精神病司法鉴定若干法律问题研究

精神病鉴定因涉及精神病医学、心理学、法学以及社会学等诸多领域的专门知识而呈现出复杂性。与其他医学学科相比,精神病医学的发展相对缓慢,在一定程度上制约了精神病鉴定制度的发展,甚至影响了鉴定程序启动的正常展开。精神病鉴定制度的不完善及其程序启动的失当又导致实践中出现精神病鉴定的乱象。从司法鉴定实践中可以发现,精神病鉴定本身的可靠程度以及刑事责任能力的评定与鉴定启动、鉴定结果选择等具有内在的互动性。尽管精神病鉴定制度无力解决精神病医学不发达的根本性问题,但科学的精神病鉴定制度对精神病鉴定技术、鉴定能力与鉴定质量的提高有较大的助益。     

A training approach for community maternal health volunteers that builds sustainable capacity

This article examines a training approach for community health volunteers which increased access to maternal health services in rural communities in Zambia. The effectiveness of the training approach was evaluated in an operations research component. Skilled birth attendance rates increased by 63% from baseline over a two-year period in the intervention districts, out-performing increases recorded in control sites at statistically significant levels. As a low-cost, high-impact intervention which shows good sustainability potential, the approach is suitable for national level scale-up and for adaptation for use in other countries in support of maternal and new-born health goals.     

La protección de los derechos fundamentales del deportista en la lucha contra el dopaje. Una visión desde el ordenamiento jurídico español

Doping is addressed in this paper from two different scopes: on one hand, the legal regulations for prevention and repression are studied; on the other hand, the clash between the anti-doping control mechanism and a fundamental right such as the athlete's privacy is noted. We start from the irrefutable fact that “awareness against doping” is practically universal. The enactment of this law was a milestone in the history of the fight against doping in the Spanish regulation. However, the problem arises when the anti-doping legislation worldwide and in Spain, which enables some healthcare professionals and other people involved, to carry out several anti-doping operations that may conflict with the athlete's fundamental right to privacy, all of this in a context of strong media and social impact. For this reason, it is pertinent to raise the issue if one of these operations, such as the duty of permanent localization, is sufficiently justified in terms of protecting the sportsperson's health.     

Mental health law and the UN Convention on the rights of persons with disabilities

People with a mental illness may be subject to the UN Convention on the Rights of Persons with Disabilities (CRPD), depending on definitions of terms such as ‘impairment’, ‘long-term’ and the capaciousness of the word ‘includes’ in the Convention's characterisation of persons with disabilities. Particularly challenging under the CRPD is the scope, if any, for involuntary treatment.     

Mental health specialized probation caseloads: Are they effective?

With the large and growing number of persons with mental illnesses under probation supervision, a form of specialized probation called specialized mental health caseload (SMHC) has been implemented. This study explores the effectiveness of a prototypic SMHC implemented statewide. A quasi-experimental design was used to compare criminal justice, mental health, and community engagement outcomes among three caseloads: a newly established SMHC supervising no more than 30 clients per officer (N = 1367); an established SMHC supervising roughly 50 clients per officer (N = 495); and a traditional caseload of clients receiving mental health treatment and supervised by officers with average caseloads of over 130 clients (N = 5453). Using a mixed methods approach, we found that the SMHC was implemented with high adherence to fidelity, and comparisons based on different caseload samples generally support the effectiveness of the specialized mental health caseload, particularly on criminal justice outcomes. Future studies using random assignment are needed to examine the connection among mental health symptoms, compliance with treatment and probation supervision, and recidivism.     

Mental disorder and probation policy and practice: A view from the UK

This article is concerned with the manner in which offenders with mental illnesses serving community sentences are identified and treated by the probation service in the UK. It presents the results of recent research examining the prevalence levels of current and lifetime mental illness, substance misuse, and dual diagnosis and suicide rates amongst those serving community sentences in the UK. These high levels of mental disorder are not being addressed by probation policy or practice in a manner that is effective or sensitive. The article concludes by considering the relevance of innovative approaches to the treatment of offenders with mental illnesses in the community currently being adopted in the US to the UK.     

Community Wise: Paving the way for empowerment in community reentry

Theoretical approaches traditionally applied in mental health and criminal justice interventions fail to address the historical and structural context that partially explains health disparities. Community Wise was developed to address this gap. It is a 12 week group intervention informed by Critical Consciousness Theory and designed to prevent substance abuse, related health risk behaviors, psychological distress, and reoffending among individuals with a history of incarceration and substance abuse. This paper reports findings from the first implementation and pilot evaluation of Community Wise in two community-based organizations. This pre–posttest evaluation pilot-tested Community Wise and used findings to improve the intervention. Twenty-six participants completed a phone and clinical screening, baseline, 6- and 12-week follow-ups, and a focus group at the end of the intervention. Measures assessed participants' demographic information, psychological distress, substance use, criminal offending, HIV risk behaviors, community cohesion, community support, civic engagement, critical consciousness, ethnic identification, group cohesion, client satisfaction, and acquired treatment skills. Research methods were found to be feasible and useful in assessing the intervention. Results indicated that while Community Wise is a promising intervention, several changes need to be made in order to enhance the intervention. Community Wise is a new approach where oppressed individuals join in critical dialogue, tap into existing community resources, and devise, implement and evaluate their own community solutions to structural barriers.     

“The ladder of the law has no top and no bottom”: How therapeutic jurisprudence can give life to international human rights

In the past two decades, therapeutic jurisprudence (TJ) has become one of the most important theoretical approaches to the law. But, there has, as of yet, been puzzlingly little written about the relationship between TJ and international human rights law. To be sure, there has been some preliminary and exploratory work on the relationship between TJ and international law in general, but virtually nothing on its relationship to international human rights law in a mental disability law context. This paper seeks to focus on this lack of consideration, to speculate as to why that might be, and to offer some suggestions as to how to infuse some new vitality and vigor into this important area of law and social policy.     

Involuntary detention and treatment of the mentally ill: China's 2012 Mental Health Law

The long-awaited Mental Health Law of China was passed on 26 October 2012 and took effect on 1 May 2013. Being the first national legislation on mental health, it establishes a basic legal framework to regulate mental health practice and recognizes the fundamental rights of persons with mental disorders. This article focuses on the system of involuntary detention and treatment of the mentally ill under the new law, which is expected to prevent the so-called “Being misidentified as mentally disordered” cases in China. A systematic examination of the new system demonstrates that the Mental Health Law of China implicitly holds two problematic assumptions and does not provide adequate protection of the fundamental rights of the involuntary patients. Administrative enactments and further national legislative efforts are needed to remedy these flaws in the new law.     

反思精神障碍强制医疗的“危险性”原则

很多国家精神卫生立法在强制医疗人院标准方面都适用了“危险性”原则,我国《精神卫生法》也在其列。然而,“危险性”原则是基于三个错误的假设,因此实际上“危险性”原则可能会增加精神疾病对患者的伤害和较大程度增加社区危险的风险。本文呼吁参考Large及Richardson的观点及美国部分州与苏格兰精神卫生立法的实证经验,在“危险性”原则基础上补充“拒绝治疗的能力”评定作为精神障碍者强制医疗入院标准。