Forensic psychiatry

Risk assessment and resource allocation [Letter]

by Christopher Ryan

Nielssen, Olav, Christopher Ryan, and Matthew Large. 2011. Risk assessment and resource allocation [Letter]. Australasian Psychiatry 19 (3): 270.

We are concerned by the recent account of the activities of a selection of the Australia ’ s specialist community... more We are concerned by the recent account of the activities of a selection of the Australia ’ s specialist community forensic services. 1 From the data presented it seems that about 600 risk assessments are conducted by these services each year, at an average cost of $ 2800 per assessment, assuming expenses of $ 200 per hour. However, the effort devoted to performing risk assessments is largely wasted, as there is almost no scientific evidence that performing risk categorization actually reduces the incidence of harmful events and the vast majority of people categorized as being at high risk will never commit a seriously harmful act. 2 Of greater concern is the much larger cost to health services arising from clinical decisions made on the basis of these risk assessments.

Screening for personality disorder in probationers: validation of the Standardised Assessment of Personality Abbreviated Scale (SAPAS)

by Graham Pluck

Risk and recovery group for offenders with mental disorders

by Seb Henagulph

"La formation du concept de perversion au XIXe siècle en France"

by Claude-Olivier Doron

This article has been published in L'information psychiatrique, vol. 88, n°1, janv. 2012, pp. 39-49

"The formation of the concept of mental perversion in the 19th century in France." In this article, we... more "The formation of the concept of mental perversion in the 19th century in France." In this article, we assess the emergence
of the psychiatric concept of “perversion” in the 19th century. We focus on two points. First, despite its common usage,
the psychiatric concept of perversion should not be based on the theologico-moral notion of “perverse” but from a medical
notion of “perversion”, which refers to the alteration of humours and then the qualitative alterations of instincts.We analyse
how the clinical knowledge of the various qualitative deviations of instincts has developed within psychiatric knowledge.
Second, we show that, in contrast, the concept of “perversion” has offered the psychiatrists a way of getting inside the
medicolegal field and to deal with the juridico-moral concept of “perversity”, a concept that became decisive in penal
practices after 1820.We evaluate this opposition between “perversity” and “perversion” and show how the “constitutional
pervert” eventually emerged in the 1860s.

PHDabstract-résumésdethèse

by Claude-Olivier Doron

This document includes english and french abstracts of my PhD Thesis on 'Races and degeneration. The emergence on the... more This document includes english and french abstracts of my PhD Thesis on 'Races and degeneration. The emergence on the knowledge on the abnormals', a detailed description of the different chapters (in french) and of its main results (in french) and its table of contents.

Moral Responsibility and Mental Illness: A Case Study

by Matthew Broome

Broome, Bortolotti and Mameli 2010 - published in Cambridge Quarterly of Healthcare Ethics

Various authors have argued that progress in the neurocognitive and neuropsychiatric sciences might threaten the... more Various authors have argued that progress in the neurocognitive and neuropsychiatric sciences might threaten the commonsense understanding of how the mind generates behavior, and, as a consequence, it might also threaten the commonsense ways of attributing moral responsibility, if not the very notion of moral responsibility. In the case of actions that result in undesirable outcomes (e.g., someone being harmed), the commonsense conception—which is reflected in sophisticated ways in the legal conception—tells us that there are circumstances in which the agent is entirely and fully responsible for the bad outcome (and deserves to be punished accordingly) and circumstances in which the agent is not at all responsible for the bad outcome (and thereby the agent does not deserve to be punished).

"Le démon du pervers: entre perversion et perversité"

by Claude-Olivier Doron

Published in Bossi, Laura & Clair, Jean (dir), Crime et folie. Actes de la fondation des Treilles/ Gallimard, Paris, 2011, pp. 233-256

Cet article propose une relecture du texte de Poe, The imp of the perverse, en démontrant l’ambiguïté du terme «... more Cet article propose une relecture du texte de Poe, The imp of the perverse, en démontrant l’ambiguïté du terme « perverse », traduit par Baudelaire « perversité », alors qu’on peut montrer que Poe joue précisément sur la distinction entre « perversion » et « perversité » qui tend à s’imposer à ce moment dans le champ médico-légal.

"Une volonté infinie de sécurité: vers une rupture générale dans les politiques pénales?"

by Claude-Olivier Doron

Published in Chevallier, Philippe & Greacen, Tim (ed.) Folie et justice: relire Michel Foucault, Erès, Paris, 2009, pp. 179-204

Cet article fait le point sur les évolutions qu’ont connues les politiques pénales en France depuis les années 1990,... more Cet article fait le point sur les évolutions qu’ont connues les politiques pénales en France depuis les années 1990, en utilisant le concept foucaldien de « dispositif de sécurité », et en analysant tout particulièrement le dispositif de mesures de sûreté mis en place depuis 1998 autour de la délinquance sexuelle. Il pose l’hypothèse, depuis largement confirmée, d’une véritable rupture dans les politiques pénales aboutissant à un progressif découplage du système pénal d’avec une rationalité légale.

"Soigner par la souffrance: la prise en charge des auteurs de violences sexuelles"

by Claude-Olivier Doron

Published in Doron, Claude-Olivier, Lefève, Céline & Masquelet, Alain, Soin et subjectivité, Les Cahiers du Centre Canguilhem, n°4, pp. 87-114

In this article, we study the question raised by the care of the sex psychopaths between justice and psychiatry. We... more In this article, we study the question raised by the care of the sex psychopaths between justice and psychiatry. We show the ambiguity of the so-called pathology to which this care is supposed to be directed: a pathology that is not a mental disease and that doesn’t produce any distress to the patient who doesn’t ask for any treatment. This ambiguity, coupled to the fact that this kind of treatment implies the cooperation of the medical staff with justice, explains why so many psychiatrists and psychologists don’t feel at ease with this kind of care. We eventually analyze two ways medical staff have to solve this tension: either they accept to develop a psycho-criminology which aims to reeducation and correction of deviant behaviors, or they try to convert all the resistances and obstacles they meet in their practice in the more familiar vocabulary of disease and care.

A CRIAÇÃO DO INDIVÍDUO INIMPUTÁVEL PELA PSIQUIATRIA FORENSE COMO UMA FORMA DE EXCLUSÃO E CONTROLE SOCIAL NA …

by Ingrid P

Catalog of the Robert L. Sadoff Library of Forensic Pyschiatry and Legal Medicine

by Jennifer Melinn

Civilizing the "Barbarian": A critical analysis of behaviour modification programmes in forensic psychiatry settings

by Stuart Murray

Co-authored with Dave Holmes, Journal of Nursing Management, 19 (2011): 293-301.

Evaluation of treatment outcomes from a medium secure unit for people with intellectual disability

by Verity Chester

An audit of a smoking cessation programme for people with an intellectual disability resident in a forensic unit

by Verity Chester

The Politics of Psychiatric Evaluation: Towards a Critical Anthropology of Forensic Psychiatry

by Samuel Lézé

Penal field. New international Journal of Criminology, Vol. V, 2008 : Varia

In the legal context, psychiatric evaluations are subject to controversy, considered as either indispensable or... more In the legal context, psychiatric evaluations are subject to controversy, considered as either indispensable or flawed, and yet rarely studied in their own right. This article puts forward a political anthropology of mental healthcare that is attentive to social context (the problem of recidivism), professional logic (the evaluation of dangerousness) and liminal practices (at the limits of the correctional and the medical). It thus intends to delimit the methodological and theoretical stakes of a study of (i) the psychiatric creation of the expert witness report (ii) its legal use (iii) its consequences on psychiatric care in prison and beyond. What makes reports authoritative or, on the contrary, how are they contested? What are the political issues at stake? Thus, the complexity of the politics of psychiatric evaluations can be drawn out from delineated ethnographic fields; a complexity linked to the situation of these evaluations between, on the one hand, legal and psychiatric theories of personality and, on the other, how they are received and effectively applied by the legal system.

(2008) «Politiques de l’expertise psychiatrique. Enjeux, démarches et terrains»,Champ pénal, Nouvelle Revue Française de Criminologie, Vol.V.

by Samuel Lézé

Article in French

Dans le cadre judiciaire, l'expertise psychiatrique est un objet de controverse, invoquée ou répudiée, mais rarement... more Dans le cadre judiciaire, l'expertise psychiatrique est un objet de controverse, invoquée ou répudiée, mais rarement étudiée pour elle-même. Dans une perspective d'anthropologie politique de la santé mentale attentive à la conjoncture sociale (problème de la récidive), aux logiques professionnelles (évaluation de la dangerosité) et aux pratiques frontières (aux confins du monde carcéral et médical), cet article a pour objectif programmatique de dégager les enjeux méthodologiques et théoriques d'une étude de i) la fabrication psychiatrique du rapport d'expert, ii) son exploitation judiciaire, iii) ses conséquences sur les soins psychiatriques en prison et au-delà. Comment l'expertise fait-elle autorité ou, au contraire, est-elle contestée ? Quels en sont les enjeux politiques ? Ainsi peut se dégager à partir de terrains ethnographiques circonscrits la complexité des politiques de l'expertise psychiatrique impliquée dans les relations entre théories juridiques et psychiatriques de la personnalité d'une part, et les modalités opératoires de réception et d'application effective de la justice d'autre part.

In the judicial field, the psychiatric expertise is an object of controversy, called upon or rejected, but rarely studied for itself. With a political anthropology of mental health perspective interested in the social conjuncture (recidivism problem), professional logic (dangerousness assessment) and boundary practice (between medicine and prison), the programmatic aim of this article is to study the theoretical and methodological stake of a research on: i) the production of expertise files; ii) its judicial uses; iii) its consequences into the psychiatric treatment in prison and anywhere else. How does psychiatric expertise set up authority or, on the contrary challenged? What are the political stakes? From fieldworks, we can enlighten complexities of the politics of psychiatric expertise in the relation between judicial and psychiatric theories of personality, in one hand, ways of reception and application of the justice, on the other hand.

The Development of a Sex Offender Assessment and Treatment Service Within a Community Learning Disability Team

by Peter Langdon

Ethical Issues in Forensic Psychiatric Research on Mentally Disordered Offenders

by Christian Munthe

Co-authored w. Susanna Radovic & Henrik Anckarsäter. Bioethics, 24 (1): 35-44. DOI: 10.1111/j.1467-8519.2009.01773.x

This paper analyses ethical issues in forensic psychiatric research on mentally disordered offenders, especially those... more This paper analyses ethical issues in forensic psychiatric research on mentally disordered offenders, especially those detained in the psychiatric treatment system. The idea of a ‘dual role’ dilemma afflicting forensic psychiatry is more complicated than acknowledged. Our suggestion acknowledges the good of criminal law and crime prevention as a part that should be balanced against familiar research ethical considerations. Risks of research subjects being burdened by improvements of criminal justice due to research should not be seen as weighty reasons. Direct substantial risks must be balanced by health benefits, and normal informed consent requirements apply. When direct risks are slight, as in register-based epidemiology, lack of consent may be counter-balanced by special measures to protect integrity and the general benefit of better understanding of treatment and prevention. Special requirements on consent procedures in the forensic psychiatric context are suggested, and the issue of the relation between decision competence and legal accountability is found to be in need of further study. The major ethical hazard in forensic psychiatric research connects to the role of researchers as assessors and consultants in a society entertaining strong prejudices against mentally disordered offenders.

Keywords: dual role dilemma, ethics, forensic psychiatry, informed consent, mentally disordered offenders, public good, research ethics

The precarious practice of risk assessment in forensic psychiatry

by Christian Munthe

Co-authored w. Nilsson T, Gustavson C, Forsman A & Anckarsäter, H. International Journal of Law and Psychiatry, Volume 32, Issue 6, Pages 400-407 , DOI: 10.1016/j.ijlp.2009.09.010, DOI: 10.1016/j.ijlp.2009.09.010

The development of forensic psychiatric risk assessments is discussed from a clinical point of view using the example... more The development of forensic psychiatric risk assessments is discussed from a clinical point of view using the example of Sweden. A central task in forensic psychiatry has traditionally been to identify dangerous, mentally disordered subjects considered to be prone to commit violent acts. Over time, “dangerousness” has been reworded into “risk”. Nevertheless, such assessments have generally been based on the psychiatric factors characterising the individual patient, while group interaction, situational factors, or social and cultural circumstances, such as the availability of alcohol and drugs, have been largely overlooked. That risk assessments have a focused on people with a diagnosis of “mental disorder” and been used as grounds for coercive measures and integrity violations has somehow been accepted as a matter of course in the public and political debate. Even the basic question whether offenders with a mental disorder are really more prone to criminal recidivism than other offenders seems to have been treated light-handedly and dealt with merely by epidemiological comparisons between groups of persons with broad ranges of psychosocial vulnerability and the general population. Legal texts, instructions and guidelines from the authorities in charge are often vague and general, while actors in the judicial system seem to put their trust in psychiatric opinions. The exchange of professional opinions, general public expectations, and judicial decision processes poses a huge risk for misunderstandings based on divergent expectations and uses of terminology.