South Africa's mental health law is person-centred, has a strong human rights emphasis, and includes the appointment of mental health review boards (MHRB) to provide oversight and consider appeals against involuntary admissions. Owing to the low number of appeals, this study aimed to determine the proportion of involuntary patients who were aware of their right to appeal at two public sector psychiatric hospitals in KwaZulu Natal Province.

Anorexia nervosa (AN) is a serious metabo-psychiatric disorder. Despite a mortality rate approximately five times higher than that of age-matched controls, most deaths result from delayed recognition, fragmented care, and limited access to integrated, evidence-based treatment. Refusal of life-sustaining nutrition in severe or longstanding AN presents profound ethical and legal dilemmas, challenging the balance between autonomy, protection, and the duty to preserve life. This paper provides a critical narrative and normative review of how clinical uncertainty, systemic failure, and legal interpretation influence decision-making in treatment refusal. It examines capacity, futility, and best-interests determinations within mental health and capacity law in England and Wales, with comparative reference to other high-income countries. The review finds that unvalidated constructs such as "severe and enduring" and end-of-life framing of AN lack empirical and legal foundation. Their adoption risks normalising treatment withdrawal and assisted dying in a treatable psychiatric disorder that predominantly affects women. Ethical analysis grounded in autonomy, beneficence, non-maleficence, and justice demonstrates that autonomy should be supported rather than presumed absolute when reasoning is impaired by malnutrition or psychopathology. The paper concludes that aligning clinical and legal practice with the Convention on the Rights of Persons with Disabilities would strengthen supported decision-making, safeguard the right to life, and promote parity between psychiatric and physical healthcare. A shift toward the prevention of avoidable deaths, rather than acceptance of inevitability, is urgently required.

Developing effective strategies to reduce perceived coercion during psychiatric hospitalization requires systematic monitoring of patients' experiences. The Admission Experience Survey (AES) evaluates patients' perceptions of the psychiatric hospitalization process. This study aimed to develop a Japanese version of the AES (AES-J) and assess its reliability and validity in individuals with mental illness. We conducted a cross-sectional survey of individuals with mental illnesses who had experienced psychiatric hospitalization in Japan. The AES-J was developed and evaluated using confirmatory factor analysis (CFA) and multi-group CFA. Spearman's correlation coefficients were calculated to assess the validity against inpatient care experience, patient satisfaction, and mental distress. Cronbach's alpha and intraclass correlation coefficients (ICC) were computed to determine internal consistency and test-retest reliability. A total of 135 participants were enrolled, and 50 completed the AES-J twice. CFA supported the original three-factor structure (Perceived Coercion, Negative Pressures, and Process Exclusion). The strict invariance model demonstrated comparable goodness-of-fit indices to the scalar invariance model. Perceived Coercion and Process Exclusion were significantly correlated with inpatient care experience and patient satisfaction. Negative Pressures was correlated considerably with inpatient care experience but not patient satisfaction. Mental distress did not demonstrate significant correlations with any of the three subscales. Cronbach's alphas were 0.82-0.88, and ICCs were 0.77-0.89. This AES-J showed acceptable validity and reliability for assessing admission experiences among individuals with mental illness in Japan.

The use of coercion in psychiatry is one of the most controversial issues in modern healthcare. There are clinical, legal and ethical arguments in favour of both the abolition and justification of coercion in psychiatry. The two lines of argument are often diametrically opposed, so further development of the discussion seems difficult. To address this unsatisfactory situation, we have applied the approach of adversarial collaboration to this issue. The two authors represent fundamentally different points of view on the question of the legitimisation of coercion in psychiatry. Through a methodically guided exchange of arguments, numerous consensus hypotheses, dissent hypotheses and general consensus hypotheses with dissent in detail were developed. The main findings include the fact that the antagonists argue from completely different starting points at the core of the argument, namely, general arguments vs. individual clinical cases. In addition, antagonists hold consistent positions on many topics. It can therefore be concluded that both those in favour and those against the abolition of coercion in psychiatry are arguing with good intentions.

Mental health tribunals provide legal safeguards for compulsory treatment for mental illness. Despite one of these tribunals' purposes being to give people subject to compulsory treatment a "day in court", research has shown that individuals' experience of mental health tribunals is highly negative. To understand these negative experiences, we conducted a multi-stakeholder study of the Consent and Capacity Board, a mental health tribunal in Ontario, Canada. Our research revealed that disputes in the hearings tended to focus on procedural requirements of the compulsory treatment orders, and although substantive legal criteria were addressed, the medical conclusions underlying those criteria were not directly challenged. Further, in cases where a client "wins" and the treatment order is revoked, our analysis shows the medical perspective remained authoritative. Finally, although people subject to treatment orders were given a chance to speak at hearings, in most cases theirs was the only voice challenging the psychiatrist's medical conclusions, and their contribution would usually only lessen the chance of the order being revoked. Therefore, we argue that rather than challenging medical decision-making, as may be expected, tribunal hearings unintentionally amplify the medical perspective in a manner that is likely to be upsetting for people subject to the treatment orders. We acknowledge that this effect is ingrained in the current system and will be challenging to ameliorate. Nonetheless, it is an important consideration for those in legal and clinical practice, and policy makers. We give some suggestions about how these experiences could be improved and for further research opportunities.

This paper examines the perspective of police officers on conflictual encounters with individuals with mental illness. The study aims to identify the frequency, challenges, reasons for intervention, conflict potential, and factors contributing to escalation and deescalation in operations involving mentally ill individuals. To achieve this, a survey of N = 157 police officers was conducted, incorporating both quantitative and qualitative elements. The results indicate that operations involving mentally disturbed individuals are common and a part of them lead to conflict situations. The primary reasons identified on the part of the individuals involved were a lack of understanding of the situation, aggression, mood instability, delusions, disorder-related factors, and resistance or a lack of manageability. On the part of the police officers, impatience, time constraints, and inappropriate intervention strategies were perceived as contributing factors to these conflictual situations. The factors identified as escalating or de-escalating conflict by the police officers were consistent with those reported by individuals with mental illness in previous studies. The report of using force more frequently in deployments with individuals with mental disorders compared to other deployments was positively correlated with insecurity about how to behave during such deployments, perceiving deployments with individuals with mental disorders as particularly dangerous, and negatively correlated with the feeling of being well-prepared for such deployments, highlighting the high relevance of profound police training. The findings are discussed in the context of training approaches for improving police handling of such situations.

Forensic psychopathology assessments play a critical role in legal decisions, particularly those related to criminal responsibility. However, despite their influence, the decision-making processes behind these assessments remain largely underexplored and inconsistently supported by empirical evidence. Emerging literature suggests that these decisions are shaped by multiple factors, including individual reasoning styles, team dynamics, and the influence of cognitive biases.

This article critically analyses provisions in the Mental Health Bill 2025 that, if passed, will amend the Mental Health Act (MHA) 1983 to create a power for tribunals and the Justice Secretary to discharge restricted patients from hospital subject to conditions that deprive them of their liberty in the community. These provisions pose a threat to the human rights of patients who straddle the divide between the mental health and criminal justice systems. Furthermore, the provisions and the cases that preceded them expose the limits of policies of de-institutionalisation and official ambitions to move people with learning disabilities and autism spectrum disorder out of psychiatric hospitals and to support them to live in the community. Such seemingly progressive moves are tempered by a political drive to continue to control those who are thought to pose risks to others. As this article makes clear, detention in the community is not a lesser form of detention than detention in hospital, and it requires stringent safeguards in light of the UK's obligations under Article 5 of the European Convention on Human Rights. This article advances an alternative solution. Instead of creating a new, and complex, power that could lead to unlawful detentions in the community, suitable community-facing hospital accommodation for restricted patients subject to the same safeguards as hospital settings should be made available.

Individuals with intellectual disabilities constitute a significant portion of those managed within the criminal justice system. Courts are increasingly challenged with determining appropriate sentencing. Additionally, many of these individuals have complex social and medical backgrounds, necessitating a multidisciplinary approach to assess their legal and moral culpability. Consequently, these factors impact sentencing outcomes, including decisions regarding incarceration versus rehabilitation programs. This current study utilises all available court judgments involving intellectual functioning and disability recorded on LawNet (Singapore's legal database) from 1985 to 2024 to examine their relationship with sentencing considerations. Broadly, this study reviews sentencing considerations related to individuals' intellectual functioning and the legislation in place to support this population. Specifically, this study further scopes into examining the outcomes of judgments that had the offender undergo an intellectual ability assessment, and its relation to current legislative frameworks' responses to the complex process of judicial decision-making. Hence, this study examines the challenges faced in tailoring legislative frameworks to the complex nature of intellectual functioning and disability in Singapore's legal arena.

The Mental Health Act 1983 (MHA) authorizes the compulsory detention and treatment of people with mental disorders who are perceived to pose a risk to themselves or to others. Since its enactment, there have been concerns that the coercive powers of the Act have been disproportionately used for Black people with mental disorders. This disproportionate impact of the MHA on Black people is most clearly seen in the excessive use of Community Treatment Orders (CTOs). Although there is limited evidence on the effectiveness of CTOs, they continue to be used increasingly in the care of Black people, with latest data showing that Black people are over seven times more likely to be issued CTOs than White people (National Health Service Digital, 2024). This is particularly concerning as CTOs are commonly perceived as intrusive and have been described as a form of racial surveillance. In this paper, we explore the idea of CTOs as instruments of racial surveillance and argue that their continued use in the care of Black people with mental disorders is an extension of the intrusive powers of the State and might constitute a form of racial injustice.

In many countries little is known about the attitudes and ethical beliefs of practicing psychiatrists towards the use of coercive practices. This is true as regards Russia where coercion was used for political purposes during the Soviet period. However, substantial changes have occurred in the psychiatric system in recent decades with a focus on patients' rights and the idea of consent. This study aimed to investigate the beliefs and attitudes of Russian psychiatrists towards coercive treatment practices in situations of clinical decision making. Data were obtained from 93 (81 % of all practicing) psychiatrists in the Arkhangelsk region in northwestern Russia. The psychiatrists completed three case vignettes to obtain information regarding the use of coercive treatment practices in different clinical situations, and responded to an ethical attitudes inventory. The psychiatrists' decisions regarding coercive treatment, and the extent of information provided to the patients and their relatives were impacted by the severity and risks (violence, suicidality) associated with the patient's disorder. In most instances psychiatrists were not responsive to pressure from the patient's family or other hospital personnel. Very few gender differences in attitudes and practices were found. Psychiatrists generally reported that they encountered different situations with abusive practices primarily in the past. This study suggests that the factors associated with the use of coercive treatment practices by Russian psychiatrists may mirror those in other countries. Further research should elucidate the actual extent to which coercive practices are used in Russian psychiatry and delineate the factors associated with their actual use.

Psychiatric advance directives have been a prominent theme in mental health system reform. This study aimed to investigate psychiatrists' attitudes towards advance statements following their introduction in the Mental Health Act 2014 in Victoria, Australia (Mental Health Act 2014 (Vic) ss 19-22). Advance statements are non-binding legal documents that permit mental health consumers to outline their treatment preferences, should they become subject to compulsory treatment. The mixed methods design involved psychiatrists completing an online survey based on a clinical vignette (n = 18) followed by in-depth interviews (n = 4). Results showed that psychiatrists viewed insufficient support from their institutions and peers as primary barriers to the effective use of advance statements, suggesting the need for deliberate implementation strategies to ensure psychiatrists make reasonable efforts to give effect to advance statements.

Despite the international recognition of children's evolving capacities and the importance of incorporating these factors into forensic assessments, there is limited research on forensic practices specific to children above the minimum age of criminal responsibility (MACR). The current study is part of a larger project examining legal and forensic assessments related to children's criminal unaccountability (criminal insanity) in Norway. The aim of the current study was to examine how forensic assessments of children above the MACR are conducted in Norway, and to what extent developmental factors are considered in these assessments. Drawing on existing literature, we first propose a set of principles for developmentally informed forensic assessments of children. The principles address direct expert-child interaction; structured assessment procedures; collateral/contextual information; cultural responsiveness; and the qualifications of forensic experts. We then evaluated 122 forensic assessments of children aged 15 to 18 years according to the proposed principles. Our findings revealed significant gaps, including minimal direct engagement with the child, low usage of structured assessment tools, limited collateral information from caregivers and schools, lack of cultural considerations and a concerning lack of child-specific expertise among forensic experts. These shortcomings underscore the need for more rigorous and developmentally sensitive practices. Recommendations include enhanced training, incorporating developmental principles into curricula, and establishing standardized protocols integrating structured assessment tools and comprehensive contextual information. While conducted in a Norwegian context, our study calls for further research in other jurisdictions to develop international guidelines that accommodate the unique developmental needs of children in forensic settings.

Assessing insanity in individuals with paedophilic disorder presents unique challenges, particularly due to the diverse aetiologies of the condition, which lead to varying symptomatology and behavioural manifestations. To address this complexity, in this article we overview the characteristics of three variants of paedophilic disorder - idiopathic, acquired, and iatrogenic - and highlight the key obstacles in differentiating these forms, resulting in inconsistent and, at times, biased judicial outcomes. Through the analysis of three real-life case studies, we illustrate how forensic evaluations must go beyond a one-size-fits-all approach, integrating neuropsychological and neuroimaging assessment to provide more precise determinations of criminal responsibility. We therefore propose a cognitive model for the forensic assessment of insanity that emphasises the role of scientific evidence in distinguishing cases in which neurological conditions or medical treatments significantly impair volitional and cognitive capacities. In such cases, incarceration may be inappropriate, as incarceration hinders rehabilitation, while treatment in specialised non-custodial facilities could better address the underlying condition and reduce the risk of recidivism. In our analysis, we argue for the inclusion of a criterion in the DSM to ensure that the symptoms of paedophilic disorders are not due to substance effects or other medical conditions. Finally, we propose guidelines for forensic assessments of insanity in child sexual offences that support a multidisciplinary approach based on the cognitive model. In this framework, behavioural analysis, neuropsychological assessment, and (if necessary) neuroimaging techniques are combined to assess how the condition affects self-determination, ultimately leading to more accurate and scientifically informed legal decisions.

The risk for general or criminal recidivism in forensic psychiatric patients has not been extensively investigated in the literature. The aim of this review is to evaluate criminal recidivism among forensic patients with mental disorders undergoing some type of outpatient treatment.

The aim of this study is to investigate the psychiatric evaluations for juvenile offenders.

This study explores the importation model's role in predicting prison misconduct, emphasizing the mediating effect of security threat group membership. Our analysis draws upon archival data from 636 individuals on death row in California. Structural equation modeling examined relationships between pre-prison characteristics-such as psychopathy, age at first arrest, and prior prisons sentences-and prison misconduct. Findings reveal that security threat group membership significantly mediates the impact of psychopathy and age at first arrest on misconduct, accounting for 60 % and 79 % of their respective effects. Moreover, security threat group membership is strongly associated with institutional misconduct, highlighting its role as a critical factor in prison disorder. The results suggest that pre-prison experiences and security threat group involvement should be integral to risk assessments and management strategies of correctional clients. These insights contribute to understanding prison dynamics and offer practical guidance for improving institutional security and reducing misconduct through targeted interventions addressing security threat group activities.

The MacArthur Competence Assessment Tool for Treatment (MacCAT-T), a semi-structured interview, is designed to evaluate patient decision-making capacity, a crucial aspect of patient-physician interaction.

Forensic psychology/psychiatry seems particularly subject to ethical tensions, as it involves not only the expert-evaluee or therapist-patient relationships, but also the judicial authorities. This exploratory study aims to identify the professional roles-namely the identity and posture-of both the expert and the therapist within the medico-legal field, with a view to uncovering potential ethical tensions that may arise in the transition from one role to the other.

New Zealand, as well as other jurisdictions, are revisiting their decision-making capacity law regimes. Currently several strands of New Zealand capacity law are under review. Reforms could impact many people across many domains of decision-making. Focussing on adult decision-making, we describe features of New Zealand's approach to decision-making capacity law that resemble other jurisdictions. We then summarise unique features of New Zealand law and explain the urgency of reform, in light of our obligations under the United Nations Convention on the Rights of Persons with Disabilities, research funded by the Human Rights Commission and the findings of New Zealand's Royal Commission of Inquiry Abuse in Care. Analysis of New Zealand's capacity law is timely, given the current review of the two key statutes governing adult decision-making and mental health legislation.

Following the 2016 South Korean statutory revision that governs psychiatric civil commitment, five regional Admission Suitability Review Boards (ASRBs) were established in 2017. These mental health tribunals were designed to provide public oversight of involuntary hospitalization of people diagnosed with mental illnesses. Most ASRBs are composed of psychiatrists or non-peer mental health professionals. Handful of ASRBs also invited peer professionals-individuals with lived experience of mental illness in recovery-to their civil commitment rulings for deliberation. This study describes observations and perspectives of those peer professionals who served on ASRBs, including their recommendations for improving the processes and outcomes of ASRB hearings.

Individuals with mental health difficulties in Iceland can be detained in police cells as a last resource place of safety when psychiatrists consider patients unsuitable for admission to a ward, for example, due to being under the influence of substances or being too violent. We aimed to investigate if detainment in a police cell affected symptoms of mental illnesses, and subsequently if police cells are an appropriate place of safety for patients in Iceland. We used a mixed methods approach utilising administrative records of detainees' visible symptoms of mental illnesses and ten semi-structured interviews with mental health professionals and police sergeants. Unpublished secondary data from the Reykjavik Metropolitan Police of detainees (n = 6874) and exceptional incidents in police cells from the 1st of January 2018 to the 18th of August 2022 was analysed. 72.1 % of all suicide attempts and 77.3 % of all self-harming behaviour took place in the initial four hours of detainment. Three themes generated from the interviews with professionals: 1) violent behaviour as a determining factor in using police cells as a place of safety, 2) the detrimental impact of detainment in police cells on mental health, and 3) the lack of support and resources for professionals to appropriately care for individuals with mental health difficulties. The study highlights police cells are not currently suitable places of safety in Iceland. New laws and regulations in Iceland should be developed to support police and mental health professionals to adequately provide safety for individuals with mental health difficulties.

Mental health legislation authorises involuntary psychiatric intervention in certain circumstances. Although human rights concerns are becoming more prominent, debates among legal experts, clinicians and activists continue to swirl around people's rights to equal recognition before the law, such as described in the (United Nations Convention on the Rights of Persons with disabilities, 2006).

Psychopathy occupies a pivotal yet unsettled position at the intersection of neuroscience, business ethics, and criminal jurisprudence. Despite rapid scientific advances, core uncertainties remain. This article examines five issues of immediate legal relevance: (1) the contested neurobiological basis of psychopathy; (2) reproducibility concerns linked to the broader replication crisis in psychological and neuroscientific research; (3) limitations of leading assessment instruments (e.g., PCL-R), and the risks of reifying cut-off scores; (4) accumulating evidence favouring a dimensional understanding of psychopathy- an approach which sits uneasily alongside law's often binary demands; and (5) the construct's extension into non-forensic domains, illustrated by workplace psychopathy, which raises questions about conceptual expansion beyond its clinical and correctional roots. In synthesising these literatures, the article offers guidance for courts and legal practitioners in applying current science cautiously, transparently, and accurately.

The First-tier Tribunal (Mental Health) was established in 2008 to deal with applications and references concerning people subject to the powers of the England and Wales Mental Health Act 1983. Substantive decisions in tribunal proceedings are made by a panel consisting of a legally qualified judge, a specialist member and a medical member. Applicants to the post of medical member must meet statutory and nonstatutory eligibility requirements including holding a consultant psychiatrist post for at least three years. In this paper, comparisons with other common law jurisdictions are drawn and it is argued that the medical member role in this tribunal is outdated and should be replaced by a newly established 'clinical member' role. Eligibility should be based on competence and skills rather than professional qualifications. The post would be open to consultant level mental health practitioners from multiprofessional backgrounds who demonstrate they are capable of meeting the specialist needs of the tribunal. Broadening the range of professionals eligible to be appointed to the clinical member post will help alleviate longstanding difficulties in medical member recruitment; will assist with tribunal efficiency; is in keeping with the extended roles introduced by the Mental Health Act 2007; and will encourage diversity in the range of persons available for selection for appointment.

Psychiatric advance directives (PADs) allow mental health service users to express their treatment preferences for future mental health crises. An accessible template for PADs can improve their implementation in practice.

Decision-making capacity (DMC) is a widely used criterion in health laws to balance respect for patient autonomy with protection from the potential consequences of treatment decisions. In 2017, lacking DMC was introduced as an additional criterion for involuntary care and treatment following comprehensive amendments to the Norwegian Mental Health Care Act. Despite the amendments aiming to reduce involuntary care and treatment rates, national health registry data indicate continued rising rates along the pre-2017 trajectory after an initial reduction in 2017. While previous studies suggesting varying DMC assessment quality, little is known about the potential factors influencing these variations.

Forensic mental health services (FMHS) seek to alleviate mental illness and reduce the risk of (violent) recidivism, but they may also be understood to be responsible for supporting patients with many other aspects of their often challenging lives. In practice, the task of an inpatient institution such as FMHS is concluded when the patient can transition to outpatient care, a move which is governed by law. Therefore, the practical goals are at least partly set by legal criteria for transition to outpatient care. Using qualitative comparative analysis, this study identifies systematic patterns of rehabilitative needs as assessed by clinicians that differentiate between FMHS patients who are deemed ready for outpatient care and those who are not. It also identifies how such systematic patterns align with legal criteria governing the transition to outpatient care. We find systematic patterns of rehabilitative needs that are associated with being considered ready for outpatient care and that these patterns map meaningfully onto the legislative criteria for forensic psychiatric care in Sweden. Mental health needs, violence risk needs, and needs associated with social functioning all bear on readiness for outpatient care but only in conjunction with one of the other. The results indicate that the transition to forensic outpatient care in Sweden depends on aspects outside the core objectives of non-recidivism and mental health, and rest on efforts by actors external to FMHS. This places high demands on clarity of institutional boundaries and the role of social functioning needs in decisions about compulsory care.

The paper by Butenko et al., 'Forensic psychiatry misuse in proceedings of administrative offenses' (International Journal of Law and Psychiatry, 2023) focused on the 'Case of Zaichenko v. Ukraine (No. 2)' in the European Court of Human Rights (2015). As the applicant in that case, I wish to respond to the paper by adding further context and detail to the arguments presented. My concerns centre on four areas: findings of national courts, errors and gaps in the European Court of Human Rights judgment, the constitutional consequences of mistranslation, and the broader legal chain of events. Overall, my response to all these circumstances is that intellectuals fear judges as fire, while lawyers fear knowledge and intellectuals. To explain such mutual fear only deepens the horror. This explanation may be correct and precise, but it is also too general. A more concrete half-answer might be this: let us recall (a) the overall number of cases before the Court; (b) the number of judges; (c) the principles of European Court of Human Rights staff recruitment; (d) the frequent incompatibility of member states' normative systems; and (e) their linguistic, confessional, and cultural diversity. Add to this the contradictions of regulation itself, and ordinary human weaknesses. Regulation today has grown to a scale that no single mind can contain, and is produced, not by Solons or Pericles, but by lesser hands. In such conditions, the individual who turns to the Court is often lost behind the informational avalanche. Whom or what can one trust, if not the Court's final judgment? Here I will not appeal to Popper or Lakatos, but only to a much older Athenian, himself once persecuted by a court: 'Question everything'.