Exploring the similarities and differences between medical assessments of competence and criminal responsibility

The medical assessments of criminal responsibility and competence to consent to treatment are performed, developed and debated in distinct domains. In this paper I try to connect these domains by exploring the similarities and differences between both assessments. In my view, in both assessments a decision-making process is evaluated in relation to the possible influence of a mental disorder on this process. I will argue that, in spite of the relevance of the differences, both practices could benefit from the recognition of this similarity. For cooperative research could be developed directed at elucidating exactly how various mental disturbances can affect decision-making processes

Routine Opt-Out HIV Testing Strategies in a Female Jail Setting: A Prospective Controlled Trial

Background: Ten million Americans enter jails annually. The objective was to evaluate new CDC guidelines for routine optout HIV testing and examine the optimal time to implement routine opt-out HIV testing among newly incarcerated jail detainees. Methods: This prospective, controlled trial of routine opt-out HIV testing was conducted among 323 newly incarcerated female inmates in Connecticut’s only women’s jail. 323 sequential entrants to the women’s jail over a five week period in August and September 2007 were assigned to be offered routine opt-out HIV testing at one of three points after incarceration: immediate (same day, n = 108), early (next day, n = 108), or delayed (7 days, n = 107). The primary outcome was the proportion of women in each group consenting to testing. Results: Routine opt-out HIV testing was significantly highest (73%) among the early testing group compared to 55 % for immediate and 50 % for 7 days post-entry groups. Other factors significantly (p = 0.01) associated with being HIV tested were younger age and low likelihood of early release from jail based on bond value or type of charge for which women were arrested. Conclusions: In this correctional facility, routine opt-out HIV testing in a jail setting was feasible, with highest rates of testing if performed the day after incarceration. Lower testing rates were seen with immediate testing, where there is a high prevalence of inability or unwillingness to test, and with delayed testing, where attrition from jail increases with each passing day

Free will and psychiatric assessment of criminal responsibility. A parallel with informed consent

In some criminal cases a forensic psychiatrist is asked to make an assessment of the state of mind of the defendant at the time of the legally relevant act. A considerable number of people seem to hold that the basis for this assessment is that free will is required for legal responsibility, and that mental disorders can compromise free will. In fact, because of the alleged relationship between the forensic assessment and free will, researchers in forensic psychiatry also consider the complicated metaphysical discussions on free will relevant to the assessment. At the same time, there is concern about the lack of advancement with respect to clarifying the nature of the forensic assessment. In this paper I argue that, even if free will is considered relevant, there may be no need for forensic researchers to engage into metaphysical discussions on free will in order to make significant progress. I will do so, drawing a parallel between the assessment of criminal responsibility on the one hand, and the medical practice of obtaining informed consent on the other. I argue that also with respect to informed consent, free will is considered relevant, or even crucial. This is the parallel. Yet, researchers on informed consent have not entered into metaphysical debates on free will. Meanwhile, research on informed consent has made significant progress. Based on the parallel with respect to free will, and the differences with respect to research, I conclude that researchers on forensic assessment may not have to engage into metaphysical discussions on free will in order to advance our understanding of this psychiatric practice. © 2010 The Author(s)

Epidemiologic and clinical updates on impulse control disorders: a critical review

The article reviews the current knowledge about the impulse control disorders (ICDs) with specific emphasis on epidemiological and pharmacological advances. In addition to the traditional ICDs present in the DSM-IV—pathological gambling, trichotillomania, kleptomania, pyromania and intermittent explosive disorder—a brief description of the new proposed ICDs—compulsive–impulsive (C–I) Internet usage disorder, C–I sexual behaviors, C–I skin picking and C–I shopping—is provided. Specifically, the article summarizes the phenomenology, epidemiology and comorbidity of the ICDs. Particular attention is paid to the relationship between ICDs and obsessive–compulsive disorder (OCD). Finally, current pharmacological options for treating ICDs are presented and discussed

Closing Italian Forensic Psychiatry Hospitals in Favor of Treating Insanity Acquittees in the Community

Originally a hedge against the death penalty, the insanity defense came to offer hospitalization as an alternative to imprisonment. In the late 19th century Italy opened inpatient services first for mentally ill prisoners and then for offenders found not guilty by reason of insanity. Within the past decade, a series of decrees has resulted in transferring the responsibility for treating NGRI acquittees (and “dangerous” mentally ill offenders) from the Department of Justice to the Department of Health, and their treatment from Italy’s high security forensic psychiatric hospitals (OPGs) to community regional facilities (REMs). Today community REMs provide the treatment and management of socially dangerous offenders. The dynamic evolution of Italy’s progressive mental health system for insanity acquittees, to our knowledge, the most libertine, community oriented approach of any country, is retraced. Discussion includes cautionary concerns as well as potential opportunities for improvements in mental health services

The Female Psychopath: A Study of a Sample of National Italian Women Offenders

After attending this presentation, attendees will be able to recognize the characteristics of the female psychopath. This presentation will impact the forensic science community be helping to identify possible gender-specific factors related to psychopathy. Background: In Italy, the treatment of mentally ill offenders not guilty by reason of insanity at risk for recidivism (a danger to society) was entrusted to the High Security Hospital (OPG). The Law no. 81 of 2014 ratified the closure of all Italian OPGs from March 31, 2015, and planned the transfer of the ill patients (about 1,500) from the OPGs to small community facilities located in their own regions, so-called Residences for the Execution of Security Measures (REMS). Until its closure, the OPG of Castiglione delle Stiviere in northern Italy, located in Castiglione’s Ghisiola Park in the province of Mantova, was the only one that admitted women; all women who have committed a crime on Italian territory and are at risk for recidivism are sent to the OPG of Castiglione. The search enrolled all the women present at the OPG (86) from February1, 2013, to the end of 2013 to research female psychopathy’s prevalence

Closing Judicial Psychiatric Hospitals: not guilty by reason of insanity offenders socially dangerous’ treatment inside psychiatric community network: an Italian perspective

Learning Overview: After attending this presentation, attendees will better understand the treatment practices of socially dangerous offenders inside the psychiatric community network called REMS (Residence for the implementation of Security Measures). Impact on the Forensic Science Community: This presentation will impact the forensic science community by demonstrating the security measures that the new national residential network is developing to share common good practices of care. Two years after the introduction of Italian forensic psychiatric reform, the new national residential network for subjects in security measures is now trying to develop and share common good practices of care, according to the contents of the new legislation. In this work, progressive steps of assessment and care of those admitted to the REMS will be illustrated, as well as the way new scenarios may impact the role of expert judgement in the courts and their effects on forensic subjects’ referrals. Some critical points fostered by the new system, including criteria for admissions and clinical rationale for releases to lower levels of security, are discussed further in this work. Regarding risk issues, the forensic and general psychiatric network may benefit from an integration with recovery-oriented models, looking at the risktaking paradigm and strength model.1 Concept of risk, in this manner, is viewed as life challenges in prosocial goals, real social integration, autonomy, advocacy, and the protection of rights.2 The combination and integration of both concepts of risk, according to a patient’s features, his environment, service provision, and quality of networks may better suit the specific institutional and cultural Italian ground for security measure