[A Forensic Psychiatric Perspective on the Draft Mental Health Act of Turkey in Light of Similar Laws and Practice in a Foreign Jurisdiction]. / Ruh Sagligi Yasasi Taslaginin Yurt Disi Bir Uygulama Örnegi Isiginda Adli Psikiyatrik Açidan Gözden Geçirilmesi.

OBJECTIVE: Designated Acts for issues related to mental health are in force in many countries throughout the world. A mental health act is also expected to be approved in Turkey soon. Under the leadership of the Psychiatric Association of Turkey, non-governmental organizations operating in the field of mental health has contributed to the emergence of a comprehensive draft. The current draft, after extensive discussion and reiterations for almost a decade, was brought to a state close to its final form and accepted as a draft bill, ready to be legislated in the Turkish Grand National Assembly. This review will discuss the potential impact of the law in matters involving Forensic Psychiatry, and present our recommendations. METHOD: Current draft, which has not yet been finalized, was compared to similar statutes in Massachusetts, USA, and potential benefits and pitfalls were discussed in light of experience with these laws in this jurisdiction. RESULTS: The draft introduces several new concepts and practices which have never existed in Turkey before. It also attempts to organize some of the existing de facto clinical practices in a uniform manner. As a whole, it appears to be in compliance with human rights and related international treaties. However, it is likely that some of the sections might have compliance issues in daily practice. CONCLUSION: In this review, we aimed to draw attention to a number of issues, based on our experience in Massachusetts, USA, where similar laws have been in force for a very long time. Rather than literally comparing the statutes in both jurisdictions, we attempted to emphasize positive aspects as well as likely problems that we might encounter should Turkish draft be legislated in the present form.

Civil commitment in Turkey: reflections on a bill drafted by psychiatrists.

Involuntary hospitalization of the mentally ill has been an issue that still remains outside the judicial system in Turkey. Despite the new Turkish Civil Code, which includes several articles relevant to involuntary psychiatric hospital admissions, there still appears to be a need for a comprehensive mental health law to address specific issues concerning civil commitment of the mentally ill. As a result of the lack of specific statutory regulation, an insufficient number of psychiatric hospital beds and limited appreciation of the safety risks involved in untreated mental illness, involuntary hospitalization remains an underutilized option by psychiatrists and the courts alike. In response to its concerned members, the Psychiatric Association of Turkey has appointed a task force to draft a proposed mental health law, entitled the "Psychiatric Patients' Bill of Rights." Although the draft suggests a model with emphasis on the right to psychiatric treatment, it also recommends close judicial oversight to prevent potential abuses of discretion by the system. However, this might present logistic problems in a country with already overburdened courts. Authors discuss the highlights of the draft within the context of Turkey's current cultural, social and judicial structure, and compare it to similar laws of other countries.

The new research ethic: will oversight requirements sink forensic research?

The conduct of research with human participants is facing increased scrutiny from government, media, and academic sources. Research oversight is consequently increasing dramatically as education and accreditation movements gain momentum. Institutional review boards themselves are undergoing significant changes in organization and accountability, implementing new tools to monitor investigator compliance. This article describes the causes of recent calls for increased scrutiny, the resultant trends in research oversight, and the general lack of preparation for increased costs in the public sector. These are costs that will be felt acutely in the forensic setting as diminishing state budgets affect hospitals, universities, and correctional institutions.

A method to measure the effective spread of focally injected muscimol into the central nervous system with electrophysiology and light microscopy.

A method was developed to quantitate the volume of brain inactivated by muscimol focally injected. Tritiated muscimol was injected into the cerebellum and closely spaced sequential microelectrode recordings made at different depths by penetrations in an X-Y pattern centered at the injection site to evaluate changes in spontaneous activity in the tissue volume. Animals were euthanized after survivals from 40 min to 6 h, the cerebellum sectioned in the sagittal plane, and the sections dried onto glass slides. The slides were dipped in photographic emulsion, exposed in the dark and developed. Silver grain densities were quantitated by light microscopy from measured standards. The extent and concentration of bound, labeled muscimol co-varied with the observed reduction in recorded spontaneous activity. For future studies, the distribution and density of silver grains alone can serve as an accurate spatial indicator of the area of muscimol inactivation at high spatial resolution.

Evaluating psychiatric disability: differences by forensic expertise.

The task of evaluating psychiatric disability poses several ethics-related and practical challenges for psychiatrists, especially when they are responding to a request from a third party for a disability evaluation on their own patient. This study sought to evaluate the differences in how forensic and nonforensic psychiatrists approach and view evaluations for Social Security disability benefits. Thirty-two forensic and 75 nonforensic psychiatrists were surveyed on their practice patterns and perceptions of role, objectivity, and dual agency in the disability evaluation process. Significant differences were found between forensic and nonforensic psychiatrists' perceptions of the dual-agency conflict, beliefs about who should perform evaluations, and beliefs about the weight given to different opinions when decisions of whether to award disability benefits are made. A minority of respondents in both groups reported having identified a patient as disabled, despite believing otherwise. The implications of these findings are discussed.