Forensic Psychiatry

John C Gunn CBE FRCPsych FMedSci   Member, Parole Board, England & Wales  Emeritus Professor of Forensic Psychiatry, Institute of Psychiatry, King's College London, UK  Pamela J Taylor FRCPsych FMedSci Professor of Forensic Psychiatry, School of Medicine, Cardiff University, UK

Introduction
Forensic psychiatry
A victim-centred approach
Context
Medical language
Achieving the knowledge and skills
Further enquiry
Criminal and civil law for the psychiatrist in England and Wales
Common law and civil or Roman law
European courts
Court structure, England and Wales
Criminal law in England and Wales
Agencies of the law
Civil law
The Coroner’s court
Mental health and capacity laws including their administering bodies
Preamble
Human rights legislation
Historical background
Mental capacity
Mental Health Act 1983 amended by the Mental Health Act 2007
Mental Capacity Act 2005 (MCA)
Legal arrangements in the rest of the British Isles and Islands
Preamble
Scotland
Northern Ireland
Military law in the United Kingdom
Isle of Man
Channel Islands
Republic of Ireland
Concluding comments
Forensic psychiatry and its interfaces outside the UK and Ireland
The scope and limits of the comparative approach
The scope and limits of this chapter
National, subnational and supranational legal structures
Controversial issues and shifts in public and professional opinions
Forensic mental health (FMH) services and interventions under criminal and civil law:
Germany and the USA
Forensic psychiatric services and interventions under criminal and civil law:
The Nine Nations (SWANZDSAJCS) Study
Specialist recognition in Europe and SWANZDSAJCS countries
Research in forensic psychiatry, psychology and allied professions
Illustrative cases
Conclusions
Further reading
Psychiatric reports for legal purposes in England and Wales
The forum of the court: Background issues
Constructing a report
The use of reports in criminal proceedings
Civil matters
Examples of other documents which may be consulted
The psychosocial milieu of the offender
Introduction
Measurement and epidemiology
The natural history of offending
Factors associated with delinquency and offending
Explaining the development of offending
Implications for prevention
Conclusions
Genetic influences on antisocial behaviour, problem substance use and schizophrenia: evidence from quantitative genetic and molecular genetic studies
Introduction
Basic genetics
Genetic study methods
The genetics of antisocial behaviour, problem substance use and schizophrenia
Conclusions
Violence
Theoretical background
Violence as a health issue
Crimes of violence
Disordered and offensive sexual behaviour
Sex offending, sexual deviance and paraphilia
Sex offending by females and adolescents
Psychiatric questions
Risk assessment
Sex offender treatment
Treatment or control
The majority of crime: theft, motoring and criminal damage (including arson)
Introduction
Recording of crime
Acquisitive offending
Criminal damage
Arson
Motoring offences
Overview
Disorders of brain structure and function and crime
Expectations and advances: Conceptualization and measurement of brain structure
Epilepsy in relation to offending
Sleep disorders
Amnesia and offending
Brain imaging studies as a route to understanding violent and criminal behaviour
Serotonergic function in aggressive and impulsive behaviour: Research findings and
treatment implications
Implications of current knowledge of brain structure and function for forensic mental
health practice and research
Offenders with intellectual disabilities
Clinical and legislative definitions
People with intellectual disability detained in secure health service facilities in the UK
Crime and people with intellectual disabilities
Theories of offending applied to people with intellectual disabilities
Offenders with intellectual disabilities and additional diagnoses
Genetic disorders, intellectual disability and offending: Genotypes and behavioural phenotypes
Alcohol and substance misuse
Care pathways for offenders with intellectual disabilities
Assessment and treatment of anger and aggression
Assessment and treatment of sexually aggressive behaviour among people with intellectual disability
Fire-setting behaviour among people with intellectual disability
Assessment and management of risk of offending and/or harm to others among offenders with intellectual disabilities
Legal and ethical considerations in working with offenders with intellectual disabilities
Conclusions
Psychosis, violence and crime
Vulnerable to violence and vulnerable to being violent
Psychosis and crime: The epidemiology
Pathways into violence through psychosis: Distinctive or common to most violent offenders?
Psychosis, comorbid mental disorders and violence
Clinical characteristics of psychosis associated with violence
Environmental factors which may be relevant to violent outcomes among people with functional psychosis
Management and treatment
Conclusions
Pathologies of passion and related antisocial behaviours
Erotomanias and morbid infatuations
Jealousy
Stalking
Persistent complainants and vexatious litigants
Conclusions
Personality disorders
Concepts of personality disorder
Personality disorder assessment tools
How common are disorders of personality?
Clinical assessment and engagement in practice
Causes and explanations of personality disorders
Treatment of personality disorder
Dangerous and severe personality disorder (DSPD): The rise and fall of a concept
Personality disorder: Some conclusions
Deception, dissociation and malingering
Deceptive mental mechanisms
Pathological falsification
Dissociative disorders
Deception
Addictions and dependencies: their association with offending
Alcohol
Other substance misuse
Pathological gambling
Juvenile offenders and adolescent psychiatry
Juvenile delinquency
UK comparisons
Mental health
Pathways of care and the juvenile justice system
Government policy for England
Special crimes
Adolescent girls
Conclusions
Women as offenders
Why a chapter on women?
Women and crime
Women, mental disorder and offending
Services for women
Conclusions
Older people and the criminal justice system
How many older offenders?
What sort of crime?
Associations between psychiatric disorder and offending in older age
Older sex offenders
Service and treatment implications
Dangerousness
Introduction
Theoretical issues
Risk assessment and structured judgment tools
Threat assessment and management
Communicating about risk
Risk assessment and management: Bringing it all together
Conclusions
Principles of treatment for the mentally disordered offender
Creating a therapeutic environment within a secure setting
Occupational, speech and language, creative and arts therapies in secure settings
Pharmacological treatments
Physical healthcare
Psychological treatments
Attachment and psychodynamic psychotherapies
Conclusions
Forensic mental health services in the United Kingdom and Ireland
Cycles in fear and stigmatization: A brief history of secure mental health services
Specialist forensic mental health services: Philosophies and a theoretical model
The nature of hospital security
Specialist community services within an NHS framework
Health service based forensic psychiatry service provision in Scotland
Health service based forensic psychiatry service provision in Northern Ireland
Health service based forensic psychiatry service provision in Ireland
Offenders and alleged offenders with mental disorder in non-medical settings
Working with the police
People with mental disorder in prison
Working with the Probation Service
Working with voluntary agencies
Service provision for offenders with mental disorder in Scotland
Service provision for offenders with mental disorder in Northern Ireland
Offenders and alleged offenders with mental disorder in non-medical settings in Ireland
Ethics in forensic psychiatry
Codes and principles
Teaching and learning ethics
Some contemporary questions
Heuristic cases
The death penalty
Deviant and sick medical staff
The medical power balance
Boundaries and offences
Abuse in institutions
Sexual assault
Clinicide and CASK
Commentary
Victims and survivors
Learning from victims and survivors
Voluntary and non-statutory bodies inspired by victims
The growing centrality of victims of serious crime in the criminal justice system
Reactions to trauma and forms of post-traumatic disorder
Psychological understanding of post-traumatic stress disorder
From victim to survivor: Help and treatment
From victims to survivors: Conclusions
Appendices
Appendix 1: ECHR
Appendix 2: MHA 1983
Appendix 3: Experts’ Protocol
Appendix 4: Hippocratic Oath
Cases cited
References
Index