Jill Peay

Mental Health Review Tribunals

This paper is concerned with the operation of the Mental Health Review Tribunal system and summarizes the findings of an empirical investigation of tribunal decision making. The tribunals constitute an independent body which reviews the necessity for the continued compulsory detention of patients in psychiatric hospitals. The research focuses on the interpretation and application of mental health legislation by individual tribunal members and the manner in which these individual approaches are qualified in the group context. The study comprises three stages: a self-report questionnaire, a national statistical analysis of decisions, and a simulation study of decision making using a videotape of a hypothetical case. The research establishes considerable inconsistency in tribunal decision making at both an individual and group level and attributes some of this inconsistency to individually based factors isolated by the research. The findings further indicate that these factors remain influential within the group decision-making context.

Mental health and crime

Does mental disorder cause crime? Does crime cause mental disorder? And if either of these could be proved to be true what consequences should stem for those who find themselves deemed mentally disordered offenders? Mental Health and Crime examines the nature of the relationship between mental disorder and crime. It concludes that the broad definition of what is an all too common human condition – mental disorder – and the widespread occurrence of an equally all too common human behaviour – that of offending – would make unlikely any definitive or easy answer to such questions. For those who offend in the context of mental disorder, many aspects of the criminal justice process, and of the disposals that follow, are adapted to take account of a relationship between mental disorder and crime. But if the very relationship is questionable, is the way in which we deal with such offenders discriminatory? Or is it perhaps to their benefit to be thought of as less responsible for their offending than fully culpable offenders? The book thus explores not only the nature of the relationship, but also the human rights and legal issues arising. It also looks at some of the permutations in the therapeutic process that can ensue when those with mental health problems are treated in the context of their offending behaviour.

Personality Disorder and the Law: Some Awkward Questions

This article raises five key problems for the law in its dealings with those with severe personality disorder. These problems are set in the context of a legislative agenda that has embraced the conflicting objectives of rehabilitation and incapacitation, while striving to improve treatment for those with severe personality disorder, and minimizing the risk that they are thought to pose to themselves or others. The problems are examined from the perspectives of legislators, realists, clinicians and courts, empiricists and, finally, normativists; in short, what should the law be doing in this arena? The article concludes by urging a cautionary adherence to issues of legal principle in preference to the, albeit starkly portrayed, alternatives: namely, the seductive attractions of therapeutic intervention, or the destructive effects of indeterminate containment.

Mental incapacity and criminal liability: redrawing the fault lines?

The proper boundaries of criminal liability with respect to those with questionable mental capacity are currently under review. In its deliberations in the areas of unfitness to plead, automatism and the special verdict of not guilty by reason of insanity the Law Commission for England and Wales have been cognizant of particular difficulties in fairly attributing criminal responsibility to those whose mental capacities may or may not have impinged on their decisions, either at the time of the offence or at trial. And they have referenced the potential breaches of the European Convention on Human Rights (ECHR) posed by the state of our current laws. However, in their efforts to remedy these potential deficiencies is the Law Commission heading in a direction that is fundamentally incompatible with the direction embodied by the United Nations Convention on the Rights of People with Disabilities (CRPD)? Whether one must cede sensibly to the other, or whether some compromise might emerge, perhaps through an extension of supportive services or through the development of disability-neutral criminal law, forms the subject of this paper.

Surviving psychiatry in an era of‘popular punitiveness’

In an era when sentencing of mentally disordered offenders has been progressively influenced by protective considerations, the role psychiatrists play in the sentencing process is problematic. Where an offenders legitimate expectation of proportionality in sentencing can be trumped by psychiatric assessments, not of therapeutic need, but of either predictions of risk or untreatability or both, leading to disproportionate and potentially damaging custodial sentences, then psychiatrists should recognize that they are ethically compromised.

Fitness to plead: development and validation of a standardised assessment instrument

The ability of an individual to participate in courtroom proceedings is assessed by clinicians using legal ‘fitness to plead’ criteria. Findings of ‘unfitness’ are so rare that there is considerable professional unease concerning the utility of the current subjective assessment process. As a result, mentally disordered defendants may be subjected unfairly to criminal trials. The Law Commission in England and Wales has proposed legal reform, as well as the utilisation of a defined psychiatric instrument to assist in fitness to plead assessments. Similar legal reforms are occurring in other jurisdictions. Our objective was to produce and validate a standardised assessment instrument of fitness to plead employing a filmed vignette of criminal proceedings. The instrument was developed in consultation with legal and clinical professionals, and was refined using standard item reduction methods in two initial rounds of testing (n = 212). The factorial structure, test-retest reliability and convergent validity of the resultant instrument were assessed in a further round (n = 160). As a result of this iterative process a 25-item scale was produced, with an underlying two-factor structure representing the foundational and decision-making abilities underpinning fitness to plead. The sub-scales demonstrate good internal consistency (factor 1: 0·76; factor 2: 0·65) and test-retest stability (0·7) as well as excellent convergent validity with scores of intelligence, executive function and mentalising abilities (p≤0·01 in all domains). Overall the standardised Fitness to Plead Assessment instrument has good psychometric properties. It has the potential to ensure that the significant numbers of mentally ill and cognitively impaired individuals who face trial are objectively assessed, and the courtroom process critically informed.

Care or Custody? Mentally Disordered Offenders in the Criminal Justice System

group members. Most participants I worked with previously could not see another way of being, because ‘You feel anger, don’t you’; they were liberated to experience anger positively and manage it appropriately and safely. The workshops will be a great asset to any rehabilitation programme as part of multi-disciplinary approaches. Nothing replaces experiential learning, a positive group life and the opportunity to be part of something that is vibrant, safe and a contribution to personal growth. The book has some monochrome photographs of the visual props used which are bold, witty and dynamic. It will be a valuable companion for staff who have the energy and experience to run an exciting group.