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

"Though penned primarily for those with more advanced knowledge of forensic issues (including those practicing within the justice system), this work might prove useful for anyone interested in the various intriguing and complicated challenges in the subspecialty of forensic psychiatry."—Steven T. Herron, MD, University of Arizona Health Sciences Center, USA" … a very comprehensive and thorough review of the whole field of forensic psychiatry. It is a book that every practising forensic psychiatrist would benefit from having. There is no other textbook as comprehensive as this concerned with UK forensic psychiatry: subjects are covered in depth with a vast array of references and articles synthesised. By and large it’s accurate and up-to-date. It’s a real achievement … . Highly Commended."—2014 BMA Medical Book Awards

• IntroductionForensic psychiatryA victim-centred approach ContextMedical language Achieving the knowledge and skills Further enquiry Criminal and civil law for the psychiatrist in England and WalesCommon law and civil or Roman law European courtsCourt structure, England and Wales Criminal law in England and Wales Agencies of the lawCivil law The Coroner’s court Mental health and capacity laws including their administering bodiesPreamble 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 IslandsPreamble Scotland Northern IrelandMilitary law in the United Kingdom Isle of Man Channel Islands Republic of Ireland Concluding comments Forensic psychiatry and its interfaces outside the UK and IrelandThe 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 opinionsForensic 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 WalesThe 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 offenderIntroduction Measurement and epidemiology The natural history of offending Factors associated with delinquency and offendingExplaining 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 studiesIntroduction Basic genetics Genetic study methods The genetics of antisocial behaviour, problem substance use and schizophrenia Conclusions ViolenceTheoretical background Violence as a health issueCrimes of violenceDisordered and offensive sexual behaviourSex offending, sexual deviance and paraphiliaSex offending by females and adolescents Psychiatric questions Risk assessment Sex offender treatment Treatment or controlThe majority of crime: theft, motoring and criminal damage (including arson)Introduction Recording of crime Acquisitive offending Criminal damage Arson Motoring offencesOverview Disorders of brain structure and function and crimeExpectations 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 andtreatment implications Implications of current knowledge of brain structure and function for forensic mentalhealth practice and research Offenders with intellectual disabilitiesClinical and legislative definitionsPeople 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 disabilitiesOffenders 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 aggressionAssessment 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 crimeVulnerable to violence and vulnerable to being violentPsychosis and crime: The epidemiology Pathways into violence through psychosis: Distinctive or common to most violent offenders? Psychosis, comorbid mental disorders and violenceClinical characteristics of psychosis associated with violenceEnvironmental factors which may be relevant to violent outcomes among people with functional psychosisManagement and treatment Conclusions Pathologies of passion and related antisocial behavioursErotomanias and morbid infatuations Jealousy Stalking Persistent complainants and vexatious litigantsConclusions Personality disordersConcepts of personality disorderPersonality disorder assessment toolsHow 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 conceptPersonality disorder: Some conclusions Deception, dissociation and malingeringDeceptive mental mechanisms Pathological falsification Dissociative disorders Deception Addictions and dependencies: their association with offendingAlcohol Other substance misuse Pathological gambling Juvenile offenders and adolescent psychiatryJuvenile delinquency UK comparisonsMental health Pathways of care and the juvenile justice system Government policy for EnglandSpecial crimesAdolescent girls Conclusions Women as offendersWhy a chapter on women?Women and crimeWomen, mental disorder and offendingServices for women ConclusionsOlder people and the criminal justice systemHow many older offenders? What sort of crime? Associations between psychiatric disorder and offending in older age Older sex offendersService and treatment implications DangerousnessIntroduction Theoretical issues Risk assessment and structured judgment toolsThreat assessment and management Communicating about risk Risk assessment and management: Bringing it all together Conclusions Principles of treatment for the mentally disordered offenderCreating a therapeutic environment within a secure settingOccupational, speech and language, creative and arts therapies in secure settings Pharmacological treatmentsPhysical healthcarePsychological treatmentsAttachment and psychodynamic psychotherapiesConclusions Forensic mental health services in the United Kingdom and IrelandCycles in fear and stigmatization: A brief history of secure mental health servicesSpecialist forensic mental health services: Philosophies and a theoretical modelThe 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 IrelandHealth service based forensic psychiatry service provision in Ireland Offenders and alleged offenders with mental disorder in non-medical settingsWorking with the police People with mental disorder in prisonWorking 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 psychiatryCodes and principles Teaching and learning ethics Some contemporary questionsHeuristic cases The death penalty Deviant and sick medical staffThe medical power balanceBoundaries and offencesAbuse in institutionsSexual assault Clinicide and CASK Commentary Victims and survivorsLearning from victims and survivors Voluntary and non-statutory bodies inspired by victims The growing centrality of victims of serious crime in the criminal justice systemReactions 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 AppendicesAppendix 1: ECHR Appendix 2: MHA 1983Appendix 3: Experts’ Protocol Appendix 4: Hippocratic Oath Cases cited References Index