Competency to be a witness: a major child forensic issue

Competency of a child witness is a changing area of case law and forensic psychiatry practice. This article summarizes the basic legal and clinical aspects of determination of competency of the child witness to testify. Guidelines for such forensic examinations are detailed. Case examples are described that highlight major clinical issues in these examinations.     

法医精神病鉴定内容架构及评定要点解析

法医精神病鉴定在刑事、民事和行政三大诉讼领域中,以鉴定意见的证据形式发挥着重要作用。然而,与其重要性不相匹配的是,法医精神病鉴定学科发展尚不完善、专业发育尚不成熟,尚不能满足社会和民众的期盼和要求,甚至引发负面评价。为进一步促进法医精神病鉴定规范化、标准化建设。以法医精神病鉴定人的视角,结合法医精神病鉴定的内容架构,重点阐述法医精神病鉴定主要项目及其作用、评定要点,尤其聚焦刑事责任能力评定,阐明当前存在分歧和困难;简要介绍法医精神病鉴定人执业要求、法医精神病鉴定质量控制;以及简述法医精神病鉴定与临床精神医学实践的区别与联系。     

The forensic psychiatrist of the future

The rate of change in scientific knowledge and the growing psychiatric sophistication of attorneys and courts have made it increasingly difficult for forensic psychiatrists to retain proficiency in the full spectrum of potential professional activities. As the consumers of forensic services become more sophisticated, forensic psychiatrists have an increasing need to become scientifically informed and a decreasing need to become legally informed. Traditional training in forensic psychiatry, which emphasizes clinical, legal, and institutional knowledge and experience, gives short shift to behavioral science and other technical knowledge that can enhance the validity of forensic assessments and their value to the legal system and society. Forensic psychiatrists can best respond to these changes and maximize the value of their assessments by narrowing their focus to some subset of the four branches of the discipline: criminal behavior, mental disability, forensic child psychiatry, and legal aspects of psychiatric practice. Maximal proficiency in each of these four branches requires a greater depth of knowledge and experience than was once sufficient among those who practiced in all four areas. Fellowship training programs and professional organizations should lead forensic psychiatry into the twenty-first century by organizing their efforts along these four parallel tracks.     

Forensic psychiatry: a subspecialty. The presidential address at the nineteenth annual meeting of the American Academy of Psychiatry and the Law

The implications of the definition of forensic psychiatry are explored, with particular reference to the field as a subspecialty of general psychiatry. The allegation of undue moral uncertainty in forensic psychiatry is denied and the moral issues are revealed to be related to the status of the underlying philosophical disputes. An outline for the organization of the forensic psychiatric assessment is presented. The charge that forensic psychiatry is not as "hard" a science as the other forensic sciences is denied. The administrative and political organizational problems facing the subspecialty are explored. The practitioners in the field are encouraged to recognize that forensic psychiatry is a subspecialty and to work for official subspecialty status. Cautious predictions about the future of the field are provided.     

略论“鉴定留置”——由邓玉姣案说起

邓玉娇故意伤害案中的司法精神医学鉴定的过程,非常典型地暴露出了我国司法精神医学鉴定中有关＂鉴定留置＂制度缺位的严重问题。精神病鉴定虽然是一个医学问题,但它更是一个法律问题,我国对司法精神病鉴定制度的规定存在严重的缺失,对精神病鉴定等一系列问题的立法必须提升到我国立法的议事日程上来。对此,我们应当借鉴国外成熟经验,首先,应认识到对犯罪嫌疑人精神病鉴定是需要干涉公民人身自由的强制处分行为,并明确限定鉴定留置的范围。其次,对于鉴定留置的适用条件,在决定适用此措施之前必须听取鉴定人、辩护人意见,同时,鉴定留置措施只能适用于具有重大犯罪嫌疑的被指控人。再次,应明确规定对犯罪嫌疑人精神病鉴定的期间,在对犯罪嫌疑人精神病鉴定的期间不计羁押期限的基础上,明确犯罪嫌疑人精神病鉴定的时间,应当能够折抵刑期。     

Forensic psychiatric units in Italy from the 1960s to the present

This article addresses the long-standing continuities in the history of the Italian forensic psychiatric units and views them as the result of conflicting forces, interests, mentalities and strategies at the cross-road of forensic psychiatry, psychiatry, prison and health services. It focuses on the period from the 1960s to the present and deals with, among other issues, the long-term impact of the anti-asylum movements and the on-going debate on the ‘phasing out’ of the forensic psychiatric units.     

英美两国对精神病人刑事责任能力评判的演变

司法精神病学是法学的一个分支学科,其诞生和演变与法学的主旋律始终保持一致。精神障碍者刑事责任能力问题是司法精神病学的主要构成部分,英国1843年的麦克·纳顿条例是专门就精神障碍者刑事责任能力问题的法律规定,它对英美法系和大陆法系国家的相关立法都产生了巨大深远的影响。美国最近20多年处理违法精神病人的法律改革对现代诸国的司法精神病学完善具有相当大的影响力,所以研究英美两个国家这一方面的司法精神病学的历史和现状对推动我国司法精神病学的进步意义重大。     

信号检测论视角下法医精神病鉴定意见的评判

鉴定意见准确是高质量法医精神病鉴定的必然要求。然而,法医精神病鉴定是由鉴定人来实施的,在鉴定过程中,鉴定人需要进行一系列判断和识别,鉴定意见是鉴定人一系列识别和判断的结果。探讨法医精神病鉴定中鉴定人识别和判断活动的特征,并结合信号检测论所揭示的人进行识别和判断活动的心理学规律,探讨法医精神病鉴定意见准确性的影响因素,以及由信号检测论所揭示的规律对于正确认识法医精神病鉴定的准确性、提高法医精神病鉴定质量的指导价值和意义。     

Self-reported versus diagnosed paraphilias in outpatient sexual offenders

Literature has repeatedly reaffirmed sexual deviance as a risk factor for sexual recidivism, making it an important subject to examine. Yet, not all studies confirm the relevance of sexual deviance and there is a lack of consensus regarding the assessment of it. In the current study, 499 Dutch adult male subjects, admitted for sexual misconduct (possession of child abuse material, child molestation and other types of inappropriate sexual behaviour) to an outpatient forensic treatment facility, were compared regarding sexual paraphilias using self-reports from clients and official DSM-IV-TR diagnoses assessed by professionals. Analyses revealed a relatively low similarity between self-reports and diagnoses, self-reports generating considerably more information. Furthermore, correlating the paraphilias revealed paedophilia associated minimally with the other paraphilias. Lastly, the different types of offenders varied significantly in number of self-reported and diagnosed paraphilias, with the miscellaneous group presenting the most. Considering these outcomes may help assessment and target treatment goals in forensic psychiatry.     

Child and adolescent victims in forensic autopsy: a 5-year retrospective study

Children of more than 3 years of age and adolescents have been largely overlooked in the forensic literature, especially the 4-9 age group. Thus, the present study was undertaken to address this particular issue of child and adolescent victims in forensic autopsies. On a 5-year period (2000-2004) in Quebec province (Canada), all forensic autopsy cases of children and adolescents from 4 to 19 years of age were retrospectively studied. A total of 223 cases of child and adolescent deaths (148 males, 75 females; 6.6% of all forensic autopsies) were reviewed. Age, gender, manner of death and cause of death were analyzed for all victims organized into three groups of age: 4-9, 10-14, and 15-19. Moreover, homicide cases (n = 54) are further analyzed in terms of method(s) used (firearm, sharp force, asphyxia, blunt force, intoxication). This 5-year retrospective study may contribute to a better understanding of typical deaths in the 4-19 group of age and therefore, bring a working basis for the forensic pathologist or medical examiner/coroner.     

刑事诉讼中法医精神病鉴定争议的反思与理论诠释

法医精神病鉴定在一些重大刑事案件中持续成为舆论关注的焦点。不论法医精神病鉴定启动与否均会陷入被质疑的困境。这既存在制度安排的问题,也存在鉴定本身的问题,还存在凭直觉判断的问题,更存在理论误导的问题。这些问题叠加在一起衍生了较为复杂的中国性问题。这一复杂问题的解决,需要合理配置启动法医精神病鉴定程序的权力(利),科学对待法医精神病鉴定本质,尊重法医精神病鉴定的医学认定,正确使用法医精神病鉴定意见中的刑事责任能力判断,在正当程序中维护法医精神病鉴定的科学性。对于非制度问题需要正确的理论诠释,避免因实践难题与理论缺陷交织触发一些不具有实质意义的纷争和枉顾科学的呼吁。     

Who's afraid of forensic psychiatry?

Forensic psychiatry has come under mounting criticism from the press and other medical professionals, largely for its participation in the insanity defense. The author argues that the expertise available from the specialty is of increasing importance to psychiatry as a whole, as more and more legal issues become relevant to the practice of general psychiatry, and should be actively encouraged and legitimized rather than ostracized. All psychiatrists should be exposed to forensic principles and practices during their training, and the ability of forensic psychiatrists to serve as transducers between the clinical and the legal/judicial should be increasingly used to present the clinical viewpoint effectively in courts and legislatures.     

DBT in an outpatient forensic setting

Literature shows that effective treatment of borderline personality disorder (BPD) has become possible. However, borderline patients in forensic psychiatry do not seem to benefit from this development. In forensic psychiatry, prevention of criminal recidivism is the main focus of treatment, not core borderline problems like parasuicidal and self-destructive behavior. A dialectical behavioral treatment program for BPD was implemented in an outpatient forensic clinic in The Netherlands. Sociodemographic, clinical, and treatment data were collected from ten male, and nineteen female forensic BPD patients, and compared with corresponding data from fifty-eight non-forensic BPD patients. The results show that it is possible to implement dialectical behavior therapy in an outpatient forensic clinic. The data indicate that the exclusion of forensic patients, and especially female forensic patients, from evidence-based treatment is unjustified given the highly comparable clinical and etiological characteristics they share with female BPD patients from general mental health settings.     

Sexual assault,irresistible impulses,and forensic psychiatry in Sweden

After forensic psychiatry was firmly established in Sweden in the 1930s, many rapists and individuals charged with assaulting children underwent a forensic psychiatric examination. The physicians found that most of them had not been “in control” of their senses or not “in complete control” of their senses at the time of the crime. If the court ordered a forensic psychiatric examination, the defendant had a very good chance of either being discharged or having his sentence reduced considerably. By the 1950s psychological perspectives began to dominate in forensic psychiatry. In the forensic records of the 1950s we can notice a shift from a biomedical to a socio-psychological perspective, and crime was increasingly related to conditions that were not seen as mental derangement from a legal point of view. As a result, it became less and less common, from the 1950s onwards, for sentences to be commuted or defendants discharged.     

Teaching forensic psychiatry to medical students

Are separate courses on forensic psychiatry available for medical students? During the 1985 to 1986 academic year, the authors surveyed all U.S. medical schools to identify courses on forensic/legal psychiatry. A minority of schools included separate courses or practicums on forensic psychiatry or mental health law. In a follow-up telephone survey, instructors of each of these courses were interviewed. Information was obtained on format of course, duration, discipline of instructor or instructors, topics covered, reading materials, institutional settings, and the number of students who took the course. The results are discussed and compared with earlier surveys.     

A case of child abandonment--reflections on criminal responsibility in adolescence

The issue of responsibility for delinquent acts has been examined in the light of adolescence as a unique developmental stage, and it has been proposed that the degree to which one should hold an adolescent morally responsible for his/her acts corresponds to the degree to which he/she has individuated from his/her family and become a psychologic adult. A case was presented in which the crime of child abandonment was committed by an adolescent who was still deeply enmeshed interpersonally with her mother and had not yet achieved a separate identity as an adult. The psychiatric findings were presented to the Court after a plea bargain had been struck and prior to sentencing. They conveyed the belief, in lay terms, that moral responsibility for this crime was collective, to be borne in part by the perpetrator's family. The Court responded humanely with a suspended sentence, conditioned on psychotherapy, allowing the young mother to remain together with her first child. Not only does this article suggest the value of an understanding of adolescent psychiatric concepts for the forensic psychiatrist, it also suggests that the more subtle aspects of assigning responsibility can be better evaluated by the court at the time of sentencing than during the trial phase.     

Sensory information in children’s statements of sexual abuse

The credibility of children’s statements of sexual abuse is a controversial issue in forensic psychiatry and psychology. Neurobiological and clinical laboratory studies show that real memories contain more information regarding sensory details than false memories. The goal of the present field study was to evaluate whether sensory information was present in children’s statements of sexual abuse, and whether this information was more often present in credible statements compared with non-credible statements. Sensory details were extracted from a sample of 96 statements of sexual abuse from children; 62 statements were considered credible and 34 statements were considered non-credible. This study showed that sensory information was present in 79% of children’s reports of child sexual abuse. Sensory information was significantly more often present in statements considered credible compared with non-credible statements (85.5%, P < 0.001), but there were large variations in the sense involved. Logistic regression analysis showed that the presence of at least one sensory detail may be a good predictor of credibility (odds ratio, OR = 23.484, P < 0.05). It seems appropriate to include sensory details when assessing the credibility of children’s statements of child sexual abuse, but it has not yet been demonstrated that use of such details significantly improves the validity of credibility assessments.KEYWORDS: Forensic sciences, forensic psychiatry, forensic psychology, credibility, sensory information, children’s statements, sexual abuse     

Management of forensic psychiatry patients who refuse medication--two scenarios

An Ohio federal court set Wyatt-type standards for treatment rights of forensic psychiatry patients and ordered legal due process-type hospital hearings to protect patients from what the court considers harmful clinical practices. Experience with this legal method for management of patients who refuse medication is examined for its impact on staff and patient care. Under legal pressure Ohio has built new regional forensic psychiatry hospitals. In one, spurred by legal activism, the prevalence of patients refusing medication has become pandemic. In its typical 16-bed ward, when 2 or more patients refuse medication, danger escalates rapidly for patients and staff. The method adopted to manage these situations is to assess the emergency of danger to patient or others, and if warranted to administer medication despite objections. This emergency management is dramatic in improving patient behavior and defusing milieu tensions. The psychiatrist ordering emergency management, however, faces challenges from several quarters--patient advocates, outside patients' rights legal advocates, and the commissioner of mental health. The clinically managed process contrasts markedly also with the legally imposed one in its impact on the personal and professional integrity of the responsible psychiatrist. Both scenarios illustrate the task yet remaining--integration of the clinical and legal concerns into a multisystem resolution of diverse interests, values, ethics, and rights.     

American forensic psychiatrists who work in state institutions

The authors surveyed a sample of American forensic psychiatrists who work in state institutions. As a group, their respondents tended to be middle-aged, white men, who had little formal training in forensic psychiatry, felt somewhat alienated from their peers, yet who were Board certified in general psychiatry. They tended to be involved primarily in the direct treatment of patients, and most often expressed concerns about the care-and prominent lack of aftercare--received by forensic patients. They also perceived a sense of patient futility in the institutional forensic setting. The authors conclude by recommending that AAPL take a more active role in appealing to and representing such forensic psychiatrists.