The journal of the American Academy of Psychiatry and the Law
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J. Am. Acad. Psychiatry Law · Jan 2005
Multicenter Study Comparative StudyCapacity of forensic patients to consent to research: the use of the MacCAT-CR.
The ability of psychiatric patients and prisoners to provide informed consent to participate in clinical research has given rise to much debate. Forensic psychiatric patients present a particular concern regarding their competence to consent to research, as they are both patients and prisoners. The primary goal of this research was to evaluate whether, by employing structured assessments of capacity to consent to research, we could determine if this combined vulnerability leads to differences in competence from the published abilities of nonforensic psychiatric patients. ⋯ Psychiatric symptoms were modestly related to decision-making. Positive symptoms were associated with poorer performance on the Understanding subscale of the MacCAT-CR, and negative symptoms were associated with lowered performance on the Reasoning subscale. These results are in accord with several published studies of nonforensic psychiatric patients and suggest that concerns regarding both forensic and nonforensic psychiatric patients' ability to provide informed consent may be unwarranted, especially in patients with few active symptoms.
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J. Am. Acad. Psychiatry Law · Jan 2005
The use of the insanity defense as a jail diversion mechanism for mentally ill persons charged with misdemeanors.
Heightened awareness and concern regarding the large number of mentally ill misdemeanants in jails has led to a search for alternatives to jail and to the development nationwide of jail diversion programs for offenders with mental illness. Two such mechanisms-diversion to civil commitment and the use of mental health courts-are briefly reviewed. ⋯ Statistics regarding such use from 1978 to 2001 are provided. The authors compare and contrast this jail alternative with both mental health courts and diversion to civil commitment, and discuss questions related to the feasibility of larger-scale use of this mechanism.
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J. Am. Acad. Psychiatry Law · Jan 2004
Comparative StudyPatterns of spouse and child maltreatment by discharged U.S. Army soldiers.
The transitional compensation (TC) program of the U. S. Army provides financial and other benefits to the families of service members discharged for child or spouse maltreatment. ⋯ The severity of maltreatment in the ACR of TC child and spouse victims was greater than the overall severity of maltreatment for those in the ACR database who were not in the TC database. Other children in the family who had not been identified as TC victims also had an ACR history that was more severe. Health and social service agencies should be aware of the TC program and be knowledgeable about its benefits for family members of soldiers discharged for abuse-related offenses.