Mental Health And Law
Mental health and law intersect in a multitude of ways. The two disciplines ought to constantly inform and transform one another.
For example, changes in the understanding of the etiology, clinical manifestation, treatment modalities, and rehabilitation of mental disorders necessitate changes in the way law views issues related to mental health. A simple illustration of how these findings have informed law is the change in the vocabulary in law, an example from insanity to mental disorder, from lunatic to a person with mental illness, or, for example, in the understanding of mental health conditions that may influence legal capacity totally or in a diminished manner.
Thus, the arena of mental health and law has been significantly broadened in the past few decades as compared to the conventional narrow understanding of forensic psychiatry. Traditionally, the primary concern was related to the criminal aspects of mental health, including the insanity plea, and could be extended at most to fitness to stand trial and testamentary capacity. Law is concerned with establishing mens rea and culpability and the mental health field is concerned with care and treatment.
Much of that has changed in recent times, and the intersection of these two disciplines has brought into focus the numerous ways law, psychiatry, psychology, and medicine interface. Thus, the field of mental health and law has become much more multidisciplinary. Of course, one needs to say in the same breath that in some countries with advanced legislations, the variety of ways in which mental health and illness have been understood, including biological, behavioral, psychodynamic and social, and the issues of jurisdiction has also led to a lot of confusion and impreciseness of what this area embraces.
Modern forensic psychiatry has benefited from four key developments: The evolution in the understanding and appreciation of the relationship between mental illness and criminality; the evolution of the legal tests to define legal insanity; the new methodologies for the treatment of mental conditions providing alternatives to custodial care; and the changes in attitudes and perceptions of mental illness among the public.
Thus, forensic psychiatry has broken free of the narrow confines of criminal responsibility to many other areas. Advances in neurosciences have helped in the understanding of the complex interplay among mind, brain, and behavior in health and disease and they need to play an important role in modern forensic psychiatric understanding.
Many new challenges emerge with respect to children in conflict with law. There are ethical issues unique to the forensic evaluation of children and adolescents. Often, forensic evaluation in this group requires a review of collateral informants. Areas of forensic evaluation of children and adolescents include delinquency, child custody, child maltreatment, personal injury, and other court-ordered and noncourt-ordered evaluations. It is also evident that there are high rates of mental disorders among elderly offenders. Thus, the developmental or lifespan approach which offers a more meaningful understanding of mental disorders at different phases in life will undoubtedly be relevant in forensic psychiatric practice.
This special supplement of the journal of the Indian Psychiatric Society brought out on the occasion of the conference of the International Academy of Law and Mental Health, Asia Pacific region, addresses some of the concerns of the present-day forensic psychiatry. The article by Fozdar highlights the importance of applying the current knowledge in neurosciences to the understanding and contemporary practice of forensic psychiatry.
Many of the older areas in forensic psychiatry still require revisiting. Hoge reviews the issue of competence to stand trial and Asokan reviews the insanity defense and related issues. Resnick reviews a rarely discussed but disturbing issue within forensic psychiatry – filicide.
In contemporary times, human rights of the mentally ill are a ubiquitous concern, globally as well as in India, and Kelly discusses the various aspects that require to be addressed. Ethics and human rights are often entwined and embrace several areas of investigation, practice, and training. Sidhu and Srinivasa Raghavan discuss the various aspects of ethics that are unique to psychiatric practice. Coercion can occur in a variety of settings and its various ramifications are discussed by Raveesh.
In India, human rights initiatives have seen positive changes in laws, policy, and practice. However, forensic psychiatric training is still in its embryonic state. Murthy et al. provide an overview of the laws related to mental health with an emphasis on how human rights concerns can be drivers of positive change. The authors also describe the needs of forensic psychiatric training. Nambi et al. provide a window into the past and a peek into the future with respect to the needs within forensic psychiatry.
Burgeoning populations, disruptions in lives and affiliations, biology, ecology, and sociocultural changes undoubtedly influence the development and manifestations of psychiatric disorders and in turn have ramifications for forensic psychiatry. Some of the articles in this supplement raise these issues and point out that the discipline of forensic psychiatry needs constant revision even in places where it is well established. It also has important lessons for contexts where this discipline is poorly developed.
