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1.
Clin Ter ; 171(2): e97-e100, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32141478

RESUMO

The Italian Law n. 9/2012 provided the Italian Regions with a new decisional role by demanding the management/rehabilitation of prisoners judged as partially/fully mentally ill to care and protection delivered by the psychiatric services of the Regional Health Service. Healthcare has to be guaranteed by the so-called High-Security Forensic Psychiatry Residences (Italian: Residenze per l'Esecuzione delle Misure di Sicurezza: REMS) and by community mental health centres. Ensuring patients' and professionals' health and safety is a complex issue which requires effective strategies to cope with several structural, technological, and organisational problems. The present paper summarises the historical evolution of the Italian laws towards the development of the High-Security Forensic Psychiatry Residences in Italy, focusing specifically on the Tuscany Region situation. The paper also presents the key issues emerging after the implementation of the Law 81/2014 which complemented the Law 9/2012. Since these reforms included the need for assessing to what extent the patient may be considered as a danger to society and for ensuring the safety of National Health Service (NHS) professionals, they underscored the importance of a preventive use of specific clinical governance tools aimed to reduce risk of adverse events. The present work has the strength of proposing a new, evidence-based scientific approach to the implementation of assessment and care pathways in High-Security Forensic Psychiatry Residences.


Assuntos
Psiquiatria Legal/legislação & jurisprudência , Pessoal de Saúde , Prisioneiros , Medidas de Segurança , Psiquiatria Legal/história , História do Século XXI , Hospitais Psiquiátricos , Habitação , Humanos , Itália , Gestão de Riscos
2.
Int J Law Psychiatry ; 66: 101456, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31706389

RESUMO

This paper examines how the symptomology of the small number of individuals with autism spectrum disorder (ASD) charged with online sexual offenses in Australia is established during legal arguments and conceived by the judiciary to impact legal liability and offending behavior. This study aims to provide empirical support for the proposition that judicial discourses regarding the connection between ASD and online sexual offending, including conduct related to child exploitation material (CEM), have little bearing on overall questions of criminal liability or the use of alternative penal dispositions. It does so by exploring a sample of nine recent Australian criminal cases, involving ten rulings, that examine how evidence of ASD is raised in legal arguments in ways that suggest a diagnosed condition may have contributed significantly to the alleged wrongdoing. We conclude by suggesting current Australian judicial practice requires more sensitivity to the impact of clinical factors associated with ASD in shaping alternative supervisory and non-custodial dispositions for individuals convicted of online sexual offenses.


Assuntos
Transtorno do Espectro Autista/psicologia , Criminosos/legislação & jurisprudência , Criminosos/psicologia , Delitos Sexuais/legislação & jurisprudência , Delitos Sexuais/psicologia , Austrália , Comportamento Criminoso , Psicologia Criminal/legislação & jurisprudência , Literatura Erótica/psicologia , Psiquiatria Legal/legislação & jurisprudência , Humanos , Internet
3.
Int J Law Psychiatry ; 66: 101473, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31706393

RESUMO

BACKGROUND: Forensic psychiatric practices and provisions vary considerably across jurisdictions. The diversity provides the possibility to compare forensic psychiatric practices, as we will do in this paper regarding Italy and the Netherlands. AIM: We aim to perform a theoretical analysis of legislations dealing with the forensic psychiatric evaluation of defendants, including legal insanity and the management of mentally ill offenders deemed insane. This research is carried out not only to identify similarities and differences regarding the assessment of mentally ill offenders in Italy and the Netherlands, but, in addition, to identify strengths and weaknesses of the legislation and procedures used for the evaluation of the mentally ill offenders in the two countries. RESULTS: Italy and the Netherlands share some basic characteristics of their criminal law systems. Yet, forensic psychiatric practices differ significantly, even if we consider only evaluations of defendants. A strong point of Italy concerns its test for legal insanity which defines the legal norm and enables a straightforward communication between the experts and the judges on this crucial matter. A strong point of the Netherlands concerns more standardized practices including guidelines and the use of risk assessment tools, which enable better comparisons and scientific research in this area. CONCLUSIONS: We argue that there appears to be room for improvement on both sides with regards to the evaluation of mentally ill offenders. More generally, a transnational approach to these issues, as applied in this paper, could help to advance forensic psychiatric services in different legal systems.


Assuntos
Criminosos/legislação & jurisprudência , Psiquiatria Legal/legislação & jurisprudência , Psiquiatria Legal/métodos , Medição de Risco/métodos , Humanos , Defesa por Insanidade , Itália , Países Baixos , Reincidência/legislação & jurisprudência
4.
Hist Psychiatry ; 30(4): 457-468, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31366245

RESUMO

This article revisits the notorious trial of William Windham, a wealthy young man accused of lunacy. The trial in 1861-2 saw the country's foremost experts on psychological medicine very publicly debate the concepts, symptoms and diagnosis of insanity. I begin by surveying the trial and the testimonies of medical experts. Their disparate assessments of Windham evoked heated reactions in the press and Parliament; these reactions are the focus of the second section. I then proceed to examine criticism of psychiatry in the newspapers more generally in the 1860s, outlining the political resistance to psychiatry and the responses of some leading psychiatrists. In conclusion, I consider what this says about the politics of medicalization at the time.


Assuntos
Pessoas Famosas , Psiquiatria Legal/história , Deficiência Intelectual/história , Transtornos Mentais/história , Diagnóstico Diferencial , Psiquiatria Legal/legislação & jurisprudência , História do Século XIX , Humanos , Deficiência Intelectual/diagnóstico , Masculino , Medicalização/história , Transtornos Mentais/diagnóstico , Política , Psiquiatria/história , Reino Unido
5.
Psychiatr Serv ; 70(7): 622-624, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31258031

RESUMO

As death row prisoners age, a new set of issues arises regarding their competence to be executed. Can a prisoner with dementia who no longer remembers the crime be put to death? What if the dementia has progressed to the point that the prisoner no longer understands that he or she faces execution, or why? These issues were considered by the U.S. Supreme Court in its recent decision in Madison v. Alabama. Implicitly rejecting the cruelty of executing a highly impaired prisoner, the court clarified the conditions that could preclude execution and the degree of impairment that must be present.


Assuntos
Pena de Morte/legislação & jurisprudência , Demência , Psiquiatria Legal/legislação & jurisprudência , Competência Mental/legislação & jurisprudência , Prisioneiros/legislação & jurisprudência , Decisões da Suprema Corte , Idoso , Humanos , Masculino , Estados Unidos
6.
Australas Psychiatry ; 27(5): 441-443, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31179722

RESUMO

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.


Assuntos
Psiquiatria Legal/ética , Psiquiatria Legal/legislação & jurisprudência , Transtornos Mentais/terapia , Pessoas Mentalmente Doentes/legislação & jurisprudência , Médicos/ética , Médicos/legislação & jurisprudência , Humanos , Medição de Risco/legislação & jurisprudência
7.
Behav Sci Law ; 37(3): 304-312, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31063254

RESUMO

Few clinical practices are as important for simultaneously augmenting patient safety and mitigating legal risk as the judicious evaluation and stratification of a patient's risk for suicide, proportionate clinical actions based thereon taken by the healthcare provider, and contemporaneous documentation of the foregoing. In this article, we draw from our combined decades of multidisciplinary experience as a clinical psychologist, forensic psychiatrist, medical malpractice attorney, and clinical psychology trainee to discuss the documentation of suicide risk assessment and management as a conduit to patient safety and legal risk mitigation. We additionally highlight documentation as a core clinical competency across disciplines and note areas of improvement, such as increased training, to bolster documentation practices.


Assuntos
Documentação/normas , Segurança do Paciente/legislação & jurisprudência , Medição de Risco/legislação & jurisprudência , Suicídio/legislação & jurisprudência , Competência Clínica/legislação & jurisprudência , Psiquiatria Legal/legislação & jurisprudência , Humanos , Comunicação Interdisciplinar , Colaboração Intersetorial , Masculino , Imperícia/legislação & jurisprudência , Pessoa de Meia-Idade , Ideação Suicida , Suicídio/prevenção & controle
8.
Int J Law Psychiatry ; 64: 88-98, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31122645

RESUMO

Demand for legal capacity assessments is increasing, especially assessments of financial capacity for estate planning purposes such as wills and enduring powers of attorney. This article proposes that such assessments will be improved by taking greater account of the client experience, including individual and relational factors and processes, and considering the practice framework. A literature review was undertaken with a two-fold aim: firstly, to understand the fundamentally important perspective (inclusive of these experiences) of the evaluee; and, secondly, to identify potential improvements in the capacity assessment process with a view to informing best practice. No studies were identified that directly addressed the individual perspective in capacity assessments. Case studies and commentaries that indirectly discuss the individual perspective were therefore analysed to identify any potential issues and recommendations. This analysis showed that individual factors, such as the evaluee's functional and disease status, and relational factors, such as trust, should be considered by examiners. This review demonstrates that there is a significant gap in the literature examining the individual's perspective and experiences in capacity assessments, as well as, any impact this may have on the assessment process and outcomes. Further research into this vital perspective is needed so that the experiences of those undergoing assessments can help inform best practice and ensure that optimal processes are adopted when assessing the capacity necessary to make legally recognised decisions. This article examines the importance of the participant perspective and experiences in capacity assessments through the novel lens of therapeutic jurisprudence. It includes practice suggestions and provides the direction for this future research.


Assuntos
Administração Financeira , Competência Mental , Psiquiatria Legal/legislação & jurisprudência , Psiquiatria Legal/métodos , Fraude/prevenção & controle , Fraude/psicologia , Humanos , Deficiência Intelectual/diagnóstico , Deficiência Intelectual/psicologia , Competência Mental/legislação & jurisprudência , Competência Mental/psicologia , Testamentos
9.
Int Rev Psychiatry ; 31(2): 114-125, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30938553

RESUMO

This article provides a comparison and comprehensive analysis of varied approaches to the assessment of sexual interest and behaviours at different international sexual behaviour assessment labs. The assessment protocols are described for four sexual behaviour laboratories: the Royal Ottawa Mental Health Centre's Sexual Behaviours Clinic in Canada; the Medical University of South Carolina's Sexual Behaviours Clinic and Laboratory in the US; the Laboratory of Evolutionary Sexology and Psychopathology in the Czech Republic; and the Laboratory of Forensic Sexology in Russia. An overview of examinee demographics and types of cases assessed is provided for each lab. Assessment protocols, including psychometric measures and objective measures of sexual interest and arousal, such as penile plethysmography or eye-tracking, are also reviewed. The differences across labs may lead to interesting and productive cross-cultural investigations and studies about the efficacy of specific assessment methods.


Assuntos
Comparação Transcultural , Internacionalidade , Transtornos Parafílicos/diagnóstico , Pletismografia , Comportamento Sexual/psicologia , República Tcheca , Psiquiatria Legal/legislação & jurisprudência , Humanos , Masculino , América do Norte , Transtornos Parafílicos/psicologia , Pênis/irrigação sanguínea , Psicometria , Federação Russa
10.
Int J Law Psychiatry ; 65: 101437, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30952490

RESUMO

Neuroscience has already changed how the law understands an individual's cognitive processes, how those processes shape behavior, and how bio-psychosocial history and neurodevelopmental approaches provide information, which is critical to understanding mental states underlying behavior, including criminal behavior. In this paper, we briefly review the state of forensic assessment of mental conditions in the relative culpability of criminal defendants, focused primarily on the weaknesses of current approaches. We then turn to focus on neuroscience approaches and how they have the potential to improve assessment, but with significant risks and limitations.


Assuntos
Psiquiatria Legal , Competência Mental/legislação & jurisprudência , Neurociências/legislação & jurisprudência , Criminosos/legislação & jurisprudência , Criminosos/psicologia , Psiquiatria Legal/instrumentação , Psiquiatria Legal/legislação & jurisprudência , Psiquiatria Legal/métodos , Humanos , Entrevista Psicológica , Competência Mental/psicologia , Transtornos Mentais/psicologia , Testes Neuropsicológicos , Decisões da Suprema Corte , Estados Unidos
11.
Clin Ter ; 170(2): e108-e109, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30993306

RESUMO

The Mastrogiovanni case was a revolutionary case in the field of Italian forensic psychiatry. A recent judgment of the Court of Cassation has defined what the legal limits of mechanical restraint should be. On the other hand, even today, there is a gap in the scientific community about the presence of guidelines governing mechanical restraint. It is probably time to create specific guidelines to protect the psychiatric patient and the mental health worker.


Assuntos
Psiquiatria Legal/legislação & jurisprudência , Restrição Física/legislação & jurisprudência , Humanos , Itália
12.
J Am Acad Psychiatry Law ; 47(1): 12-21, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30760480

RESUMO

Organized medicine and psychiatry have a long tradition of governmental advocacy and public engagement. The American Academy of Psychiatry and the Law (AAPL), since its founding 50 years ago, has made some forays into these fields. However, its involvement has been less substantial than other similarly situated professional organizations. With its increasing membership and expertise, AAPL now possesses the capacity to dedicate some of its organizational attention, energy, and resources to educating policymakers and the public on current and future topics related to forensic mental health. In addition, an increasing number and type of professional activities related to this discipline are affected by governmental regulation and public opinion. Therefore, the need to become involved in shaping policy is more urgent, particularly in light of the fact that other forensic mental health organizations have been actively involved in governmental advocacy for decades. Finally, as a field and in the near future, we likely will deal with life-changing technological innovations related to the practice of forensic psychiatry. AAPL and its members are perhaps uniquely qualified and have a responsibility to help ensure that these innovations are developed, implemented, and utilized appropriately. This can only be accomplished by having a proverbial seat at the table in the process.


Assuntos
Psiquiatria Legal/legislação & jurisprudência , Psiquiatria Legal/organização & administração , Política Organizacional , Formulação de Políticas , Sociedades/legislação & jurisprudência , Sociedades/organização & administração , Psiquiatria Legal/educação , Psiquiatria Legal/tendências , Humanos , Liderança , Opinião Pública , Sociedades/tendências , Estados Unidos
13.
Int J Law Psychiatry ; 62: 45-49, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30616853

RESUMO

In Italy, following the closure of psychiatric hospitals in 1978 and the release of psychiatric patients into community care, there was a mismatch between common psychiatric patients and the convicted mentally ill who were sentenced to serve in state forensic psychiatric hospitals. The recent closure of such structures following the Prime Minister's Decree of April 1, 2008, fostered the need to create new structures. These are called "REMS," and they are based in the community and led by psychiatrists and healthcare staff who may rely on the collaboration of public security staff. This act completed a course of progressive deinstitutionalization of all psychiatric patients. However, some problems remain, and persons regarded as "partially mentally disabled" at the time of crime perpetration must serve part of their sentence in prison and the rest in the aforementioned structures or in psychiatric rehabilitation communities, depending on their claimed "social dangerousness." Psychiatric services now face the ambiguity of treating persons who are considered dangerous by court orders, while the civil law criteria for involuntary hospitalization is based only on the need of care. The complete closure of forensic hospitals may be considered a decisive step forward in the humanization of society, but there are still some issues to address to make it work better. The implementation of multidisciplinary teams and effective psychotherapy, psychoeducational, and rehabilitation interventions can help.


Assuntos
Psiquiatria Legal , Serviços Comunitários de Saúde Mental/história , Desinstitucionalização/história , Psiquiatria Legal/história , Psiquiatria Legal/legislação & jurisprudência , Psiquiatria Legal/métodos , História do Século XX , História do Século XXI , Hospitais Psiquiátricos/história , Humanos , Defesa por Insanidade/história , Itália
15.
Int J Law Psychiatry ; 65: 101359, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29909218

RESUMO

Various neuroscientific techniques are increasingly being used in criminal courts causing a vivid debate on the way that this kind of techniques will and should be used as scientific evidence. The role of experts in this context is important, since it is them that analyse, present, interpret and communicate the results of these techniques to the judges and the jury. In an attempt to contribute to the discussion about the role of the experts in criminal cases where neuroimaging evidence was introduced, we examined twenty seven cases from the US and Europe. Focusing on the role of experts and their presentation of neuroscientific evidence, we aimed to examine the extent to which neuroimaging data can contribute to the construction of a solid and more objective, "scientifically - based" case. We found that neurobiological information introduced through experts' testimony is generally used in order to demonstrate some physical, organic base of a psychiatric condition, or/and in order to make visible some brain lesion, (structural or functional), susceptible to have affected the capacity to reason and to control one's impulses. While neuroimaging evidence is often presented by the defence as a scientific method able to offer a precise diagnosis of the pathology in question, our case analysis shows that the very same neurobiological evidence can be interpreted in different - sometimes diametrically opposed - ways by defence and State experts. Conflicting testimony about the same empirical evidence goes against the hypothesis of neuroscientific techniques constituting "objective and hard evidence", able to reach solid, scientific and objective conclusions. Frequent conflicts between neuroimaging experts require the courts to deal with the resulting uncertainty. As the law changes with technology, it is necessary for legal professionals to train and be prepared for the new issues they may encounter in light of new developments in neuroscience, so that they become more vigilant as to the interpretation of neuroscientific data.


Assuntos
Criminosos/psicologia , Prova Pericial/métodos , Psiquiatria Legal/métodos , Transtornos Mentais/diagnóstico por imagem , Neuroimagem/psicologia , Neurociências/legislação & jurisprudência , Lesões Encefálicas/diagnóstico por imagem , Criminosos/legislação & jurisprudência , Europa (Continente) , Psiquiatria Legal/legislação & jurisprudência , Humanos , Neurociências/métodos , Estados Unidos
16.
Int J Law Psychiatry ; 65: 101409, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30591221

RESUMO

In this paper, we focus on, a significant Australian sentencing appeal in which, after hearing expert evidence pertaining to cognitive function, brain scans, and neuropsychological testing, the Court imposed a less severe sentence than that originally imposed. Our aim is to produce an interdisciplinary critical analysis of the decision, and we approach this by analysing the judicial comments on the evidence pertaining to the offender's mental condition, and the reasoning about punishment. We conclude that the Court's inferences about frontal lobe damage and likely dementia are contestable, and the reasoning about mitigation of punishment based on these questionable inferences could have been improved by a focus on sentencing's retributive aim.


Assuntos
Transtornos Cognitivos/psicologia , Criminosos/psicologia , Tomada de Decisões , Psiquiatria Legal , Neurociências/legislação & jurisprudência , Punição/psicologia , Idoso , Austrália , Transtornos Cognitivos/diagnóstico por imagem , Direito Penal/legislação & jurisprudência , Criminosos/legislação & jurisprudência , Prova Pericial , Psiquiatria Legal/legislação & jurisprudência , Humanos , Masculino
17.
Psychol Sci Public Interest ; 20(3): 135-164, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32065036

RESUMO

In this article, we report the results of a two-part investigation of psychological assessments by psychologists in legal contexts. The first part involves a systematic review of the 364 psychological assessment tools psychologists report having used in legal cases across 22 surveys of experienced forensic mental health practitioners, focusing on legal standards and scientific and psychometric theory. The second part is a legal analysis of admissibility challenges with regard to psychological assessments. Results from the first part reveal that, consistent with their roots in psychological science, nearly all of the assessment tools used by psychologists and offered as expert evidence in legal settings have been subjected to empirical testing (90%). However, we were able to clearly identify only about 67% as generally accepted in the field and only about 40% have generally favorable reviews of their psychometric and technical properties in authorities such as the Mental Measurements Yearbook. Furthermore, there is a weak relationship between general acceptance and favorability of tools' psychometric properties. Results from the second part show that legal challenges to the admission of this evidence are infrequent: Legal challenges to the assessment evidence for any reason occurred in only 5.1% of cases in the sample (a little more than half of these involved challenges to validity). When challenges were raised, they succeeded only about a third of the time. Challenges to the most scientifically suspect tools are almost nonexistent. Attorneys rarely challenge psychological expert assessment evidence, and when they do, judges often fail to exercise the scrutiny required by law.


Assuntos
Prova Pericial/normas , Psiquiatria Legal/legislação & jurisprudência , Jurisprudência , Ciência/legislação & jurisprudência , Prova Pericial/legislação & jurisprudência , Humanos , Papel Profissional , Ciência/normas , Estados Unidos
20.
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