A few years ago, members of the forensic psychiatry research team at St. Joseph’s Healthcare Hamilton started an exciting journey with the decision to create a new forensic mental health journal.
Read moreVol. 2, No. 1, 2019
Is the Anticipated Consent to Treatment in Advance Directives a Solution to Compulsory Treatment in Forensic Psychiatry?
As a result of a German Federal Constitutional Court decision on compulsory treatment, in its state Law the federal state of Hesse has newly regulated the possibility of compulsory treatment (Section 7 Paragraph 2 of the Hesse Law on the Enforcement of Court-ordered Hospital Treatment) and expressly incorporated the observance of a patient’s advance directive as defined by Sections 1901a and 1901b of the German Civil Code (Bürgerliches Gesetzbuch [BGB]). Having been sentenced to a hospital treatment order under section 63 of the Ger- man Criminal Code (Strafgesetzbuch [StGB]) in the Vitos Haina Forensic Psychiatric Hospital, thirteen patients with schizophrenia stated in a patient’s advance directive that they wished to be treated with certain antipsychotic medication in case of a recurring psychotic episode. In particular, the patient’s advance directive stated that this treatment should be compulsory if necessary. Based on a case vignette this article delineates both the motivation of the patients for such a patient’s advance directive, as well as the legal limitations and the enforceability of such a patient’s advance directive. There is no prevailing view in the jurisdiction or literature on the utilization of a patient’s advance directive to guarantee an explicitly desired treatment in case of incapacity for consent. This article wishes to highlight the perspectives of those directly affected and to encourage discussion. While of special interest for forensic psychiatry, these considerations may also be of importance for treatment considerations in general psychiatry.
Read moreForensic Psychiatry in the Largest Secure Ward in Portugal: Characteristics of the Population and Psychopharmacological Intervention
Forensic psychiatry is defined as a specialty of psychiatry in which clinical and scientific knowledge is applied to the legal system, both with regard to civil and criminal law. Nowadays, the largest security ward is in Coimbra, at the University Hospital. It comprises 111 patients: 91 males and 20 females. The aim of the security measures, according to the penal code, is the protection of legal assets and psychosocial rehabilitation. In our sample, the most frequent diagnosis was Schizophrenia (37.8%); Moderate Intellectual Disability (23.4%) and Mild Intellectual Disability (14.4%) were the second and third most frequent diagnoses. The criminal acts accounting for the most prevalent security measures fell under domestic violence (19.8%) first, followed by attempted murder (16.2%), and theft (14.5%). The elaboration of a therapeutic and rehabilitation plan is essential, and its aim is to diminish the person’s dangerousness. It is fundamental to think of the safety ward as a health production space and not as a place of mere disease management or “dangerous states”, thus trying to solve the patient’s problems.
Read moreThe Implementation of Cognitive Behavioural Therapy for Psychosis (CBTp) in a Forensic Setting: Lessons Learned and Future Directions
Schizophrenia is a debilitating psychotic illness that affects approximately 1% of the population. Within the Canadian forensic psychiatric system, patients are detained under a provincial Review Board after being found not criminally responsible (NCR) on account of a mental disorder. Here, the prevalence rate of schizophrenia is 53% [1]. Even with the use of psychotropic medication, it is estimated that approximately only 25% of patients fully recover from the illness [2]. The presence of active psychotic symptoms increases the risk of violent behaviour [3]. Thus, psychological interventions have been developed to be employed in conjunction with medication to assist in managing or even reducing symptomatology.
Read moreScales for Evaluating the Acceptance of the Rape Myth: Benefits and Limitations
Society’s views regarding rape and sexual aggression have significantly evolved in recent years. Rape is now a felony, and the context of marital rape is an aggravating circumstance. Nonetheless, common representations could tend to minimize the perpetrator’s responsibility and to excuse their actions. This shows acceptance of a set of attitudes, beliefs and stereotypes that we call the Rape Myth. Acceptance of these representations or of the Rape Myth is widespread, including among those who work in the legal and healthcare fields and among jurors, and may lead to a reduced penal response [1,2]. It also exists among rape victims and may prevent them from reporting the events or being able to reconstruct them precisely [3]. The existence of strong correlations between acceptance of the Myth and a propensity for rape and other coercive sexual behaviour [4-7] underscores the importance of this factor. In this way, the acceptance of the Rape Myth could lead to cognitive distortions that rationalize, minimize or justify the behaviours of sexual offenders [8,9]. Cognitive distortions also serve to protect sexual abusers’ image so that they do not feel guilty, blame themselves or consider themselves to be monsters.
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