ETHICAL ISSUES IN FORENSIC PSYCHIATRIC RESEARCH ON MENTALLY DISORDERED OFFENDERS

Bioethics ◽  
2010 ◽  
Vol 24 (1) ◽  
pp. 35-44 ◽  
Author(s):  
CHRISTIAN MUNTHE ◽  
SUSANNA RADOVIC ◽  
HENRIK ANCKARSÄTER
Keyword(s):  
Ethical Issues ◽  
Psychiatric Research ◽  
Mentally Disordered Offenders ◽  
Mentally Disordered ◽  
Forensic Psychiatric

Is There a Need for Elderly Forensic Psychiatric Services?

2005 ◽  
Vol 45 (2) ◽  
pp. 154-160 ◽  
Author(s):  
I O Nnatu ◽  
F Mahomed ◽  
A Shah
Keyword(s):  
Mental Illness ◽  
Old Age ◽  
The Elderly ◽  
Mentally Disordered Offenders ◽  
Mentally Disordered ◽  
Court Diversion ◽  
Mental Health Difficulties ◽  
Old Age Psychiatry ◽  
Forensic Psychiatric ◽  
Developed Nations

The population of the elderly in most developed nations is on the increase. Furthermore, the prevalence of mental disorder amongst elderly offenders is high. The true extent of `elderly' crime is unknown because much of it goes undetected and unreported. This leads to a failure to detect mental illness in such offenders. Court diversion schemes may improve recognition of mental illness but these schemes usually tend to deal with the more severe crimes. This may result in an overestimation of the amount of serious crime committed by the elderly and a failure to detect mental illness amongst those who commit less serious crimes. Efforts to service this hidden morbidity call for multi-agency collaboration. Improved detection and reporting of crimes is essential if mental health difficulties in the elderly are not to go unnoticed. The needs of elderly mentally-disordered offenders are complex and fall within the expertise of old age and forensic psychiatry, without being adequately met by either one. Therefore, consideration should be given to the development of a tertiary specialist forensic old-age psychiatry service.

scholarly journals European Psychiatric Association (EPA) guidance on forensic psychiatry: Evidence based assessment and treatment of mentally disordered offenders

2018 ◽  
Vol 51 ◽  
pp. 58-73 ◽  
Author(s):  
Birgit A. Völlm ◽  
Martin Clarke ◽  
Vicenç Tort Herrando ◽  
Allan O. Seppänen ◽  
Paweł Gosek ◽  
...  
Keyword(s):  
Forensic Psychiatry ◽  
Best Practice ◽  
Ethical Issues ◽  
Expert Witness ◽  
Rapid Review ◽  
Cochrane Library ◽  
Mentally Disordered Offenders ◽  
Review Of The Literature ◽  
Mentally Disordered ◽  
Assessment And Treatment

AbstractForensic psychiatry in Europe is a specialty primarily concerned with individuals who have either offended or present a risk of doing so, and who also suffer from a psychiatric condition. These mentally disordered offenders (MDOs) are often cared for in secure psychiatric environments or prisons. In this guidance paper we first present an overview of the field of forensic psychiatry from a European perspective. We then present a review of the literature summarising the evidence on the assessment and treatment of MDOs under the following headings: The forensic psychiatrist as expert witness, risk, treatment settings for mentally disordered offenders, and what works for MDOs. We undertook a rapid review of the literature with search terms related to: forensic psychiatry, review articles, randomised controlled trials and best practice. We searched the Medline, Embase, PsycINFO, and Cochrane library databases from 2000 onwards for adult groups only. We scrutinised publications for additional relevant literature, and searched the websites of relevant professional organisations for policies, statements or guidance of interest. We present the findings of the scientific literature as well as recommendations for best practice drawing additionally from the guidance documents identified. We found that the evidence base for forensic-psychiatric practice is weak though there is some evidence to suggest that psychiatric care produces better outcomes than criminal justice detention only. Practitioners need to follow general psychiatric guidance as well as that for offenders, adapted for the complex needs of this patient group, paying particular attention to long-term detention and ethical issues.

Community forensic psychiatric services in England and Wales

CNS Spectrums ◽  
2020 ◽  
Vol 25 (5) ◽  
pp. 604-617
Author(s):  
Richard Latham ◽  
Hannah Kate Williams
Keyword(s):  
Research Evidence ◽  
Medical Specialty ◽  
Community Services ◽  
Mentally Disordered Offenders ◽  
Late 20Th Century ◽  
England And Wales ◽  
Mentally Disordered ◽  
Forensic Psychiatric ◽  
Criminal Legislation ◽  
The 19Th Century

Forensic psychiatry is an established medical specialty in England and Wales. Although its origins lie in the 19th century, the development of secure hospitals accelerated in the late 20th century. Services for mentally disordered offenders in the community have developed most recently and it is these services, which are the focus of this article. We have looked broadly at community services and have included criminal justice liaison and diversion services in our remit. We have also considered partnerships between health and justice agencies as well as mental health and criminal legislation. We consider the limited research evidence in relation to community forensic services and the discussion this has provoked.

scholarly journals Long Term Metabolic and Inflammatory Effects of Second-Generation Antipsychotics: A Study in Mentally Disordered Offenders

2021 ◽  
Vol 11 (11) ◽  
pp. 1189
Author(s):  
Emilia Vassilopoulou ◽  
Dimitris Efthymiou ◽  
Evangelia Papatriantafyllou ◽  
Maria Markopoulou ◽  
Efthymia-Maria Sakellariou ◽  
...  
Keyword(s):  
Side Effects ◽  
Second Generation ◽  
Psychotic Disorders ◽  
Psychiatric Patients ◽  
Mentally Disordered Offenders ◽  
Metabolic Complications ◽  
Mentally Disordered ◽  
Increased Risk ◽  
Forensic Psychiatric

Mentally disordered offenders provided with forensic psychiatric care are often treated with second generation antipsychotic (SGA) medication and experience metabolic and inflammatory side effects. Aim: In this paper, we monitored the three-year fluctuation of selected anthropometric, biochemical, and inflammatory indices in forensic psychiatric patients receiving antipsychotic (AP) medication for more than five years, according to the type of AP. Methods: Thirty-five patients with psychotic disorders were classified into two groups based on the type of AP. Specifically: AP1, related to a lower risk, and AP2, related to an increased risk of weight gain (WG) and metabolic complications. Biochemical, hematological, anthropometric, blood pressure (BP), and medication data were retrieved from the individual medical files. Statistical analysis was performed with SPSS 23. Results: No significant differences in weight and glucose and cholesterol levels were observed, but patients taking AP2 more often needed drugs to control diabetes mellitus (DM), lipidemia, and cardiovascular disease (CVD). In those taking AP1, the mean HDL level decreased significantly over time (p < 0.05) and a higher proportion developed higher BP (52.9% of AP1 vs. 16.7% AP2). In the AP2 group the median level of C-reactive protein (CRP) (p < 0.001) and the white blood cell count (WBC) increased over the three years (p < 0.001). Conclusions: The proposed sub-classification of SGAs into AP1 and AP2, depending on their potential for metabolic and inflammatory effects, might facilitate study of their long-term side-effects but also help in personalized prevention or treatment measures to counteract these side-effects.

The interface of general psychiatric and forensic psychiatric services

2017 ◽  
Author(s):  
Lisa Wootton ◽  
Tom Fahy ◽  
Simon Wilson
Keyword(s):  
Psychiatric Service ◽  
Evidence Base ◽  
Models Of Care ◽  
Mentally Disordered Offenders ◽  
Mentally Disordered ◽  
The United Kingdom ◽  
Specialist Services ◽  
Pros And Cons ◽  
Forensic Psychiatric ◽  
Community Psychiatric Service

This chapter examines community psychiatric service provision for mentally disordered offenders, focussing on the United Kingdom and United States. In doing so, it acknowledges that mentally disordered offenders are at risk of rejection and of falling between services. They are doubly stigmatized by having a mental illness and being offenders. It explores the context, commissioning, components of a service, and models of care (including the evidence base for them). Also considered are the pros and cons of specialist services, as well as how they might differentiate their task from that of the CMHT. The chapter concludes by considering how services can work together to meet the needs of this complex and challenging group of patients.

Ethical Issues in Secure Psychiatric Settings

2014 ◽  
Author(s):  
Gwen Adshead
Keyword(s):  
Mental Health Professionals ◽  
Ethical Issues ◽  
Mentally Disordered Offenders ◽  
Ethical Challenges ◽  
Dual Roles ◽  
Case Examples ◽  
Mentally Disordered ◽  
Correctional Settings ◽  
Secure Psychiatric Care

In this chapter, I discuss the particular ethical challenges associated with the care of mentally disordered offenders. This chapter deals with the ethical issues that arise in secure psychiatric care, not purely correctional settings which are addressed in another chapter. I describe some of the general ethical problems in secure psychiatric settings, which (I suggest) arise from the dual roles of care and custody that mental health professionals have to carry out. I set out some fictitious case examples, and explore two complementary ways of helping both residents and staff manage these challenges: an approach using the concept of values-based practice (VBP) and an approach based on “relational security.”

Changes to the Criminal Code Provisions for Mentally Disordered Offenders and their Implications for Canadian Psychiatry

1993 ◽  
Vol 38 (2) ◽  
pp. 122-126 ◽  
Author(s):  
Simon Davis
Keyword(s):  
Civil Rights ◽  
Criminal Code ◽  
Assessment Process ◽  
Mentally Disordered Offenders ◽  
Mentally Disordered ◽  
Procedural Law ◽  
Not Criminally Responsible ◽  
Forensic Psychiatric ◽  
C 30 ◽  
Code Provisions

Bill C-30, implemented in February 1992, made a number of significant changes to the Criminal Code provisions concerning the assessment, treatment and disposition of mentally disordered persons charged with a crime, including persons considered to be unfit to stand trial or pleading insanity. The changes deal mainly with procedural law and the civil rights of persons being assessed or held in custody, and put limits on where, how long and for what purpose persons may be detained. The new law abolishes the automatic, indeterminate detention of persons found unfit to stand trial or not criminally responsible on account of mental disorder. The changes may mean that the forensic psychiatric route is now a more “attractive option” for defendants. The new law may create administrative problems for clinicians by leading to increased requests for psychiatric assessments while at the same time constraining the assessment process.

A Comparative Perspective on Forensic Psychiatry in Canada and England

1988 ◽  
Vol 28 (4) ◽  
pp. 329-335 ◽  
Author(s):  
M. Green Christopher ◽  
Laurence J. Naismith
Keyword(s):  
Forensic Psychiatry ◽  
Legal Aspects ◽  
Comparative Perspective ◽  
Mentally Disordered Offenders ◽  
Mentally Disordered ◽  
Department Of Health ◽  
Psychiatric Institutions ◽  
English System ◽  
Correctional System ◽  
Forensic Psychiatric

ABSTRACT: An outline is presented of the development and practice of forensic psychiatry, including relevant legal aspects, in Canada, in comparison to the English system. It is written by two English-trained psychiatrists, who have provided forensic services in both Canada and England. Canadian forensic psychiatry is portrayed as having a greater medico-legal emphasis than at present in England, with a continuing dependence on the insanity verdict for seriously mentally disordered offenders. Canadian forensic psychiatric institutions are often attached to the correctional system, whereas in England they are under the Department of Health. Within this framework, the article elaborates upon clinical and medico-legal differences.

Dangerous or merely ‘difficult’? The new population of forensic mental hospitals

2009 ◽  
Vol 24 (6) ◽  
pp. 365-372 ◽  
Author(s):  
H. Schanda ◽  
T. Stompe ◽  
G. Ortwein-Swoboda
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Community Mental Health Services ◽  
European Countries ◽  
Mentally Disordered Offenders ◽  
Mentally Disordered ◽  
Mental Hospitals ◽  
Psychiatric Institutions ◽  
Forensic Psychiatric ◽  
Mental Health Policies

AbstractBackgroundDuring recent decades, there has been a substantial increase in admissions to forensic mental hospitals in several European countries. It is not known if reforms implemented in mental health policies and practices are responsible for this development.ObjectiveOur study examined the development of mental health care in Austria and the incidence and prevalence of mentally disordered offenders judged not guilty by reason of insanity (NGRI).MethodsWe analysed data on service provision and data from criminal statistics between 1970 and 2008 from several national sources.ResultsDuring the first decade when reforms to mental health practice were implemented, the incidence and prevalence of offenders judged NGRI remained unchanged, despite a reduction of mental hospital beds by nearly 50% and little outpatient care. Surprisingly, the enormous increase in admissions to forensic inpatient treatment began in Austria only after community mental health services were rolled out across the country in the 1990s. This increase was primarily due to admissions of patients who had committed less severe offences, while rates of those who had committed homicide remained unchanged.ConclusionOur results cannot be explained by details of the reforms such as the downsizing of mental hospitals or a lack of outpatient facilities, nor by changes to criminal sentencing. Rather, the results provide evidence of an increasingly inadequate provision of comprehensive care for “difficult” but not extremely dangerous psychotic patients living in the community. This may result from the attitudes of mental health professionals who have become less inclined to integrate aggressive behaviour into their understanding of psychosis. As a consequence, increasing numbers of “difficult” patients end up in forensic psychiatric institutions. This development, which can be observed in nearly all European countries, raises concerns with regard to efforts to destigmatize both patients and psychiatry.

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