Hani hmed dessoki,forensic psychiatry


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  • This slide depicts the JSO characteristics…a JSO that is less severe will have the same characteristics yet what creates the difference is the level of severity or risk that is estimated and assessed as the youth is in the community
  • AOIC DVD - Evaluations 2005 Donya L. Adkerson, MA, LCPC
  • AOIC DVD - Evaluations 2005 Donya L. Adkerson, MA, LCPC
  • AOIC DVD - Evaluations 2005 Donya L. Adkerson, MA, LCPC
  • AOIC DVD - Evaluations 2005 Donya L. Adkerson, MA, LCPC
  • AOIC DVD - Evaluations 2005 Donya L. Adkerson, MA, LCPC
  • AOIC DVD - Evaluations 2005 Donya L. Adkerson, MA, LCPC
  • AOIC DVD - Evaluations 2005 Donya L. Adkerson, MA, LCPC
  • AOIC DVD - Evaluations 2005 Donya L. Adkerson, MA, LCPC
  • AOIC DVD - Evaluations 2005 Donya L. Adkerson, MA, LCPC
  • Hani hmed dessoki,forensic psychiatry

    1. 1. By: Dr. Hani Hamed Dessoki, M.D. Psychiatry Associate Prof. Psychiatry Acting Head, Psychiatry Department Beni Suef University Supervisor of Psychiatry Department El- Fayuom University 2013
    2. 2. Introduction  “…there is no know psychological test, profile, evaluation procedure, of combination of such tools that prove or disprove whether an individual has committed a specific sexual act.”
    3. 3. Defence of mental disorder (Section 16)Defence of mental disorder (Section 16) No person is criminally responsible for an actNo person is criminally responsible for an act committed or an omission made while sufferingcommitted or an omission made while suffering from a mental disorder that rendered the personfrom a mental disorder that rendered the person incapable of appreciating the nature and qualityincapable of appreciating the nature and quality of the act or omission or of knowing that it wasof the act or omission or of knowing that it was wrong.wrong. Every person is presumed not to suffer from aEvery person is presumed not to suffer from a mental disorder so as to be exempt frommental disorder so as to be exempt from criminal responsibilitycriminal responsibility by virtue of subsection.by virtue of subsection.
    4. 4. Agenda  Introduction  Prevalence  Who are sex offenders  Types  General Rules  Preparing your self for the evaluation  Assessment
    5. 5. ‫مقدمه‬ ‫المركز‬ ‫مصر‬ ‫احتلل‬ ‫إلى‬ ‫تشير‬ ‫دراسة‬ ‫نشر‬ ‫مع‬ ‫بالتزامن‬ ،‫الجنسية‬ ‫الجريمة‬ ‫معدلت‬ ‫في‬ ‫العربي‬ ‫الدول‬ ‫بين‬ ‫الول‬ ‫إدارة‬ ‫أن‬ ‫المصرية‬ ‫الداخلية‬ ‫وزارة‬ ‫في‬ ‫مصدر‬ ‫كشف‬ ‫من‬ ‫أكثر‬ ‫ضبطت‬ ‫الداب‬ ‫جرائم‬ ‫مكافحة‬45‫جريمة‬ ‫ألف‬ ‫عام‬ ‫بداية‬ ‫منذ‬ ‫آداب‬2006‫مارس‬ ‫وحتى‬2007‫بينما‬ ، ‫العام‬ ‫شهد‬2006‫من‬ ‫أكثر‬52‫جنسي‬ ‫تحرش‬ ‫جريمة‬ ‫ألف‬ ‫واغتصاب‬.   ‫الجتماعية‬ ‫للبحوث‬ ‫القومي‬ ‫للمركز‬ ‫حديثة‬ ‫بإحصائية‬ ‫إن‬ ‫تقول‬ ‫مصر‬ ‫في‬ ‫والجنائية‬20‫اغتصاب‬ ‫حالة‬ ‫ألف‬ ‫يا‬ّ ‫سنو‬ ‫مصر‬ ‫في‬ ‫ترتكب‬ ‫جنسي‬ ‫وتحرش‬.  
    6. 6. ‫مقدمه‬ ‫الطبيب‬ ‫عن‬ ‫الشرعي‬ ‫النفسي‬ ‫الطبيب‬ ‫مهام‬ ‫تختلف‬ ‫ومحقق‬ ‫طبيب‬ ‫هو‬ ‫الشرعي‬ ‫فالطبيب‬ ‫العادي‬ ‫النفسي‬ ‫مريض‬ ‫مع‬ ‫يتعامل‬ ‫لنه‬ ‫الوقت‬ ‫نفس‬ ‫في‬ ‫وشاهد‬ ‫وفاحص‬ ‫من‬ ‫يهرب‬ ‫حتي‬ ‫والجنون‬ ‫المرض‬ ‫يدعي‬ ‫يكون‬ ‫ان‬ ‫وارد‬ ‫الجنائية‬ ‫المسئولية‬ ‫الـ‬ ‫تتعدي‬ ‫الجنون‬ ‫يدعون‬ ‫الذين‬ ‫المتهمين‬ ‫نسبة‬70‫من‬ % ‫الشرعي‬ ‫النفسي‬ ‫الطب‬ ‫وحدة‬ ‫إلي‬ ‫تحول‬ ‫التي‬ ‫الحالت‬ ‫ول‬ ‫المتهم‬ ‫عن‬ ‫الدفاع‬ ‫عن‬ ‫المتهم‬ ‫محامي‬ ‫يعجز‬ ‫وعندما‬ ‫أن‬ ‫تفيد‬ ‫روشتة‬ ‫أو‬ ‫شهادة‬ ‫باستخراج‬ ‫يقوم‬ ‫مخرج‬ ‫أي‬ ‫يجد‬ ‫طبيب‬ ‫لدي‬ ‫يعالج‬ ‫كان‬ ‫المتهم‬
    7. 7. Prevalence of Legal Sexual Compulsive Behavior  According to the Internet Filter Review site, 40 million Americans visit Internet porn sites at least once a month (Maltz, 2008).  Currently, over 60 percent of all visits on the Internet involve a sexual purpose (Schneider and Weiss, 2010).
    8. 8. Prevalence of Legal Sexual Compulsive Behavior  A record breaking 25% of employees in the United States are accessing porn at work, (Maltz, 2008).
    9. 9. Prevalence of Legal Sexual Compulsive Behavior  There are 100,000 Web sites dedicated to selling sex in some way-not including chat rooms, emails, or other forms of sexual contact on the web (Cybersex Unhooked, 2007).
    10. 10. Prevalence of Legal Sexual Compulsive Behavior  In the United States, twenty million “adult” magazines are sold each month.
    11. 11. Prevalence of Legal Sexual Compulsive Behavior  Pornography has become a substantial part of the United States’ economy .  No matter it’s means of access, pornography produced annual revenues in excess of $13 billion dollars in the United States.  Worldwide it produced $100 billion.
    12. 12. 2006 World Wide Pornography Revenue
    13. 13. Pornography’s Effects  Evidence shows that as many as one in three rapists and child molesters use pornography to become sexually aroused immediately proceeding and during the commission of their crimes (Marshall, 1989).  And other studies report that 56% of rapists and 42% of child molesters reported that pornography was somehow implicated in their offense (Able, 1985).
    14. 14. Pornography’s Effects  Persons reporting exposure to pornography are 28% more likely to engage in sexually deviant behavior (such as exhibitionism or voyeurism) than the general population.  Risk of engaging in sexual perpetration - that is, sexually hostile or violent behavior - was found to increase by between 21 and 30% for persons exposed to pornography.
    15. 15. A word on calling it “Sexual Addiction”
    16. 16. Who are sex offenders? What comes to mind when you think about sex offenders?
    17. 17. In Fact. . . . Sex Offenders: Juveniles Adults Juveniles comprise 25.8% of all sexual offenses
    18. 18. What is a Juvenile Sex Offender? An adolescent male or female who has been adjudicated (charged and found responsible) for engaging in sexually aggressive behaviors, who sexually abuse or offend, or who engage in inappropriate sexual behaviors that victimize others.
    19. 19. Common Characteristics of JSO’s ? •11-17 years of age •Prior sex offense unlikely •47% have been physically abused •58% have witnessed domestic violence •35% have been sexually abused •Most have problems with impulse control •60% have learning disabilities and academic problems •Most have social deficits •Likely have other behavior and mental health problems
    20. 20. Age and Sex of Juveniles Who Offend 0 5 10 15 20 25 30 35 40 45 50 Age Age The rate of sexual offense behavior rises sharply at the age of 12, and plateaus after age 14. The vast majority of juveniles who sexually offend are male (93%).  Females who offend tend to be younger, have more victims, offend alongside peers more, have more male victims, and have more victims that are family members.
    21. 21. Differences  Juveniles are more likely to offend in groups than adults (24% as opposed to 14%).  They are more likely to have a male victim (25% versus 13%).  They are less likely to offend at home (69% versus 80%) and more likely to offend at school (12% versus 2%).
    22. 22. Hands On Hands Off  Sexual assault  Rape  Molestation  Forcible sodomy  Sexual touching  Exhibitionism  Possessing illicit pornography  Obscene telephone calls  Voyeurism  Sexual harassment Types of Sexual Crimes
    23. 23. Overview of field: Old Paradigm  Those—especially males--who have been sexually abused are going to become offenders.  “Once an offender, always an offender.”  Offenders—including children and adolescents-- do not respond positively to treatment.
    24. 24. Old Paradigm  Must come from highly dysfunctional families.  There is no specific family profile. No unique family pattern has been identified The characteristics of are diverse and may or may not be considered dysfunctional.
    25. 25. Who are the Abusers?Who are the Abusers?  86% of ALL (adult and child) sexual assault cases reported to law enforcement were committed by someone known to the victim – a family member or acquaintance (Bureau of Justice Statistics, 2000).  93% of victims under the age of 17 & 73% of victims age 18 and older, were assaulted by someone they knew.  Where the victim was a child, 34% of offenders were family members and 59% were acquaintances (Bureau of Justice Statistics, 2000).
    26. 26. New York StatisticsNew York Statistics ** 85% of registered NYS sex offenders have V < 18 y.o. ** Source: NYS SOR as of 3/30/2010 Produced by: DCJS OJRP - Crimestat Unit
    27. 27. What reactions do all of victims elicit?What reactions do all of victims elicit?
    29. 29. General Rules
    30. 30. Some history of the insanity defense  M’Naghten Rule: England, 1843 – Insanity is not knowing the difference between right and wrong (cognitive test) – Still used as the definition of insanity in half of all U.S. states  In some jurisdictions, rule broadened by including the irresistable impulse test – A “sane” person must know right from wrong, AND – Be able to resist the impulse to do a wrong deed (volitional aspect)
    31. 31. Substantial Capacity Attempted to remove problems of both M’Naghten and Irresistible Impulse while maintaining the legal nature of both Emphasizes reason and will Substantial capacity is not complete mental capacity Individuals with some, but limited capacity may still be found insane
    32. 32. Diminished Capacity  Distinguish between diminished responsibility – Diminished responsibility What I did was wrong, but under the circumstances I am less responsible. Seeks to be punished for lesser offense – Diminished capacity Focuses on defendant’s capacity to commit a specific intent crime  Most states reject both diminished capacity and diminished responsibility defenses…or allow the court to consider it for sentencing purposes
    33. 33. Legal competence  Psychological issue most frequently addressed in the court system = competence  Competence involves the defendant’s ability to – Understand the charges against him/her – Participate in proceedings in a meaningful way
    34. 34. Children and competence  Children generally presumed incompetent until age 7 (sometimes even 10 or 14)  Factors bearing on a child’s competence: – Understanding difference between truth and falsehood – Capacity to understand and describe events – Memory ability – Suggestibility (biasing influences from parents, attorneys, etc.)
    35. 35. Age The defense of age focuses on whether defendant was too young to have the capacity to commit a crime (not whether he or she will be tried in juvenile court…whether he or she could be tried at all)
    36. 36. European Age  Republic of Ireland - 12  France, Holland, Poland - 13  Germany and Italy - 14  Spain - 16  Luxembourg - 18
    37. 37. Voluntary act is the first principle of criminal liability In order to have criminal liability there must be criminal conduct Criminal conduct is conduct that is without justification or excuse Voluntary act is the “conduct” part of criminal conduct Many crimes don’t include a criminal intent or bad result.
    38. 38. Elements of Criminal Liability Actus Reus— the criminal act Mens rea— the criminal intent Concurrence—the requirement that the criminal intent trigger the criminal act Attendant circumstances (when a crime does not require the criminal intent, it generally requires some attendant circumstance) Bad result causing a criminal harm
    39. 39. Elements of Criminal Liability (cont.) Corpus delicti = “body of crime” but it doesn’t necessarily mean a physical body. It refers, instead to the elements of a crime Criminal conduct = criminal act triggered by the criminal intent Criminal act = voluntary bodily movement.
    40. 40. Preparing yourself for the evaluation The right preparation makes all the difference
    42. 42. What an Evaluation can do:  Clarify recidivism risk level  Determine guilt or innocence regarding a specific crime  Identify problem areas and complications to the offending problem  Identify treatment needs  Lay groundwork for treatment
    43. 43. Components of the Evaluation  Review of History  Collateral interviews  Client interview  Client testing  Actuarial assessment  Writing report
    44. 44. Structuring the Evaluation  Safe and comfortable setting  Full days vs. multiple short sessions  Collateral before client interviews  Start with low defense areas, move to difficulty subjects later
    45. 45. As the Evaluator, you should:  Know your subject – sexual offenders – before doing any evaluation  Get education, training, supervision and experience
    46. 46. As the Evaluator, you should:  Do your homework. There is no substitute for thorough background research before your client interview  Think Kojak/Columbo.  Understand your client’s agenda; it will not be the same as yours  Respect the client as a person
    47. 47. Evaluation Interview skills  Take thorough notes. Get the name, age, gender of every person the client mentions  Don’t give away what you know.  Rephrase and re-ask questions at different points in the interview.  Bring your poker face. Smile pleasantly at appropriate opportunities to help put the client at ease.
    48. 48. Watch the NONVERBAL language Words are not the only way people communicate, and nonverbal communication becomes very important when working with people who may be motivated to be dishonest. No matter how good you are at reading nonverbals, you still can't catch every lie.
    49. 49. Watch the NONVERBAL language  Eye contact/changes noted  Voice tone/changes noted  Tearfulness  Power/control behaviors (i.e., walks around office during interview, handles objects from desk, tries to direct interview, silence)
    50. 50. Watch the NONVERBAL language  Nervous behaviors (i.e., leg shaking, tapping)  Defensive/evasive posturing (arms tightly closed, refuses to remove coat, gaze fixed to side or ceiling)  Destructive (to body, clothing, furniture, office objects, other)
    51. 51. Creating Comfort with the Client  Assure the client of your knowledge, experience, comfort with the issues to help decrease embarrassment.  Choose language appropriate for the client’s developmental age and functioning.  Be sure terms are understood.  Use the client’s terms whenever possible.
    52. 52. Using Discomfort in the Interview  Use silence to your advantage when you want the client to tell more.  Don’t rush to speak.  Use hints of your information without details to elicit information in areas the client first omits.
    53. 53. Helpful Interview Techniques  Mind-reading  Prediction  Leading
    54. 54. Assessment of Legal Compulsive Sexual Behavior  Extensive Questionnaire  Detailed Clinical Interview  Assessment instruments  Collateral information from the spouses
    55. 55. Ask open ended questions Use presumptive questioning Build rapport Start with more neutral questions (non judgmental) Ask questions in unique ways, and at different times, helps get away from “rehearsed” answers Don’t help them be a better liar by pointing out inconsistencies Ask good follow up. Assessment
    56. 56. ________________________________________________________________________________________________________________________Su ccessfully Investigating Acquaintance Sexual Assault: A National Training Manual for Law Enforcement“ Developed by the National Center for Women & Policing, with support provided by the Violence Against Women Office, Office of Justice Programs (Grant #97-WE-VX-K004) Interview Techniques  The interviewing investigator must be very comfortable with abhorrent sexual behaviors  Use a soothing and reassuring voice throughout the interview  Keep an open mind at all times
    57. 57. Factors To Be Considered In Assessing Criminal Responsibility  Evidence of mental disorder currently, in the past and at time of offense presence of delusions, mood disorder  Motive for offense - if no apparent motive other than psychotic, suggests valid mental disorder - if rational motive also present, such as profit, suspect malingering or coincidental mental disorder  Consider planning and preparation for crime  Evidence of impaired functioning within a few days of the crime
    58. 58. Gather information about  History of aggression or violence,  History of sexually abusive behavior, including details about victims, tactics used in the commission of the offense, and the circumstances in which the sexual abuse occurred,  Level of cognitive functioning,  Medical and mental health histories,  Official and unreported history of sexual and nonsexual crimes,
    59. 59. Gather information about  Peer and romantic relationship histories,  Substance use/abuse  Relevant personality traits such as, but not limited to suspiciousness, hostility, risk-taking, impulsivity, and psychopathy,
    60. 60. Gather information about  Sexual history, including sexual fantasies, urges, and behavior, early sexual experiences; number and duration of sexual relationships; gender identity and sexual orientation; masturbation and intercourse frequency; sexual functioning; unusual sexual interests or behavior that are not sexually deviant.  Use of sexually arousing materials (e.g., magazines, videos, computer porn, internet sites, phone sex)
    61. 61. Use multiple sources of information  Sexual preference measures  Relevant psychometric testing  Risk assessment  Client interview
    62. 62. Areas to Assess – Specifics of sexual crimes – Sexual deviance patterns – Sexual dysfunction – Sexual preferences – Sexual practices – Attitudes and cognitions (thoughts) about sexuality & offending
    63. 63. Areas to Assess  Level of denial and deception  Level of violence and coercion  Evaluation of risk
    64. 64. Do not base conclusions on Client self report alone  Describe the sources of information  Identify any significant missing information in the report and note the impact this information could have on results/recommendations
    65. 65. What is a Risk Assessment?  A comprehensive evaluation to determine a particular sex offender’s likelihood to commit a subsequent sex crime, and a determination of their likelihood to benefit from treatment
    66. 66. Risk Assessment  Actuarial Risk Assessment  Clinical Risk Assessment – Psychiatric Assessment
    67. 67. Actuarial Risk Assessment  Objective and Reliable  Questionable generalization to other populations  Static historical data generating Static risk  Not amenable to change  Ignore individual factors  Make statements about groups not individuals
    68. 68. Actuarial Assessment  Assessment based on research statistical analysis of factors strongly correlated with recidivism risk.  This type of assessment is currently only available for adult male sexual offenders.  Continuing research is needed before such tools will be available for minors and for females.
    69. 69. Clinical Risk Assessment  Thorough psychiatric assessment with reasoned opinion  Understanding phenomenology of sexual behaviours for the purpose of treatment/risk management – Paraphilias  Patient focused and treatment orientated  Should take into consideration actuarial risk assessment tools  Both static and dynamic risks
    70. 70. The Content  A risk assessment should be comprehensive, and include at least some information on all of the following areas:
    71. 71. The Content Reason for Referral Family History Educational History Vocational History Military History Legal History Drug and Alcohol Use History  Treatment History  Sexual History  Previous Psychological Evaluations  Previous Sexual Crimes  Previous Risk Assessments  Current Sexual Crime  Diagnoses  Summary and Recommendations
    72. 72. Offender ObligationsOffender Obligations  Register as a sex offender upon release to the community, whether released from incarceration or to probation or discharged upon payment of fine, given conditional or unconditional discharge  Annually verify address  Notify of change of address  Notify if attending, enrolled in, residing, or employed by an institution of higher education  Provide internet information  Provide updated photograph  Notify of employment address  Personally verify address every 90 days
    73. 73. Written report  The product from the evaluation process.  The report serves to document, educate and guide decisions regarding the client’s containment and treatment.  It should be detailed and specific.
    74. 74. Thoughts…Comments