and treatment procedures in these settings.
{"title":"Cognition in older offenders in North Rhine-Westphalia: A comparison of prisoners and patients in forensic psychiatry hospitals","authors":"S. Verhülsdonk , A.K. Folkerts , K. Dietrich , B. Höft , T. Supprian , M. Jänner , E. Kalbe","doi":"10.1016/j.ijlp.2023.101892","DOIUrl":"10.1016/j.ijlp.2023.101892","url":null,"abstract":"<div><p>The number of elderly delinquent individuals living in prisons and forensic hospitals is increasing. For both settings, complex needs have been described for the elderly related to age-related changes and frequent somatic disorders as well as mental disorders, primarily depressive symptoms.. One of the biggest challenges are cognitive impairments which have been described for both groups, probably not least due to frequent risk factors (e.g., substance abuse, depressive symptoms). Given that the group of forensic patients has a manifest mental illness, which is usually treated with psychopharmaceuticals, the question arises as to what extent cognitive deficits are more frequent here. For both groups, the detection of cognitive deficits with regard to therapy and release planning is of relevance. In sum, studies on cognitive function in both populations are rare, and the results are hard to compare due to different instruments to assess cognition.</p><p>Sociodemographic, health-, and incarceration-related data were collected as well as neuropsychological functions using established instruments to evaluate global cognitive functioning (Mini-Mental State Examination [MMSE], DemTect), executive function (Frontal Assessment Battery [FAB], and Trail Making Test [TMT]).</p><p>In the final sample, 57 prisoners and 34 forensic inpatients from North Rhine Westphalia, Germany being 60 years and older were included. The groups were comparable in age (prisoners: M = 66.5 years, SD ± 5.3; forensic inpatients: M = 66.8 years, SD ± 7.5) and education (prisoners: M = 11.47, SD ± 2.91; forensic inpatients: M = 11.39, SD ± 3.64), but the offenders in forensic psychiatry had spent significantly more time in the correctional setting than prisoners (prisoners: M = 8.6, SD ± 10.8; forensic inpatients: M = 15.6 years, SD ± 11.9). In both groups cognitive deficits were frequent. Depending on the tests and population, between 42% and 64% showed impairments in global cognition, and between 22% and 70% were classified with impaired executive functioning. We found no significant differences in global cognition or executive functions assessed with the TMT between the two groups. However, forensic inpatients were significantly more impaired in the FAB compared to the prisoners.</p><p>The results emphasize the high frequency of cognitive dysfunction in both settings and a possibly higher frequency of “frontal” dysfunction in forensic inpatients, and, thus, indicate the relevance of routine neuropsychological diagnostic and treatment procedures in these settings.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9932261","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 : 2023-05-01DOI: 10.1016/j.ijlp.2023.101885
J. Biegańska-Banaś , P. Banaś , M. Zięba , J.K. Gierowski , J. Trzebiński
This study aimed to assess the accuracy of post-traumatic stress disorder (PTSD) diagnoses made by mental health experts in people reporting post-traumatic stress symptoms related to traffic accidents. Data were collected from sixty participants: 30 with possible traumatic experiences and 30 who had never experienced this or other types of traumatic events. Six professional diagnosticians examined the participants with Structured Clinical Interview for the Study of Axis I Disorders (SCID-I for DSM-IV-TR) in conditions similar to those typical of judicial cases related to traffic accident damage claims. There was no significant difference in the number of PTSD diagnoses between malingerers and non-malingerers. Some PTSD symptoms were more frequently recognized in malingerers. This study demonstrates that even professional diagnosticians with clinical and jurisprudence experience have significant difficulty identifying PTSD malingering. This difficulty can be linked to the limitations of diagnoses based on introspective reports.
{"title":"PTSD malingering detection in damage claim cases: Diagnostic accuracy in cases of personal injury as a result of motor vehicle accidents","authors":"J. Biegańska-Banaś , P. Banaś , M. Zięba , J.K. Gierowski , J. Trzebiński","doi":"10.1016/j.ijlp.2023.101885","DOIUrl":"10.1016/j.ijlp.2023.101885","url":null,"abstract":"<div><p>This study aimed to assess the accuracy of post-traumatic stress disorder (PTSD) diagnoses made by mental health experts in people reporting post-traumatic stress symptoms related to traffic accidents. Data were collected from sixty participants: 30 with possible traumatic experiences and 30 who had never experienced this or other types of traumatic events. Six professional diagnosticians examined the participants with Structured Clinical Interview for the Study of Axis I Disorders (SCID-I for DSM-IV-TR) in conditions similar to those typical of judicial cases related to traffic accident damage claims. There was no significant difference in the number of PTSD diagnoses between malingerers and non-malingerers. Some PTSD symptoms were more frequently recognized in malingerers. This study demonstrates that even professional diagnosticians with clinical and jurisprudence experience have significant difficulty identifying PTSD malingering. This difficulty can be linked to the limitations of diagnoses based on introspective reports.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9629423","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 : 2023-05-01DOI: 10.1016/j.ijlp.2023.101893
Timothy I. Lawrence , Logan A. Yelderman
Parole boards are often required to make many release recommendations after reviewing a substantial amount of information in a short timeframe. While making release decisions, parole board members might be motivated to sacrifice accuracy and, instead, use heuristics, such as their emotions. Emotions might increase the reliance on risk or threat related information, such as an inmate's mental illness status. The current study applies the appraisal tendency framework of emotion to assess the impact of emotion on parole decisions involving juvenile mental health diagnoses. Using a 3(emotion: anger, compassion, and control) x 4(mental illness: conduct disorder, oppositional defiant disorder, depression, and control) factorial design, this study examined the extent to which mock parole board members' emotions impacted evaluations of inmates with juvenile mental illness diagnoses and subsequent release decisions. Results indicated that there was no effect of emotion on parole decisions. However, the inmates' mental illnesses did play a role in parole release decisions. Specifically, parole candidates with depression were released on parole at higher rates compared to conduct disorder, oppositional defiant disorder, and the control condition. Policy implications are discussed.
{"title":"The effects of emotion and juvenile diagnoses on parole release decisions: An experimental approach","authors":"Timothy I. Lawrence , Logan A. Yelderman","doi":"10.1016/j.ijlp.2023.101893","DOIUrl":"10.1016/j.ijlp.2023.101893","url":null,"abstract":"<div><p>Parole boards are often required to make many release recommendations after reviewing a substantial amount of information in a short timeframe. While making release decisions, parole board members might be motivated to sacrifice accuracy and, instead, use heuristics, such as their emotions. Emotions might increase the reliance on risk or threat related information, such as an inmate's mental illness status. The current study applies the appraisal tendency framework of emotion to assess the impact of emotion on parole decisions involving juvenile mental health diagnoses. Using a 3(emotion: anger, compassion, and control) x 4(mental illness: conduct disorder, oppositional defiant disorder, depression, and control) factorial design, this study examined the extent to which mock parole board members' emotions impacted evaluations of inmates with juvenile mental illness diagnoses and subsequent release decisions. Results indicated that there was no effect of emotion on parole decisions. However, the inmates' mental illnesses did play a role in parole release decisions. Specifically, parole candidates with depression were released on parole at higher rates compared to conduct disorder, oppositional defiant disorder, and the control condition. Policy implications are discussed.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9630491","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 : 2023-05-01DOI: 10.1016/j.ijlp.2023.101874
Silvia Marcó-García , Georgina Guilera , Marta Ferrer-Quintero , Susana Ochoa , Gemma Escuder-Romeva , Arantxa Martínez-Mondejar , Vanessa Montalbán-Roca , Núria del Cacho , Elena Rubio-Abadal , Ana Escanilla-Casal , Francisco Martínez-Zambrano , Sol Balsells-Mejía , Elena Huerta-Ramos
Severe mental disorder (SMD) includes people with long-term mental disorders, disability and social dysfunction. The mental capacity evaluation of the people has been a key aspect in legislative systems around the world and different proposals have been made. In countries like Spain, until 2021, the mental capacity of individuals was assessed by means of legal proceedings. In the last years, there has been a notable increase in the number of claims for legal incapacity, but no data are available on the total number of persons with CM, neither on the specific pathologies, or clinical and cognitive profiles. In view of the total absence of data on the profile of people with SMD and modification of capacity, the RECAPACITA study was born. This study includes patients with SMD and CM, as well as those without CM, with the aim to describe exhaustively their clinical, neuropsychological and functional profile of people with SMD and CM, as well as obtaining a basic description of the social environment.
Objectives
To describe CM in SMD, to identify clinical diagnoses, clinical severity and neuropsychological deterioration. Methods: Cross-sectional descriptive study. 77 adult patients with SMD and CM, inpatients from the mental health sector of the Parc Sanitari Sant Joan de Déu (Spain), outpatients linked to the community rehabilitation services (CRS), and penitentiary inmates. CM, sociodemographic, clinical, functional and neuropsychological data are collected.
Results
In the sample, 59.5% present total CM. 74.7% are men (mean: 52.5 years). 87,0% have a diagnosis of schizophrenia. The estimated premorbid IQ is 91.4. The Global Assessment of Functioning (GAF) had a mean of 50.5, the “Clinical Global Impression Scale” (CGI) was 4.6 and Scale Unawareness of Mental Disorders (SUMD) was 9.28. The cognitive results shows a profile with slow proceeding speed (mean scale score: 6.6), good working memory (mean SC: 8.3) and adequate verbal comprehension (mean SC: 7.3). In memory, coding is altered (Pz: −1.9), and long-term spontaneous recall (Pz: −2.3). In abstract reasoning, a slight alteration is obtained (Mean SC: 6), as well as in semantic fluency (Mean SC: 6.3), phonological (Mean SC: 5.9), and inhibitory capacity (Mean SC: 5.7).
Conclusions
Most of the sample are men with schizophrenia, with a total MC assumed by a tutelary foundation. They show a moderate alteration in global functioning and clinical global impression, with partial awareness of the disease. They present dysexecutive mild cognitive impairment, with poor memory coding and free retrieval capacity, and a normal IQ, adequate verbal comprehension and working memory. This study is the first to present objective data on the psychiatric, functional and cognitive status of a group of patients with CM. Such research could be a good starting point to address a topic of great interest from the health, social and legal p
{"title":"The RECAPACITA project: Description of the clinical, neuropsychological and functional profile of a sample of people with severe mental disorder and legal capacity modification in Spain","authors":"Silvia Marcó-García , Georgina Guilera , Marta Ferrer-Quintero , Susana Ochoa , Gemma Escuder-Romeva , Arantxa Martínez-Mondejar , Vanessa Montalbán-Roca , Núria del Cacho , Elena Rubio-Abadal , Ana Escanilla-Casal , Francisco Martínez-Zambrano , Sol Balsells-Mejía , Elena Huerta-Ramos","doi":"10.1016/j.ijlp.2023.101874","DOIUrl":"10.1016/j.ijlp.2023.101874","url":null,"abstract":"<div><p>Severe mental disorder (SMD) includes people with long-term mental disorders, disability and social dysfunction. The mental capacity evaluation of the people has been a key aspect in legislative systems around the world and different proposals have been made. In countries like Spain, until 2021, the mental capacity of individuals was assessed by means of legal proceedings. In the last years, there has been a notable increase in the number of claims for legal incapacity, but no data are available on the total number of persons with CM, neither on the specific pathologies, or clinical and cognitive profiles. In view of the total absence of data on the profile of people with SMD and modification of capacity, the RECAPACITA study was born. This study includes patients with SMD and CM, as well as those without CM, with the aim to describe exhaustively their clinical, neuropsychological and functional profile of people with SMD and CM, as well as obtaining a basic description of the social environment.</p></div><div><h3>Objectives</h3><p>To describe CM in SMD, to identify clinical diagnoses, clinical severity and neuropsychological deterioration. Methods: Cross-sectional descriptive study. 77 adult patients with SMD and CM, inpatients from the mental health sector of the Parc Sanitari Sant Joan de Déu (Spain), outpatients linked to the community rehabilitation services (CRS), and penitentiary inmates. CM, sociodemographic, clinical, functional and neuropsychological data are collected.</p></div><div><h3>Results</h3><p>In the sample, 59.5% present total CM. 74.7% are men (mean: 52.5 years). 87,0% have a diagnosis of schizophrenia. The estimated premorbid IQ is 91.4. The Global Assessment of Functioning (GAF) had a mean of 50.5, the “Clinical Global Impression Scale” (CGI) was 4.6 and Scale Unawareness of Mental Disorders (SUMD) was 9.28. The cognitive results shows a profile with slow proceeding speed (mean scale score: 6.6), good working memory (mean SC: 8.3) and adequate verbal comprehension (mean SC: 7.3). In memory, coding is altered (Pz: −1.9), and long-term spontaneous recall (Pz: −2.3). In abstract reasoning, a slight alteration is obtained (Mean SC: 6), as well as in semantic fluency (Mean SC: 6.3), phonological (Mean SC: 5.9), and inhibitory capacity (Mean SC: 5.7).</p></div><div><h3>Conclusions</h3><p>Most of the sample are men with schizophrenia, with a total MC assumed by a tutelary foundation. They show a moderate alteration in global functioning and clinical global impression, with partial awareness of the disease. They present dysexecutive mild cognitive impairment, with poor memory coding and free retrieval capacity, and a normal IQ, adequate verbal comprehension and working memory. This study is the first to present objective data on the psychiatric, functional and cognitive status of a group of patients with CM. Such research could be a good starting point to address a topic of great interest from the health, social and legal p","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9629410","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 : 2023-05-01DOI: 10.1016/j.ijlp.2023.101884
Eirini Alexiou , Thomas Nilsson , Peter Andiné , Alessio Degl' Innocenti
Background
The aim of this study was to evaluate criminal outcomes of mentally disordered offenders in compulsory forensic psychiatric care during the year 2010 versus 2018. More specifically, we sought to identify the occurrence of new criminal sentences during ongoing treatment and possible factors associated with recidivistic criminality. Another aim was to map previous criminality, types of index crime, and whether there were any changes within this decade.
Methods
Crime-, clinical, and treatment-related variables were collected from the Swedish National Forensic Psychiatric Register for all unique inpatients registered from January 1–December 31 in 2010 (N = 717) and 2018 (N = 757). The mean, frequency, percentage, and standard deviation were calculated per variable and stratified by study year and gender. Between-group comparisons were made using t-tests and Chi-square tests. Binary logistic regression was performed to determine whether variables expected to be associated with recidivism showed any relation to criminal recidivism for each study cohort.
Results
Most patients were male and approximately one-quarter and one-half of the men, respectively, had a previous sentence for non-violent and violent crimes. The 2018 cohort showed significantly lower rates of sentences to forensic psychiatry with special court supervision although the numbers were low in both cohorts and for both men and women. Previous violent conviction was associated with criminal recidivism during treatment in 2010, while this was joined by index crime under the influence of alcohol/illicit drugs for the 2018 cohort.
Conclusions
Overall, these results showed more similarities between the 2010 and 2018 cohorts then dissimilarities, while on the other hand some quite substantial differences were described between males versus females. The results of this study indicate that it may be possible to tailor forensic psychiatric treatment to gender as a proxy for other variables related to increased criminal recidivism in offenders sentenced to forensic psychiatric care.
{"title":"Criminal recidivism of patients in Swedish forensic psychiatry: A register-based comparison study","authors":"Eirini Alexiou , Thomas Nilsson , Peter Andiné , Alessio Degl' Innocenti","doi":"10.1016/j.ijlp.2023.101884","DOIUrl":"10.1016/j.ijlp.2023.101884","url":null,"abstract":"<div><h3>Background</h3><p>The aim of this study was to evaluate criminal outcomes of mentally disordered offenders in compulsory forensic psychiatric care during the year 2010 versus 2018. More specifically, we sought to identify the occurrence of new criminal sentences during ongoing treatment and possible factors associated with recidivistic criminality. Another aim was to map previous criminality, types of index crime, and whether there were any changes within this decade.</p></div><div><h3>Methods</h3><p>Crime-, clinical, and treatment-related variables were collected from the Swedish National Forensic Psychiatric Register for all unique inpatients registered from January 1–December 31 in 2010 (<em>N</em> = 717) and 2018 (<em>N</em> = 757). The mean, frequency, percentage, and standard deviation were calculated per variable and stratified by study year and gender. Between-group comparisons were made using <em>t</em>-tests and Chi-square tests. Binary logistic regression was performed to determine whether variables expected to be associated with recidivism showed any relation to criminal recidivism for each study cohort.</p></div><div><h3>Results</h3><p>Most patients were male and approximately one-quarter and one-half of the men, respectively, had a previous sentence for non-violent and violent crimes. The 2018 cohort showed significantly lower rates of sentences to forensic psychiatry with special court supervision although the numbers were low in both cohorts and for both men and women. Previous violent conviction was associated with criminal recidivism during treatment in 2010, while this was joined by index crime under the influence of alcohol/illicit drugs for the 2018 cohort.</p></div><div><h3>Conclusions</h3><p>Overall, these results showed more similarities between the 2010 and 2018 cohorts then dissimilarities, while on the other hand some quite substantial differences were described between males versus females. The results of this study indicate that it may be possible to tailor forensic psychiatric treatment to gender as a proxy for other variables related to increased criminal recidivism in offenders sentenced to forensic psychiatric care.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9576559","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 : 2023-05-01DOI: 10.1016/j.ijlp.2023.101887
Rita de Cassia Consule, Carla Aparecida Arena Ventura
In the Brazilian penal system, a person with a mental disorder who commits an offense may be exempt from penalty if, at the time of the offense, they were entirely unable to understand the illicit character of the fact. A forensic psychiatric expert makes this determination and may also recommend to the magistrate the type of commitment to be applied. As a rule, this measure is stipulated based on the judge's sentence rather than the kind of treatment that the mental disorder requires. This difference motivates the present study that seeks to identify criteria for expertise. Additionally, this work focuses on the biopsychological method which influences the application of the measure as detailed in the expert's report. Expert reports have considerable importance in criminal proceedings and often influence determinations of the deadline for compliance and, potentially, hospitalisation. For this question, a scoping review searched for relevant literature, regardless of the study design. Of 1014 references, 27 answered the guiding question, giving rise to 10 categories with several items corresponding to the criteria for expertise. These items, although not exhaustive, demonstrated the deficient interrelationship between law and mental health due to the lack of communication and interaction between them the two. This could be addressed through interdisciplinary legislation or alteration of criminal and criminal procedural laws. Additionally, the lack of communication could be further addressed through the magistrate's interpretation of mental health laws as a new parameter for criminal law based on the human dignity principle which recognises fundamental human rights.
{"title":"A scoping review of the forensic psychiatric expertise for compulsory treatment application in Brazil","authors":"Rita de Cassia Consule, Carla Aparecida Arena Ventura","doi":"10.1016/j.ijlp.2023.101887","DOIUrl":"10.1016/j.ijlp.2023.101887","url":null,"abstract":"<div><p>In the Brazilian penal system, a person with a mental disorder who commits an offense may be exempt from penalty if, at the time of the offense, they were entirely unable to understand the illicit character of the fact. A forensic psychiatric expert makes this determination and may also recommend to the magistrate the type of commitment to be applied. As a rule, this measure is stipulated based on the judge's sentence rather than the kind of treatment that the mental disorder requires. This difference motivates the present study that seeks to identify criteria for expertise. Additionally, this work focuses on the biopsychological method which influences the application of the measure as detailed in the expert's report. Expert reports have considerable importance in criminal proceedings and often influence determinations of the deadline for compliance and, potentially, hospitalisation. For this question, a scoping review searched for relevant literature, regardless of the study design. Of 1014 references, 27 answered the guiding question, giving rise to 10 categories with several items corresponding to the criteria for expertise. These items, although not exhaustive, demonstrated the deficient interrelationship between law and mental health due to the lack of communication and interaction between them the two. This could be addressed through interdisciplinary legislation or alteration of criminal and criminal procedural laws. Additionally, the lack of communication could be further addressed through the magistrate's interpretation of mental health laws as a new parameter for criminal law based on the human dignity principle which recognises fundamental human rights.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9931772","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 : 2023-05-01DOI: 10.1016/j.ijlp.2023.101886
Inge Jeandarme , Sam Vandenbosch , Jan Boucké , Ingrid Dekkers , Gokhan Goktas , Peter Vanhopplinus
Background
Increasing freedom of movement and community reintegration is a vital part of recovery for forensic service users. Clinical teams realize that risk of unauthorized leave exists when granting leave, tasking them with balancing the recovery-based treatment needs of the patients with the larger obligation to protect the public from undue risk of harm. While considerable literature exists on unauthorized leave from acute psychiatric units, there is still little research specific to unauthorized leave from forensic settings.
Aims
The aim of this study is twofold. First, to examine the prevalence rates and characteristics of unauthorized leaves (i.e., absconds and escapes) among 654 high security forensic patients. Second, to identify individual patient factors associated with unauthorized leaves. A broad array of risk factors is taken into account, including demographic, clinical, judicial and criminal factors.
Principal results
During the 8-year period (17th of November 2014 until 17th of November 2022), there were 59 unauthorized leaves, which represents a very low percentage (0.2%) relative to the total number of leaves. Most patients returned to the hospital or were caught within one week. The reasons that led to an unauthorized leave were in more than half of the incidents frustration and in more than a third goal-directed. Only a minority of the unauthorized leaves was associated with subsequent offending, notwithstanding substance use was more frequent. Patients that absconded or escaped more often had a personality and comorbid substance misuse disorder, but less often a paraphilic disorder. They were younger, had more convictions and higher risk scores. After logistic regression, only personality disorder, comorbid substance misuse disorder and number of convictions were independently associated with unauthorized leave.
Conclusions
The results of this study indicate that ULs occurred rarely, and in most instances, patients returned within a short period without further incidents. Personality disordered patients with comorbid substance misuse and prior convictions posed the greatest risk to abscond or escape. Overall, the rate of unauthorized leaves and subsequent offending was small relative to the total number of leaves. This suggests that the risk for absconding was assessed in an adequate manner by the clinical teams. The study hopefully adds to reducing the stigma towards leaves from forensic psychiatric hospitals.
{"title":"Hospital break. An eight-year review of escapes and absconds from two high security forensic centers","authors":"Inge Jeandarme , Sam Vandenbosch , Jan Boucké , Ingrid Dekkers , Gokhan Goktas , Peter Vanhopplinus","doi":"10.1016/j.ijlp.2023.101886","DOIUrl":"10.1016/j.ijlp.2023.101886","url":null,"abstract":"<div><h3>Background</h3><p>Increasing freedom of movement and community reintegration is a vital part of recovery for forensic service users. Clinical teams realize that risk of unauthorized leave exists when granting leave, tasking them with balancing the recovery-based treatment needs of the patients with the larger obligation to protect the public from undue risk of harm. While considerable literature exists on unauthorized leave from acute psychiatric units, there is still little research specific to unauthorized leave from forensic settings.</p></div><div><h3>Aims</h3><p>The aim of this study is twofold. First, to examine the prevalence rates and characteristics of unauthorized leaves (i.e., absconds and escapes) among 654 high security forensic patients. Second, to identify individual patient factors associated with unauthorized leaves. A broad array of risk factors is taken into account, including demographic, clinical, judicial and criminal factors.</p></div><div><h3>Principal results</h3><p>During the 8-year period (17th of November 2014 until 17th of November 2022), there were 59 unauthorized leaves, which represents a very low percentage (0.2%) relative to the total number of leaves. Most patients returned to the hospital or were caught within one week. The reasons that led to an unauthorized leave were in more than half of the incidents frustration and in more than a third goal-directed. Only a minority of the unauthorized leaves was associated with subsequent offending, notwithstanding substance use was more frequent. Patients that absconded or escaped more often had a personality and comorbid substance misuse disorder, but less often a paraphilic disorder. They were younger, had more convictions and higher risk scores. After logistic regression, only personality disorder, comorbid substance misuse disorder and number of convictions were independently associated with unauthorized leave.</p></div><div><h3>Conclusions</h3><p>The results of this study indicate that ULs occurred rarely, and in most instances, patients returned within a short period without further incidents. Personality disordered patients with comorbid substance misuse and prior convictions posed the greatest risk to abscond or escape. Overall, the rate of unauthorized leaves and subsequent offending was small relative to the total number of leaves. This suggests that the risk for absconding was assessed in an adequate manner by the clinical teams. The study hopefully adds to reducing the stigma towards leaves from forensic psychiatric hospitals.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9568073","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 : 2023-05-01DOI: 10.1016/j.ijlp.2023.101894
Elvira Pértega , Christopher Holmberg
Introduction
Restraints, a highly regulated and contentious measure in pediatric psychiatry, have significant negative impacts on children. The application of international human rights standards, such as the Convention of the Rights of the Child (CRC) and the Convention of the Rights of Persons with Disabilities (CRPD), has spurred global efforts to reduce or eliminate the use of restraints. However, a lack of consensus on definitions and terminology, as well as quality indicators in this field, hinders the ability to compare studies and evaluate interventions consistently.
Aim
To systematically map existing literature on restraints imposed upon children in inpatient pediatric psychiatry against a human rights perspective. Specifically, to identify and clarify gaps in literature in terms of publication trends, research approaches, study contexts, study participants, definitions and concepts being used, and legal aspects. These aspects are central to assess whether published research is contributing to achieve the CRPD and the CRC in terms of interpersonal, contextual, operational, and legal requirements of restraints.
Methods
A systematic mapping review based on PRISMA guidelines was conducted, adopting a descriptive-configurative approach to map the distribution of available research and gaps in the literature about restraints in inpatient pediatric psychiatry. Six databases were searched for literature reviews and empirical studies of all study designs published between each database's inception and March 24, 2021, manually updated on November 25, 2022.
Results
The search yielded 114 English-language publications, with a majority (76%) comprising quantitative studies that relied primarily on institutional records. Contextual information about the research setting was provided in less than half of the studies, and there was an unequal representation of the three main stakeholder groups: patients, family, and professionals. The studies also exhibited inconsistencies in the terms, definitions, and measurements used to examine restraints, with a general lack of attention given to human rights considerations. Additionally, all studies were conducted in high-income countries and mainly focused on intrinsic factors such as age and psychiatric diagnosis of the children, while contextual factors and the impact of restraints were not adequately explored. Legal and ethical aspects were largely absent, with only one study (0.9%) explicitly referencing human rights values.
Conclusions
Research on restraints of children in psychiatric units is increasing; however, inconsistent reporting practices hinder the understanding of the meaning and frequency of restraints. The exclusion of crucial features, such as the physical and social environment, facility type, and family involvement, indicates inadequate incorporation of the CRPD. Additionally, t
{"title":"A systematic mapping review identifying key features of restraint research in inpatient pediatric psychiatry: A human rights perspective","authors":"Elvira Pértega , Christopher Holmberg","doi":"10.1016/j.ijlp.2023.101894","DOIUrl":"10.1016/j.ijlp.2023.101894","url":null,"abstract":"<div><h3>Introduction</h3><p>Restraints, a highly regulated and contentious measure in pediatric psychiatry, have significant negative impacts on children. The application of international human rights standards, such as the Convention of the Rights of the Child (CRC) and the Convention of the Rights of Persons with Disabilities (CRPD), has spurred global efforts to reduce or eliminate the use of restraints. However, a lack of consensus on definitions and terminology, as well as quality indicators in this field, hinders the ability to compare studies and evaluate interventions consistently.</p></div><div><h3>Aim</h3><p>To systematically map existing literature on restraints imposed upon children in inpatient pediatric psychiatry against a human rights perspective. Specifically, to identify and clarify gaps in literature in terms of publication trends, research approaches, study contexts, study participants, definitions and concepts being used, and legal aspects. These aspects are central to assess whether published research is contributing to achieve the CRPD and the CRC in terms of interpersonal, contextual, operational, and legal requirements of restraints.</p></div><div><h3>Methods</h3><p>A systematic mapping review based on PRISMA guidelines was conducted, adopting a descriptive-configurative approach to map the distribution of available research and gaps in the literature about restraints in inpatient pediatric psychiatry. Six databases were searched for literature reviews and empirical studies of all study designs published between each database's inception and March 24, 2021, manually updated on November 25, 2022.</p></div><div><h3>Results</h3><p>The search yielded 114 English-language publications, with a majority (76%) comprising quantitative studies that relied primarily on institutional records. Contextual information about the research setting was provided in less than half of the studies, and there was an unequal representation of the three main stakeholder groups: patients, family, and professionals. The studies also exhibited inconsistencies in the terms, definitions, and measurements used to examine restraints, with a general lack of attention given to human rights considerations. Additionally, all studies were conducted in high-income countries and mainly focused on intrinsic factors such as age and psychiatric diagnosis of the children, while contextual factors and the impact of restraints were not adequately explored. Legal and ethical aspects were largely absent, with only one study (0.9%) explicitly referencing human rights values.</p></div><div><h3>Conclusions</h3><p>Research on restraints of children in psychiatric units is increasing; however, inconsistent reporting practices hinder the understanding of the meaning and frequency of restraints. The exclusion of crucial features, such as the physical and social environment, facility type, and family involvement, indicates inadequate incorporation of the CRPD. Additionally, t","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9581144","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 : 2023-05-01DOI: 10.1016/j.ijlp.2023.101873
Samuel Law , Vicky Stergiopoulos , Juveria Zaheer , Arash Nakhost
In the era of on-going efforts to empower persons with mental illness to be independent decision makers as informed by the United Nations' Convention on the Rights of Persons with Disability (CRPD), family members acting as substitute decision makers (SDM) for people suffering from disabling serious mental illness (SMI) remain an integral part of the medical-legal system in psychiatric care in many parts of the world, including Canada; yet their experiences and perspectives are rarely studied. This explorative qualitative study examines the lived experiences and reflections of 14 family member SDMs in Toronto, Canada. Five key themes related to being SDM emerged: 1) Varied subjective understanding of the responsibility and authority of the SDM role; 2) Varied role demands and impact on SDMs' lives; 3) Challenges in dealing with the mental health system; 4) Leveraging decision making status to promote patient care; and 5) SDM role impact on family relationships. The need to improve SDM understanding of their role, acknowledging their value and care-taker burden, finding a balance for their involvement, and improving their support in efforts to enhance care for the patients are discussed.
{"title":"“Everyone means well but the one person who's really going to go to bat” - experiences and perspectives of substitute decision makers in caring for their loved ones with serious mental illness","authors":"Samuel Law , Vicky Stergiopoulos , Juveria Zaheer , Arash Nakhost","doi":"10.1016/j.ijlp.2023.101873","DOIUrl":"10.1016/j.ijlp.2023.101873","url":null,"abstract":"<div><p>In the era of on-going efforts to empower persons with mental illness to be independent decision makers as informed by the United Nations' Convention on the Rights of Persons with Disability (CRPD), family members acting as substitute decision makers (SDM) for people suffering from disabling serious mental illness (SMI) remain an integral part of the medical-legal system in psychiatric care in many parts of the world, including Canada; yet their experiences and perspectives are rarely studied. This explorative qualitative study examines the lived experiences and reflections of 14 family member SDMs in Toronto, Canada. Five key themes related to being SDM emerged: 1) Varied subjective understanding of the responsibility and authority of the SDM role; 2) Varied role demands and impact on SDMs' lives; 3) Challenges in dealing with the mental health system; 4) Leveraging decision making status to promote patient care; and 5) SDM role impact on family relationships. The need to improve SDM understanding of their role, acknowledging their value and care-taker burden, finding a balance for their involvement, and improving their support in efforts to enhance care for the patients are discussed.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9575805","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}
On 25 June 2021, the Law on Euthanasia in Spain came into force, providing for two modes of helping an individual end their life: euthanasia and/or medically assisted suicide. Among the requisites that a request for euthanasia has to fulfil are that the individual must be suffering a severe, chronic and debilitating condition or a severe and incurable disease, at the same time as that person shows the necessary competence to decide. The possibility exists that a patient suffering mental health problems submits such a request; however, the specific characteristics of a mental health disorder make such a request considerably more complex. In this article, based on a narrative review of the law itself and the related literature, the requisites established under the law are analysed from an ethical-legal perspective with the aim of defining when a request for euthanasia from a person with a mental health disorder may be deemed legitimate and in line with legal provisions. This should help clinicians make rational, reasoned decisions when dealing with a request of this type.
{"title":"Persons with mental disorders and assisted dying practices in Spain: An overview","authors":"Sergio Ramos-Pozón , Núria Terribas-Sala , Anna Falcó-Pegueroles , Begoña Román-Maestre","doi":"10.1016/j.ijlp.2023.101871","DOIUrl":"10.1016/j.ijlp.2023.101871","url":null,"abstract":"<div><p>On 25 June 2021, the Law on Euthanasia in Spain came into force, providing for two modes of helping an individual end their life: euthanasia and/or medically assisted suicide. Among the requisites that a request for euthanasia has to fulfil are that the individual must be suffering a <em>severe, chronic and debilitating condition</em> or a <em>severe and incurable disease</em>, at the same time as that person shows the necessary <em>competence to decide</em>. The possibility exists that a patient suffering mental health problems submits such a request; however, the specific characteristics of a mental health disorder make such a request considerably more complex. In this article, based on a narrative review of the law itself and the related literature, the requisites established under the law are analysed from an ethical-legal perspective with the aim of defining when a request for euthanasia from a person with a mental health disorder may be deemed legitimate and in line with legal provisions. This should help clinicians make rational, reasoned decisions when dealing with a request of this type.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9474119","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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