July 6 juillet 13:45 – 15:45
Room NCDH–200
Chair: José G.V. Taborda
, Federal Faculty of
Medical Sciences of Porto Alegre
After a brief introduction, the authors approach the three different methods of psychiatric admission in accordance with the law in the Portuguese Penal Legislation, namely, (1) the Admission of Inimputable (N.G.R.I./N.C.R.) patients by reason of “Psychic Anomaly” (Penal Code’s article 20), judged with dangerousness (Penal Code’s Article 91) and convicted with Security Measures by penal sanction decreed by a competent Court; (2) compulsive admission of patients with “Psychic Anomaly”, due to the law 36/98 (Mental Health Law); and (3) preventive admission to a psychiatric hospital of the criminal is subject to constraint measures (preventive emprisonment) with presumed mental disorder, which is determined by the magistratein accordance with Article 202 of the Penal Process Code. The authors comment on these three ways of admission, on a critical point of view, with respect to the rehabilitation process of Inimputable Patients, and the flaws in the legislation leading to some confusion between Penalties and Security Measures. The Mental Health Law’s evolution is discussed, and some problems which may occur in the future concerning the admission of drug abusers and those with personality disorders, which are difficult to strictly consider as “Psychic Anomaly”.
This presentation will focus on violent incidents against
others (assaults) and against self (suicide) in Canadian federal penitentiaries.
Some statistics demonstrating the incidents of violence at the national,
regional (Ontario) and a Maximum-security penitentiary will be reviewed along
with the characteristics of offenders who commit violence against others and
self. Explanations for the causes for these incidents, preventive measures and
treatments available for these offenders will also be discussed.
The author describes the common elements of a series of
rebellions which occured in the Brazilian Pententiary System in the period of
1996 to 2000, as recorded in the Brazilian press. Most rebellions involved male
inmates and were frequently very violent, with the kidnapping of guards,
interns, volunteer workers or other prisoners, and often resulted in the killing
of some of the hostages. The author analyzes data on the prisoner population,
vacancies and alleged reasons for the rebellions, in an attempt to establish
directives for understanding and preventing these social tragedies. The growth
of the Brazilian incarcerated population is far greater than the general
population growth. According to the government’s National Penitentiary
Department, in July 2000 there were 216,780 prisoners under the System’s care,
which represents a 45.7% increase on 1995 figures. As a result, current
facilities show a deficit of 66,400 vacancies to meet the demand, and forcing a
large number of convicts to serve their sentences in precinct jails. In this
situation, prisoners who have committed crimes of very different natures are
placed together, causing the violation of the weaker prisoners’ rights by the
more dangerous inmates. Security breaches are common, and prisoners have easy
access to firearms and illegal dugs. The combination of the above with the
similarity observed in the sadistic code of values of prisoners and guards
alike, and the delays in the legal system–resulting in prisoners not being
released after serving their sentences or not having their applications for
parole analyzed–are a social timebomb.
The authors describe the various aspects of violence inside and outside the Forensic Psychiatric Insitute and discuss the solution that is being used. Violence is defined as: (1) Violence against patients: social, governmental and family abandonment are crucial sources of violence, leading to a worse prognosis; (2) suicide as the innermost form of violence; (3) the social exclusion itself as a form of violence; (4) a judicially indefinite period for inpatient treatment is viewed as a potential source of violence; (5) staff’s violent behavior, denial, and silence, which makes the pyschiatrists’ work more difficult; (6). patients’ violent behavior within the institution: sexual and psychological abuse, burglary and homicides; (7) violence against the psychiatrist’s work: the psychiatrist evaluates his or her own patient for legal purposes (dangerouness evaluation, as an annual report for the judiciary). In conclusion, the authors discuss what is being done to minimize the problem of violence inside the insitution. Psychiatrists, with a broad vision of the patient’s treatment from the begining through the time of discharge, with access to the various legal reports that are required during treatment, may diminish social violence against patients. This can be attained through a legal authorization to continue patient’s treatment in an outpatient basis as soon as possible, called progressive discharge. The progressive discharge is a judicial and a psychiatric authorization for the patient to be outside the institution.
The study examines the relationship between psychopathy and mental major disorders in two criminal populations. Subjects were assessed on the basis of the Psychopathy Checklist (CPCL-R; Hare, 1991) and the screening version of the Diagnostic Interview Schedule (DISSI, Robins & Marcus, 1987). The subjects (N=120) were french-speaking male adult offenders confined to either (a) high security prison (N=60), or (b) security hospital (N=60). Comorbidity of psychopathy will be assessed by factor analysis procedures. The hypothesis of a distinct entity of psychopathy will be discussed with reference of the classical trait-state debate.
Violent behavior represents one of the greatest potential
challenges in a forensic and correctional setting. It is far more frequently
encountered than in general psychiatry. The greater propensity for violence in
this population is briefly addressed, noting the more frequently encountered
causes and environmental factors. The need for history, assessment and diagnosis
should, ideally, be undertaken prior to management. The risk for violence in the
short term, should be assessed as part of the initial assessment of any person
in this setting. The medical and legal implications of failure to anticipate and
treat potentially violent patients are in particular, of great importance.
Attention will be given to the basic techniques, which should be used in order to prevent the use of involuntary methods of treatment. The first need will be to “talk down” a potentially violent patient, depending on the etiology. This will include attention to the setting and the need to establish rapport. Violence can often be prevented by appropriate action at critical times when violent incidents are more likely to occur.
Where ever possible, involuntary treatment should be avoided. In order to fully comply with the Charter for Human Rights and Mental Health Legislation, a medical certificate should be completed whenever involuntary detention and/or treatment is required, dependent on the Province concerned. Minimal force should be used but adequate show of force may be required in some instances.
Psychotropics are not always appropriate in all conditions, however, where required, the indications are specific. Advantages and disadvantages of currently available compounds and delivery forms and new delivery forms will be discussed. There is a preference for rapidly dissolving Olanzapine (Zydis) and for Zuclopenthixol (Clopixol) Acuphase by intra-muscular injection. A benzodiazepine may be utilized to facilitate the onset of action. Overall, however, second generation neuroleptics are preferred.
The indications for seclusion and, even in extreme instances, restraint, will be reviewed. Violent behavior should be carefully monitored and reviewed subsequently, to prevent or reduce future incidents.
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