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Mental health
Published in Gary Chan Kok Yew, Health Law and Medical Ethics in Singapore, 2020
Mental health is at present a protean and contested concept that does not have fixed boundaries. As we learn more about human brain processes, behaviours, and associated mental abnormalities and disabilities, the law has to constantly adapt to better protect and balance the interests of mentally ill persons, their family members and caregivers as well as members of the public. Mentally disordered persons may be detained in a psychiatric hospital for treatment only where there is a threat of danger to himself or the public as ascertained by medical practitioners in psychiatric institutions and external experts. The MCA provides a framework with built-in legal safeguards to allow a mentally capable person the autonomy to make decisions on his personal welfare and financial matters as far as possible, and should he lose mental capacity, for proxy decision-makers (donees, court deputies and professional deputies) to make such decisions in his best interests with supervision from the Public Guardian and the courts. Psychiatric expertise remains crucial in criminal proceedings involving mentally disordered accused persons relying on Penal Code defences based on unsoundness of mind, intoxication or diminished responsibility. Doctors may be liable not only to the patient for negligent diagnosis, treatment and omission to provide material information on the risks, benefits, complications and alternatives to enable the person with mental illness to make or participate in a decision as to his treatment, but in more exceptional cases, to third parties who have not been warned of physical harm caused by the mentally ill patient.
Automatism
Published in John Rumbold, Automatism as a Defence in Criminal Law, 2018
Insanity is a general defence, although there is some debate over whether or not it is a defence to crimes of strict liability. In English law, there is a presumption of sanity. This is an exception amongst defences. The justification for this exception is that the defendant is the person best placed to provide of his mental state, therefore it is reasonable to place the burden of proof on the accused. In English law, this has to be proved on the balance of probabilities. In the USA, the standard of proof in Federal trials is that a clear preponderance of evidence supports insanity. The accused may opt to argue the insanity defence, or the judge may direct the jury to consider the insanity defence. The prosecution can only ask for the insanity defence to be considered when the defendant is pleading diminished responsibility.
Manslaughter, gross negligence and recklessness
Published in Jane Lynch, Tim Pettis, Ahmed Shoka, Medico-Legal Essentials Clinical Responsibility, 2018
Jane Lynch, Tim Pettis, Ahmed Shoka
The Homicide Act 19574 introduced ‘diminished responsibility’ as a defence in cases of unlawful killing, which would normally invoke the mandatory life sentence for murder (at the time there was also the death penalty). It only applies to the offence of unlawful killing. It allows for a defendant to be convicted of manslaughter instead of murder by virtue of his diminished responsibility.
A Survey for Examining the Validity and Reliability of the Japanese Version of the Forensic Psychiatric Nursing Competence Scale
Published in International Journal of Forensic Mental Health, 2023
Kayo Matsuura, David Timmons, Ayumi Takano
The MTSA aimed to prevent the recurrence of similar acts and promoted the rehabilitation of individuals who committed a serious offense in a state of irresponsibility or diminished responsibility due to a mental disorder. Therefore, specific rules for the management of such individuals were established, and continuous appropriate medical treatment and supervision were provided rather than punishment. Serious offenses include homicide, arson, robbery, rape, forcible indecency (which included attempts), and injury. The MTSA is implemented in two main situations. First, an individual for whom the public prosecutor withdraws a charge on the grounds of irresponsibility or diminished responsibility due to a mental disorder, and second, an individual acquitted or given a mitigated sentence without imprisonment on the grounds of irresponsibility or diminished responsibility due to a mental disorder. Individuals in these conditions are referred to the District Court by the public prosecutor. Following the referral, the court orders a psychiatric evaluation for the individual as part of the process.
Unidimensionality of the Strengths and Vulnerabilities Scales in the Short-Term Assessment of Risk and Treatability (START)
Published in International Journal of Forensic Mental Health, 2022
Richard Whittington, Charlotte Pollak, Alice Keski-Valkama, Andrew Brown, Alina Haines-Delmont, Jesper Bak, Jacob Hvidhjelm, Roger Almvik, Tom Palmstierna
Three of these services (FS, SH and SC) are regional in scope serving catchment areas with a population of approximately 2 million people. The fourth service (VV) is a national hospital covering the whole of Finland with a population of 5.5 million. The four samples largely reflect the overall demographic and clinical profile of each service and are broadly comparable. The average admission duration (years) was as follows: VV: 7.0; FS: 4.9; SC: 2.3; SH: 2.2. The percentage of each sample that was male and the mean/median age was as follows: VV: 79%, 41 years; FS: 84%, 35 years; SC: 98%, 33 years; SH: 94%, 40 years. The most common diagnosis was schizophrenia or psychosis in all services and the most common legal decision governing compulsory treatment in all services was diminished responsibility, not guilty by reason of insanity or equivalent. The median number of days between admission to the service and the first START assessment varied substantially being 8 months in FS and 57 months in SH. Further information on the demographic and clinical characteristics of the samples is not available as such information was required to be removed to obtain ethical approval. The project is co-ordinated by the Brøset Center for Research and Education in Forensic Psychiatry, Trondheim, Norway.
Validation of the Test of Memory Malingering in a Clinical Population from Singapore
Published in International Journal of Forensic Mental Health, 2020
Ivana Chan, Isabelle Shu Min Ong, Kenji Gwee Dpsych
Possible motivations to feign include avoiding military duty, obtaining principal compensation, or avoiding the death sentence (APA, 2013). Under the Singapore Penal Code (Penal Code, 2008), in the event that the criminal defendant is able to successfully feign cognitive impairment, he/she may be found to have diminished responsibility and successfully avoid consequences as severe as the death sentence, despite having committed a crime. Overburdened mental health services may also be stretched in providing care for individuals without a legitimate cognitive deficit. On the other hand, a false positive classification of feigning may lead to a genuinely impaired individual being unfairly subjected to criminal proceedings despite being not competent to proceed. Due to the more serious consequences of committing false positives, neuropsychologists generally agree that an adequate PVT requires high specificity (e.g., at least 90%), even at the cost of lower sensitivity (Harlow, 2009). In the present study, sensitivity refers to the probability of feigners who are correctly identified by a PVT, whereas specificity is defined as the probability of honest participants who are correctly classified as such.