认知障碍严重程度与精神健康法院关于审判能力的裁定。

Severity of cognitive disability and mental health court determinations about fitness to stand trial.

机构信息

Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.

Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, West Australia, Australia.

出版信息

J Intellect Disabil Res. 2018 Feb;62(2):126-139. doi: 10.1111/jir.12468.

DOI:10.1111/jir.12468

PMID:29349929

Abstract

BACKGROUND

Little is known about the socio-demographic, clinical and legal determinants of mental health court decisions of unsoundness of mind and unfitness to stand trial for people with cognitive disability. We aimed to estimate the association between severity of cognitive disability and mental health court determinations of unsoundness or unfitness and describe the socio-demographic, clinical and legal factors that predict these determinations.

METHODS

Case file data were extracted on 92 individuals who had a criminal case referred to the Queensland Mental Health Court between 1 January 2013 and 31 December 2014 due to cognitive disability. We fit a modified multivariable Poisson regression model to estimate the association between severity of cognitive impairment and mental health court determination, controlling for socio-demographic, clinical and legal factors.

RESULTS

Adjusting for covariate effects, severity of cognitive impairment was positively associated with being found unfit to stand trial (adjusted prevalence risk ratio = 1.57; 95% confidence interval: 1.07, 2.33; P = 0.023), and comorbid psychotic disorder predicted an increased risk of being found unsound of mind at the time of offence (adjusted prevalence risk ratio = 3.63; 95% confidence interval: 1.38, 9.54; P = 0.009) by the Queensland Mental Health Court.

CONCLUSIONS

Severity of cognitive disability is associated with determinations of unfitness but does not predict determinations of unsoundness in the Queensland Mental Health Court. Psychiatric assessments of cognitive impairment play a pivotal role in mental health court determinations for people with cognitive disability.

摘要

背景

对于认知障碍人士的精神健康法庭审判中的精神错乱和不适宜受审的决定的社会人口统计学、临床和法律决定因素知之甚少。我们旨在评估认知障碍严重程度与精神健康法庭作出的精神错乱或不适宜的决定之间的关联，并描述预测这些决定的社会人口统计学、临床和法律因素。

方法

从 2013 年 1 月 1 日至 2014 年 12 月 31 日期间，由于认知障碍，92 名刑事案件被转介至昆士兰精神健康法庭的患者的案件档案数据被提取出来。我们拟合了改良的多变量泊松回归模型，以估计认知障碍严重程度与精神健康法庭裁决之间的关联，同时控制社会人口统计学、临床和法律因素。

结果

在调整了协变量的影响后，认知障碍的严重程度与被判定不适宜受审呈正相关（调整后的流行率风险比=1.57；95%置信区间：1.07，2.33；P=0.023），并且合并的精神病性障碍预测了在昆士兰精神健康法庭作出的犯罪时精神错乱的风险增加（调整后的流行率风险比=3.63；95%置信区间：1.38，9.54；P=0.009）。