Forensic patients, treating psychiatrist and the Mental Health Review Tribunal - An ethical question?

OBJECTIVE: In inpatient forensic settings, a psychiatrist is expected to wear 'Two Hats', as a treating physician and as an expert to provide risk assessments and expert advice to the judicial authorities for leave and release decisions. Although dual roles have long been accepted as an inevitable part of independent forensic practice, there are additional ethical challenges for the treating psychiatrist to provide an expert opinion. This paper examines the specific ethical ambiguities for a treating psychiatrist at the interface of legal process related to leave and release decisions in the treatment of forensic patients. CONCLUSIONS: While respect for justice is the prevailing ethical paradigm for court-related forensic work, the medical paradigm should remain the key ethical framework for psychiatrists in treatment settings. Thus, psychiatrist should be aware of possible adverse consequences in acting as forensic experts for their patients. A conscientious adherence to clinical facts and awareness of the 'Two Hats' ethical pitfall can serve as important reference points in framing the psychiatric evidence in the decision-making process and safeguard treating psychiatrist's role.

Forensic Interviews for Child Sexual Abuse Allegations: An Investigation into the Effects of Animal-Assisted Intervention on Stress Biomarkers.

The use of therapy animals during forensic interviews for child sexual abuse allegations is a recommendation by the Therapy Animals Supporting Kids Program to help ease children's discomfort during the forensic interview process. Based on this recommendation, this study incorporated a certified therapy canine into the forensic interview process for child sexual abuse allegations. This study investigated changes in salivary cortisol, immunoglobulin A, blood pressure, and heart rate as a result of forensic interview phenomenon (e.g., outcry) incorporating animal-assisted intervention versus a control condition in children (N = 42) interviewed for alleged child sexual abuse. The results supported significantly greater heart rate values for the control group (n = 23) who experienced sexual contact and/or indecency than the experience of aggravated sexual assault compared to no difference in HR for the intervention group (n = 19). The results suggest that the presence of the canine in the forensic interview may have acted as a buffer or safeguard for the children when disclosing details of sexual abuse. In the intervention group, children's HR was lower at the start of the forensic interview compared to the control group. Finding an effect of having a certified handler-canine team available during the forensic interview on physiological measures of stress has real-world value for children, child welfare personnel, and clinical therapists. It is suggested that animal-assisted intervention be expanded to children facing other types of trauma and to treatment programs for child survivors of sexual abuse.

[Forensic psychiatry and Islamic law].

Islam is the second most popular monotheistic religion in the world. Its followers, the Muslims, are about 1.2 billion people and are the majority in 56 countries around the globe. Islam is an holistic way and model of life and its rules, according to a large proportion of Muslims, should have more power than the laws deriving from any secular authority. This means that the divine laws, as depicted from Islam's holy scripts, should be the laws of the land. In the strict Islamic states, as Saudi Arabia, the Islamic law or the Shari'ah prevails. Shari'ah means the path, the road each faithful Muslim should follow according to the rules of God. The Islamic views on mental health have some interesting characteristics: on the one hand, the moral necessity for the protection and care of the vulnerable individuals is very strong, but on the other hand superstitions and stigmatization influence the peoples' attitude against mental health patients. At the beginning of its historical course, Islamic world was a pioneer concerning mental health care. Unfortunately, as time passed by, we have observed considerable regression. In our days mental health services provided in most of the Islamic states cannot be considered adequate according to modern Western standards. The same course characterizes the Forensic Psychiatric services and the relevant legislation in the Islamic world.

Maternal infanticide associated with mental illness: prevention and the promise of saved lives.

OBJECTIVE: Although maternal infanticide is a rare event, a high proportion of cases occurs in the context of postpartum mental illness. The author reviews historical, legislative, and contemporary psychiatric perspectives on infanticide and discusses ways in which the psychiatric community can improve prevention of infanticide and promote appropriate treatment of mentally ill women who commit infanticide. METHOD: The case of Texas v. Andrea Yates, involving a mother with mental illness who drowned her five children, is used to illustrate society's complicated reactions to infanticide in the context of postpartum mental illness. RESULTS: In the United States, the complexity of the response to infanticide is demonstrated by the judicial system's reaction to such cases. Whereas England's Infanticide Law provides probation and mandates psychiatric treatment for mothers with mental illness who commit infanticide, "killer mothers" may face the death penalty in the United States. Contemporary neuroscientific findings support the position that a woman with postpartum psychosis who commits infanticide needs treatment rather than punishment and that appropriate treatment will deter her from killing again. Psychiatrists have a vital role in recognizing the signs and symptoms of peripartum psychiatric disorders, particularly postpartum psychosis, and in early identification of and intervention with at-risk mothers. CONCLUSIONS: The absence of formal DSM-IV diagnostic criteria for postpartum psychiatric disorders promotes disparate treatment under the law. The psychiatric community should develop guidelines for the treatment of postpartum disorders, foster sharing of knowledge between psychiatry and the law, and do more to enlighten society about the effects of mental illness on thought and behavior so that decisions about the treatment and punishment of mentally ill persons will not be left exclusively in the hands of the judicial system.

Medical-legal issues in Charcot's neurologic career.

OBJECTIVE: Trace the medical-legal involvement of the 19th century clinical neurologist Jean-Martin Charcot. BACKGROUND: The two major neurologic concerns of the 1800s that involved legal questions were topics of particular academic interest to Charcot: post-traumatic neurologic syndromes and the behavioral consequences of hysteria and hypnotism. Although Charcot's medical views influenced several nonmedical fields, including art, poetry, and drama, his impact on medical-legal issues has not been examined. METHODS: Original documents from the Bibliothèque Charcot at the Salpêtrière Hospital in Paris, legal documents, and publications from Charcot's era were examined. RESULTS: Although his involvement in medical-legal affairs was a modest element of Charcot's multifaceted career, he was involved in four different types of medical-legal activities: as a cited authority in the medical-legal literature, as an author of articles within medical-legal contexts, as a subpoenaed expert consultant, and as an expert examiner. CONCLUSIONS: Charcot's involvement demonstrates the long tradition of an interface between neurology and legal medicine and provides a model for highly limited but authoritative involvement by academic neurologists in medical-legal affairs.

Psychiatry in the Palestine Authority: legal, ethical and forensic issues.

The historical and political reality of life in the West Bank and Gaza has deeply influenced the development of psychiatric services, and particularly the provision of evaluation and care for Palestinian forensic patients by Palestinian psychiatrists. The difficulties are presented and how they have changed during the events of the last decades.