forensic psychiatry Flashcards
forensic patient locations
- prison
- inpatients - central mental
- general adult psych
how are people admitted to the central mental
- from prison/court under the criminal law act 2006
2. from psych hospitals under mental health act 2001
remand prisoner
awaiting trial that is not convicted and not released on bail
sentenced prisoner
tried and guilty and serving
prisoner gender
m»>f
mentally ill prisoners + violence
most offences minor and non violent - should get bail but because mental illness don’t eg. homeless/no money/no family to vouch for them
rate of mental illness in prisons?
higher than community
6 month prevalence of psychosis in male remand prisoners is 10x that of community
why is there a high rate mental illness in irish remand centres?
- no formal court diversion mechanism
- no mental health court
- not enough investment in community services
what is court diversion?
transfer people with mental illness from criminal justice system to psych hosp
when are people with mental illness identified in legal system?
- point of arrest
- court appearance
- remand centres
when are patients sent to CMH?
major mental illness + major offence
when are patients sent to local psych service?
major mental illness, minor offence
when are patients treated in prison?
major offence, minor illness
when OPD tx by local psych service?
minor mental illness, minor offence
what specific mental illnesses are more common in the male prisoner population?
antisocial PD
personality disorder
what meds are high currency value in prison?
- benzos
- hypnotics
- mirtazapine
- olanzapine
intimidate staff and other inmates
what is the book of evidence?
- charge sheet
- transcript of interview after arrest
- statements from witnesses and victim
- list of exhibits for trial
- a copy is given to the accused, prosecutors, defencers, psychiatrist
psychiatric court report features
- impartial regardless of who comissions it
- detailed
- duty is to the court
which courts have juries?
circuit and central criminal
what is a summary offence?
- less serious than indictable
- hear in district court
- max sentence of one month for one offence
what is an indictable offence?
- circuit or central criminal
- up to life in prison
- sometimes special criminal
fitness to be tried means?
capacity at time of trial not at time of offence
when is someone unfit to be tried?
can’t:
- plead to charge
- instruct legal representative
- can’t elect for trial by jury
- can’t challenge a juror
- can’t understand the evidence
what if someone is unfit to be tried?
postpones trial
what is the insanity plea?
actus rea without mens rea
criteria for not guilty by reason of insanity?
- suffering at the time of the offence
- cannot be held responsible because:
a. did not know the nature of the act
b. did not know the act was wrong
c. could not stop from committing the act
if NGRI?
CMH
diminished responsibility vs NGRI?
NGRI can be any charge, DR only murder
criteria of DR?
- person did the act alleged
- was suffering from a mental disorder at the time
- mental disorder substantially diminished the responsibility for the act
what happens if DR?
murder = automatic life sentence, but if DR then reduced to manslaughter - can sentence for any time
what is the mental health review board?
reviews CMH patients who have been referred by criminal law act 2006 by court if unfit to stand trial or NGRI
max interval 6 months
members of mental health review board?
chair - solicitor/barrister
consultant psych
lay person
drugs/alcohol - offence?
theft
driving
violence
SCZ - offence?
minor public order
rarely violence!
depression- offence?
shoplifting
suicide + homicide
LD - offence?
sexual
arson
mania - offence?
fraud
sexual
dementia - offence?
minor
exhibition
morbid jealousy - offence?
rape
homicide
directed at partner of affected individual
children - may think are product of extra-marital relationship
love rivals
dissocial PD - offence?
10x risk homicide
epilepsy - offence?
controversial association
doesn’t seem to be a link
manslaughter vs murder?
murder - killing with malice
manslaughter- killing without malice
characteristics of rape offenders?
- M>F
2. usually
characteristics of rape victims?
- females>males
- CSA = higher risk
- alcohol by offender or victim
- more in summer, first half of night, weekends
when are kids most vulnerable to CSA?
8-12 yrs
f>m
men who abuse boys orientation
usually say heterosexual
how long average CSA abuse relationship last?
4 years
RFs for NAI?
- ill child
- premature
- first born
- single parent
- young mother
- parents suffered abuse
- low income
- substances
categories of CA?
neglect
emotional
physical
sexual
children first guidelines?
anyone who suspects must report to health board - HB will get SW on the case
if emergency - gardai
stalking + mental health problems?
personality disorder delusional disorder abused substances SCZ BPAD/anxiety
how do we know the risk of violence posed by those with mental illnesses?
HCR-20 risk assessment
what is the HCR 20 RA?
1. risk factor checklist H - historical factors C - clinical factors R -risk management issues 20 - 20 items altogether
