Accountability and psychiatric disorders: How do forensic psychiatric professionals think?

Swedish penal law does not exculpate on the grounds of diminished accountability; persons judged to suffer from severe mental disorder are sentenced to forensic psychiatric care instead of prison. Re-introduction of accountability as a condition for legal responsibility has been advocated, not least by forensic psychiatric professionals. To investigate how professionals in forensic psychiatry would assess degree of accountability based on psychiatric diagnoses and case vignettes, 30 psychiatrists, 30 psychologists, 45 nurses, and 45 ward attendants from five forensic psychiatric clinics were interviewed. They were asked (i) to judge to which degree (on a dimensional scale from 1 to 5) each of 12 psychiatric diagnoses might affect accountability, (ii) to assess accountability from five case vignettes, and (iii) to list further factors they regarded as relevant for their assessment of accountability. All informants accepted to provide a dimensional assessment of accountability on this basis and consistently found most types of mental disorders to reduce accountability, especially psychotic disorders and dementia. Other factors thought to be relevant were substance abuse, social network, personality traits, social stress, and level of education.     

What harm,whose justice?: excavating the restorative movement

The city of Hull in the northeast of England gave itself the ambitious task of becoming the world’s first restorative city. The aim of this strategy was to create a more socially and emotionally confident youth population which in turn would encourage a more entrepreneurial and aspirational outlook across the City. Based on a two-year National Lottery-funded project exploring peoples’ experiences of restorative approaches and a Knowledge Transfer Project to help develop restorative skills, the development of restorative justice is analysed. How does a restorative classroom, workplace, or family really behave? Is there a common objective within, and across, all restorative initiatives and if so, what is it? The answer to these questions is that communication breakdown can be understood as the common harm within, and across the restorative movement. This raises some interesting questions and challenges for zemiology where both restorative justice and social harm perspectives contain quite different notions of harm suggesting that neither has yet developed a clear or solid foundation upon which to build an alternative focus to criminal harms.     

Making the case for school-based health: where do we stand?

School-based health centers (SBHCs) have proliferated rapidly nation-wide and remain politically popular. This article explores the disconnect between the evidence and the discourse on SBHCs, drawing upon the authors' evaluation of SBHCs in Newark, New Jersey, and a critical assessment of the evaluative literature and public discourse on school clinics to argue that a number of important issues are being overlooked by both research and advocacy. These issues include variations in the health needs and health care resources of different communities and the questions of whether and how SBHCs can best integrate with existing resources to fill unmet local needs. Furthermore, despite the cautions of experts that third-party reimbursement (via traditional fee-for-service insurance or participation in health maintenance organizations) cannot cover clinic expenses and is difficult to obtain, pursuit of reimbursement continues to be a goal of some SBHC sponsors, helping to promote a clinic model that in some communities is very likely not to be the best way to address student needs or to build on clinic strengths. Discussion around SBHCs should focus on diagnosing specific community needs, identifying the best approach to meeting those needs, and seeking funding sources that match the work that needs to be done.     

Who do I turn to? Resolving complaints by mental health consumers and carers

The current Australian system for handling complaints by mental health consumers and carers against service providers is complex and difficult to navigate. Complaints may be made to a range of people and organisations, including the relevant mental health service, community or official visitors, Health Services Commissioners, Chief Psychiatrists, Public Advocates, Ombudsmen and Members of Parliament. This Legal Issues column provides an overview of the law relating to complaints handling by community or official visitors, health service commissions and offices of the Chief Psychiatrist. It argues that while health service commissions may provide the best current avenue for complaints, there is a need for independent, centralised complaints bodies in Australian jurisdictions with similar powers to that of the Mental Welfare Commission for Scotland.     

Beyond the Visible Pattern: Historical Particularities,Development, and Age at First Marriage in Transylvania, 1850–1914

The present study focused on age at first marriage in Transylvania between 1850 and 1914, a time of both social-economic change and resilient historically entrenched particularities. Based on data extracted from the Historical Population Database of Transylvania we constructed an extensive sample from settlements with a broad range of social-economic characteristics, which allowed for a comparative view into the influence of various factors on marriage timing. We examined in this sense both individual-level co-variates, such as denominational affiliation, migration background, and social-occupational status, as well as broader factors, such as the development level attained by certain settlements and the time frame. We found that the area level of development measured according to a heuristic index was in many cases more decisive than individual characteristics in shaping individuals’ constraints and opportunities on the marriage market. More significantly, the analysis showed that the ways in which the development level worked to transform marriage timing for both men and women could be explained by historically entrenched differences and specificities. At the same time, these patterns in age at first marriage, given by factors such as denomination, might be the result of other largely still invisible factors, for which the variables used are merely imperfect proxies.     

Originalism 2.0 Meets the First Amendment: The “New Originalism,” Interpretive Methodology,and Freedom of Expression

Constitutional originalism emerged as a legal and political movement in the last quarter of the twentieth century largely as a conservative reaction to perceived excesses of the Supreme Court of the United States. Early originalist attempts to formulate a coherent constitutional methodology were met with stinging criticism from many scholars. In recent years, a group of constitutional scholars has championed a different approach under the rubric “the New Originalism.” One of the key methodological innovations of New Originalism has been to reject the search for the intentions of the framer or ratifiers of constitutional provisions and instead seek to identify the “original public meaning” of such provisions. This article explores New Originalism in the context of the First Amendment speech and press clauses. The article also analyzes originalist opinions by Supreme Court justices to determine if New Originalism is affecting how the justices approach First Amendment interpretation.     

Using the role-play at the lectern: developing “work-ready” and confident professionals

As Waters notes, the role-play is not traditionally used as a teaching technique in law schools. Educators utilise role-play in many disciplines, including health, business, psychology, economics and literature; yet apart from clinical settings or for teaching practical legal skills, the role-play seems to be underutilised in legal education. An empirical study of 67 law students from the University of Western Australia (UWA) Law School set out to investigate the utility of the role-play as a device for instilling confidence in students and assisting them to prepare for professional practice. Although the classroom and class size were large and teaching took place in a lecture theatre, the role-play worked effectively. Students reported greater knowledge, understanding, confidence and skill with conducting themselves in a professional practice context. The study shows the need to embrace the role-play as an experiential learning technique that can work as effectively in an intensive, large-class setting as it does in smaller or clinical classrooms. The study revealed that the role-play technique worked very well and that the role-play is a versatile and very much “alive” pedagogical technique of value to any law school.     

Australian mental health tribunals--'Space' for rights, protection, treatment and governance?

This paper draws on a multi-year Australian collaborative study of mental health review tribunals ('MHTs') in three jurisdictions (Victoria, New South Wales and the Australian Capital Territory) undertaken in conjunction with the NSW Law and Justice Foundation, using qualitative and quantitative methods to examine the role of MHTs in advancing goals such as fairness, legality and access to treatment. Study findings regarding stakeholder and client concerns - about access to quality treatment and associated support services, review of treatment adequacy and drug regimes, and their 'participation' or dignity of engagement in review processes - are presented as variants of the need for adequate hearing 'space': temporal, jurisdictional, cognate/relational, physical and symbolic, and 'connective'. Building on earlier arguments for MHTs to engage not only legal, but also clinical and social domains, and for adopting some processes more characteristic of case-conferencing, this paper examines the implications of tribunal 'flexibility' and a wider overall 'governance' jurisdiction in mental health.     

Balancing in a crisis? Bioterrorism, public health and privacy

Post-September 11, the government has been rapidly funding public health initiatives to bolster the Nation's ability to respond to bioterrorist attacks. While the infusion of money into the public health system is laudable, the pressure to enact legislation quickly has resulted in laws and policies that ignore privacy and civil liberties and that favor anti-bioterror initiatives over more common public health concerns. A public health agenda that ignores privacy and civil liberties will undermine public trust, leading people to not fully participate in critical public health activities. Our Nation is far more likely to succeed in preventing and responding to a potential act of bioterrorism if we embrace the principle that advancing public health and preserving individual liberties are symbiotic and inextricable.     

Passing it on: should health care professionals be permitted to disclose patients' genetic information to their reproductive partners?

This article considers whether Australian law should permit health care professionals to disclose patients' genetic information to their reproductive partners without the patients' consent. The issue is addressed with reference to four genetic disorders (Huntington Disease, Familial Adenomatous Polyposis, Multiple Endocrine Neoplasia Type 2A and Cystic Fibrosis) which illustrate differences in inheritance traits and availability of effective treatments. The article explores the familial nature of these disorders and the notion that genetic information has implications which extend beyond the individual patient to third parties such as reproductive partners. It addresses the opinions of legal academics and regulatory bodies regarding the potential amendment of Australian laws to permit such disclosure. Ultimately, it is submitted that the application of current laws regarding medical information to the needs of genetics is unlikely to generate adequate results. To allow for a more appropriate response to this debate, health care professionals' duties to patients should be qualified when it concerns reproductive partners.