The Paradox of the Waiting List to Enter REMS: A Delay in the Execution of Magistrates' Orders or a Search for a Better Way to Treat Mentally Disordered Offenders? Reflections Three Years after the Closure of Forensic Psychiatric Hospitals in Italy

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.

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The Imprisonment of Mentally Disordered Offenders

The British Journal of Psychiatry ◽

10.1192/bjp.133.3.194 ◽

1978 ◽

Vol 133 (3) ◽

pp. 194-199 ◽

Cited By ~ 24

Author(s):

J. H. Orr

Keyword(s):

Health Service ◽

Mental Disorder ◽

Care Management ◽

Medical Officer ◽

Psychiatric Hospitals ◽

Present Condition ◽

States Of Mind ◽

Criminal Offence ◽

Mentally Disordered Offenders ◽

Mentally Disordered

I am glad to have this opportunity to talk about an unfortunate consequence of developments in the Health Service over recent years. My theme will be what is now happening to mentally disordered people who have committed criminal offences. At present, many of them are going to prison. The prison system—already severely overcrowded—contains some hundreds of mentally disordered offenders who in the opinion of prison medical officers need and are capable of gaining benefit from care, management and treatment in psychiatric hospitals. When using the term ‘mental disorder’ I shall, of course, be referring to those states of mind which have been classified and defined in Section 4 of the Mental Health Act 1959: members of the College who work in the National Health Service will be relieved to know that I do not share the view of the citizens of Samuel Butler's Erewhon that crime itself is an illness, whose sufferers should all be placed in the hands of the omniscient psychopathologists. Indeed, when one has the practical responsibility for the provision of health care for prisoners, it is quite irrelevant whether or not they committed their offences as a result of a mental disorder or whether their mental disorder developed before or after the offence or trial. The only thing that matters is their present condition. If a prisoner is suffering from mental disorder of a nature or degree that warrants his detention in hospital for treatment, then the prison medical officer will want to bring about his admission to hospital under the appropriate section of the 1959 Act. This is wholly in accordance with the philosophy of the Act, which does not limit hospital admission to cases in which the criminal offence was causally related to a mental disorder. In this talk I shall want to consider why in so many cases hospital places cannot be found.

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Community forensic psychiatric services in England and Wales

CNS Spectrums ◽

10.1017/s1092852919001743 ◽

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.

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ETHICAL ISSUES IN FORENSIC PSYCHIATRIC RESEARCH ON MENTALLY DISORDERED OFFENDERS

Bioethics ◽

10.1111/j.1467-8519.2009.01773.x ◽

2010 ◽

Vol 24 (1) ◽

pp. 35-44 ◽

Cited By ~ 15

Author(s):

CHRISTIAN MUNTHE ◽

SUSANNA RADOVIC ◽

HENRIK ANCKARSÃ„TER

Keyword(s):

Ethical Issues ◽

Psychiatric Research ◽

Mentally Disordered Offenders ◽

Mentally Disordered ◽

Forensic Psychiatric

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

Journal of Personalized Medicine ◽

10.3390/jpm11111189 ◽

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.

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The interface of general psychiatric and forensic psychiatric services

10.1093/med/9780198738664.003.0017 ◽

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.

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

The Canadian Journal of Psychiatry ◽

10.1177/070674379303800210 ◽

1993 ◽

Vol 38 (2) ◽

pp. 122-126 ◽

Cited By ~ 11

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.

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A Comparative Perspective on Forensic Psychiatry in Canada and England

Medicine Science and the Law ◽

10.1177/002580248802800413 ◽

1988 ◽

Vol 28 (4) ◽

pp. 329-335 ◽

Cited By ~ 2

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.

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

European Psychiatry ◽

10.1016/j.eurpsy.2009.07.006 ◽

2009 ◽

Vol 24 (6) ◽

pp. 365-372 ◽

Cited By ~ 18

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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