Forensic Psychiatry 2nd Edition

Visit the link below to download the full version of this book:

https://medipdf.com/product/forensic-psychiatry-2nd-edition/

Click Download Now

OXFORD SPECIALIST
HANDBOOK OF

Forensic Psychiatry
SECOND EDITION

Nigel Eastman
Emeritus Professor of Law and Ethics in Psychiatry
St George’s, University of London
Honorary Consultant Forensic Psychiatrist
South West London & St George’s Mental Health NHS Trust

Gwen Adshead
Consultant Forensic Psychiatrist and Psychotherapist
Broadmoor Hospital

Simone Fox
Consultant Clinical and Forensic Psychologist
South London and Maudsley NHS Foundation Trust

Richard Latham
Consultant Forensic Psychiatrist
East London NHS Foundation Trust

Seán Whyte
Consultant Forensic Psychiatrist and Clinical Director
South-West London & St George’s Mental Health NHS Trust
Visiting Senior Lecturer, Institute of Psychiatry, Psychology &
Neuroscience, King’s College London

Hannah Kate Williams

Specialty Registrar in Forensic Psychiatry & Medical Psychotherapy
South-​West London & St George’s Mental Health NHS Trust
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Oxford University Press 2023
The moral rights of the authors have been asserted
First Edition published in 2020
Second Edition published in 2023
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by licence or under terms agreed with the appropriate reprographics
rights organization. Enquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above
You must not circulate this work in any other form
and you must impose this same condition on any acquirer
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America
British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number is on file at the Library of Congress
ISBN 978–​0–​19–​882558–​6
DOI: 10.1093/​med/​9780198825586.001.0001
Printed in the UK by
Ashford Colour Press Ltd, Gosport, Hampshire
Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
the product information and clinical procedures with the most up-​to-​date
published product information and data sheets provided by the manufacturers
and the most recent codes of conduct and safety regulations. The authors and
the publishers do not accept responsibility or legal liability for any errors in the
text or for the misuse or misapplication of material in this work. Except where
otherwise stated, drug dosages and recommendations are for the non-​pregnant
adult who is not breast-​feeding
Links to third party websites are provided by Oxford in good faith and
for information only. Oxford disclaims any responsibility for the materials
contained in any third party website referenced in this work.
 Professor Nigel Eastman died unexpectedly in February 2022, while this work
was still in press. Prof. Eastman was a passionate and dedicated educator, and
his publications are a testimony to that passion, and the culmination of a life-
time of study, clinical practice and research. This book would not exist without
him and it is with both sadness and respect that we, his co-​authors and editors,
dedicate this book to him, as a posthumous thank you for the enthusiasm,
intellect and generosity that made it possible.

As for the first edition, this book is dedicated to the late Dr James
MacKeith, a compassionate forensic psychiatrist who dedicated his wisdom
and integrity to both the care of his patients and properly informing legal
process
 vii

Preface
The preface to the first edition of the handbook offered justification for ad-
dressing its ‘psychiatry and law interface’, alongside clinical forensic psych-
iatry, based upon the fact that UK practice of forensic psychiatry had, by
2012, substantially moved on from its largely clinical service roots. So that
‘forensic psychiatry’ had become, and now firmly is, concerned with both
the clinical discipline of assessing and treating mentally disordered offenders
and the meeting of law and all psychiatry, within the academic discipline
of ‘psycho-​legal studies’. Hence, now a significant proportion of higher
trainee forensic psychiatrists not only train in their clinical speciality but also
undertake some form of legal training, most commonly an LLM in Mental
Health Law; based upon recognition that clinical forensic psychiatry cannot
be practised effectively, or ethically, without a real understanding of how
psychiatry and law relate to one to the other (and often ‘don’t’). Whilst
some higher training schemes have developed ‘psycho-​legal workshops’,
which aim to offer ‘quasi experience’ at the interface between clinical psych-
iatry and law. And, most notably, the GMC New Curriculum for Forensic
Psychiatry includes the express requirement for forensic trainees (surely
also seniors) of gaining both ‘knowledge’ of a wide range of relevant law
and also ‘capabilities’ that are not only clinical but also ‘clinico-​legal’.
This second edition of the handbook is published alongside its companion
volume, the Oxford Casebook of Forensic Psychiatry. This offers a wide range
of ‘case problems’ across both ‘clinical forensic psychiatry’ and ‘law and
psychiatry’, as well as some related separate advisory text on ‘decision-​
making techniques’ and ‘critiquing paradigms for decisions taken’; with cross
referencing into this new edition of the handbook to enable the reader to
find information relevant to each case. It is also presented in a fashion that
allows for psychiatrists from other Commonwealth common law jurisdic-
tions to import their own particular law into the cases.
The necessity of understanding ‘law and psychiatry’ is not limited to
those who practice the designated speciality of forensic psychiatry. It ap-
plies to all psychiatrists who are regulated by, operate within, or make use
of law. And this is emphasised by the advancing scope and complexity of
mental health and mental capacity legislation, and their interface; making
increasingly ‘technical’ satisfying the duty of all psychiatrists not only to treat
their patients well clinically but also to pay proper regard to their civil rights.
The three domestic jurisdictions, plus the RoI, reflect each nation’s different
emphasis on individual freedom, paternalism, legalism, and public protec-
tion. So that, whilst their various mental health laws remain true to many of
the principles of the first very early Mental Health Acts, particularly medical
dominance within the legal process, the details have diverged in the four
jurisdictions. So that we lay out a detailed comparison of each of the four
jurisdiction’s law in regard to treatment of both mental and physical condi-
tions; including for Northern Ireland the new ‘fusion’ legislation expressed
by the MCA(NI) Act 2016, due soon to come into force. Notably, the UK
viii Preface

government has very recently published, post the Wessely Review, a White
Paper for its intended new Mental Health Act for England and Wales.
It is also not possible for criminal lawyers effectively to represent or pros-
ecute someone with a mental disorder, or for any civil lawyer to deal prop-
erly with a litigant in any legal context involving psychiatric evidence, without
a real understanding of both the nature of psychiatry and of its interface
with law. Hence, this handbook remains distinct from others in the OUP
series in addressing not one discipline but two, and the relationship between
them. As such it is intended therefore not only for trainees and senior prac-
titioners in forensic psychiatry, indeed all psychiatry, but also for all lawyers
who need to understand psychiatric concepts and thinking, and how they
relate to law and legal process.
The justification for a second edition of the handbook lies not only in its
‘companion’ relationship with the Oxford Casebook but also in the substan-
tial legal, research, clinical, and service developments that have occurred
since publication of the first edition.
The first edition was published very soon after the partial defences to
murder had been reformed in England and Wales, based upon the recom-
mendation of Law Commission that particularly ‘diminished responsibility’
should be made much more congruent with psychiatry. With the implica-
tion also that there should be less room for jury decision-​making not prop-
erly underpinned by expert evidence. However, in a number of important
cases the Court of Appeal has been highly resistant to this change, and
effectively has dragged the law back towards its perhaps natural, and more
comfortable, incongruence with medicine, expressed in reiteration of the
traditional ‘primacy’, even ‘exclusivity’, of the jury, so as to render the prac-
tical impact of the reform minimal. We also further describe developments
in the law of insanity, automatism, and intoxication, as well as in regard to
‘joint enterprise’; with an update also on the law of self-​defence in Irish law.
And there is new law in England and Wales on both ‘coercive control’ and
‘slavery’. We have also updated our treatment of safeguarding in light of its
new statutory basis. In regard to civil rights, there is new law on ‘deprivation
of liberty safeguards’, and the boundary between applying the MHA and
MCA, and on Article 2 of the ECHR, plus further developed extradition
case law. We also now give law relating to the regulation of medical prac-
tice, including expert witness practice, enhanced space.
The Sentencing Council helpfully published in 2020 Sentencing Offenders
with Mental Disorders, Developmental Disorders, or Neurological Impairments.
Although this emphasises ‘culpability’ over ‘safety’, including perhaps
privileging ‘hybrid orders’ over ‘hospital orders’. The Guidance not only re-
quires expert witnesses to offer reports written in its terms, but also pre-
sents ethical challenges to such experts. It also has potential implications
for services.
In line with our intention to render both the handbook and the case-
book further applicable to non-​ UK common law jurisdictions in the
Commonwealth, this edition also deals with the death-​penalty and related
capital jurisdiction practice.
Relevant epidemiological knowledge has advanced a good deal since the
first edition was published, particularly expressed through a number of
 Preface ix

well-​designed systematic reviews which allow us to be better able to quan-

tify the magnitude by which various mental disorders affect the risk of vio-
lence, and, perhaps more importantly, to examine hypotheses about how
much other factors such as socioeconomic status, family environment, and
substance misuse do (or do not) explain away increased risks of violence
for some mental disorders. For this reason, the clinical pages have changed
substantially, with updated epidemiological data and with many questions
posed in the first edition now answered, on occasion leading to new under-
standing that contradicts what was common understanding at the time of
publication of the first edition. We have also included reference to recent
research about the effectiveness of various treatment programmes dis-
cussed in the first edition, for example sex offender programmes, whilst
highlighting some gaps upon which the next generation of researchers might
focus their efforts. Forensic psychotherapy was inadequately dealt with in
the first edition, and we hope that we have now rectified this.
Clinically we have enhanced our treatment, in relation to offending, of
developmental disorders, including autism, ADHD, and intellectual dis-
ability; neuroscience; dementia; traumatic brain injury; genetic disorders;
and sexsomnias. We have also included more about marginalised groups,
with new pages on ethnicity, transgender issues, and old age psychiatry
within forensic psychiatry. Of particular importance, we have now given
more space to physical health in secure forensic settings, given the vexed
problem of weighing risk management against causing iatrogenic disease.
Whilst we have brought together and updated topics previously scattered
throughout the first edition. We also have added new topics, including ‘rad-
icalisation’ and its relationship with mental disorder (if any), given expansion
of the government’s Prevent and Channel anti-​radicalisation programmes
into health and social services; plus new drugs of misuse, including ‘legal
highs’; and ‘gangs’.
The issue of ‘integrated’ versus ‘parallel’ service provision has now
largely been settled in favour of extending specialist service provision into
the community (perhaps logically so, in that assessing and managing risk is
the more difficult in that context). Alongside some geographically prox-
imate comprehensive forensic mental health services seeking efficiencies
and economies of scale by forming ‘service partnerships’. Whilst, in regard
to the issue of ‘prison versus hospital’ service provision for offenders with
severe personality disorder, DSPD within hospital has been abandoned, in
favour of an OPD pathway favouring prison, with some medium secure
and very limited high secure provision. We have also now included infor-
mation about new assessment tools, both in regard to appropriate secure
placement of patients and in regard to sexual offenders with intellectual
disability.
As regards diagnostic aids, DSM-​IV has become -​5, and ICD has become
11, and we of have course taken account of this. Although, to economise
on space, this edition now refers the reader to those volumes, or to the
Handbook of General Psychiatry, for detailed description of categories, ra-
ther than reproducing them within the handbook. Both DSM-5 and ICD11
are referred to in the book, but with a focus primarily on DSM-5.
x Preface

We hope that this new edition of the handbook will make a further con-
tribution to enhanced understanding and enjoyment of the ethical practice
of forensic psychiatry, and to the practice of lawyers who have to deal with
mentally disordered individuals subject to criminal or civil law.
NE
GA
SF
RL
SW
HKW
London
August 2021
 xi

Acknowledgements
In compiling and writing this handbook we have benefited from the hard
work and good advice of a considerable number of our colleagues and
friends, and from the support of our families and employers. We would like
to thank in particular the following psychiatrists, psychologists, barristers,
solicitors, judges, academics, and other colleagues for their support and for
giving of their time so freely to comment upon drafts of parts of the hand-
book, and to suggest corrections and improvements:
Dr Ali Ajaz
Ms Jo Bownas
Dr Bee Brockman
Mr Michael Botham
Mr Chris Butterfield
Dr Bernard Chin
Ms Emma Chandra
Prof John Crichton
Dr Hannah Crisford
Dr Rachel Daly
Prof Kimberlie Dean
Dr Mayura Deshpande
Dr Claire Dimond
Dr Bridget Dolan QC
Ms Lorna Downing
Dr Simon Duff
Ms Mhairi Fleming
Dr Alasdair Forrest
Dr Rachel Gibbons
Dr Emily Glorney
Dr Adrian Grounds
Prof Gisli Gudjonsson
Dr Az Hakeem
Dr Nick Hallett
Ms Stephanie Harrison QC
Mr Anthony Haycroft
Dr Eleanor Hind
Dr Nick Hindley
Ms Julia Houston
Prof Harry Kennedy
Prof Michael Kopelman
Dr Sanya Krijes
Ms Julia Krish
Dr Tina Irani
Dr Sarah Mackenzie Ross
Ms Heldi McCaskill
Prof Amina Memon
Prof Gill Mezey
xii acknowledgements

Dr Anna Motz
Dr Catherine Penny
Prof Derek Perkins
Dr Danny Riordan
Mr Mark Simpson
Dr Andrew Smith
Dr Huw Stone
Dr Derek Tracey
Prof Birgit Völlm
Ms Connie Wernham
Mrs Lisa Whyte
Mr Brian Williams
Dr David Alun Williams
Prof Huw Williams
We would also like to thank trainees from the South London Higher Training
Scheme in Forensic Psychiatry who read some parts of the handbook
alongside ‘test-using’ cases in the companion Oxford Casebook of Forensic
Psychiatry; also Rachel Goldsworthy, Lauren Tiley, and Pete Stevenson at
OUP for their advice, support, patience, and hospitality.
 xiii

Contents

Abbreviations xv

Part I Introduction to the handbook

1 Introduction to the handbook 3

Part II Clinical forensic psychiatry

2 Clinical and social aspects of crime 19
3 Mental disorders in forensic psychiatry 71
4 Assessment in forensic psychiatry 121
5 Risk assessment 163
6 Treatment 181
7 Risk management 237
8 Forensic psychiatric services 255

Part III The ethics of forensic psychiatry

9 Ethical decision-​making 281
10 Professional duties and personal integrity 293
11 Conflicting ethical values 311
12 Clinical matters raising ethical issues 327

Part IV Law relevant to psychiatry

13 The interface between psychiatry and law 351
14 Legal systems 361
15 Criminal law 397
16 Mental health and mental capacity law 461
17 Civil law 547
 xiv Contents

Part V Psychiatry within the legal system0

565 18 The criminal justice system
601 19 Legal tests relevant to psychiatry
651 20 The psychiatrist in court
661 21 Applied ethics and testimony
677 22 Providing reports
711 23 Giving evidence

Part VI Appendices
731 Appendices

Index 789
 xv

Abbreviations
5HT 5-​Hydroxy Tryptamine (also BPD Borderline Personality
known as serotonin) Disorder
AA Alcoholics Anonymous BPSD Behavioural and Psychological
ABC Antecedents, Behaviours, Symptoms of Dementia
Consequences CAF Common Assessment
ABH Actual Bodily Harm Framework
ABI Acquired Brain Injury CAMHS Child & Adolescent Mental
Health Services
AC Approved Clinician (E&W)
CARATS Counselling, Assessment,
ACCT Assessment, Care in Custody, Referral, Advice, and
and Teamwork Throughcare Services
ACE Adverse Childhood CAT Cognitive Analytic Therapy
Experiences
CBT Cognitive-​Behavioural Therapy
ACS Abel Cognitions Scale
CCE Child Criminal Exploitation
ADHD Attention Deficit Hyperactivity
Disorder CCG Clinical Commissioning Group
(England)
ADMCA Assisted Decision-​Making
(Capacity) Act 2015 (RoI) CCRC Criminal Cases Review
Commission (UK)
AMCP Approved Mental Capacity
Professional (E&W) CD Clinical Director/​Conditional
Discharge/​Conduct Disorder
AMHP Approved Mental Health
Professional (E&W) CE of the Common Era
(equivalent to AD, Anno
AMP Approved Medical Practitioner Domini)
(Scotland)
CFT Community Forensic Team
AOT Assertive Outreach Team
CHAT Comprehensive Health
AP Approved Premises Assessment Tool
APA American Psychiatric CID Criminal Investigation
Association Department
ART Aggression Replacement CJD Creutzfeld-​Jacob Disease
Training
CJS Criminal Justice System
ASBO Antisocial Behaviour Order
CLIA Criminal Law (Insanity) Act
ASD Autistic Spectrum Disorder 2006 (RoI)
ASPD Antisocial Personality Disorder CMHT Community Mental
ASR Annual Statutory Report Health Team
ASSET Assessment Tool (used CoP Court of Protection (E&W)
by YOTs) Coru ‘Fair’, the Health & Care
ASW Approved Social Worker (NI) Professional Regulator (RoI)
AWIA Adults With Incapacity CPA Care Programme Approach
(Scotland) Act 2000 (E&W), Continuing Power of
BAME Black, Asian, and Attorney (Scotland)
Minority Ethnic CPD Continuing Professional
BCE Before the Common Era Development
(equivalent to BC, Before CPN Community Psychiatric Nurse
Christ) CPS Crown Prosecution
BCS British Crime Survey Service (E&W)
BMI body mass index CPSA Criminal Procedure (Scotland)
Act 1995
xvi Abbreviations

CQC Care Quality Commission EPSE Extra-​pyramidal Side Effects

(England) EQUIP Equipping Peers to Help One
CRPD UN Convention on the Rights Another
of Persons with Disabilities ERASOR Estimate of Risk of Adolescent
CSA Child Sexual Abuse Sexual Offence Recidivism
CSE Child Sexual Exploitation ETS Enhanced Thinking Skills
CSO Community Support Officer EU European Union
CT Computed Tomography EUPD emotionally unstable
CTO Community (E&W)/​ personality disorder
Compulsory Treatment Order E&W England & Wales
(Scotland) EWO Education Welfare Officer
CU Callous-​Unemotional FASD Foetal Alcohol Spectrum
DA Dopamine, or Dopaminergic Disorder
DBS Deep Brain Stimulation FBI Federal Bureau of
DBT Dialectical Behaviour Therapy Investigation (US)
DHSC Department of Health & Social FCAMHS Forensic CAMHS
Care (E&W) FFT Functional Family Therapy
DoJ Department of Justice (RoI) FIPP Firesetting Intervention
DoL deprivation of liberty Programme for Prisoners
DoLS Deprivation of Liberty FME Forensic Medical Examiner
Safeguards (E&W) (formerly known as police
surgeon)
DMP Designated Medical
Practitioner (Scotland) FMHU Forensic Mental Health Unit
DPP Director of Public fMRI Functional Magnetic
Prosecutions Resonance Imaging
DSM-​5 APA Diagnostic and Statistical FRQ Forensic Restrictiveness
Manual, 5th Edition Questionnaire
DSPD Dangerous & Severely FSH Follicle-​Stimulating Hormone
Personality Disordered FTTMH First Tier Tribunal (Mental
DTO Detention and Training Health) (E&W)
Order (E&W) GAD Generalised Anxiety Disorder
DVLA Driver and Vehicle Licensing GBH Grievous Bodily Harm
Agency (UK) GCS Glasgow Coma Scale
DVPO Domestic Violence Prevention GMC General Medical Council (UK)
Order (UK)
GnRH gonadotrophin releasing
ECG Electrocardiogram hormone
ECHR European Convention on GP General Practitioner
Human Rights & Fundamental
Freedoms GRC Gender Recognition
Certificate
ECtHR European Court of
Human Rights HCA Health Care Assistants
ECT Electroconvulsive Therapy HCP Health Care Professional
EDR Expected Date of Release HCPC Health & Care Professions
Council (UK)
EEG Electroencephalogram
HCPTS Health & Care Professions
EGVE Ending Gang Violence and Tribunal Service (UK)
Exploitation
HCR20 Historical, Clinical & Risk
EIS/​T Early Intervention (in Management 20-​Item Scale
psychosis) Service/​Team
HIW Healthcare Inspectorate Wales
EMDR Eye Movement Desensitisation
Reprogramming HLA human leukocyte antigen
EPA Enduring Power of HMP Her Majesty’s Prison
Attorney (RoI) HMPPS Her Majesty’s Prison and
Probation Services
 Abbreviations xvii

HMRC Her Majesty’s Revenue and LPS Liberty Protection

Customs Safeguards (E&W)
HoNOS Health of the Nation LREC Local Research Ethics
Outcome Scale Committee (UK)
HR Human Resources LSU Low Secure Unit
HSE Health Service Executive MACI Millon Adolescent Clinical
(Ireland) Inventory
IAPT Improving Access to MAO Monoamine Oxidase (MAOA,
Psychological Therapies type A; MAOB, type B)
ID Intellectual Disability MAPPA Multi-​Agency Public Protection
ICD11 WHO International Arrangements (E&W,
Classification of Diseases, 11th Scotland)
Edition MAPPP Multi-​Agency Public
ICJ International Court of Justice, Protection Panel
The Hague MARAC Multi-​Agency Risk Assessment
ICS Integrated Care System (UK)/​ Conferences
Indefinite Custodial Sentence MASH Multi-​Agency
(NI), Indeterminate Custodial Safeguarding Hub
Sentences MBT Mentalisation-​Based Therapy
IM Impression Management MC Medical Council (RoI)
IMCA Independent Mental Capacity MCA Mental Capacity Act
Advocate (E&W) 2005 (E&W)
IMHA Independent Mental Health MCANI Mental Capacity Act
Advocate (E&W) (Northern Ireland) 2016
IMR Inmate Medical Record (in MDO Mentally Disordered Offender
prison)
MDT multidisciplinary team
IPP Indeterminate sentence of
imprisonment for Public MHA Mental Health Act (E&W
Protection 1983; RoI 2001)
IPS Individual Placement and MHC Mental Health Commission
Support (NI, RoI)
IPT Interpersonal Therapy MHCTA Mental Health (Care and
Treatment) (Scotland)
IPV Intimate Partner Violence Act 2003
IQ Intelligence Quotient MHNIO Mental Health (Northern
IRA Irish Republican Army Ireland) Order 1986
IRMS Integrated Risk Management MHO Mental Health Officer
Services (Scotland; a social worker)
IRRMS Intensive Risk and MHRT Mental Health Review Tribunal
Rehabilitation Managements (NI, RoI)
Services MHT Mental Health Tribunal
ISSP Intensive Supervision and (Scotland)
Surveillance Programme MHU Mental Health Unit (of the
IT Information Technology Ministry of Justice, E&W)
JP Justice of the Peace MI Motivational Interviewing (or
LA Local Authority Mental Illness)
LALY Liberty-​Adjusted Life Year MoCA Model of Creative Ability
LD Learning Disability MoHO Model of Human Occupation
LED Licence Expiry Date MoJ Ministry of Justice
LH Luteinising Hormone MPCS MacArthur Perceived
Coercion Scale
LHB Local Health Board (Wales)
MPTS Medical Practitioners Tribunal
LPA Lasting Power of Service (UK)
Attorney (E&W)