Thursday, October 23, 2008

What I Learned Part 1

For new readers, it's a ClinkShrink tradition to report on the annual American Academy of Psychiatry and Law conference, which is being hosted in Seattle this year.

Today was the first day of the conference. It began with an excellent keynote address by AAPL president Dr. Jeffrey Janofsky, who talked about reducing inpatient suicides. He presented the result of an interesting quality assurance study done at Johns Hopkins Hospital which applied the principles of "failure mode and effects analysis" (FMEA) to the problem of inpatient suicide. He found that there were over 40 potential failure points with 90 possible causes, all of which could lead to a completed suicide. FMEA is a process developed for use in manufacturing but which is more recently being applied to hospital-based medical errors.

From there I went to a debate over the treatment of Dangerous Seriously Personality Disordered offenders (DSPD), people committed indefinitely for treatment under Britain's DPSD act. There was some debate over whether or not the costs of confinement outweighed any potential benefit, but almost no practical discussion of whether or not the treatment actually benefitted the offenders which I think is a more relevant issue. The more interesting point that came out was a discussion of Hollands TBS sentencing system. This allows judge, at the time of sentencing, to determine a proportional amount of criminal responsibility for an offense and to assign the offender to either a hospital or a prison for the amount of time proportional to that responsibility. In other words, if you're found 60% responsible and 40% impaired you'd spend about half your time in a treatment facility until you 'earn' your way out to a prison. It's an interesting idea. It has reduced recidivism from almost 50% to around 17%.

In the afternoon I attended the obligatory serial killer talk. There has to be one at every meeting. In my early forensic days these were the talks you looked forward to because they were the most intriguing. Now after several years of forensic work I find them mostly very speculative and theoretical. The only data-based statement I heard was that about a quarter of all sadistic serial killers were also masochists. I heard a lot of psychoanalytic speculation. Too much speculation. The only definitive thing I came away with was the knowledge that the BTK killer looked lousy in women's lingerie.

The best presentation was given by members of the American Academy of Forensic Sciences. I try to make their presentations every year because they've uniformly been fascinating. This year's presentation was about arson investigation and how electrical causes of fires leave certain predictable traces. It was great. Then the president of the AAFS, an attorney, gave a presentation about how lawyers use the Internet to investigate expert witnesses. That was great too. She gave a run-down of common Internet diploma mills and talked about the infamous case of the famous hypnotherapy expert witness, Dr. Zoe Katze. If you haven't read this, it's worth a trip to follow the link. And here I spent all that money getting re-credentialled in forensic psychiatry.

So that's how I spent my day. There were loads of poster presentations I'm not going to review here, because frankly a lot of them weren't that great. I'm getting picky in my old age when it comes to conference material.

More to follow. I'm off to dinner now.

Oh yeah, I'm on the 46th floor of a 47 floor hotel. The view is terrific, but not quite as good as the view from the top of Seneca Rocks:

Click here to see what ClinkShrink learns in Part 2.