PSYCHIATRIC HOSPITAL CAPACITY,HOMELESSNESS, AND CRIME AND ARREST RATES*

As a result of developments in pharmacology, stricter standards for involuntary commitment, and changes in public expenditures, there has been a dramatic decline in the capacity of public psychiatric hospitals to maintain America's most severely mentally ill. Psychiatric deinstitutionalization has led to an increased presence of persons with mental illness in urban areas, many “falling through the cracks” of community‐based services. This is hypothesized to have contributed to homelessness, crime, and arrests. Individual‐level research has documented disproportionate and increasing numbers of mentally ill persons in jails and prisons. It has also found higher rates of violence and arrest among persons with mental illness compared to the general population. This study takes a macro‐level social control approach and examines the relationships between psychiatric hospital capacity, homelessness, and crime and arrest rates using a sample of eighty‐one U.S. cities. I find that public psychiatric hospital capacity has a statistically significant negative effect on crime and arrest rates, and that hospital capacity affects crime and arrest rates in part, through its impact on homelessness. In addition, I find no crime‐reducing effect of private and general psychiatric hospital capacity.     

Forensic psychiatry in China

This article reviews the legal basis for the development of forensic psychiatry in China, the organization of clinical assessments, and training of forensic psychiatrists. Regulations for the management of patients in Ankang hospitals and the role of forensic psychiatrists within the Criminal Justice system are described. The primary role of forensic psychiatrists is to provide expert opinions on competence to stand trial and criminal responsibility in criminal cases. They are increasingly involved in civil court proceedings and tribunals at the request of a range of official agencies. The clinical cases assessed by Chinese forensic psychiatrists are very similar to those of their counterparts in Western countries, but the organizational and legal framework for these assessments reflects a very different system that has evolved independently.     

谈精神病患者被迫长期住院现象

精神病人长期住院现象在精神医疗实践中并不罕见。除因治疗之外,患者也会受到其他原因的制约而难以出院,其中包括人们对精神病患者自主权的忽视、受患者监护人及社会治安防控意识的影响等。毫无疑问,该现象的出现不仅是对患者人身自由权的侵害,对其自身发展十分不利;而且从社会角度上而言,也会造成大量医疗资源的浪费。文章对该现象出现的原因进行了分析,对其所具有的危害性作了阐述,并提出了解决该问题的具体建议,以期能使该社会顽疾得到逐步改善。     

道路交通事故所致精神损害的法医学评价

目的研究RTA所致PTSD的相关法医学问题,为司法实践中精神损害赔偿提供科学依据和司法建议。方法对156例因RTA申请伤残程度鉴定的被鉴定人,通过临床精神病学检查确定PTSD的诊断,法医临床学检查评定躯体损伤的伤残程度,并通过问卷调查进一步确定受害人的心理社会状态。结果156例被调查对象PTSD发生率为51.92%。男女PTSD的发生率具有统计学的显著性差异;随着伤残程度的严重性增加,发生PTSD的可能性也随着增加;PTSD组与非PTSD组在生活质量总均分和生理、心理、社会关系、环境四个维度以及焦虑、抑郁的各项得分中都有显著性差异;获得赔偿将明显降低PTSD的发生率。结论RTA作为创伤性事件,申请赔偿的RTA受害人存在较高的PTSD发生率,获得良好的赔偿可以明显地降低申请赔偿的RTA受害人PTSD的发生率。     

The Criminogenic,Clinical, and Social Problems of Forensic and Civil Psychiatric Patients

Forensic psychiatric patients consume an increasing proportion of mental health resources in Canada and the United States. To inform mental health policy and practice, we compared the criminogenic, clinical, and social problems of forensic patients to those of civilly committed psychiatric patients in two Canadian studies. We predicted that forensic patients would score higher on criminogenic problems and lower on clinical and social problems than civil patients in two studies: one comparing 83 forensic and 189 civil inpatients on a clinician-completed form, the Resident Assessment Instrument--Mental Health, at an urban mental health center, and the second comparing 423 forensic and 178 civil patients assessed at different times using the Patient Problem Survey. The two studies were quite similar in their findings, despite differences in their samples, measures, and data collection methods. In both studies, forensic patients were similar to or lower than civil psychiatric patients in all criminogenic, clinical, and social problems. We conclude that forensic mental health services would benefit greatly by drawing from knowledge accumulated in the general psychiatric literature. This finding also supports the idea that many forensic patients can be appropriately diverted to nonforensic mental health services.     

An Examination of Mental Health and Psychiatric Care among Older Prisoners in the United States

Despite that prisons in the United States (and other high-income countries) have witnessed an increase in the proportion of older inmates, and that prison populations exhibit high rates of psychiatric illness, there is limited knowledge on the nature of older inmates’ psychological health and use/provision of psychiatric care. The present study addresses these gaps, analyzing a nationally representative sample of 1,907 male and female older inmates (age range = 50–84 years; M = 56) housed in U.S. state and federal prisons. The results highlight: (a) the prevalence of psychological issues among older prisoners; (b) factors associated with certain mental disorders and symptoms of mental health issues; (c) the prevalence of psychiatric treatment before and during imprisonment for those with (and without) reported psychological health issues; (d) similarities and differences between male and female older inmates in relation to psychological health, factors associated with psychological issues, and the use/provision of psychiatric care. Discussion points toward recommendations for managing inmate mental health, as well as direction for further research on older inmate mental health and psychiatric care.     

Future Uncertainty as a Challenge to Law's Programmes: The Dilemma of Parental Disputes

The article poses the problem of the need for judges to make 'right' decisions. It then describes how judges have attempted to meet this requirement in difficult cases concerning parental disputes over contact with children where there have been allegations of domestic violence. Applying Luhmann's concepts of the legal system, law's function, law's coding and law's programmes (Das Recht der Gesellschaft (Society's Law) 1997), offers a very different perspective on the issue to that of the judiciary or legal commentators who tend to see the issue of the law, determining, with expert help, what is best for the child. Law's function of stabilizing expectations over time obliges it to deal with all matters that come before the courts through the application of 'conditional programmes' and prevents it from applying the 'purpose oriented programmes' of politics and those who see the issue in terms of ideological conflict.     

法国“精神卫生分区化治疗模式”的发展与启示

基于我国目前社区精神病学的发展需要，文章以欧洲精神病学发展史为背景探讨“法国精神卫生分区化治疗模式”得以实现的历史条件及过程。我们认为精神病学在19世纪中叶以后的新发展，即二战后改革派精神病科医生基于圣 阿尔拜精神病院的成功经验而构建的“组织性精神疗法”为该模式的实现提供了科学技术支撑，同时，年轻的精神病科医生们为推广“组织性精神疗法”而做出的政治宣传、教育培训活动则为该治疗模式的实现获得了有利的社会政治资源。文末，我们对法国目前“精神卫生分区化治疗模式”具体架构及运行情况做了介绍并总结评论其对我国社区精神卫生工作的启示。     

Secondary Iatrogenic Harm: Claims for Psychiatric Damage Following a Death Caused by Medical Error

The purpose of this paper is to investigate the feasibility of claims for psychiatric damage following the death of a family member, where that death has been caused by medical error. ¹ The relative's position is a subject of heightened interest since the exposure of the plight of the parents involved in the UK organ scandal, ² and in the case of an iatrogenic death it is, of course, the family who are essentially the focus of the law's attempts to provide redress. Whilst the cases of deceased patients' relatives seeking damages for mental harm are inherently problematic in light of the restrictive secondary victim criteria applicable to psychiatric damage claims, a close look at the rules which permeate this area of compensation reveals that denying compensation to the relative suffering psychiatric harm is difficult to sustain. ³