Mental Health Acts - Perspectives from Mental Health and Law in Ireland and in Portugal.

Mental health legislation is a cornerstone to ensure that individuals with severe mental illness access proper care and treatment. Each country establishes their own legislation. We aimed to compare the Portuguese and Irish Mental Health Acts (MHAs). We reviewed the respective MHA and the literature. While the definition of mental disorder is similar in general, who, where, when and how one can be detained differ. Judges decide on detentions in Portugal, while consultant psychiatrists may do so in Ireland. Community-based compulsory treatment is possible and used in Portugal while it is not possible in Ireland. Pros and cons of each approach are discussed with a reflection on the protection of human rights. Further theoretical and empirical studies comparing systems in different jurisdictions would be helpful to deepen our understanding of the legislation and guide on how to better serve individuals with severe mental illness.

Assessing NGRI and dangerousness: Perspectives from forensic reports in Portugal.

In Portugal the expert whose report supports the criminal defence of not guilty by reason of insanity (NGRI) must also consider the defendant's dangerousness. Nevertheless, the concept of dangerousness has received little attention in the Portuguese critical literature. Moreover, there is concern that the concept is often used improperly. We endeavoured to evaluate a sample of Portuguese forensic reports in order to discuss: 1) the prevalence of defendants who were considered guilty, NGRI, and dangerous; 2) which treatments were proposed; and 3) the frequency of technical errors found. We analysed 124 case folders from the year 2006, from both mainland Portugal and the archipelagos of Madeira and the Azores, which included an evaluation of dangerousness of the defendants. These 124 cases were analysed using frequencies, correlations and multiple logistic regressions. The majority of the defendants were male and single. Thirty-nine percent (39%) were considered NGRI. A total of 34% of the defendants were considered dangerous or no dangerousness could be excluded. In 66% of cases treatment was recommended but in only 9% was admission to a forensic hospital recommended. Technical errors in the forensic reports, both of format and content, were identified in 26% of the 124 cases, the incidence of errors being high in reports from certain institutions. The majority of the forensic reports did not discuss the educational background of the defendants or their criminal history/records. We conclude that the experience of the expert is crucial in producing an appropriate report. The establishment of uniform criteria for the preparation of forensic reports and enhanced training of psychiatrists in forensic psychiatry should be considered as possible strategies to improve the accuracy of forensic reporting, particularly when assessing dangerousness.

The donating capacity of the elderly: A case report of vascular dementia.

Seniors may be more vulnerable to the influence of others, being less able to make judicious decisions. The legal legitimacy of donating capacity is based on the clinical assumption that, at the time of the event, the donor is able to understand the nature of the transaction, weigh its consequences and determine his/her actions according to it. From the point of view of forensic psychiatry, the evaluation of such premises is a challenge, reflecting the difficulty in assessing, retrospectively, the subject's cognitive functions at the time of the event. In cases where the cross-sectional evaluation favours the diagnosis of dementia it is crucial to objectify the onset and course of the illness. The authors report and discuss the case of a donation from father to sons, involving a great deal of money, made by an 85-year-old man, who had suffered an ischaemic cerebrovascular accident 5 years before.