Enys Delmage - Academia.edu (original) (raw)
Papers by Enys Delmage
Cambridge University Press eBooks, 2017
Cambridge University Press eBooks, Aug 13, 2018
Relations between representatives of the legal profession and psychiatrists cannot be regarded wi... more Relations between representatives of the legal profession and psychiatrists cannot be regarded with much satisfaction by either side?except in so far as satisfaction can be obtained by acid criticism of the other. The fundamental difficulties, though clear, are not always evident to the man in the street and are particularly easy to neglect when involved in the highly sensational atmosphere of a murder trial; this is of course particularly so if the details are horrific or sexual or both and if a plea of insanity is raised in defence. It may therefore be helpful to restate the points at issue. The first point is that lawyers and doctors talk in different terms. This is not quite so simple as to say, in the words of a judge, that one language is forensic and one scientific, for the confusion is made worse confounded by the fact that certain terms are used by the two professions in different senses. Further, it is very easy for discussion to get bogged down in terminological misconception : readers of the Heath trial?just published in the Notable British Trial Series (William Hodges, Glasgow, 1953)?will notice the confusion of "moral defect" and "moral insanity". The second point is that the methods of law and medicine in arriving at the facts of a case are very different. The law holds that the truth will best come to light by allowing opposing counsel to bring forward opposing views, in black or white. To the doctor much is grey, and this is especially so for the psychiatrist who realises that if he is to get a full account of the patient's conduct and motives, he must show the greatest sympathy and tolerance. Because of this and because of the deeper understanding he may thus obtain, he is likely to be (as well as to seem) more sympathetic, either in his consulting room or in court.
Cambridge University Press eBooks, May 3, 2017
Journal of Psychiatric and Mental Health Nursing, 2018
The Journal of Forensic Psychiatry & Psychology, 2013
Youth Justice
Children receive sentences underpinned by deterrence theory in many jurisdictions, as demonstrate... more Children receive sentences underpinned by deterrence theory in many jurisdictions, as demonstrated by recent cases in Australia and England and Wales. This article explores whether deterrent sentencing is justified from a legal, criminological and neuroscientific perspective. Analysis of international instruments suggests that deterrent sentencing conflicts with children’s rights, particularly the obligation to factor in the child’s age and best interests. There is scant criminological evidence that deterrent sentencing works for children. The principles that underpin deterrent sentencing are at odds with the way children make decisions according to recent neuroscientific evidence. Principles of deterrence should not apply when sentencing children.
Forensic Child and Adolescent Mental Health
Justice for Children and Families
Relations between representatives of the legal profession and psychiatrists cannot be regarded wi... more Relations between representatives of the legal profession and psychiatrists cannot be regarded with much satisfaction by either side?except in so far as satisfaction can be obtained by acid criticism of the other. The fundamental difficulties, though clear, are not always evident to the man in the street and are particularly easy to neglect when involved in the highly sensational atmosphere of a murder trial; this is of course particularly so if the details are horrific or sexual or both and if a plea of insanity is raised in defence. It may therefore be helpful to restate the points at issue. The first point is that lawyers and doctors talk in different terms. This is not quite so simple as to say, in the words of a judge, that one language is forensic and one scientific, for the confusion is made worse confounded by the fact that certain terms are used by the two professions in different senses. Further, it is very easy for discussion to get bogged down in terminological misconception : readers of the Heath trial?just published in the Notable British Trial Series (William Hodges, Glasgow, 1953)?will notice the confusion of "moral defect" and "moral insanity". The second point is that the methods of law and medicine in arriving at the facts of a case are very different. The law holds that the truth will best come to light by allowing opposing counsel to bring forward opposing views, in black or white. To the doctor much is grey, and this is especially so for the psychiatrist who realises that if he is to get a full account of the patient's conduct and motives, he must show the greatest sympathy and tolerance. Because of this and because of the deeper understanding he may thus obtain, he is likely to be (as well as to seem) more sympathetic, either in his consulting room or in court.
Criminal Behaviour and Mental Health, 2019
Background: A small proportion of every nation's young people become sufficiently antisocial to c... more Background: A small proportion of every nation's young people become sufficiently antisocial to come into contact with the criminal justice system. Many also have disorders of mental health or emotional well-being. Although countries vary in designating age of criminal responsibility, all must provide services for offenders, perhaps as young as 10, both to help them and safeguard their peers and the wider public. Aim: The aim of this article is to map the range of research required to support the development of satisfactory services for young mentally disordered offenders and identify knowledge gaps from a practitioner's perspective. Methods: Using a public health prevention framework, we identified the main streams of research pertinent to young, mentally disordered offenders and sought examples of each to consider the extent to which they have been used to inform service development in England.
The Journal of Forensic Psychiatry & Psychology, 2017
Background: Psychotropic medication is widely prescribed for patients with emotionally unstable p... more Background: Psychotropic medication is widely prescribed for patients with emotionally unstable personality disorder, despite a limited evidence base. In adults, clozapine has been shown to demonstrate a reduction in the incidents of aggression and subsequent restraints. This study seeks to examine the effect of clozapine on the overall functioning and on the rates of incidents of aggression, seclusion and restraint, in female adolescents with severe emotionally unstable personality disorder. Methods: Routinely collected data of functioning and rate of incidents in 15 adolescent females with severe emotionally unstable personality disorder admitted to two secure adolescent mental health hospitals was compared before and after the prescription of clozapine. Results: Following the prescription of clozapine, patients in both hospitals had reduced rates of general incidents, use of restraint and use of seclusion. There was also an improvement in their overall functioning. Conclusions: This is the first case series describing the prescription of clozapine in adolescents with emerging severe emotionally unstable personality disorder, and despite limitations in the study design it provides some evidence for the use of clozapine in this specific patient group.
Youth Justice, 2013
The minimum age of criminal responsibility is set in England and Wales at 10 years of age (Childr... more The minimum age of criminal responsibility is set in England and Wales at 10 years of age (Children and Young Persons Act 1963), whilst the effective age of most civil responsibilities is 16. Research allows us to consider the speed of development of key brain structures in terms of decision-making and this in turn aids in discussion of where the minimum age should be set. This article reviews the evolution of the minimum age of criminal responsibility and examines the setting of this age in light of both civil attainment ages and the current scientific understanding of brain development.
The Journal of Forensic Psychiatry & Psychology, 2013
Obesity is a significant problem among patients in mental health services, with implications for ... more Obesity is a significant problem among patients in mental health services, with implications for morbidity and mortality. This is particularly challenging in forensic services where patients often remain in hospital for prolonged periods, may be on higher doses of medication and often have less access to exercise opportunities. This survey was conducted to investigate weight management strategies in medium secure units (MSUs) and to identify potential barriers to effective prevention and management of obesity. More than half of the MSUs do not currently have an effective strategy for managing obesity, although most have a reasonable range of weight management options available. There is dissonance among clinicians about the ethics of restricting patients' access to food in order to reduce obesity. Whilst more coercive strategies may prove challenging in terms of maintaining the balance with human rights, it is clear that hospitals need to rigorously pursue education and health promotion.
Canadian Journal of Education / Revue canadienne de l'éducation, 1980
The Journal of Forensic Psychiatry & Psychology, 2015
Cambridge University Press eBooks, 2017
Cambridge University Press eBooks, Aug 13, 2018
Relations between representatives of the legal profession and psychiatrists cannot be regarded wi... more Relations between representatives of the legal profession and psychiatrists cannot be regarded with much satisfaction by either side?except in so far as satisfaction can be obtained by acid criticism of the other. The fundamental difficulties, though clear, are not always evident to the man in the street and are particularly easy to neglect when involved in the highly sensational atmosphere of a murder trial; this is of course particularly so if the details are horrific or sexual or both and if a plea of insanity is raised in defence. It may therefore be helpful to restate the points at issue. The first point is that lawyers and doctors talk in different terms. This is not quite so simple as to say, in the words of a judge, that one language is forensic and one scientific, for the confusion is made worse confounded by the fact that certain terms are used by the two professions in different senses. Further, it is very easy for discussion to get bogged down in terminological misconception : readers of the Heath trial?just published in the Notable British Trial Series (William Hodges, Glasgow, 1953)?will notice the confusion of "moral defect" and "moral insanity". The second point is that the methods of law and medicine in arriving at the facts of a case are very different. The law holds that the truth will best come to light by allowing opposing counsel to bring forward opposing views, in black or white. To the doctor much is grey, and this is especially so for the psychiatrist who realises that if he is to get a full account of the patient's conduct and motives, he must show the greatest sympathy and tolerance. Because of this and because of the deeper understanding he may thus obtain, he is likely to be (as well as to seem) more sympathetic, either in his consulting room or in court.
Cambridge University Press eBooks, May 3, 2017
Journal of Psychiatric and Mental Health Nursing, 2018
The Journal of Forensic Psychiatry & Psychology, 2013
Youth Justice
Children receive sentences underpinned by deterrence theory in many jurisdictions, as demonstrate... more Children receive sentences underpinned by deterrence theory in many jurisdictions, as demonstrated by recent cases in Australia and England and Wales. This article explores whether deterrent sentencing is justified from a legal, criminological and neuroscientific perspective. Analysis of international instruments suggests that deterrent sentencing conflicts with children’s rights, particularly the obligation to factor in the child’s age and best interests. There is scant criminological evidence that deterrent sentencing works for children. The principles that underpin deterrent sentencing are at odds with the way children make decisions according to recent neuroscientific evidence. Principles of deterrence should not apply when sentencing children.
Forensic Child and Adolescent Mental Health
Justice for Children and Families
Relations between representatives of the legal profession and psychiatrists cannot be regarded wi... more Relations between representatives of the legal profession and psychiatrists cannot be regarded with much satisfaction by either side?except in so far as satisfaction can be obtained by acid criticism of the other. The fundamental difficulties, though clear, are not always evident to the man in the street and are particularly easy to neglect when involved in the highly sensational atmosphere of a murder trial; this is of course particularly so if the details are horrific or sexual or both and if a plea of insanity is raised in defence. It may therefore be helpful to restate the points at issue. The first point is that lawyers and doctors talk in different terms. This is not quite so simple as to say, in the words of a judge, that one language is forensic and one scientific, for the confusion is made worse confounded by the fact that certain terms are used by the two professions in different senses. Further, it is very easy for discussion to get bogged down in terminological misconception : readers of the Heath trial?just published in the Notable British Trial Series (William Hodges, Glasgow, 1953)?will notice the confusion of "moral defect" and "moral insanity". The second point is that the methods of law and medicine in arriving at the facts of a case are very different. The law holds that the truth will best come to light by allowing opposing counsel to bring forward opposing views, in black or white. To the doctor much is grey, and this is especially so for the psychiatrist who realises that if he is to get a full account of the patient's conduct and motives, he must show the greatest sympathy and tolerance. Because of this and because of the deeper understanding he may thus obtain, he is likely to be (as well as to seem) more sympathetic, either in his consulting room or in court.
Criminal Behaviour and Mental Health, 2019
Background: A small proportion of every nation's young people become sufficiently antisocial to c... more Background: A small proportion of every nation's young people become sufficiently antisocial to come into contact with the criminal justice system. Many also have disorders of mental health or emotional well-being. Although countries vary in designating age of criminal responsibility, all must provide services for offenders, perhaps as young as 10, both to help them and safeguard their peers and the wider public. Aim: The aim of this article is to map the range of research required to support the development of satisfactory services for young mentally disordered offenders and identify knowledge gaps from a practitioner's perspective. Methods: Using a public health prevention framework, we identified the main streams of research pertinent to young, mentally disordered offenders and sought examples of each to consider the extent to which they have been used to inform service development in England.
The Journal of Forensic Psychiatry & Psychology, 2017
Background: Psychotropic medication is widely prescribed for patients with emotionally unstable p... more Background: Psychotropic medication is widely prescribed for patients with emotionally unstable personality disorder, despite a limited evidence base. In adults, clozapine has been shown to demonstrate a reduction in the incidents of aggression and subsequent restraints. This study seeks to examine the effect of clozapine on the overall functioning and on the rates of incidents of aggression, seclusion and restraint, in female adolescents with severe emotionally unstable personality disorder. Methods: Routinely collected data of functioning and rate of incidents in 15 adolescent females with severe emotionally unstable personality disorder admitted to two secure adolescent mental health hospitals was compared before and after the prescription of clozapine. Results: Following the prescription of clozapine, patients in both hospitals had reduced rates of general incidents, use of restraint and use of seclusion. There was also an improvement in their overall functioning. Conclusions: This is the first case series describing the prescription of clozapine in adolescents with emerging severe emotionally unstable personality disorder, and despite limitations in the study design it provides some evidence for the use of clozapine in this specific patient group.
Youth Justice, 2013
The minimum age of criminal responsibility is set in England and Wales at 10 years of age (Childr... more The minimum age of criminal responsibility is set in England and Wales at 10 years of age (Children and Young Persons Act 1963), whilst the effective age of most civil responsibilities is 16. Research allows us to consider the speed of development of key brain structures in terms of decision-making and this in turn aids in discussion of where the minimum age should be set. This article reviews the evolution of the minimum age of criminal responsibility and examines the setting of this age in light of both civil attainment ages and the current scientific understanding of brain development.
The Journal of Forensic Psychiatry & Psychology, 2013
Obesity is a significant problem among patients in mental health services, with implications for ... more Obesity is a significant problem among patients in mental health services, with implications for morbidity and mortality. This is particularly challenging in forensic services where patients often remain in hospital for prolonged periods, may be on higher doses of medication and often have less access to exercise opportunities. This survey was conducted to investigate weight management strategies in medium secure units (MSUs) and to identify potential barriers to effective prevention and management of obesity. More than half of the MSUs do not currently have an effective strategy for managing obesity, although most have a reasonable range of weight management options available. There is dissonance among clinicians about the ethics of restricting patients' access to food in order to reduce obesity. Whilst more coercive strategies may prove challenging in terms of maintaining the balance with human rights, it is clear that hospitals need to rigorously pursue education and health promotion.
Canadian Journal of Education / Revue canadienne de l'éducation, 1980
The Journal of Forensic Psychiatry & Psychology, 2015