An analysis of arguments for the retention of the defence of mental impairment.

This article summarises the main arguments for the retention of the defence of mental impairment presented in an online debate that took place in August 2021. It canvases the justifications for the defence, rebuts human rights arguments for its abolition and outlines why there is a lack of viable alternatives. It concludes that advances in knowledge should lead to the reform of the defence rather than its abolition.

Fitness to Stand Trial: Contemporary Clinical Issues.

The assessment of fitness to stand trial in Australian jurisdictions has been grounded in the R v Presser criteria for more 60 years. However, a range of subsequent precedents has assisted expert witnesses to ensure that clinical assessments can inform the legal process more effectively, as have changes in legal process. Awareness of particularly vulnerable cohorts, and of contemporary approaches to disability, has led some jurisdictions to introduce supports for defendants.

Trauma-informed sentencing of serious violent offenders: an exploration of judicial dispositions with a gendered perspective.

Experience of psychological trauma is correlated with violent offending, with exposure reported for most offenders entering the criminal justice system. The practice of trauma-informed sentencing recognises this complex and consistent relationship, and endeavours to respond in a way that avoids re-traumatisation and reduces harm to offenders and victims. Trauma-informed approaches to offenders improve safety in custodial settings, enhance prospects of correctional rehabilitation and recovery from mental illness and promote the health and welfare of staff working with offenders.

Personality Disorder and Moral Culpability: Brown v The Queen.

The influential Victorian appellate judgment of R v Verdins [2007] VSCA 102 provided a sentencing framework for "impaired mental functioning" not only in Victoria but in other Australian jurisdictions. Following the judgment of Director of Public Prosecutions (Vic) v O'Neill (2015) 47 VR 395; [2015] VSCA 325, it appeared that personality disorders were not considered within the scope of the Verdins principles. In Brown v The Queen [2020] VSCA 212, the decision of the Victorian Court of Appeal broadened the potential for impaired mental functioning to include personality disorders as relevant to moral culpability.

Post-sentence Detention and Supervision: The Role of Multi-agency Panels.

Victoria's Complex Adult Victim Sex Offender Management Review Panel recommended that an independent body be established to manage high-risk offenders with input from multi-agency panels. The Panel's recommendations were influenced by the Multi-Agency Public Protection Arrangements that exist across the United Kingdom. This column compares the operation of the sole Multi-Agency Panel that has been established in Victoria with that of the Multi-Agency Public Protection Panels (MAPPPs) in Scotland and the Risk Assessment and Management Panels set up to combat family violence in Victoria.

The Extension of the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 to the Children's Court: Opportunities and Shortfalls.

In 2014, the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 in Victoria was extended to the Children's Court of Victoria. This article describes the processes that preceded this change and the changes that occurred. The potential opportunities consequent to the changes are described, with their corresponding ethical implications.

Covert and Implicit Influences on the Interpretation of Violence Risk Instruments.

Forensic mental health practitioners are frequently asked to estimate the risk of future violence. Legal decisions concerning the sentencing, management and disposition of offenders often rely on the advice of such testimony. The burgeoning use of violence risk instruments in these settings undoubtedly injects a level of scientific rigour into forensic evaluations for courts and tribunals.

Solitary Confinement: Going Down the Rabbit Hole.

For many years, solitary confinement has been a contentious correctional intervention. This column explores the evidence that solitary confinement harms mental health, and reviews some of the international and local perspectives on the practice. Recommendations are made to end solitary confinement, contending that this is to the benefit of prisoners and prisons, as well as the communities to which prisoners will return.

METHAMPHETAMINE: WHERE WILL THE STAMPEDE TAKE US?

Methamphetamine, particularly "ice", currently preoccupies the media and there are a range of government initiatives which seem to follow media interest. We summarise the progress of government attention, briefly review health concerns associated with methamphetamine use, and summarise the evidence for treatments, including psychosocial interventions and medications. Amid concerns that governments will seek to fund any promising initiative in order to be perceived as responding to an epidemic, we caution that existing treatments should not be abandoned in favour of untested but potentially attractive treatments.

Smoking bans in secure psychiatric hospitals and prisons.

The proposal of complete smoking bans in closed institutions, such as prisons and psychiatric hospitals, creates a tension between individual "rights" and the health of all members of that community. Smokers in closed institutions generally smoke more, suffer more health consequences and are less likely to quit than smokers in other settings. Complete smoking bans do not cause an increase in behavioural problems, nor do bans cause worsening of mental illness or quality of life.

Disorders, sublime menu: the DSM-5.

The release of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the culmination of a long and remarkably public discussion which was accompanied by a great deal of controversy. Diagnostic criteria for many disorders have changed, the structure of the DSM is different, and there remain significant concerns about the forensic application of the DSM. This column briefly covers the primary changes and summarises the debate about various diagnoses, with a particular focus on diagnoses of relevance to medico-legal psychiatry and the legal system.

Commentary: exploring hormonal influences on problem sexual behavior.

The conceptualization of sexual offending remains problematic and prey to fashion and enthusiasm. Progress can come only on the basis of sound research on the biological, social, and psychological associations to such offending. This study, though in some ways modest in its contribution, offers a model of the systematic approaches which offer the best chances of eventually understanding and managing sexual offending.

A new ball game: the United Nations Convention on the Rights of Persons with Disabilities and assumptions in care for people with dementia.

The United Nations Convention on the Rights of Persons with Disabilities is a powerful international instrument which imposes significant responsibilities on signatories. This column discusses changes in the definition of legal capacity which will have significant impacts on decision-making related to people with dementia. Various restrictions and limitations on personal freedoms are discussed in light of the Convention.

Managing risks of violence in a youth mental health service: a service model description.

Aim: There is a significant relationship between experiencing a severe mental illness, particularly psychosis, and exhibiting violent or offending behaviour. Reducing, if not preventing, the risks of violence among patients of mental health services is clinically warranted, but models to address this are limited.

Methods: We provide a rationale for, and service description of, a pilot forensic satellite clinic embedded within an early intervention service for patients with emerging psychosis, mood disorder and/or personality disorders.

Access to expensive anti-cancer drugs.

Expensive anti-cancer drugs expose controversy underlying the process for resource allocation decisions, and intermittently result in marked publicity, emotive discussions about access to novel and expensive treatments, and political involvement which may override existing processes. This column outlines the methods of determining whether or not a treatment is considered appropriate to fund, and focuses upon the evidence of patient and doctor wishes. The existing research illustrates the complexity of patient and oncologist decision-making when these drugs are to be considered.

Videoconferencing and forensic mental health in Australia.

Videoconferencing is in common use in Australian forensic mental health services. It provides opportunities to link remote prisons, courts, and psychiatric clinics with distant specialist services, and enables a range of activities including assessment, treatment and feedback, expert testimony, education, and inter-service planning. These functions are acceptable to patients and clinicians, and in Australia videoconferencing minimizes disruption to small services and their patients, who might otherwise face lengthy journeys.

The neuropsychiatry of Niemann-Pick type C disease in adulthood.

Psychotic symptoms occur in a variety of medical and neurological conditions. The authors describe three young men with a variant form of Niemann-Pick type C disease, a neurodegenerative disorder related to abnormal intracellular cholesterol metabolism, who presented with psychosis in early adulthood. Two patients were treated for schizophrenia for many years prior to a diagnosis of Niemann-Pick type C.

Teaching psychiatry in Ethiopia.

There is a pressing need to train psychiatrists in low- and middle-income countries. Psychiatrists from high-income countries have an opportunity to share expertise in teaching and assessing trainees, while learning much in the process. Three trainees from a London psychiatric hospital were invited to help organise a revision course for the Department of Psychiatry, Addis Ababa University, and this paper reports their experiences.

Legislation in Victoria on sexual offenders: issues for health professionals.

New legislation passed in Victoria (the Serious Sex Offenders Monitoring Act 2005) extends the role of doctors in managing and treating sex offenders. This legislation is not based on a solid understanding of the research evidence on treatment of sex offenders or on their risk of reoffending. The legislation creates ethical and professional dilemmas for health professionals through the conflation of legal control of offenders with the medical management of disorders of sexual preference.