Mental disorder and legal responsibility: The relevance of stages of decision making

The paper discusses the relevance of decision-making models for evaluating the impact of mental disorder on legal responsibility. A three-stage model is presented that analyzes decision making in terms of behavioral control. We argue that understanding dysfunctions in each of the three stages of decision making could provide important insights in the relation between mental disorder and legal responsibility. In particular, it is argued that generating options for action constitutes an important but largely ignored stage of the decision-making process, and that dysfunctions in this early stage might undermine the whole process of making decisions (and thus behavioral control) more strongly than dysfunctions in later stages. Lastly, we show how the presented framework could be relevant to the actual psychiatric assessment of a defendant's decision making within the context of an insanity defense.     

Suicide Case Due to Phosphoric Acid Ingestion: Case Report and Review of Literature

Ingesting caustic substances represents a common event which may result in serious injuries of the gastrointestinal system. Severity of injury depends on the type of ingested substance: Caustic burns are more frequently associated with acid ingestion and their severity depends on type, concentration, time of exposure, and amount of the ingested substance. We report a case of phosphoric acid ingestion leading to death in a patient with depressive disorder. While reports ingestion of other acids and organophosphates can be found in the literature, there are no reports detailing a death due to phosphoric acid ingestion. We hope that presenting the findings in this case can aid death investigators in future cases that may involve ingestion of such a substance. After autopsy pH, phosphate and calcium ions concentration in the blood were analyzed. The cause of death was due to systemic effects: metabolic acidosis, hypophosphatemia, hypocalcemia, and hyperkalemia.     

道路交通事故轻度精神伤残者智能损害评定

目的探索道路交通事故轻度精神伤残者智能损害评定方法和价值。方法通过分析智商测定在轻度精神伤残者评定中的运用,探索智商测定在轻度精神伤残者智能损害评定中的运用价值。结果不同性质颅脑损伤组间不同智能损害程度构成比有统计学差异（P〈0.05）;量表智商与颅脑损伤性质有关（P〈0.05）,除继发全面性与继发局部性损害（P〈0.05）、继发局部性与混合性损害之间（P〈0.01）有统计学差异外,其余各组两两之间均无统计学差异;不同颅脑损伤程度组间不同智能损害程度构成比无统计学差异;量表智商与颅脑损伤程度呈负相关（P〈0.01）,除中型与重型损伤之间无统计学差异外,其余各组两两之间均具有统计学差异;智能损害程度、量表智商均与精神伤残等级呈正相关（P〈0.01）;量表智商并非评价智能损害的唯一指标,智能损害也并非精神伤残唯一的构成因素。结论智商测定对评价智能损害与精神伤残具有一定参考价值,精神伤残评定需根据颅脑损伤性质与程度、智能损害或精神障碍程度以及生活、社会功能状况综合评定。     

治理我国实践中司法鉴定失序的正途

司法鉴定制度作为司法制度的组成部分在诉讼中发挥着关键性的作用。然而,在我国司法实践中因相关职权履行不到位衍生了鉴定失序的现象,尤其是目前“诉讼掮客”引发的“鉴定黄牛”,更加剧了司法鉴定的乱象。由于理论对鉴定失序的原因研究不充分,司法实践对此现象分析的错位,在一定程度上干扰了司法鉴定制度改革的方向。基于此,深化司法鉴定制度改革更需要在强化司法行政有效管理和保障鉴定能力提高的基础上,更需要司法机关在实践中积极地扮演“第二守门员”的角色,履行鉴定启动决定权和鉴定使用选择权的控制职能,借助于鉴定人出庭作证来控制重复鉴定,同时还应通过保障当事人的鉴定权利使司法机关采纳鉴定意见获得可接受性,进而降低当事人重复鉴定的欲望,使司法实践中鉴定失序在正途中被不断纠正。     

限定刑事责任能力评定量表在器质性精神障碍司法鉴定中的运用

目的探讨《精神病人限定刑事责任能力评定量表》在器质性精神障碍犯罪嫌疑人司法鉴定中的运用。方法多中心收集73例被评定为限定刑事责任能力的器质性精神障碍犯罪嫌疑人,完成量表评定,同时将限定刑事责任能力进行三级划分。结果小部分组、部分组、大部分组量表评定总分的平均分依次升高且存在显著性差异,分别为22.00±2.24、27.46±5.46、31.94±4.93;量表共15个条目与评定分显著相关,相关系数从0.233至0.661不等;因子分析得到7个因子,能解释76.306%变异,判别分析结果表明68.5%的样本能被正确划分。结论精神病人限定刑事责任能力评定量表内部构建合理,在器质性精神障碍犯罪嫌疑人司法鉴定中,其评定总分能有效反映三级限定刑事责任能力之间差异。     

精神卫生法的理想与现实

《精神卫生法》的立法经历了一个极其漫长的过程,最终出台的法律文本仍然存在非常严重的问题,其立法所要解决的问题所要达到的目的非常高,而与中国的现实严重脱节。《精神卫生法》立法的三大理想中,保护精神病患者的合法权益是核心,并希望立法来解决包括被精神病等一系列的社会现实问题。但是,立法脱离现实,相关的内容甚至出现了错误,表现在精神病患者的收治、实施导致人体器官丧失功能的外科手术、急诊急救、基层医疗机构的精神卫生保障等方面。由于存在不切合中国实际国情的规定,《精神卫生法》在我国的实施将会大打折扣。建议《精神卫生法》重点关注严重精神疾病患者得不到治疗、肇事肇祸的严重精神疾病患者得不到强制医疗的现象,关注财政投入不足、强制收治不规范等方面的问题。     

Piquerism in homicide: A knife wound analysis of a sexually motivated serial killer

As part of a wider research project into paraphilic disorders and homicide, a case is presented of a piquerist who achieved sexual satisfaction through the infliction of stabbing wounds. Against a background of sexual domination with willing and unwilling sexual partners, the offender stabbed four men to death. A study of the resulting autopsy reports, in association with the offender's testimony and crime scene documentation, was undertaken to discern a piquerist crime scene signature. An excessive number of stabbing wounds, the targeting of sexual areas, and a variation in wound size and depth were found to be evidence of piquerism. Although there was opportunity to commit a sexual assault upon victims, the preference was to penetrate them with a knife. It is contended that, even without any evidence of sexual assault at a crime scene, a knife wound analysis can reveal a sexual motivation in some cases of homicide.     

A LONGITUDINAL TEST OF SOCIAL DISORGANIZATION THEORY: FEEDBACK EFFECTS AMONG COHESION,SOCIAL CONTROL,AND DISORDER*

Social disorganization theory holds that neighborhoods with greater residential stability, higher socioeconomic status, and more ethnic homogeneity experience less disorder because these neighborhoods have higher social cohesion and exercise more social control. Recent extensions of the theory argue that disorder in turn affects these structural characteristics and mechanisms. Using a data set on 74 neighborhoods in the city of Utrecht in the Netherlands spanning 10 years, we tested the extended theory, which to date only a few studies have been able to do because of the unavailability of neighborhood‐level longitudinal data. We also improve on previous studies by distinguishing between the potential for social control (feelings of responsibility) and the actual social control behavior. Cross‐sectional analyses replicate earlier findings, but the results of longitudinal cross‐lagged models suggest that disorder has large consequences for subsequent levels of social control and residential instability, thus leading to more disorder. This is in contrast to most previous studies, which assume disorder to be more a consequence than a cause. This study underlines the importance of longitudinal data, allowing for simultaneously testing the causes and consequences of disorder, as well as the importance of breaking down social control into the two dimensions of the potential for social control and the actual social control behavior.     

Obligatory dangerousness criteria in the involuntary commitment and treatment provisions of Australian mental health legislation

Objective

Involuntary commitment and treatment (IC&T) of people affected by mental illness may have reference to considerations of dangerousness and/or need for care. While attempts have been made to classify mental health legislation according to whether IC&T has obligatory dangerousness criteria, there is no standardised procedure for making classification decisions. The aim of this study was to develop and trial a classification procedure and apply it to Australia's mental health legislation.

Method

We developed benchmarks for ‘need for care’ and ‘dangerousness’ and applied these benchmarks to classify the mental health legislation of Australia's 8 states and territories. Our focus was on civil commitment legislation rather than criminal commitment legislation.

Results

One state changed its legislation during the course of the study resulting in two classificatory exercises. In our initial classification, we were able to classify IC&T provisions in legislation from 6 of the 8 jurisdictions as being based on either ‘need for care’ or ‘dangerousness’. Two jurisdictions used a terminology that was outside the established benchmarks. In our second classification, we were also able to successfully classify IC&T provisions in 6 of the 8 jurisdictions. Of the 6 Acts that could be classified, all based IC&T on ‘need for care’ and none contained mandatory ‘dangerousness’ criteria.

Conclusions

The classification system developed for this study provided a transparent and probably reliable means of classifying 75% of Australia's mental health legislation. The inherent ambiguity of the terminology used in two jurisdictions means that further development of classification may not be possible until the meaning of the terms used has been addressed in case law. With respect to the 6 jurisdictions for which classification was possible, the findings suggest that Australia's mental health legislation relies on ‘need for care’ and not on ‘dangerousness’ as the guiding principle for IC&T.     

Prisoners with psychosis in England and Wales: diversion to psychiatric inpatient services?

The prevalence of psychosis among prisoners in England and Wales is ten times that in the household population and UK government policy is that prisoners should receive equivalent care to those in the community. This study investigated the implications of policy to divert more from the criminal justice system for psychiatric treatment. Psychotic prisoners were compared with psychotic persons in households and with other prisoners in two surveys of psychiatric morbidity in representative samples of the UK population. Psychotic prisoners were younger, more from ethnic minorities, with comorbid anxiety, substance misuse, ASPD, and childhood behavioural problems compared to psychotic persons in households. Less than a third had received previous inpatient treatment. Psychotic prisoners had similar criminal histories and higher psychopathy scores than non-psychopathic prisoners. Diversion is unfeasible without improved screening for psychosis and increasing bed numbers at higher levels of security to accommodate more patients who would pose high risk to the public. Future research should investigate why UK psychiatric services fail to identify psychotic prisoners and provide aftercare.