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Forty-five revolutions per minute: a qualitative study of Hybrid Order use in forensic psychiatric practice

机译:每分钟四十五转:对法医精神诊所的杂交秩序使用的定性研究

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Psychiatrists who recommend a Hybrid Order (Section 45A) as a disposal option at the point of sentencing accept that the convicted individual, as well as being mentally disordered and in need of treatment, is also culpable and deserving of criminal punishment. Ethical and clinical concerns have typically limited its clinical use. However, in 2015 the Court of Appeal specified in R v Vowles and others that the Hybrid Order disposal should be considered first in terms of potential mental health disposals. This judgement sets a high threshold for the use of the hospital order which has been the bedrock of inpatient forensic psychiatric practice since 1983. This study sought to explore the attitudes of consultant forensic psychiatrists towards the use of the Hybrid Order in the wake of the Vowles judgement. We interviewed 12 consultant forensic psychiatrists with longstanding experience of psychiatric sentencing recommendations. We found that the majority of consultants considered the Hybrid Order to be a valuable disposal option when used under specific circumstances. However, significant concerns were raised about its use in those with an enduring psychotic illness. Community aftercare arrangements for Hybrid Order disposals were viewed as inferior to community aftercare arrangements for Section 37/41 patients.
机译:在判决时推荐混合令(第45A节)的精神科医生接受被定罪的个人以及精神紊乱和需要治疗,也是如此令人谴责和应得的刑事处罚。伦理和临床关注通常限制其临床使用。但是,2015年,在潜在的心理健康处置方面,应首先考虑混合阶处置的上诉法院。此判断为自1983年以来,该判断旨在使用医院订单的使用,这是一直是住院性法医精神审查实践的基岩。本研究试图探讨顾问法医精神病学家在大吼大叫中使用混合命令的态度判断。我们采访了12名顾问法医精神科医生,具有长期的精神判刑建议。我们发现,大多数顾问在特定情况下使用时,顾问被认为是一个有价值的处置选择。然而,在那些持久的精神病疾病中的使用情况提出了重大问题。混合命令处理的社区追踪安排被视为逊有于第37/41款患者的社区追踪安排。

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