Summary There is a dearth of research on risk management of violent patients during the phase of ... more Summary There is a dearth of research on risk management of violent patients during the phase of transition from hospital to community care. Discharge can only be contemplated when identified risk factors are managed and tested in non-secure environments. Therefore this process should proceed cautiously and over as protracted a period as circumstances allow. A gradated programme which caters for various levels of risk allows for the testing of measures within a relatively well controlled milieu. Initial measures would include anticipating and preparing for future living arrangements (especially accommodation, supervision, finances) and psychoeducation for the patient and care givers. Specific risk factors, such as co-morbidity (especially alcohol and substance abuse), and relationship difficulties may need specialized or particular individual interventions. Increasingly cultural issues will have to be considered and incorporated into management plans.
Objective. To investigate the understanding and expectations of defendants referred to Valkenberg... more Objective. To investigate the understanding and expectations of defendants referred to Valkenberg Hosprtal for 3O-day observation. Design. Defendants referred for 30 days of psychiatric assessment were surveyed by means of a semi-structured interview within 3 days of admission. Participants. One hundred consecutive referrals from the Western, Northern and Eastern Cape were considered; 88 were eventually entered into the study. Results. AJI defendants were generally ignorant of the reasons for referral, but had a good understanding of court procedure and wrongfulness. Mentally ill subjects differed only in their not being able to distinguish between a guilty/not guilty plea Most did not have legal representation, did not personally request the assessment and denied guilt of the alleged offence. Conclusions. Mental illness affects triability but not necessarily criminal responsibility. Disturbingly, most defendants were without legal representation and were unaware of the purpose, implications and possible outcomes of psychiatric observation. It is imperative that the legislation governing these aspects be reviewed.
Objective: South Africa has a shortage of facilities and psychiatrists to assess adjudicative com... more Objective: South Africa has a shortage of facilities and psychiatrists to assess adjudicative competence of prisoners awaiting assessment under sections 77 to 79 of the Criminal Procedures Act of 1977. Various solutions have been proposed by the Department of Health. The recent linking of a Magistrate's court and a prison by videoconferencing offers the opportunity to implement a forensic telepsychiatry service. The literature on forensic telepsychiatry for assessment of adjudicative competence was reviewed. Method: The electronic databases, PubMed, Scopus, Cinahl and Google Scholar were searched for papers on forensic telepsychiatry. The inclusion criterion was papers reporting the use of videoconferencing for assessment of adjudicative competence or for assessment for referral out of the judicial system, by psychiatrists or psychologists. Results: 411 papers were found of which 13, published between 1997 and 2008 were relevant. The use of videoconferencing for forensic psychiatric assessment was reported from four countries. The courts in those jurisdictions have accepted the use of videoconferencing for assessment and no successful appeals have been mounted on the basis of the use of videoconferencing for assessment. User satisfaction has not been reported for assessing adjudicative competence. Forensic telepsychiatry has been found to be cost effective, improve access to scarce specialist skills and reduce transport of prisoners under guard to hospitals or psychiatrists to prisons. Conclusion: There is nothing in the literature to suggest that a forensic telepsychiatry service is not feasible in South Africa and a pilot project is being planned.
International Journal of Forensic Mental Health, 2009
... e , Sean Kaliski f , Kazuo Yoshikawa g , Pierre Gagné h & Lindsay Thomson... more ... e , Sean Kaliski f , Kazuo Yoshikawa g , Pierre Gagné h & Lindsay Thomson i pages 81-96. ... 112: 330–350. [CrossRef], [PubMed], [Web of Science ®] View all references) or higher crime rates (Farrington, 19936. Farrington, DP 1993. “The psychosocial milieu of the offender”. ...
The information minefield: access to clinical information stand a cacophony of 'interested partie... more The information minefield: access to clinical information stand a cacophony of 'interested parties' clamouring for the sensitive information inside their folders. Privilege and privacy Privilege refers to an individuals right to control which information that was conveyed in confidence can be revealed in juridical proceedings, whereas privacy is the individual's right to confidentiality when (usually by necessity) one or more professionals have access to sensitive information. 3 In South Africa clinicians cannot refuse to reveal sensitive information in court on the basis of privilege. Lawyers and journalists routinely do. The latter do so probably as a matter of expediency (to protect future sources), and the former cannot adequately represent a client without it. Mental health professionals have argued, unsuccessfully in many courts everywhere that without the right of absolute privilege their ability to act in their patients' best interests is impaired. Threats to privacy are varied, and probably have become more common (and serious) as technological progress facilitates ever easier access to information. Not only are medical records now held in vast databases that can straddle continents, but amorphous entities (such as medical aids, insurers, government departments, multidisciplinary teams, hospital administrations etc) can claim valid interests in obtaining certain details. Many of these entities do not necessarily consider themselves bound by the same ethical standards that physicians impose on themselves. 4 This may result in, for example, an insurer selling information about its clients to other commercial groups. Patients and clinicians often do not realise that when they fill out forms, or provide information on the telephone that these particulars are being logged and passed on. It is now quite common for contracts between health users and providers to contain clauses authorising access to sensitive information. Unfortunately many do not realise the implications of signing these agreements. Clinicians are often careless in safe guarding their patients' privacy. How often has one overheard a colleague conducting a conversation with a patient on a cell phone? Can anyone recall an incident when a colleague has pointed out that the person he has just greeted in the restaurant happens to be a patient? Even discussions with colleagues about an 'interesting' or 'difficult' patient, whose anonymity may be easy to penetrate (my nameless patient is a well In 1966 Lord Moran, Sir Winston Churchill's physician, published a detailed medical memoir about his illustrious patient. His revelations were applauded by contemporary historians for providing much needed insights into the motivations and actions of an important historical figure. But the British Medical Association voted overwhelmingly to censure him, distraught that he had betrayed the trust and confidence of a patient, which they declared was "doubly owed to the dead". 1 The critical issue is that clinicians and patients enjoy a fiduciary relationship, which simply means that patients should always be able to trust their doctor to act in their best interests. 2 Clinicians are taught and encouraged to keep accurate detailed records. These notes often contain not only intimate confidences trusted to the physician but also possibly sensitive collateral information from others, as well the doctor's own speculative musings. Although the clinician (or employing institution) is the owner of these records, they do not always have absolute control over their use. Before our new Constitution was implemented patients had no right of access to their own clinical records, and likewise a doctor had no right of access to another practitioner's or a hospital's clinical records, even with the patient's consent. It was considered a courtesy, but not an obligation to provide another involved practitioner with clinical information. There is a general overriding obligation to preserve the privacy of patients. The Health Professions Council of SA (HPCSA) specifically states in its Ethical Rules that disciplinary action will be considered if professional confidentiality is breached by "Divulging any information regarding a patient which ought not to be divulged, except with the express consent of the patient or, in the case of a minor under the age of 14 years, with the written consent of his or her parent or guardian, or in the case of a deceased patient, with the written consent of his or her next-of-kin or the executor of his or her estate." (Rule 20) Disclosure, therefore, usually proceeds according to accepted exceptions to this rule. Even though the dedicated clinician may act zealously to protect their patient, they nowadays often have to with
Summary There is a dearth of research on risk management of violent patients during the phase of ... more Summary There is a dearth of research on risk management of violent patients during the phase of transition from hospital to community care. Discharge can only be contemplated when identified risk factors are managed and tested in non-secure environments. Therefore this process should proceed cautiously and over as protracted a period as circumstances allow. A gradated programme which caters for various levels of risk allows for the testing of measures within a relatively well controlled milieu. Initial measures would include anticipating and preparing for future living arrangements (especially accommodation, supervision, finances) and psychoeducation for the patient and care givers. Specific risk factors, such as co-morbidity (especially alcohol and substance abuse), and relationship difficulties may need specialized or particular individual interventions. Increasingly cultural issues will have to be considered and incorporated into management plans.
Objective. To investigate the understanding and expectations of defendants referred to Valkenberg... more Objective. To investigate the understanding and expectations of defendants referred to Valkenberg Hosprtal for 3O-day observation. Design. Defendants referred for 30 days of psychiatric assessment were surveyed by means of a semi-structured interview within 3 days of admission. Participants. One hundred consecutive referrals from the Western, Northern and Eastern Cape were considered; 88 were eventually entered into the study. Results. AJI defendants were generally ignorant of the reasons for referral, but had a good understanding of court procedure and wrongfulness. Mentally ill subjects differed only in their not being able to distinguish between a guilty/not guilty plea Most did not have legal representation, did not personally request the assessment and denied guilt of the alleged offence. Conclusions. Mental illness affects triability but not necessarily criminal responsibility. Disturbingly, most defendants were without legal representation and were unaware of the purpose, implications and possible outcomes of psychiatric observation. It is imperative that the legislation governing these aspects be reviewed.
Objective: South Africa has a shortage of facilities and psychiatrists to assess adjudicative com... more Objective: South Africa has a shortage of facilities and psychiatrists to assess adjudicative competence of prisoners awaiting assessment under sections 77 to 79 of the Criminal Procedures Act of 1977. Various solutions have been proposed by the Department of Health. The recent linking of a Magistrate's court and a prison by videoconferencing offers the opportunity to implement a forensic telepsychiatry service. The literature on forensic telepsychiatry for assessment of adjudicative competence was reviewed. Method: The electronic databases, PubMed, Scopus, Cinahl and Google Scholar were searched for papers on forensic telepsychiatry. The inclusion criterion was papers reporting the use of videoconferencing for assessment of adjudicative competence or for assessment for referral out of the judicial system, by psychiatrists or psychologists. Results: 411 papers were found of which 13, published between 1997 and 2008 were relevant. The use of videoconferencing for forensic psychiatric assessment was reported from four countries. The courts in those jurisdictions have accepted the use of videoconferencing for assessment and no successful appeals have been mounted on the basis of the use of videoconferencing for assessment. User satisfaction has not been reported for assessing adjudicative competence. Forensic telepsychiatry has been found to be cost effective, improve access to scarce specialist skills and reduce transport of prisoners under guard to hospitals or psychiatrists to prisons. Conclusion: There is nothing in the literature to suggest that a forensic telepsychiatry service is not feasible in South Africa and a pilot project is being planned.
International Journal of Forensic Mental Health, 2009
... e , Sean Kaliski f , Kazuo Yoshikawa g , Pierre Gagné h & Lindsay Thomson... more ... e , Sean Kaliski f , Kazuo Yoshikawa g , Pierre Gagné h & Lindsay Thomson i pages 81-96. ... 112: 330–350. [CrossRef], [PubMed], [Web of Science ®] View all references) or higher crime rates (Farrington, 19936. Farrington, DP 1993. “The psychosocial milieu of the offender”. ...
The information minefield: access to clinical information stand a cacophony of 'interested partie... more The information minefield: access to clinical information stand a cacophony of 'interested parties' clamouring for the sensitive information inside their folders. Privilege and privacy Privilege refers to an individuals right to control which information that was conveyed in confidence can be revealed in juridical proceedings, whereas privacy is the individual's right to confidentiality when (usually by necessity) one or more professionals have access to sensitive information. 3 In South Africa clinicians cannot refuse to reveal sensitive information in court on the basis of privilege. Lawyers and journalists routinely do. The latter do so probably as a matter of expediency (to protect future sources), and the former cannot adequately represent a client without it. Mental health professionals have argued, unsuccessfully in many courts everywhere that without the right of absolute privilege their ability to act in their patients' best interests is impaired. Threats to privacy are varied, and probably have become more common (and serious) as technological progress facilitates ever easier access to information. Not only are medical records now held in vast databases that can straddle continents, but amorphous entities (such as medical aids, insurers, government departments, multidisciplinary teams, hospital administrations etc) can claim valid interests in obtaining certain details. Many of these entities do not necessarily consider themselves bound by the same ethical standards that physicians impose on themselves. 4 This may result in, for example, an insurer selling information about its clients to other commercial groups. Patients and clinicians often do not realise that when they fill out forms, or provide information on the telephone that these particulars are being logged and passed on. It is now quite common for contracts between health users and providers to contain clauses authorising access to sensitive information. Unfortunately many do not realise the implications of signing these agreements. Clinicians are often careless in safe guarding their patients' privacy. How often has one overheard a colleague conducting a conversation with a patient on a cell phone? Can anyone recall an incident when a colleague has pointed out that the person he has just greeted in the restaurant happens to be a patient? Even discussions with colleagues about an 'interesting' or 'difficult' patient, whose anonymity may be easy to penetrate (my nameless patient is a well In 1966 Lord Moran, Sir Winston Churchill's physician, published a detailed medical memoir about his illustrious patient. His revelations were applauded by contemporary historians for providing much needed insights into the motivations and actions of an important historical figure. But the British Medical Association voted overwhelmingly to censure him, distraught that he had betrayed the trust and confidence of a patient, which they declared was "doubly owed to the dead". 1 The critical issue is that clinicians and patients enjoy a fiduciary relationship, which simply means that patients should always be able to trust their doctor to act in their best interests. 2 Clinicians are taught and encouraged to keep accurate detailed records. These notes often contain not only intimate confidences trusted to the physician but also possibly sensitive collateral information from others, as well the doctor's own speculative musings. Although the clinician (or employing institution) is the owner of these records, they do not always have absolute control over their use. Before our new Constitution was implemented patients had no right of access to their own clinical records, and likewise a doctor had no right of access to another practitioner's or a hospital's clinical records, even with the patient's consent. It was considered a courtesy, but not an obligation to provide another involved practitioner with clinical information. There is a general overriding obligation to preserve the privacy of patients. The Health Professions Council of SA (HPCSA) specifically states in its Ethical Rules that disciplinary action will be considered if professional confidentiality is breached by "Divulging any information regarding a patient which ought not to be divulged, except with the express consent of the patient or, in the case of a minor under the age of 14 years, with the written consent of his or her parent or guardian, or in the case of a deceased patient, with the written consent of his or her next-of-kin or the executor of his or her estate." (Rule 20) Disclosure, therefore, usually proceeds according to accepted exceptions to this rule. Even though the dedicated clinician may act zealously to protect their patient, they nowadays often have to with
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