International Journal of Law and Psychiatry最新文献

{"title":"Insight, the law and psychiatry: Going round in circles or playing nice?","authors":"Anthony S. David","doi":"10.1016/j.ijlp.2026.102194","DOIUrl":"10.1016/j.ijlp.2026.102194","url":null,"abstract":"<div><h3>Background</h3><div>Insight is an important facet of psychosis which can predict many clinical outcomes. Recently, the construct has come under scrutiny, particularly in medicolegal settings where lack of insight is given as a justification for involuntary treatment.</div></div><div><h3>Objectives</h3><div>This article reviews the arguments around the use of insight in evidence in cases of involuntary treatment and admission to hospital, and capacity to make healthcare-related decisions. It aims to clarify the place of insight and how it might be used beneficially in such discussions for clinicians and legal practitioners.</div></div><div><h3>Methods</h3><div>This is a narrative review of the insight construct in clinical psychiatry and medicolegal settings. The article draws on case material and in particular a recent case brought before the England and Wales Court of Protection (CoP).</div></div><div><h3>Results</h3><div>The insight concept is most often used to explain non-compliance with treatment and rejection of or disbelief in a mental illness diagnosis, where it has been faulted on grounds of circular reasoning. Its invocation in legal settings has been criticised, not least by the National Institute of Health and Care Excellence (NICE) since insight is often poorly defined and is not part of the criteria for, for example, mental incapacity. Nevertheless, a deeper understanding of what psychiatrists mean by insight can help in understanding how a patient's psychotic illness might seriously impair their capacity and lead to them to require care without their consent. The case discussed in the CoP exemplifies how insight can be misunderstood and misused by parties in a dispute.</div></div><div><h3>Discussion</h3><div>Insight remains a commonly discussed aspect of psychopathology and frequently arises in medicolegal arguments. Mental health practitioners giving clinical accounts and expert testimony should be aware of the strict definition of mental capacity and criteria for involuntary treatment. If they wish to refer to the patient's insight, they should take care to define what they mean but crucially they should carefully explain how insight can shed light on aspects of capacity, as advised by NICE. However, poor insight is a core aspect of psychosis and is closely related to lack of capacity and (<em>contra</em> NICE) should not be treated as a distinct concept.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"105 ","pages":"Article 102194"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037459","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":"Analysing risk factors for involuntary admission from an intersectional perspective: A latent class analysis","authors":"Jona Carlet,&nbsp;Florian Hotzy,&nbsp;Anke Maatz,&nbsp;Philipp Homan,&nbsp;Mario Müller","doi":"10.1016/j.ijlp.2026.102191","DOIUrl":"10.1016/j.ijlp.2026.102191","url":null,"abstract":"<div><h3>Background</h3><div>Involuntary admission (IA) is a contentious practice in mental healthcare, justified only to prevent harm to self or others. Previous studies have identified individual sociodemographic characteristics as risk factors for IA. Intersectional theories argue that such approaches overlook the complexities of social identities and related health inequalities. <em>Intersectionality</em> stresses the interconnected nature of social identities, such as race or class, and analyses how these overlapping factors create unique experiences of marginalisation and discrimination. This study aimed to adopt an intersectional framework to identify subgroups with specific sociodemographic characteristics and assess their risk for IA. We hypothesized that groups facing multiple forms of marginalisation would be strongly associated with higher risk for IA.</div></div><div><h3>Methods</h3><div>We analysed data from 16,024 cases at the Psychiatric University Clinic Zurich, Switzerland, between 2017 and 2020 using Latent Class Analysis to identify subgroups with distinct sociodemographic characteristics. Variables included sex, age, nationality, residence status, educational attainment, employment status, and language proficiency. Classes were validated against clinical factors including IA.</div></div><div><h3>Results</h3><div>Four distinct classes emerged. The class most strongly associated with IA was characterized by unemployment, social welfare dependency, non-European citizenship, temporary residency or refugee status, and low educational attainment. In contrast, classes with Swiss nationality, permanent residency, and employment were significantly less likely to experience IA.</div></div><div><h3>Conclusion</h3><div>Adopting an intersectional framework, our findings suggest that individuals facing multiple marginalised identities are at higher risk for IA, indicating possible barriers to voluntary and early treatment. Further research is needed to explore and address these barriers.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"105 ","pages":"Article 102191"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037458","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 services in selected Sub Saharan African countries: A scoping review","authors":"Chrispen Madondo ,&nbsp;Walter Mangezi ,&nbsp;Roy W. Batterham ,&nbsp;Marc G. Van der Putten","doi":"10.1016/j.ijlp.2026.102187","DOIUrl":"10.1016/j.ijlp.2026.102187","url":null,"abstract":"<div><h3>Purpose</h3><div>This study synthesised the literature on forensic mental health services for offenders with mental health and substance use conditions in selected Sub-Saharan African countries to guide planned action research on a diversion program.</div></div><div><h3>Methods</h3><div>A scoping review methodology was applied, using a Boolean search strategy in retrieving publications from relevant databases and search engines. Selection of literature was facilitated by PRISMA-ScR.</div></div><div><h3>Results</h3><div>Following forensic mental health services: psychiatric hospital-based, court-based, prison-based, community-based services and diversion programs. Forensic mental health services in the selected countries are fragmented. Poor multisectoral coordination, and limited of human, financial and infrastructural resources attributed to this fragmentation.</div></div><div><h3>Conclusions</h3><div>Where adoption of a diversion program is considered, it is important to focus on aligning interventions to local needs, priorities, capacities and resources to inform the application of international policy recommendations.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"105 ","pages":"Article 102187"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146020277","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":"Conflictual encounters with individuals with mental illness from the perspective of police officers: Reasons, challenges, and experiences with escalating and De-escalating factors – An empirical study of German police officers","authors":"Lena Posch","doi":"10.1016/j.ijlp.2025.102167","DOIUrl":"10.1016/j.ijlp.2025.102167","url":null,"abstract":"<div><div>This paper examines the perspective of police officers on conflictual encounters with individuals with mental illness. The study aims to identify the frequency, challenges, reasons for intervention, conflict potential, and factors contributing to escalation and deescalation in operations involving mentally ill individuals. To achieve this, a survey of <em>N</em> = 157 police officers was conducted, incorporating both quantitative and qualitative elements. The results indicate that operations involving mentally disturbed individuals are common and a part of them lead to conflict situations. The primary reasons identified on the part of the individuals involved were a lack of understanding of the situation, aggression, mood instability, delusions, disorder-related factors, and resistance or a lack of manageability. On the part of the police officers, impatience, time constraints, and inappropriate intervention strategies were perceived as contributing factors to these conflictual situations. The factors identified as escalating or de-escalating conflict by the police officers were consistent with those reported by individuals with mental illness in previous studies. The report of using force more frequently in deployments with individuals with mental disorders compared to other deployments was positively correlated with insecurity about how to behave during such deployments, perceiving deployments with individuals with mental disorders as particularly dangerous, and negatively correlated with the feeling of being well-prepared for such deployments, highlighting the high relevance of profound police training. The findings are discussed in the context of training approaches for improving police handling of such situations.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"105 ","pages":"Article 102167"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617328","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":"Best Interests decision-making processes in learning disability services in Northern Ireland","authors":"Danielle McIlroy,&nbsp;Lorna Montgomery,&nbsp;Gavin Davidson","doi":"10.1016/j.ijlp.2025.102185","DOIUrl":"10.1016/j.ijlp.2025.102185","url":null,"abstract":"<div><div>Decision-making is part of our daily lives. However, for those who lack mental capacity to make specific decisions, such as where to live, the decision-making process may require others to make the decision in their Best Interests. The aim of this research study was to explore how decisions were made for individuals with a learning disability when they lacked the mental capacity to make a specific decision. The research focused on those whose decision-making may be impaired and so has not excluded people if they lack the capacity to understand the research. Instead, facilitated by the partial implementation of the Mental Capacity Act (NI) 2016, and underpinned by ethical approval and procedural safeguards, those individuals with a learning disability who did not have capacity to understand this study, were recruited and permitted to participate. Using a mixed methods approach the results demonstrate the value of including the voices of individuals with a learning disability who have had direct experience of Best Interests decisions. Furthermore, including professionals highlighted their perspectives of the Best Interests decision-making process. The findings reinforce the importance of involving the individual and their carers / supporters throughout the decision-making process including making them aware of the options available and how the individual's preferences are captured. The research suggests the need for a regionally agreed approach to Best Interests decision-making processes in Northern Ireland. A three-stage model to support decision-making has been developed by the research team and is currently being piloted by the Department of Health in Northern Ireland. Further research is required to explore the experiences of carers / supporters of individuals who are subject to Best Interests decisions.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"105 ","pages":"Article 102185"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146077615","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":"Suicidal ideation amongst incarcerated populations: An examination of contributing factors amongst male inmates in Southwest Nigeria","authors":"Gift Onwuadiamu ,&nbsp;Godwin Egbe","doi":"10.1016/j.ijlp.2025.102186","DOIUrl":"10.1016/j.ijlp.2025.102186","url":null,"abstract":"<div><div>Mental health issues are a significant concern in prisons worldwide. Research shows that the prevalence of mental health problems is much higher among prison populations compared to other groups. One common mental health issue found among prison population is suicidal behaviors. This study uses data collected from a sample of male inmate in a maximum-security prison, in southwestern Nigeria to examine risks factors that predisposes suicidal ideation amongst male inmates in the correctional facility. Initial findings indicate that time spent in prison is a marginally significant predictor of suicidal ideation. Findings also showed that unwanted physical and sexual prior experiences significantly and negatively contributed to suicidal ideation, and hopelessness also played a significant role in suicidal ideation, controlling for other factors including age, religion, educational qualification, convictions, etc. This study has implications for policy in advancing mental health intervention in the criminal justice system and the need for pre and post mental health evaluation in prison.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"105 ","pages":"Article 102186"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839934","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":"Can coercion in psychiatry be justified? A theoretical adversarial collaboration approach","authors":"Dirk Richter ,&nbsp;Tilman Steinert","doi":"10.1016/j.ijlp.2025.102171","DOIUrl":"10.1016/j.ijlp.2025.102171","url":null,"abstract":"<div><div>The use of coercion in psychiatry is one of the most controversial issues in modern healthcare. There are clinical, legal and ethical arguments in favour of both the abolition and justification of coercion in psychiatry. The two lines of argument are often diametrically opposed, so further development of the discussion seems difficult. To address this unsatisfactory situation, we have applied the approach of adversarial collaboration to this issue. The two authors represent fundamentally different points of view on the question of the legitimisation of coercion in psychiatry. Through a methodically guided exchange of arguments, numerous consensus hypotheses, dissent hypotheses and general consensus hypotheses with dissent in detail were developed. The main findings include the fact that the antagonists argue from completely different starting points at the core of the argument, namely, general arguments vs. individual clinical cases. In addition, antagonists hold consistent positions on many topics. It can therefore be concluded that both those in favour and those against the abolition of coercion in psychiatry are arguing with good intentions.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"105 ","pages":"Article 102171"},"PeriodicalIF":1.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617326","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":"Attitudes and ethical beliefs of Russian psychiatrists towards the use of coercive treatment practices","authors":"Andrew Stickley ,&nbsp;Roman Koposov ,&nbsp;Johan Isaksson ,&nbsp;Tomiki Sumiyoshi ,&nbsp;Oleg A. Ponomarev ,&nbsp;Vladislav Ruchkin","doi":"10.1016/j.ijlp.2025.102142","DOIUrl":"10.1016/j.ijlp.2025.102142","url":null,"abstract":"<div><div>In many countries little is known about the attitudes and ethical beliefs of practicing psychiatrists towards the use of coercive practices. This is true as regards Russia where coercion was used for political purposes during the Soviet period. However, substantial changes have occurred in the psychiatric system in recent decades with a focus on patients' rights and the idea of consent. This study aimed to investigate the beliefs and attitudes of Russian psychiatrists towards coercive treatment practices in situations of clinical decision making. Data were obtained from 93 (81 % of all practicing) psychiatrists in the Arkhangelsk region in northwestern Russia. The psychiatrists completed three case vignettes to obtain information regarding the use of coercive treatment practices in different clinical situations, and responded to an ethical attitudes inventory. The psychiatrists' decisions regarding coercive treatment, and the extent of information provided to the patients and their relatives were impacted by the severity and risks (violence, suicidality) associated with the patient's disorder. In most instances psychiatrists were not responsive to pressure from the patient's family or other hospital personnel. Very few gender differences in attitudes and practices were found. Psychiatrists generally reported that they encountered different situations with abusive practices primarily in the past. This study suggests that the factors associated with the use of coercive treatment practices by Russian psychiatrists may mirror those in other countries. Further research should elucidate the actual extent to which coercive practices are used in Russian psychiatry and delineate the factors associated with their actual use.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"104 ","pages":"Article 102142"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145011221","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":"Addressing insanity in paedophilic disorder: The need for a cognitive approach for forensic assessment to correctly identify idiopathic, acquired and iatrogenic forms","authors":"Alexa Schincariol ,&nbsp;Liisa Camilla Gatto ,&nbsp;Georgia Zara ,&nbsp;Pietro Pietrini ,&nbsp;Giuseppe Sartori ,&nbsp;Stefano Ferracuti ,&nbsp;Cristina Scarpazza","doi":"10.1016/j.ijlp.2025.102164","DOIUrl":"10.1016/j.ijlp.2025.102164","url":null,"abstract":"<div><div>Assessing insanity in individuals with paedophilic disorder presents unique challenges, particularly due to the diverse aetiologies of the condition, which lead to varying symptomatology and behavioural manifestations. To address this complexity, in this article we overview the characteristics of three variants of paedophilic disorder – idiopathic, acquired, and iatrogenic – and highlight the key obstacles in differentiating these forms, resulting in inconsistent and, at times, biased judicial outcomes. Through the analysis of three real-life case studies, we illustrate how forensic evaluations must go beyond a one-size-fits-all approach, integrating neuropsychological and neuroimaging assessment to provide more precise determinations of criminal responsibility. We therefore propose a cognitive model for the forensic assessment of insanity that emphasises the role of scientific evidence in distinguishing cases in which neurological conditions or medical treatments significantly impair volitional and cognitive capacities. In such cases, incarceration may be inappropriate, as incarceration hinders rehabilitation, while treatment in specialised non-custodial facilities could better address the underlying condition and reduce the risk of recidivism. In our analysis, we argue for the inclusion of a criterion in the DSM to ensure that the symptoms of paedophilic disorders are not due to substance effects or other medical conditions. Finally, we propose guidelines for forensic assessments of insanity in child sexual offences that support a multidisciplinary approach based on the cognitive model. In this framework, behavioural analysis, neuropsychological assessment, and (if necessary) neuroimaging techniques are combined to assess how the condition affects self-determination, ultimately leading to more accurate and scientifically informed legal decisions.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"104 ","pages":"Article 102164"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579284","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 importation model mediated: New evidence for security threat group in the prediction of prison misconduct","authors":"Matt DeLisi ,&nbsp;H. Daniel Butler ,&nbsp;Ben Stickle ,&nbsp;Brendan D. Dooley","doi":"10.1016/j.ijlp.2025.102163","DOIUrl":"10.1016/j.ijlp.2025.102163","url":null,"abstract":"<div><div>This study explores the importation model's role in predicting prison misconduct, emphasizing the mediating effect of security threat group membership. Our analysis draws upon archival data from 636 individuals on death row in California. Structural equation modeling examined relationships between pre-prison characteristics—such as psychopathy, age at first arrest, and prior prisons sentences—and prison misconduct. Findings reveal that security threat group membership significantly mediates the impact of psychopathy and age at first arrest on misconduct, accounting for 60 % and 79 % of their respective effects. Moreover, security threat group membership is strongly associated with institutional misconduct, highlighting its role as a critical factor in prison disorder. The results suggest that pre-prison experiences and security threat group involvement should be integral to risk assessments and management strategies of correctional clients. These insights contribute to understanding prison dynamics and offer practical guidance for improving institutional security and reducing misconduct through targeted interventions addressing security threat group activities.</div></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"104 ","pages":"Article 102163"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579283","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}