From the U.K. Annual Meeting of the Royal College of Forensic Psychiatry, February 8-10, 2000. This meeting, attended by several hundred psychiatrists and registrars (residents) is actually better attended than the Royal College General Psychiatry Annual Meeting,
Again this year, the issue that continues to preoccupy the members is the Government's proposed new Dangerous Severe Personality Disorder (DSPD) Law. In brief, the Government proposes to detain for indefinite periods of civil commitment persons who are certified to have a DSPD.(1) A DSPD evaluation can be initiated for anyone charged or sentenced criminally. After forensic evaluation, the court may certify the person as DSPD and confine them for an indefinite period in a facility. There is no requirement that the alleged DSPD person have been adjudicated for a violent crime, and DSPD orders can be obtained for current psychiatric patients who have no criminal history or other documented history of violence.
The opening speech at the conference was given by the Lord Chief Justice of the U.K., Lord Wolf, who spoke in general terms about what society expects of forensic psychiatry and about the government's proposal, carefully not taking any position. Government officials then presented the proposal in more detail. The questions from the floor amply illustrated the profound mistrust and concern that the Government's proposal has created among psychiatrists. Almost all seem to be thoroughly opposed. Furthermore, a good part of the business meeting was devoted not to business, but to discussing the response the College should make to the proposed law.
Wide range of topics There were workshops on: Aspergers' syndrome; sex offending in sports; race; new research on fitness to plead; religion; management of stalkers; offender assessment; women, psychiatry, sex and the law; learning disabilities; prevention of antisocial personality disorder in adolescents; prisons; and psychotherapy. The wide range of topics gives some indication of the range of public clinical forensic practice in the UK.
Although the concept of evidence based medicine originated in the U.S., the U.K. has been more active in assessing the extent to which actual practice is evidence based. The prison system in the U.K. provides active forensic psychiatric treatment for inmates, and the prison system is currently developing a system of evidence based standards for accrediting prison forensic psychiatric programs. In concert with this the Home Office is also developing a certification program for forensic experts of all kinds, including mental health professionals.
Prof. Paul Mellon gave an informative and entertaining lecture on stalking. He and his group have been studying stalking for years and he is well worth hearing wherever he speaks. David James reported on a study of violence in London stalkers. The variables associated with minor violence did not predict serious violence. For example, seriously violent stalkers were less likely to have a criminal record than stalkers who committed minor violence. This is a finding worth following up.
The adolescent workshop provided an enthusiastic endorsement of the short term intensive family oriented treatment for juveniles that has been developed in South Carolina. Sue Bailey, who heads the only forensic inpatient adolescent service in the U.K. presented their initial work applying this model to patients transitioning to the community from hospital.
Recently a general practitioner practicing near Manchester was convicted of murdering many of his elderly female patients, perhaps as many as several hundred. One of the forensic psychiatrists who evaluated him gave an interview to the media and this raised concerns about confidentiality in high profile cases. Several sessions at the conference focused on confidentiality. Ronald Schouten discussed the problems faced by the Mass. General Psychiatry & Law Service when they evaluated Mike Tyson. I engaged in a debate with Prof. Chris Cordess, who has written a new book on confidentiality (2), on what should have been the appropriate response when a psychiatrist learns that his patient, who is a psychiatric resident planning to go into child psychiatry, is a pedophile. (3). This served as a springboard for a wide ranging audience discussion of psychiatrists' current responsibilities. The UK has nothing corresponding to the Tarasoff decision and so questions of confidentiality are discussed in clinical and ethical rather than legal terms.
In summary, I found this, as I have in the past to be an informative and enjoyable meeting. The meeting is particularly relevant to forensic psychiatrists doing criminal work-either evaluations or treatment. Our colleagues in the U.K. welcome Americans, and I would be happy to discuss the practical aspects with anyone who is thinking about attending next year.
References
1)Walcott DM & Beck JC. Dangerous severe personality disorder: extension of the use of civil commitment in the United
Kingdom. J Am Acad Psychiatry Law 28: 469-75, 2000.
2) Cordess C. (Ed) Confidentiality and Mental Health, Jessica Kingsley, London, 2001.
3) Almonte v. New York Medical College, Civil No. 3:93CV00116(AHN), United
States District Court for The District Of Connecticut, 851 F. Supp. 34; 1994
U.S. Dist. LEXIS 4292, March 31, 1994, Decided