Educationals

Introduction

Legislation forms an important component in the implementation of mental healthcare. Legislation is an expression of society with regard to the way it views and cares for mentally ill individuals. It has long been known that there is a dynamic relationship between the concept of mental illness, the treatment of the mentally ill and the Law.

Forensic psychiatry is the branch of medicine that deals with disorders of the mind and their relation to legal principles. Forensic psychiatry continues to be concerned primarily with mentally disordered offenders but now encompasses a wide range of offences and gives much more prominence to diagnosis, management and treatment, in prison, hospital or the community, using the skills of various mental health professionals.

The development of this speciality has resulted in growing links with colleagues in other disciplines, the Law, criminology, psychology, sociology and many others. There is an increasing awareness regarding mental health in our population. Along with this comes an increasing involvement of psychiatry with the Law. Patients who require expert psychiatric opinion in the judiciary are:

• Those who may do harm to themselves or to society.
• Those who may not look after themselves, the welfare of their family or property.
• Those who may turn out to be dangerous if they act upon their abnormal thinking.
• Spouses of mentally ill patients may require psychiatrists' evidence in the court of law in the matter of divorce.

There is now increasing awareness of rights in our democratic set up which results in an increase in litigation. Civil rights movements and consumer protection councils are gaining more and more importance in our day-to-day life.

Hence mental health professionals should have a better understanding to the medico-legal aspects of mental health. The mental health professional should know the following basic forensic psychiatry

• Crime and psychiatric disorders.
• Criminal responsibility.
• Civil responsibility.
• Laws relating to psychiatric disorders.
• Admission procedures of patients in a psychiatric hospital.
• Civil rights of the patient.
• Psychiatrists and the Court.

Crime and psychiatric disorders

Traditionally criminality has been associated with mental illness, though there is no definite evidence. The studies of the relationship between dangerous behavior and mental disorders reveal that "there did seem to be a greater than chance association between mental, disorder and crime"

The frequency of the association between crime and mental illness depends on the sample being studied, which could be mental illness among criminal offenders, the history of criminal offences in psychiatric patients and correlation in community samples.

While some studies suggest a weak association, if any, between crime and mental illness (Rappoport et al. 1965,Hafner and Boker, 1982) assessment of frequency of a history of crime among psychiatrically ill has shown a consistent association at least in several of the offences. (Cohen, 1980,Sosowsky, 1980).

An analysis done by Walker and McCabe, (1973) of hospital order cases, showed that 41% of the count could be diagnosed as having schizophrenia, 35% mentally subnormality, 12% psychopathic disorder and 8% affective disorder (Gunn, 1977). It is to be understood that crime may not always be directly related to current psychopathology, other factors such as the personality structure and the social setting may be equally important.

Schizophrenia

In India some studies of mentally ill criminals show schizophrenia to be the commonest diagnosis (Sosmasundaram, 1960, Varma and Jha, 1966,Nambi, 1992). Schizophrenia was the commonest (74%) diagnosis among 58 Broadmoor patients who killed their relatives. Taylor, (1982) reviewing schizophrenia and violence came to the following conclusions:

• That schizophrenia disposes the patients to violence though the overall numbers are small.
• That paranoid and catatonic excitement are the subgroups most likely to be associated with violence.
• That the violence is more common as a late accompaniment of the illness.
• That the violence is more common in those patients who have recurrent exacerbations, rather than those who are continuously ill.
• That at the time of the offence the offender is generally psychotic and without insight.

Vivkkunen, (1974) found that only one-third offended directly as a result of their delusions and hallucinations. The remaining two-thirds offended because of problems arising from stress produced within the family.

In paranoid disorders criminal acts may follow from delusional belief. Paranoids are more hostile than normal or other subgroups of schizophrenia. A well recognised association is that of homicide associated with delusional jealousy.