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PubMed2000

Law and the confinement of psychopaths.

Civil commitment in the United States historically has followed a medical, targeting individuals with serious mental disorders and providing for their treatment in the least restrictive setting. In the last decade, however, commitment laws have appeared in some states permitting the hospitalization of personality-disordered criminal offenders at the end of a penal sentence. The American Psychiatric Association has fiercely opposed these laws. The U.S. Supreme Court has given its qualified approval, although legal challenges persist. These laws, together with British proposals to permit the civil commitment of dangerous personality-disordered individuals, should be resisted by all professional disciplines.

Antisocial Personality Disorder↗
PubMed2001

Psychopathy and community violence among civil psychiatric patients: results from the MacArthur Violence Risk Assessment Study.

Although psychopathy is recognized as a relatively strong risk factor for violence among inmates and mentally disordered offenders, few studies have examined the extent to which its predictive power generalizes to civil psychiatric samples. Using data on 1,136 patients from the MacArthur Violence Risk Assessment project, this study examined whether the 2 scales that underlie the Psychopathy Checklist: Screening Version (PCL:SV) measure a unique personality construct that predicts violence among civil patients. The results indicate that the PCL:SV is a relatively strong predictor of violence. The PCL:SV's predictive power is substantially reduced, but remains significant, after controlling for a host of covariates that reflect antisocial behavior and personality disorders other than psychopathy. However, the predictive power of the PCL:SV is not based on its assessment of the core traits of psychopathy, as traditionally construed. Implications for the 2-factor model that underlies the PCL measures and for risk assessment practice are discussed.

Adolescent↗
PubMed2002

The impact of the legal system on educational programming for young children with autism spectrum disorder.

Since 1990, State Educational Agency (SEA) and Local Educational Agency (LEA) policies and practices of educational programming for young children with autism have evolved in response to the due process system and court decisions. This has become an issue because of an increase in the identification of children with autism, reclassification of children previously reported under other disability categories, publicity about the competition between methodologies, parent advocacy for specific methodologies, shortages of qualified personnel, and the demand for due process to ensure appropriate services. A review is made of substantive and procedural issues presented in due process and court cases, the legal standards used by hearing officers and judges, and a synthesis of the case law. It is recommended that school districts consider legal standards as programs are designed, that programs fit the unique needs of the child, that programs ensure appropriate progress educationally and socially, and that communication between parents and school districts be open and honest so that the due process system is used as the last resort.

Adolescent↗
PubMed1986

Racism, psychological injury, and compensatory damages.

Psychiatrists and other mental health professionals have paid only modest attention to the idea that discriminatory conduct causes emotional suffering for those who are the object of it. However, courts have held that if such racist conduct is willful and outrageous and the ensuing suffering is severe, the plaintiff has a reasonable claim to compensatory damages. The authors trace these developments in the legal arena in both tort actions and complaints under civil rights statutes. They also point out how psychiatrists could be more influential in sharpening considerations about the idea that racism causes psychological injury.

Black or African American↗
PubMed1981

Patients' rights raises questions for psychology, psychiatry and law.

This paper briefly introduces the issue of patients' rights which has become increasingly recognised in the United States. Resulting from the inter-relationship of law and mental health, the rights issue involves those psychologists and psychiatrists providing treatment as well as civil rights lawyers pressing for protection for their clients. A sample list of patients' rights demands is presented and discussed. It is suggested that resolution will be assisted by the inputs of the client consumer in collaboration with psychologists, psychiatrists, and lawyers. Research on the questions raised will be required.

Civil Rights↗
PubMed2002

Responding to inpatient violence at a psychiatric hospital of special security: a pilot project.

Within secure psychiatric hospitals, staff have to manage many difficult and challenging situations. Crichton (1997) suggested that when staff perceive a greater degree of responsibility on patients for their actions there is a particularly morally censorious response. The aim of this pilot study was to discover if this association, discovered using a hypothetical scenario, was also present in how nursing staff respond to real violent patient behaviour. Over a five week period all episodes of inter-personal violence in a hospital with special security were identified and those involved interviewed. Thirty-one episodes of inter-personal violence were identified. A disproportionate number were caused by female patients and patients detained under civil sections of mental health legislation. A personality disorder diagnosis and the staff belief that mental disorder did not reduce the individual patient's blame for the incident were associated with the response of a restrictive sanction (both cases p < 0.01).

Attitude of Health Personnel↗
PubMed2000

A randomized field trial in Oakland, California.

This study evaluates the impact of a civil remedy program (Beat Health) on drug and disorder problems under experimental field trial conditions. Using calls for service data, the authors find statistically significant differences between the control and experimental groups, when drug problem calls prior to the start of the intervention were compared to drug calls during a 12-month follow-up period. The Beat Health sites, especially the residential sites, improved relative to the control sites. By contrast, the control treatment (patrol response) led to significant increases in drug problems, particularly at the commercial properties included in this study. The authors also examined the spatial influences of the Beat Health and patrol responses in catchment areas surrounding each of the 100 study sites. The results show some improvement in the experimental residential sites. The authors found, however, a possible displacement of drug problems in and around both the commercial experimental and control sites. They show that the displacement effect is most notable in the commercial control sites.

California↗
PubMed2001

Poor Beard!! Charcot's internationalization of neurasthenia, the "American disease".

OBJECTIVE: To analyze the role of the seminal 19th-century neurologist, Jean-Martin Charcot, in the internationalization of neurasthenia, previously known as "the American disease." BACKGROUND: The New York neurologist, George Beard, first described neurasthenia in 1869 and considered it a disorder related to the particular stress of modern civilization, most typified in the United States. METHODS: Charcot's personal files on neurasthenia from the Bibliothèque Charcot, Salpêtrière Hospital, Paris, were studied and his teaching lessons and lectures were examined. RESULTS: Charcot presented numerous cases of neurasthenia, always crediting Beard with the original name and description. Calling Beard's 1880 work a "remarkable monograph," Charcot emphasized that patients with neurasthenia also comprised the bulk of his own private practice. Focusing on the signs of sexual impotency, fatigue, and a tight band of pressure around the head, Charcot categorically distinguished patients with neurasthenica from patients with hysteria. Like Beard, Charcot concluded that the origin of neurasthenia was psychological stress and felt the European society also fostered the environment to precipitate the disease. Charcot adamantly opposed extrapolations that called for early childhood educational reforms to reduce current classroom stress. Charcot sympathized more with the treating physician than the patient, calling neurasthenics insufferable (insupportables). On the front sheet of his neurasthenia file, he wrote in large script, "Poor Beard!!" CONCLUSION: By emphasizing the prevalence of neurasthenia and extending Beard's observations, Charcot internationally legitimized the new diagnosis. Adding neurasthenia to the other neurologic descriptions from the United States by Hammond, Mitchell, and Dana, Charcot helped to foster the recognition of the American Neurologic School.

France↗