Cessation of dangerousness status: an analysis of 224 reports from the Instituto de Perícias Heitor Carrilho, Rio de Janeiro, Brazil

Objectives: To evaluate factors related to dangerousness cessation at the end of involuntary commitment based on an analysis of expert reports. In light of the current legal requirement of dangerousness cessation as a pre-requisite for prison or internment release of individuals subjected to the safety measure, we sought elements to reflect on the practice of expert examiners in charge of making this decision. Methods: The authors revised 224 expert psychiatric dangerousness cessation reports released 2011 through 2014 and collected data for a statistical analysis. Results: The following variables were associated with positive risk cessation assessments: no inadequate behavior (according to the assistant professionals), no productive psychotic symptoms, no negative symptoms, presence of insight, presence of a support network, and no psychoactive substance abuse. The following variables were associated with negative dangerousness cessation decisions: early onset of malfunction, lack of insight, negative attitudes, active signs of major mental illness, presence of impulsiveness, poor response to treatment, presence of plans lacking feasibility, exposure to destabilizing factors, lack of personal support, and presence of stress. Conclusions: In this study we were able to identify factors associated with dangerousness in a sample of expert reports. The knowledge of factors linked to a higher risk of recidivism in illegal activities or violent behavior is crucial for decision-making regarding the release of offenders after their legally established period of involuntary commitment.

O (des)preparo do hospital judiciário para a ressocialização: violação de direitos humanos / The (un)preparation of the judiciary hospital for resocialization: violation of human rights

Objective: To analyze the hospital's capacity of custody and treatment for resocialization of patients with psychic disorders, under security measure. Methods: An empirical, qualitative, interpretive and cross-sectional study was carried out in a hospital of custody and treatment (HCT) of a city in the southeast region of Minas Gerais, Brazil, with 22 administrative, health e security workers, through an interview with a semi-structured instrument and non-participant observation. Data were submitted to Content Analysis and presented in the categories: the hospital of custody and treatment: therapeutic space, in fact?; the HCT as a place of segregation and punishment; and the in(ability) of the legal mental hospitals for resocialization. Results: Some professionals considered the hospital as a treatment space, while others considered it an instrument of punishment. However, the punitive nature of the interventions predominated. From the perspective of the participants, the hospital does not promote the resocialization. Conclusion: In the hospital there are no treatments that attend to the uniqueness of the patients who were under safety measure, therefore, they are not prepared to return to the social life, as it happens in prisons. The institution does not promote the resocialization of the patients.

Objetivo: Analizar la capacidad del hospital de custodia y tratamiento para la resocialización de los pacientes con trastornos mentales en medida de seguridad. Métodos: Estudio empírico, cualitativo, interpretativo y transversal, desarrollado en el Hospital de Custodia y Tratamiento de un municipio del Sudeste de Minas Gerais, Brasil, con 22 trabajadores administrativos, de salud e de seguridad, por medio de entrevista semiestructurada y observación no participante. Los datos fueron sometidos al Análisis de Contenido y presentado en las categorías: Hospital de custodia y tratamiento: espacio terapéutico, de hecho?; El HCT como espacio de segregación y punición; e in(capacidad) del manicomio judicial para la rehabilitación. Resultados: Algunos profesores consideraron el hospital como espacio de tratamiento, otros, instrumento de punición. Para los participantes, no se promueve una resocialización. Conclusión: No hay hospitales que atiendan a la singularidad de los pacientes en medida de seguridad. La institución no promueve una resocialización de los pacientes.

Objetivo: Analisar a capacidade do hospital de custódia e tratamento para a ressocialização de pacientes com transtornos psíquicos, em medida de segurança. Métodos: Estudo empírico, qualitativo, interpretativo e transversal, desenvolvido em um Hospital de custódia e tratamento de um município da região Sudeste de Minas Gerais, Brasil, com 22 trabalhadores administrativos, da saúde e de segurança, por meio de entrevista com instrumento semiestruturado e observação não participante. Os dados foram submetidos à análise de conteúdo e apresentados nas categorias: o hospital de custódia e tratamento: espaço terapêutico, de fato?; o HCT como lugar de segregação e punição; e a in (capacidade) do manicômio judiciário para a ressocialização. Resultados: Alguns profissionais consideraram o hospital como espaço de tratamento, enquanto outros o consideraram instrumento de punição. No entanto, predominou o caráter punitivo das intervenções. Na perspectiva dos participantes, o hospital não promove a ressocialização. Conclusão: No hospital não há tratamentos que atendam à singularidade dos pacientes que estavam em medida de segurança, portanto, estes não são preparados para retornar ao convívio social, assim como ocorre nos presídios. A instituição não investe na ressocialização de seus pacientes.

Comentarios de la psiquiatría forense al concepto de inimputabilidad en Colombia / Comments forensic psychiatry the concept of criminal responsibility in Colombia

Este artículo de reflexión presenta los aspectos relevantes de la figura jurídica de la inimputabilidad, desde el punto de vista de la psiquiatría forense con base en el análisis de la legislación penal colombiana al respecto. Se define el concepto de imputabilidad, se muestran las asociaciones jurídicas psiquiátricas forenses que se correlacionan con los hallazgos psicopatológicos más frecuentes, que determinan la defensa por insania mental, a la luz del nuevo sistema penal acusatorio en Colombia. Luego se discuten las medidas de seguridad asignadas a los enfermos mentales nominados insanos mentales e inimputables.

This reflection paper presents relevant aspects of the legal concept of Mental Insanity Defense, from the viewpoint of forensic psychiatry, based on the analysis of the Colombian criminal legislation in this regard. As an introduction examples of the concept of criminal responsibility in regulation of some countries and legal aspects are showed and discussed. The concept of liability is defined; forensic psychiatric legal associations correlated to the most frequent psychopathological findings are showed and it is explained that they determine the mental insanity defense in light of the new accusatory penal system in Colombia. Then, we discuss the security measures assigned to mentally ills, named mentally ills or insanes.

La inimputabiliaad: concepto y alcance en el código penal Colombiano / The Insanity: Defense Concept in the Colombian Penal Code

Desde la antigüedad el legislador ha considerado los aspectos subjetivos del autor de un hecho ilícito en el momento de juzgarlo. La historia del derecho penal es rica en ejemplos que ilustran las diferentes concepciones acerca del influjo de los estados mentales en la comisión de hechos delictivos, y muestra la forma como el trastornado mental se sustraía del tratamiento penal ordinario previsto para los sujetos normales. A medida que se fue desarrollando la teoría del delito se fueron incorporando figuras jurídicas específicas referentes al inimputable y a la inimputabilidad. En el ordenamiento penal colombiano los estados de trastorno mental e inmadurez psicológica permiten inferir inimputabilidad si se cumplen los presupuestos generales de incapacidad para comprender la ilicitud o de determinarse de acuerdo con esa comprensión, al momento de cometer un ilícito. Desde el punto de vista jurídico, trastorno mental es toda condición médico-psicológica que afecte decisivamente las esferas cognoscitiva y volitiva del sujeto. La inimputabilidad surge cuando el sujeto no está en capacidad de entender la naturaleza de su acto o de determinar su conducta, a causa de trastorno mental o inmadurez psicológica. La diversidad sociocultural puede, asimismo, dar lugar a la calificación de inimputabilidad. La imputabilidad, al contrario, presupone culpabilidad y ésta se asienta en el conocimiento del acto y la libre determinación de ejecutarlo o no. Los sujetos declarados como inimputables reciben medidas de seguridad.

Dating from antiquity the legislator, when judging an illicit act, has considered the subjective aspects of the perpetrator. The history of criminal justice is rich in examples that illustrate different conceptions about the influence of mental states in the perpetration of criminal acts and shows the ways in which the mentally deranged avoided ordinary punishment destined for normal subjects. As crime theory developed, legal figures referring specifically to insanity were incorporated. In the Colombian penal code the states of mental disorder and psychological immaturity allow for insanity to be inferred if at the time of committing an illicit act, the general conditions of incapacity to understand the illicitness or to determine oneself according to this understanding, are met. From a legal point of view, mental disorder is any medical or psychological condition that decisively affect the cognitive and volitional spheres of the subject. Insanity arises when the subject is not in capacity of understanding the nature of his acts or to determine his conduct, due to mental disorder or psychological immaturity. Sociocultural diversity can also give rise to the qualification of insanity. The opposite of insanity supposes culpability that is based on the knowledge of the act and the free determination to execute it or not. Persons declared insane receive safety measures.

Visión psicoanaíítica del trastorno mental frene a otras condiciones psicológiicas en el código penal Colombiano / Mental Disorder versus Other Psychological Conditions in the Colombian Penal Code

La psiquiatría forense puede ayudar a la justicia, en materia penal, en dictámenes distintos al de la inimputabilidad. Así, miedo insuperable, temor intenso, ira e intenso dolor y otros tantos términos traídos desde la psicología por el derecho, para atenuar la pena de la persona imputada, pueden ser entendidos y explicados por el perito. En este artículo se intentan abrir otras posibilidades a la mente de los juzgadores, los investigados y sus apoderados.

Forensic psychiatry can be of assistance to criminal justice in other matters besides insanity defense. Insurmountable fear, intense fear, wrath and intense pain and so many other terms brought from psychology by the lawyer, to attenuate the conviction of the accused, can be understood and explained by the expert. The purpose of this paper is to disclose other possibilities to the minds of judges, those investigated and their attorneys.

Inimputabilida yy riesgo de violencia / Insanity and the Risk of Violence

En este artículo se presenta un reporte de caso de inimputabilidad en relación con el delito de lesiones personales. El paciente se encuentra interno bajo medida de seguridad en una clínica privada. En este caso, la estimación del riesgo de violencia ha permitido que el individuo se integre progresivamente al medio social. A partir del caso, se analiza cuán difícil es evaluar el riesgo de violencia, sobre todo cuando dicha acción, en algunos casos, no sólo está en manos de los psiquiatras forenses, sino en los psiquiatras generales. La bibliografía existente, en su mayoría, procede del ámbito legal, donde aplica a pacientes que han cometido un delito; de ahí la necesidad de definir el riesgo de que el evento violento se vuelva a presentar.

This paper presents a case report of insanity defense in relation to the crime of personal injuries. The patient is interned under safety measures in a private clinic. Estimation of the risk of violence in this case, has allowed the individual to integrate progressively with the social milieu. The evaluation of the risk of violence is a difficult task that is not exclusive of forensic psychiatrists, since on occasions it must also be done by general psychiatrists. The majority of the existing literature comes from the legal arena, where it applies to patients who have previously committed a crime and is necessary to define the risk of the violent event presenting again.