International Journal of Law and Psychiatry最新文献

{"title":"A template for a psychiatric advance directive: Co-development and qualitative evaluation with key stakeholders","authors":"Anne-Sophie Gaillard ,&nbsp;Jakov Gather ,&nbsp;Iris Haferkemper ,&nbsp;Jochen Vollmann ,&nbsp;Sarah Potthoff ,&nbsp;Matthé Scholten ,&nbsp;Esther Braun","doi":"10.1016/j.ijlp.2025.102135","DOIUrl":"10.1016/j.ijlp.2025.102135","url":null,"abstract":"<div><h3>Background</h3><div>Psychiatric advance directives (PADs) allow mental health service users to express their treatment preferences for future mental health crises. An accessible template for PADs can improve their implementation in practice.</div></div><div><h3>Aim</h3><div>Developing and evaluating a PAD template tailored to the German context together with key stakeholders.</div></div><div><h3>Method</h3><div>We co-developed a prototype PAD template based on a systematic review of the content of PADs and a review of existing templates in consultation with our research group's lived experience council. The prototype was evaluated in 5 focus groups with service users, relatives, mental healthcare professionals, peer support workers and legal guardians as well as 4 consultation sessions with clinical and legal experts and the research group's lived experience council. We revised the template after each feedback round.</div></div><div><h3>Results</h3><div>Participants valued the inclusion of the options to articulate personal values, preferred types of support in their recovery process, and preferred measures of supported decision-making in the template. They recommended including a summary page with the most important information in a crisis, a section for service users to describe themselves when stable or well, and the option to state preferences for post-inpatient care. There was controversy among study participants on whether the template should include individual indicators of decision-making capacity, preferences regarding treatment setting, and de-escalation strategies.</div></div><div><h3>Conclusions</h3><div>This study presents the development of the first German PAD template together with key stakeholders. The study design can be used as a model for developing templates tailored to other legal contexts.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"103 ","pages":"Article 102135"},"PeriodicalIF":1.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144773196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Restricted patients and detention in the community: The human rights implications of supervised discharge under the Mental Health Bill 2025","authors":"Ailbhe O'Loughlin ,&nbsp;Iain McKinnon","doi":"10.1016/j.ijlp.2025.102136","DOIUrl":"10.1016/j.ijlp.2025.102136","url":null,"abstract":"<div><div>This article critically analyses provisions in the Mental Health Bill 2025 that, if passed, will amend the Mental Health Act (MHA) 1983 to create a power for tribunals and the Justice Secretary to discharge restricted patients from hospital subject to conditions that deprive them of their liberty in the community. These provisions pose a threat to the human rights of patients who straddle the divide between the mental health and criminal justice systems. Furthermore, the provisions and the cases that preceded them expose the limits of policies of de-institutionalisation and official ambitions to move people with learning disabilities and autism spectrum disorder out of psychiatric hospitals and to support them to live in the community. Such seemingly progressive moves are tempered by a political drive to continue to control those who are thought to pose risks to others. As this article makes clear, detention in the community is not a lesser form of detention than detention in hospital, and it requires stringent safeguards in light of the UK's obligations under Article 5 of the European Convention on Human Rights. This article advances an alternative solution. Instead of creating a new, and complex, power that could lead to unlawful detentions in the community, suitable community-facing hospital accommodation for restricted patients subject to the same safeguards as hospital settings should be made available.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"103 ","pages":"Article 102136"},"PeriodicalIF":1.3,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The practical goals of inpatient forensic mental health services in Sweden – A qualitative comparative analysis of met and unmet rehabilitative needs in the transition to outpatient care","authors":"S.H. Pedersen ,&nbsp;F. Lindström ,&nbsp;J. Nyman ,&nbsp;A.G. Crocker ,&nbsp;L. Eriksson ,&nbsp;T. Nilsson","doi":"10.1016/j.ijlp.2025.102138","DOIUrl":"10.1016/j.ijlp.2025.102138","url":null,"abstract":"<div><div>Forensic mental health services (FMHS) seek to alleviate mental illness and reduce the risk of (violent) recidivism, but they may also be understood to be responsible for supporting patients with many other aspects of their often challenging lives. In practice, the task of an inpatient institution such as FMHS is concluded when the patient can transition to outpatient care, a move which is governed by law. Therefore, the practical goals are at least partly set by legal criteria for transition to outpatient care. Using qualitative comparative analysis, this study identifies systematic patterns of rehabilitative needs as assessed by clinicians that differentiate between FMHS patients who are deemed ready for outpatient care and those who are not. It also identifies how such systematic patterns align with legal criteria governing the transition to outpatient care. We find systematic patterns of rehabilitative needs that are associated with being considered ready for outpatient care and that these patterns map meaningfully onto the legislative criteria for forensic psychiatric care in Sweden. Mental health needs, violence risk needs, and needs associated with social functioning all bear on readiness for outpatient care but only in conjunction with one of the other. The results indicate that the transition to forensic outpatient care in Sweden depends on aspects outside the core objectives of non-recidivism and mental health, and rest on efforts by actors external to FMHS. This places high demands on clarity of institutional boundaries and the role of social functioning needs in decisions about compulsory care.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"103 ","pages":"Article 102138"},"PeriodicalIF":1.3,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personality disorder, mental capacity and compulsory intervention","authors":"Gavin Davidson ,&nbsp;Steph Kerr ,&nbsp;Iain McDougall ,&nbsp;Claire McCartan ,&nbsp;Patrick Hann ,&nbsp;Emily Stirling","doi":"10.1016/j.ijlp.2025.102127","DOIUrl":"10.1016/j.ijlp.2025.102127","url":null,"abstract":"<div><div>In Northern Ireland, the current main legal framework for compulsory intervention is the Mental Health (Northern Ireland) Order 1986. It is a traditional mental health law which enables detention in hospital if mental disorder and risk criteria are met. However, under Article 3(2), it states that people should not be detained “by reason only of personality disorder”. There has been a process of law reform in Northern Ireland to create a non-discriminatory, comprehensive legal framework for all. This resulted in the Mental Capacity Act (Northern Ireland) 2016. The Act, when fully implemented, will replace the Order for everyone aged 16 and over, which is in contrast to most other countries where there are both mental health and mental capacity laws. Under the new Act there are no specific exclusions so, if a person is unable to make the relevant decision, including if the cause of impairment relates to issues associated with personality disorder, then compulsory intervention is allowed as long as the proposed intervention is in the person's ‘best interests’. The Act was partially implemented in 2019 and currently is only used when the Order does not apply. This article explores: the development of this new legal framework; the implementation of the Act; and some of the ongoing debates, and practice complexities, related to services for people with a diagnosis of personality disorder.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"103 ","pages":"Article 102127"},"PeriodicalIF":1.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A mixed-methods analysis of the influence of bio-behavioral scientific evidence on U.S. judges' reasoning and sentencing decision-making","authors":"Mia A. Thomaidou,&nbsp;Colleen M. Berryessa,&nbsp;Sandy S. Xie","doi":"10.1016/j.ijlp.2025.102126","DOIUrl":"10.1016/j.ijlp.2025.102126","url":null,"abstract":"<div><div>In contemporary criminal justice systems, the integration of neuroscience evidence into legal proceedings poses complex challenges as well as opportunities. This study investigates how judges–shaped by their beliefs and personal characteristics–approach sentencing decision-making in light of scientific explanations of behavior or psychiatric diagnoses. Specifically, it addresses two research questions: (1) How do scientific explanations of behavior influence how judges assess responsibility? (2) What cognitive biases or misconceptions may affect their interpretations of such evidence? We utilized a mixed-methods approach, including Natural Language Processing techniques and qualitative analysis, to analyze data from semi-structured interviews with 34 U.S. criminal court judges. Sentiment analysis revealed differences in emotional tone between judges with varying degrees of belief in scientific determinism and based on gender, age, geographical region, and professional background. Structural Topic Modeling identified key considerations, including determinism, responsibility, treatment needs, and moral concerns. Qualitative analysis enriched these results by unraveling the philosophical and legal considerations that judges grapple with when considering scientific explanations for defendants' behavior. Findings underscore the nuanced interplay between scientific understandings of behavior, personal beliefs, and judicial decision-making.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"102 ","pages":"Article 102126"},"PeriodicalIF":1.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144634089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Swinging the pendulum from ‘a necessary evil’ to ‘the dignity of risk’: Can new UN legislative guidance help to end psychiatric coercion?","authors":"Laura Davidson","doi":"10.1016/j.ijlp.2025.102102","DOIUrl":"10.1016/j.ijlp.2025.102102","url":null,"abstract":"<div><div>The Convention on the Rights of Persons with Disabilities (CRPD) came into force almost two decades ago. Prohibitive of disability discrimination, Article 1 includes “long-term…mental…[and] intellectual impairments”. Thus, psychiatric coercion and the detention and forced medical treatment of persons with permanent cognitive impairment are unlawful acts. Due to non-compliance with the CRPD, the World Health Organization (WHO) withdrew its legislative mental health guidance several years ago. It has since conducted lengthy consultations with stakeholders, including many with lived experience of psychosocial disability.<span><span>¹</span></span> This has led to new guidance compiled jointly with the UN Office of the High Commissioner for Human Rights (OHCHR), <em>Mental Health, Human Rights and Legislation: Guidance and Practice</em> (2023). The publication is described as a useful resource for states and decision-makers, and a “call to action” to realise the CRPD's vision of a shift from coercive care to equality and non-discrimination. It offers suggestions for legislative provisions that promote human rights and dignity in mental health systems to comply with international human rights norms and standards. Furthermore, it exhorts states to ensure that legislation recognises the “dignity of risk” for service users, which runs contrary to the current dominant biomedical model. This article considers the Guidance's take on key CRPD provisions and reflects on its logic and the legislative solutions it offers to various legal and ethical questions surrounding “hard cases”. The article also discusses some of the likely implications arising from compliance with the Guidance and the CRPD on which it is based, with particular reference to the law of England and Wales.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"102 ","pages":"Article 102102"},"PeriodicalIF":1.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144535739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the sensitivity of the Health Screening of People in Police Custody (HELP-PC) tool in Northumbria Police, UK","authors":"Thomas Cranshaw ,&nbsp;Helena Austin ,&nbsp;John Moore ,&nbsp;Evelyn Evans ,&nbsp;Salma Rauf ,&nbsp;Faye Groom ,&nbsp;Ellie Mannix ,&nbsp;Ellen Whitehouse ,&nbsp;Iain McKinnon","doi":"10.1016/j.ijlp.2025.102101","DOIUrl":"10.1016/j.ijlp.2025.102101","url":null,"abstract":"<div><div>This paper presents an evaluation of a novel health screening tool implemented in 2016 by Northumbria Police, in the North East of England, United Kingdom. The aim of the study was to determine the sensitivity of the tool in detecting physical and mental health conditions. Secondary aims were to produce useful data on the prevalence of these conditions and onward referrals within custody. The tool was compared to a clinical interview carried out within the custody suite by research psychiatrists. Researchers spent a total of 64 days within the custody suite and interviewed 177 participants. The tool performed variably, with 100 % sensitivity for diabetes, epilepsy and psychosis, however in other areas the sensitivity was lower such as for opioid dependency (18 %). When compared to the pilot study of the tool there is a non-significant trend towards improved sensitivity, with no areas in which sensitivity has reduced. In comparison to a previous evaluation of an alternative tool, this tool has improved sensitivity for asthma (92 vs 49 %, <em>p</em> &lt; 0.001), cardiovascular complaints (38 vs 2 %, <em>p</em> &lt; 0.0001), head injury (72 vs 17 %, <em>p</em> = 0.004) and intellectual disability (82 vs 25 %, <em>p</em> = 0.016).</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"102 ","pages":"Article 102101"},"PeriodicalIF":1.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A repertoire and critical review of international resources relevant to medical assistance in dying where a mental disorder is the sole underlying medical condition","authors":"Caroline Favron-Godbout ,&nbsp;Izadora Foster ,&nbsp;Eric Racine","doi":"10.1016/j.ijlp.2025.102114","DOIUrl":"10.1016/j.ijlp.2025.102114","url":null,"abstract":"<div><h3>Background</h3><div>The possibility of asking for help in ending one's life is at the heart of some of the most enduring debates in medicine and bioethics. As a growing number of countries open to the practice, many concerns are emerging internationally about medical assistance in dying where a mental disorder is the sole underlying medical condition (MAiD-MD). It is paramount to understand what academic literature and resources are available to support different stakeholders in the context of MAiD-MD.</div></div><div><h3>Objectives</h3><div>This review aims to specifically identify various resources related to MAiD-MD and to initiate a process of compiling international resources to raise awareness about certain resources and support stakeholders to develop new resources.</div></div><div><h3>Methods</h3><div>This review of resources adopted a methodology inspired by the work of Arksey and O'Malley (2005) and Levac et al. (2010)’s scoping studies, as well as more structured forms of thematic literature reviews for content extraction.</div></div><div><h3>Results</h3><div>165 resources related directly or indirectly to MAiD-MD were identified and grouped according to the following six categories: 1) Laws, judgments, decisions, and reports from the operationalization of laws; 2) Ethical and clinical guidelines, protocols, practice guides, and information for healthcare professionals; 3) Resource directories; 4) Resources for sharing experiences, discussions, support or training; 5) Written resources for MAiD applicants, their relatives or the population; 6) Resources to support reflections and guide the development of practices. Twenty main relevant themes were identified through the thematic analysis. These themes are addressed and explored in varying degrees of depth throughout different resources.</div></div><div><h3>Discussion</h3><div>A diversity of relevant resources is developed internationally, but these are sometimes dispersed, little known, or inaccessible to the public. Numerous resources are developed to inform the various stakeholders and train healthcare professionals, but there seems to be a need to develop advanced support resources to help the various stakeholders in the context of MAiD-MD.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"102 ","pages":"Article 102114"},"PeriodicalIF":1.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hoarding disorder, therapeutic jurisprudence and residential tenancy law: A complex relationship and opportunities for reform","authors":"Adam Finkelstein,&nbsp;Marie Bismark,&nbsp;Rebecca Bentley,&nbsp;Erika Martino","doi":"10.1016/j.ijlp.2025.102125","DOIUrl":"10.1016/j.ijlp.2025.102125","url":null,"abstract":"<div><div>For many, home represents comfort and security. However, for renters living with hoarding disorder, stable housing is often at risk. Hoarding disorder is a chronic mental illness associated with significant public health risks to both communities and individuals across jurisdictions. Internationally, residential tenancy laws often address hoarding using blunt legal measures at odds with the treatment needs of people living with the condition, which can negatively impact their health and wellbeing and potential recovery.</div><div>Leveraging a therapeutic jurisprudence framework to consider biopsychosocial outcomes, this paper examines residential tenancy laws in Victoria, Australia to consider how tenancy laws affect tenure security and the extent to which they hinder the promotion of health and wellbeing among renters living with hoarding disorder. A rapid review of international academic and grey literature, Victorian case-law and relevant parts of the Residential Tenancies Act 1997 (Vic) was conducted.</div><div>Analysis showed that, in the case of Victoria, the legal framework does not fully align with therapeutic jurisprudence principles, instead relying on impersonal task-centred approaches to address hoarding related issues in rental properties. Consequently, renters living with hoarding disorder are at increased risk of psychological distress, homelessness, and a reluctance to engage with supports. Recommendations with international relevance and applicability are discussed, including sector coordination and capacity building, and common avenues for legislative reform. Future research should prioritise lived experience perspectives, along with generating improved evidence through robust data collection that can inform reform in the rental sector.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"102 ","pages":"Article 102125"},"PeriodicalIF":1.4,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case study of forensic psychiatry experts' reports analysis through large language models","authors":"Giulia Petroni ,&nbsp;Salvatore Alaimo ,&nbsp;Gabriele Mandarelli ,&nbsp;Roberto Catanesi ,&nbsp;Cinzia Niolu ,&nbsp;Alberto Siracusano ,&nbsp;Alfredo Pulvirenti","doi":"10.1016/j.ijlp.2025.102122","DOIUrl":"10.1016/j.ijlp.2025.102122","url":null,"abstract":"<div><div>The integration of artificial intelligence (AI) technologies in forensic psychiatry has gained significant attention due to their potential to enhance tasks such as outcome prediction and decision-making. In this study, we explored the feasibility and performance of a large language model (LLM-GPT) in extracting both clinical and non-clinical variables from authentic forensic psychiatric reports concerning defendants' criminal responsibility and social dangerousness. We employed GPT-4o to extract relevant data using a set of custom queries, which we applied to two forensic psychiatric expert reports. The results of the study demonstrated that the system was capable of extracting information from the forensic psychiatric reports and generating a summarized version. Identifying the most important parts to construct a meaningful synthesis in a highly specialized application domain is currently a challenge. This study highlights the potential of AI in forensic psychiatry and suggests that this approach could be valuable for collecting semi-automated or automated data from reports, enabling the creation of a large dataset that could be used for further research and analysis.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"102 ","pages":"Article 102122"},"PeriodicalIF":1.4,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}