Discrimination against offenders with mental disorder.

BACKGROUND: Mentally disordered offenders may suffer discrimination on the basis of mental disorder, or on the basis of being offenders, or both. AIMS: The aim of this paper is to outline a framework for examining discrimination affecting mentally disordered offenders. It is argued that there should be systematic comparisons between offenders with mental disorder and nonoffenders with mental disorder in order to identify and characterise specific failures to ensure equivalence of mental health care; and systematic comparisons between offenders with mental disorder and offenders without mental disorder in order to identify how mental disorder may constitute a barrier to forms of support and constructive intervention available to other offenders. METHODS: A critical review was conducted of official documents presenting criminal justice and mental health policy for England and Wales, principally since 2012, together with reports of inspectorate and oversight bodies and relevant research studies. FINDINGS: There is evidence that offenders with mental disorder may not be able to access mental health care equivalent to that for nonoffenders with mental disorder. There is also evidence that they may not be able to access interventions available to other offenders. Further disadvantage may arise in the criminal courts since, in England and Wales, if inpatient care is required, the powers of criminal courts to effect hospital admission under Part III of mental health legislation are weakened by the statutory requirement of information that places are available. This is discriminatory against offenders with mental disorder insofar as forms of court disposal for other offenders are not prevented by the capacity of criminal justice agencies. CONCLUSIONS AND IMPLICATIONS: The review supports the need for systematic comparisons to identify forms of disadvantage and discrimination experienced by mentally disordered offenders in relation to both mental health and criminal justice policies services.

Forensic psychiatry and public protection.

The prominence of risk in UK social and criminal justice policy creates opportunities, challenges and dangers for forensic psychiatry. The future standing of the specialty will depend not only on the practical utility of its responses to those opportunities and challenges, but also the ethical integrity of those responses.

Cross-cultural clinical judgment bias in personality disorder diagnosis by forensic psychiatrists in the UK: a case-vignette study.

Previous research in the UK has suggested that cross-cultural bias in personality disorder diagnosis might partly account for the smaller proportion of Black, relative to White, patients with personality disorder in secure psychiatric hospitals. Using the case-vignette method, we investigated cross-cultural clinical judgment bias in the diagnosis of personality disorder in African Caribbean men by 220 forensic psychiatrists in the UK. In the vignette describing possible DSM-IV antisocial personality disorder, Caucasians were 2.8 times more likely to be given a diagnosis of personality disorder than African Caribbeans. Diagnosis also varied according to the ethnicity of the clinicians. No cross-cultural bias was found in the vignette describing possible DSM-IV borderline personality disorder. These findings are important in relation to recent policies for offenders and others with personality disorder, and to the current focus on delivering race equality in mental health services in the UK. Ongoing debates about the strengths and limitations of the case-vignette method are also discussed.

Forensic psychiatry and political controversy.

This article gives a U.K.-based perspective on the involvement of forensic psychiatry organizations in questions of political controversy. Medical professional bodies are fundamentally concerned to uphold good standards of clinical practice and patient welfare, and to uphold professional medical ethics. In our specialty, when acting as individual expert witnesses, we seek to serve the courts with objectivity and respect for the law. However, as members of our professional bodies we have a legitimate medical concern about how the law affects the mentally disordered as a class. We should articulate a collective view about what treating the mentally disordered justly and appropriately in the legal system means and should challenge the law when it fails to achieve this.