Ethical Issues in Clinical Forensic Psychiatry Artemis Igoumenou Editor 123 Ethical Issues in Clinical Forensic Psychiatry Artemis Igoumenou Editor Ethical Issues in Clinical Forensic Psychiatry Editor Artemis Igoumenou Senior Clinical Lecturer and Honorary Consultant Psychiatrist, Division of Psychiatry, University College London London UK ISBN 978-3-030-37300-9 ISBN 978-3-030-37301-6 (eBook) https://doi.org/10.1007/978-3-030-37301-6 © Springer Nature Switzerland AG 2020 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Preface The conception of this book started as an idea which occurred towards the end of my clinical training in forensic psychiatry. During the years of exploration of a fascinating medical field and a relentless study of textbooks and scholar con- tributions, it occurred to me that there were no books on ethical issues faced in everyday clinical practice. Hence, I started expanding my knowledge in particu- lar ethical considerations and attending conferences to present my work. It was following one of these conferences that the proposal from Springer was offered to prepare and publish this book and I whole-heartedly accepted the challenge. The aim of this book is to cover the gap in the existing literature and facilitate clinical thinking by focusing on ethical issues that clinicians face in everyday prac- tice of forensic psychiatry. It is mainly aimed at forensic psychiatrists and forensic psychiatry trainees but should also be a useful guide for other forensic mental health clinicians, including psychologists, nurses, occupational therapists, and social workers. Likewise, it can be a helpful resource for psychiatrists and other doctors that find themselves looking after patients in prison settings or in countries where forensic psychiatry does not exist as a psychiatry subspecialty. It is meant to be a practical guide of what a clinician should consider when faced with moral dilemmas in their day-to-day practice and offer direction for reflection. Forensic psychiatry is an exciting specialty but also one that brings forward a lot of ethical controversies. This book consists of seven chapters. The first chapter puts in perspective the context of forensic psychiatry in different countries. It describes in detail forensic psychiatry practice in the UK, and subsequently moves on to the rest of Europe, Australia, Asia, America, and the Arab world. The second chapter focuses on generic ethical issues. It starts with a definition of ethics and a discussion of ethical issues in mental health in general before moving to ethical considerations specific to forensic mental health. The subsequent chapters focus on specialized areas of forensic clinical practice that come with specific challenging ethical issues. The third chapter focuses on ethi- cal dilemmas arising from the prescription of medication for the treatment of sex offenders and issues around treatment vs punishment, autonomy, coercion, and free will are debated. v vi Preface Chapter 4 is also dedicated in the treatment of sex offenders. It explores and discusses the ethical dilemmas in the use of polygraphy, a controversial method of truth facilitation, for the management of mentally disordered sex offenders. Chapter 5 addresses ethical issues pertained in prescription of antipsychotics for mentally ill forensic patients, with particular focus on polypharmacy and prescrip- tion of high doses. It unfolds the clinical thinking behind medication prescribing and discusses it in context of the principles of autonomy, beneficence, non- maleficence, and justice. Issues around capacity, informed consent, and free will are also addressed. Consequently, the use of electronic monitoring ("tagging") for offenders that are deemed dangerous is discussed in the sixth chapter. Electronic monitoring despite being used in the USA for a while has been heavily criticized and opposed. It has been gradually introduced in the UK and other European countries; hence, consid- eration of the ethical issues and dilemmas surrounding its use is timely and necessary. The last chapter of this book focuses on patient populations within clinical foren- sic psychiatry that present with specific challenges. It is divided into two parts. In the first part, the authors discuss ethical issues in the assessment and treatment of forensic psychiatry transgender populations. In the second part, practical and ethical issues in the treatment of offenders with intellectual disability are addressed. The list of moral dilemmas that clinicians face in their everyday clinical practice is not exhaustive as it would be impossible to debate all of them in one book. It is with this insight that we offer this book to clinicians with the hope that it will be a useful resource for those working in forensic psychiatry settings or work with offender populations when it comes to ethical decisions faced in their clinical practice. Finishing this introduction, I would like to thank all authors for their excellent contributions to this book. I would also like to thank Springer for this opportunity and their confidence in delivering this book. London, UK Artemis Igoumenou Contents Part I Clinical Forensic Psychiatry 1 Clinical Forensic Psychiatry: Settings and Practices �������������������������������� 3 Catherine Marshall, Katharina Seewald, and Hasanen Al Taiar 2 Forensic Psychiatry and the Mentally Disordered Offender: Ethical Issues in the Treatment Provision within Secure Hospital Environments—Clinical and Legal ������������������������������������������������������������ 29 Oriana Chao, Despoina Konstandinidou, and Artemis Igoumenou Part II Ethical Issues in the Treatment and Management of Sex Offenders 3 Introduction �������������������������������������������������������������������������������������������������� 47 Artemis Igoumenou 4 The Use of Medication for the Treatment of Sex Offenders: Ethical Issues and Controversies . 51 Artemis Igoumenou 5 The Use of Polygraph Test in Clinical Forensic Psychiatry Settings . 85 Nicky Collins Part III Ethical Issues in the Assessment, Treatment and Management of Violent Offenders and Sex Offenders in Clinical Settings 6 Ethical Issues Arising from the Prescription of Antipsychotic Medication in Clinical Forensic Settings . 99 Harriet Hunt-Grubbe 7 The Many Faces of Surveillance: Ethical Considerations That Encompass the Use of Electronic Monitoring in Criminal and Clinical Populations . 115 Harriet Hunt-Grubbe 8 Assessment and Management of Specific Populations . 135 Philip Baker, Sumi Ratnam, and Leah Wooster Index �������������������������������������������������������������������������������������������������������������������� 151 vii Part I Clinical Forensic Psychiatry Clinical Forensic Psychiatry: Settings and Practices 1 Catherine Marshall, Katharina Seewald, and Hasanen Al Taiar 1.1 Forensic Psychiatry in the UK Catherine Marshall Clinical forensic psychiatry is the evidence-based assessment, treatment and rehabili- tation of mentally disordered offenders. In practice, however, ‘the forensic patient’ is a term which encompasses a broader range of individuals, including those who have not committed an offence but have a mental disorder and are presenting with behav- iour considered to be dangerous (relative to their environment) and are at risk of offending (Mullen 2000). Typically, forensic patients are those with chronic and com- plex mental disorders whose actions, having been wholly or in part influenced by their psychopathology, ultimately pose a serious risk to others. At times, this risk of harm is also extended towards themselves. Specialist forensic settings and services provide a greater degree of security and more intensive interventions in order to manage these risks and support the individual towards recovery and rehabilitation. Detaching from the labels which link ‘mad’ behaviour with being ‘bad’ or ‘evil’ is arguably the biggest battle of modern-day psychiatry and perhaps the most chal- lenging one in forensic psychiatry, given the dual stigmatisation of being an offender and having mental health problems (Adshead 2012). Criminology cannot be simply characterised as pathological, nor are all mentally disordered individuals