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
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
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