International Journal of Law and Psychiatry最新文献

{"title":"An integrative review exploring decision-making processes in forensic psychopathology investigations","authors":"Barchielli Benedetta ,&nbsp;Cricenti Clarissa ,&nbsp;Giantesani Mario ,&nbsp;Parmigiani Giovanna ,&nbsp;Ferracuti Stefano ,&nbsp;Scarpazza Cristina","doi":"10.1016/j.ijlp.2025.102170","DOIUrl":"10.1016/j.ijlp.2025.102170","url":null,"abstract":"<div><div>Forensic psychopathology assessments play a critical role in legal decisions, particularly those related to criminal responsibility. However, despite their influence, the decision-making processes behind these assessments remain largely underexplored and inconsistently supported by empirical evidence. Emerging literature suggests that these decisions are shaped by multiple factors, including individual reasoning styles, team dynamics, and the influence of cognitive biases<strong>.</strong></div></div><div><h3>Aim</h3><div>To explore the factors that influence expert decision-making in forensic psychopathology evaluations, with a focus on cognitive bias, procedural complexity, and the use of structured tools.</div></div><div><h3>Method</h3><div>An integrative review guided by Cooper's framework was conducted. Eight studies meeting inclusion criteria were analyzed using narrative synthesis and thematic coding.</div></div><div><h3>Results</h3><div>Three key themes were identified: (1) cognitive bias as a pervasive influence on expert judgment, (2) the iterative and context-dependent nature of forensic decision-making, and (3) inconsistencies between subjective clinical reasoning and structured assessment tools. While structured professional judgment tools and validated instruments showed potential for increasing accuracy and inter-rater reliability, their use remained uneven. Additionally, experienced clinicians often favored subjective judgment over formalized methods, which may limit transparency and reproducibility. The review highlights the need to reframe forensic evaluation as a reflective, evidence-informed process grounded in transparency and standardization. Integrating structured methods and debiasing strategies from other medical disciplines may enhance the validity and fairness of forensic judgments. These findings have implications for clinical training, interdisciplinary collaboration, and legal policy, and underscore the urgency of further research in this underdeveloped area of forensic mental health.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"105 ","pages":"Article 102170"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617327","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":"Is anti-ligature an automatic requirement for suicide prevention?: Assessing legal obligations in alternative mental health crisis services","authors":"Joshua Finn ,&nbsp;Piers Gooding ,&nbsp;Lisa Brophy ,&nbsp;Deb Carlon ,&nbsp;Chris Maylea","doi":"10.1016/j.ijlp.2025.102182","DOIUrl":"10.1016/j.ijlp.2025.102182","url":null,"abstract":"<div><div>Around the world, peer-run, bed-based services that offer voluntary support to people experiencing mental health crisis are emerging as alternatives to hospital-based mental healthcare. In Victoria, Australia, where these ‘alternative crisis services’ are expanding, a key legal question has arisen: must non-coercive settings adopt the suicide prevention architectural design (or ‘anti-ligature design’) mandated in psychiatric wards under negligence and occupational health and safety laws?</div><div>This article answers that question through a three-stage study: (1) a doctrinal analysis of Victorian case law and statutes that shape duties to prevent suicide; (2) a narrative review of evidence on anti-ligature measures in hospital environments; and (3) thematic analysis of interviews with clinicians, designers, peer leaders and legal experts (<em>n</em> = 12).</div><div>The findings indicate that empirical evidence <em>only</em> associates anti-ligature design with reduced suicide rates when paired with search, detention and close observation powers, which are absent from alternative crisis services. There was no evidence identified that anti-ligature design will reduce suicide in settings which do not also implement these practices.</div><div>This absence of data does not justify retreat to institutional templates, especially considering key differences in the care models that differentiate alternative crisis services from traditional hospital-based offerings. Interviewees warned that conspicuous anti-ligature hardware can undermine the therapeutic value of alternative crisis services, and merely displace, rather than prevent, suicidal behaviour. Wholesale transplantation of hospital anti-ligature standards into alternative crisis services is therefore unlikely to satisfy the ‘reasonableness’ test and may contravene the therapeutic mandate of services. Instead, this study calls for regulators to endorse context-specific standards for mental health service design, some of which may require further empirical research on rights-based, peer-led safety strategies.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"105 ","pages":"Article 102182"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925058","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":"Involuntary patients awareness of their entitlement to appeal an admission and existence of the mental health review board in South Africa","authors":"Shamima Saloojee,&nbsp;Zinhle Shozi,&nbsp;Vuyokazi Ntlantsana,&nbsp;Sibongile Mashapu","doi":"10.1016/j.ijlp.2025.102184","DOIUrl":"10.1016/j.ijlp.2025.102184","url":null,"abstract":"<div><h3>Background</h3><div>South Africa's mental health law is person-centred, has a strong human rights emphasis, and includes the appointment of mental health review boards (MHRB) to provide oversight and consider appeals against involuntary admissions. Owing to the low number of appeals, this study aimed to determine the proportion of involuntary patients who were aware of their right to appeal at two public sector psychiatric hospitals in KwaZulu Natal Province.</div></div><div><h3>Method</h3><div>A group of conveniently selected involuntary patients was interviewed in a descriptive study that entailed the collection of quantitative data through the administration of a study-specific questionnaire, and the Birchwood Insight Scale from June 2020 to December 2020.</div></div><div><h3>Results</h3><div>Of the 131 participants, most were unemployed (72.5 %) and had at least a high school level of education (61.06 %). The majority were diagnosed with a psychotic disorder (79.4 %), with a median duration of admission of 17.00 days (IQR 9.00, 69.00), and 63.4 % had good insight into their illness. Not a single patient appealed the current involuntary admission, and only one patient appealed a previous admission.</div><div>Only 11.5 % of the participants were aware that they had the right to appeal their admission, and 8.4 % were aware of the existence of the MHRB.</div></div><div><h3>Conclusion</h3><div>Most patients were unaware of their legal right to appeal and of the MHRB, highlighting the challenges in implementing the letter and practice of the law in underresourced settings without the necessary pre-conditions to fully realise its spirit.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"105 ","pages":"Article 102184"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145670383","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":"Between expertise and judgment: Discordance between forensic psychiatric reports and judicial decisions in Brazilian litigation","authors":"Felipe Rodrigues De Queiroz ,&nbsp;Natalia Vieira Souza Jordão","doi":"10.1016/j.ijlp.2026.102190","DOIUrl":"10.1016/j.ijlp.2026.102190","url":null,"abstract":"<div><div>This study investigates the discordance between forensic psychiatric reports and judicial decisions in Brazilian civil and administrative litigation. Using a retrospective documentary design, we analyzed a random sample of 200 cases (50 per domain) from the Brazilian Electronic Judicial Process (PJe) across four areas: social security (INSS), public service examinations, access to medications, and alleged medical error. Overall concordance was high (87.5%), but 12.5% of cases showed discordance, which clustered significantly in public service examinations (20%) and medical error disputes (20%), with no discordance in social security cases. Qualitative analysis revealed that judicial divergence often stems from the reinterpretation of clinical findings through normative constructs such as “residual capacity” or “duty of diligence,” and is facilitated by reports with low structural standardization. Multivariable analysis indicated that longer time lags between the index event and evaluation, along with the absence of structured instruments, were associated with higher odds of discordance. The findings highlight the need for standardized reporting protocols and interdisciplinary training to strengthen the interface between forensic psychiatry and the law in Brazil.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"105 ","pages":"Article 102190"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077614","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":"Prescription patterns of benzodiazepines and Z-drugs in Berlin prisons","authors":"Nicolas Schwarzer ,&nbsp;Julia Krebs ,&nbsp;Norbert Konrad ,&nbsp;Marc Lehmann ,&nbsp;Annette Opitz-Welke","doi":"10.1016/j.ijlp.2026.102189","DOIUrl":"10.1016/j.ijlp.2026.102189","url":null,"abstract":"<div><h3>Background</h3><div>Benzodiazepines and <em>Z</em>-drugs are commonly prescribed medications in psychiatric treatment. Prisoners are a unique patient population due to their elevated prevalence of substance abuse and psychiatric morbidity. Given the limited data about the medical treatment for prisoners, this study aims to provide an initial exploratory overview of the prescription patterns of benzodiazepines and <em>Z</em>-drugs in Berlin prisons.</div></div><div><h3>Materials and methods</h3><div>A data set was compiled by extracting information from the documentation systems of all seven Berlin prisons. All inmates with a prescription for benzodiazepines or <em>Z</em>-drugs as of the cut-off date were included. Demographic characteristics, arrest circumstances, and medical histories were considered. Supplementary information on the overall prison population was obtained from officially published sources.</div></div><div><h3>Results</h3><div>As of August 31, 2022, the point prevalence of benzodiazepine and Z-drug prescriptions among Berlin prisoners was 3.9% (<em>n</em> = 136). The duration of 46 (33.8%) prescriptions exceeded six weeks. The prescription rate in female prisoners (6.8%, n = 13/190) was significantly higher than in male prisoners (4.1%, <em>n</em> = 123/3299). The prescription rate in default imprisoned individuals (16.5%, <em>n</em> = 62/376) was significantly higher compared to in convicted and remand detainees (2.1%, <em>n</em> = 71/3095).</div></div><div><h3>Conclusion</h3><div>Benzodiazepines and <em>Z</em>-drugs were prescribed less frequently in Berlin prisons than in general outpatient care. Approximately 1/3 of all prescriptions exceeded the recommended maximum duration. Prescription rates in prison were higher among female inmates. Rates among remand detainees did not exceed those of convicted prisoners. Default imprisonment was identified as a factor influencing prescription practices, likely due to its strong association with homelessness and alcohol abuse.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"105 ","pages":"Article 102189"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031318","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":"Distinctive and common risk factors contributing to violent offending in patients with schizophrenia compared to people without a mental illness","authors":"Yan Gu ,&nbsp;Yong He ,&nbsp;Yingying Xie ,&nbsp;Wenqian Lu ,&nbsp;Hao Liu ,&nbsp;Yan Li ,&nbsp;Gangqin Li","doi":"10.1016/j.ijlp.2026.102192","DOIUrl":"10.1016/j.ijlp.2026.102192","url":null,"abstract":"<div><h3>Background</h3><div>Studies have suggested that there are common violence risk factors in both patients with schizophrenia and the general population, a comparison of the characteristics of these two distinct groups could allow for a better understanding.</div></div><div><h3>Methods</h3><div>Forensic archives of criminal cases in a Chinese Forensic Centre from January 2015 to December 2019 were reviewed. The male criminal offenders were included and divided into four groups: ① violent and ② non-violent offenders with schizophrenia, and ③ violent and ④ non-violent offenders without mental illness. The sociodemographic, criminological, and clinical information were extracted from the archives, and the psychiatric symptoms, social function, and aggressive behaviors were quantified using the brief psychiatric rating scale, the social disability screening schedule, and the modified overt aggression scale. Data were compared between the four groups and the influencing factors for violence were examined.</div></div><div><h3>Results</h3><div>Three hundred and twenty-one male offenders with schizophrenia (234 violent, 87 non-violent) and 186 male offenders without mental illness were included. Results showed that the violent offenses committed by patients with schizophrenia were more likely to target family members and relatives, occur in rural and public areas, and have fewer quarrels before the offense. Thought disorders and hostility-suspiciousness were identified as the violence risk factors for the patients with schizophrenia. Verbal aggression was a common violence risk factor in both patients with schizophrenia and the people without mental illness.</div></div><div><h3>Conclusions</h3><div>Violence prevention and intervention for patients with schizophrenia need to focus more on verbal aggression, thought disorders, and hostility-suspiciousness.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"105 ","pages":"Article 102192"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077682","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":"Forensic mental health research: The potential of Danish national registers","authors":"Christian Jentz ,&nbsp;Harry Kennedy ,&nbsp;Lisbeth Uhrskov Sørensen","doi":"10.1016/j.ijlp.2026.102188","DOIUrl":"10.1016/j.ijlp.2026.102188","url":null,"abstract":"<div><div>Forensic psychiatric research faces persistent methodological and ethical challenges, limiting the development of robust evidence to inform practice and policy. This article examines these barriers in the Danish context, highlighting the underutilized potential of national register data to overcome current limitations. Despite Denmark having a relatively large forensic psychiatric patient population and comprehensive national health registers, critical obstacles remain, including inconsistent patient identifiers, fragmented service delivery, and restrictive ethical frameworks that impede patient inclusion in research. The authors argue for greater methodological rigor, improved identification strategies, and clearer ethical guidelines, proposing that leveraging existing register-based data could significantly enhance the scope and quality of forensic mental health research. Addressing these barriers would help fill crucial knowledge gaps and support more evidence-based interventions for this vulnerable population.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"105 ","pages":"Article 102188"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145925059","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":"Restraint in health and social care settings","authors":"Steph Kerr ,&nbsp;Danielle McIlroy ,&nbsp;Gavin Davidson","doi":"10.1016/j.ijlp.2026.102195","DOIUrl":"10.1016/j.ijlp.2026.102195","url":null,"abstract":"<div><div>The use of restraint in health and social care settings, particularly for individuals who lack capacity, remains a complex and contentious legal and ethical issue. Restraint encompasses a range of interventions, including but not limited to physical, chemical, mechanical, and psychological methods, each requiring stringent safeguards to prevent misuse and ensure compliance with human rights standards. The phased implementation of the Mental Capacity Act (Northern Ireland) 2016, particularly Section 12 which focuses specifically on restraint, marks a significant shift towards a more rights-based approach, aligning legal and policy frameworks with ethical principles of autonomy and dignity. This article critically analyses the evolving regulatory landscape governing restraint, drawing on key legislation, the <span><span>Department of Health's (2023)</span></span> Regional Policy on the use of Restrictive Practices in Health and Social Care Settings and relevant case law. It further explores ethical dilemmas and operational challenges, including staff training, documentation, and oversight mechanisms necessary for lawful and proportionate restraint use. Finally, the article examines preventative strategies through person-centred care approaches, advocating for a cultural shift towards minimising restrictive interventions and promoting human rights-driven practice.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"105 ","pages":"Article 102195"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077616","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":"Lack of challenge to substantive criteria at mental health tribunals: Amplifying the medical perspective?","authors":"Sam Boyle ,&nbsp;Fiona Jager ,&nbsp;Jean-Laurent Domingue ,&nbsp;Amélie Perron","doi":"10.1016/j.ijlp.2025.102166","DOIUrl":"10.1016/j.ijlp.2025.102166","url":null,"abstract":"<div><div>Mental health tribunals provide legal safeguards for compulsory treatment for mental illness. Despite one of these tribunals' purposes being to give people subject to compulsory treatment a “day in court”, research has shown that individuals' experience of mental health tribunals is highly negative. To understand these negative experiences, we conducted a multi-stakeholder study of the Consent and Capacity Board, a mental health tribunal in Ontario, Canada. Our research revealed that disputes in the hearings tended to focus on procedural requirements of the compulsory treatment orders, and although substantive legal criteria were addressed, the medical conclusions underlying those criteria were not directly challenged. Further, in cases where a client “wins” and the treatment order is revoked, our analysis shows the medical perspective remained authoritative. Finally, although people subject to treatment orders were given a chance to speak at hearings, in most cases theirs was the only voice challenging the psychiatrist's medical conclusions, and their contribution would usually only lessen the chance of the order being revoked. Therefore, we argue that rather than challenging medical decision-making, as may be expected, tribunal hearings unintentionally amplify the medical perspective in a manner that is likely to be upsetting for people subject to the treatment orders. We acknowledge that this effect is ingrained in the current system and will be challenging to ameliorate. Nonetheless, it is an important consideration for those in legal and clinical practice, and policy makers. We give some suggestions about how these experiences could be improved and for further research opportunities.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"105 ","pages":"Article 102166"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145584496","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":"Validity and reliability of the Japanese version of the admission experience survey in individuals with mental illness","authors":"Mayui Nara ,&nbsp;Asami Matsunaga ,&nbsp;Yuuki Yamada ,&nbsp;Chiyo Fujii ,&nbsp;Maki Taniguchi","doi":"10.1016/j.ijlp.2025.102169","DOIUrl":"10.1016/j.ijlp.2025.102169","url":null,"abstract":"<div><div>Developing effective strategies to reduce perceived coercion during psychiatric hospitalization requires systematic monitoring of patients' experiences. The Admission Experience Survey (AES) evaluates patients' perceptions of the psychiatric hospitalization process. This study aimed to develop a Japanese version of the AES (AES-J) and assess its reliability and validity in individuals with mental illness. We conducted a cross-sectional survey of individuals with mental illnesses who had experienced psychiatric hospitalization in Japan. The AES-J was developed and evaluated using confirmatory factor analysis (CFA) and multi-group CFA. Spearman's correlation coefficients were calculated to assess the validity against inpatient care experience, patient satisfaction, and mental distress. Cronbach's alpha and intraclass correlation coefficients (ICC) were computed to determine internal consistency and test–retest reliability. A total of 135 participants were enrolled, and 50 completed the AES-J twice. CFA supported the original three-factor structure (Perceived Coercion, Negative Pressures, and Process Exclusion). The strict invariance model demonstrated comparable goodness-of-fit indices to the scalar invariance model. Perceived Coercion and Process Exclusion were significantly correlated with inpatient care experience and patient satisfaction. Negative Pressures was correlated considerably with inpatient care experience but not patient satisfaction. Mental distress did not demonstrate significant correlations with any of the three subscales. Cronbach's alphas were 0.82–0.88, and ICCs were 0.77–0.89. This AES-J showed acceptable validity and reliability for assessing admission experiences among individuals with mental illness in Japan.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"105 ","pages":"Article 102169"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145584495","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}