搜索结果：International journal of law and psychiatry

Insight is an important facet of psychosis which can predict many clinical outcomes. Recently, the construct has come under scrutiny, particularly in medicolegal settings where lack of insight is given as a justification for involuntary treatment. This article reviews the arguments around the use of insight in evidence in cases of involuntary treatment and admission to hospital, and capacity to make healthcare-related decisions. It aims to clarify the place of insight and how it might be used beneficially in such discussions for clinicians and legal practitioners. This is a narrative review of the insight construct in clinical psychiatry and medicolegal settings. The article draws on case material and in particular a recent case brought before the England and Wales Court of Protection (CoP). The insight concept is most often used to explain non-compliance with treatment and rejection of or disbelief in a mental illness diagnosis, where it has been faulted on grounds of circular reasoning. Its invocation in legal settings has been criticised, not least by the National Institute of Health and Care Excellence (NICE) since insight is often poorly defined and is not part of the criteria for, for example, mental incapacity. Nevertheless, a deeper understanding of what psychiatrists mean by insight can help in understanding how a patient's psychotic illness might seriously impair their capacity and lead to them to require care without their consent. The case discussed in the CoP exemplifies how insight can be misunderstood and misused by parties in a dispute. Insight remains a commonly discussed aspect of psychopathology and frequently arises in medicolegal arguments. Mental health practitioners giving clinical accounts and expert testimony should be aware of the strict definition of mental capacity and criteria for involuntary treatment. If they wish to refer to the patient's insight, they should take care to define what they mean but crucially they should carefully explain how insight can shed light on aspects of capacity, as advised by NICE. However, poor insight is a core aspect of psychosis and is closely related to lack of capacity and (contra NICE) should not be treated as a distinct concept.

Despite the introduction of legislative changes aimed at a human rights-based approach to mental health care, the rates of involuntary treatment continue to be high and are rising in Queensland, Australia. This paper aims to explore the perspective of the Mental Health Review Tribunal legal members and independent legal representatives on the high and rising rates of involuntary psychiatric treatment in Queensland. A qualitative methodology was utilised through two separate focus group discussions comprised of the Mmental Hhealth review tribunal legal members and independent lawyers who represent consumers in the tribunal hearings. Participants opted into participation via an expression of interest process to share their opinions about the increased use of involuntary treatment under the Mental Health Act 2016 (Qld). Focus group discussions were hosted online and were recorded and transcribed for thematic analysis to identify key themes and sub-themes FINDINGS: Participants in both focus groups generally agreed that involuntary treatment was utilised out of necessity and often in preference to less restrictive options within the current system. This tendency was seen to be tied to resource limitations, issues with mental health law and policy, culture of the mental health services, and systemic issues preventing the uptake of less restrictive and voluntary treatment options CONCLUSION: To effect significant change in involuntary treatment rates, lawyers identified several practical strategies which included revision of the Mental Health Act 2016 (Qld), increased mental health resources especially in the community, supporting consumer participation and legal representation in the tribunal process, and robust leadership to drive meaningful systemic, cultural and attitudinal change in the mental health system.

Capacity to consent or decision-making capacity to healthcare is a key prerequisite for a valid informed consent. A clear understanding of this concept is important to protect patients' autonomy. Without it, clinical assessments may vary, jeopardising patients' participation in decisions about their care and increasing the risk of delayed, denied or harmful treatment. Despite substantial international debate and reforms concerning norms on capacity assessment, there remains a paucity of scholarly literature comparing national approaches, which could enable countries to learn from one another. This study aimed to explore how the concept of capacity to consent to healthcare and the assessment is described in documents, guiding healthcare professionals, issued by health authorities in: Norway, England and Wales, Belgium, France, Sweden and Ireland. Explorative qualitative document analysis of health laws, national guidelines and recommendations published by national health authorities in each country. There is no uniform description of the concept of capacity to consent to healthcare across all countries, although some commonalities exist, such as the functional approach and some countries are more conceptually aligned. The level of descriptive detail on the assessment varied, and in some countries the documents did not include such descriptions. To protect patients' autonomy, it is important that healthcare professionals are provided with a comprehensive guidance document to support their understanding of the concept of capacity to consent to healthcare and how to assess this capacity. The findings indicate that several countries lack such provisions. This could threaten patient safety and wellbeing and make research and clinical practice development more challenging.

France, one of the principal countries from which fighters leave for Syria, is the primary European target of Islamist terrorists. The majority of the data of the literature indicate that psychiatric disorders are not overrepresented in perpetrators of terrorist acts. Nevertheless, these data do not examine expert opinions regarding the discernment of jihadi terrorists at the time of the offense. We aimed to examine abolition and impairment of discernment in psychiatric expert reports on convicted jihadi terrorists in France, and to study any psychiatric disorders identified by the experts as related to the offenses. Our secondary objective was to describe the sociodemographic, psychopathological and criminological characteristics of convicted jihadi terrorists, the type of offense and the mode of radicalization. In collaboration with the national counter-terrorism prosecutor's office (Parquet National Antiterroriste, PNAT), we carried out a retrospective descriptive study of the data collected in the pre-sentence penal psychiatric reports of individuals definitively convicted of a terrorist offense from 2017 onwards. We studied 100 pre-sentence penal psychiatric expert reports and their corresponding case files. No reports concluded on abolition of discernment at the time of the offenses, and a minority concluded on impairment. The experts observed personality disorders, but little mental illness. Social media had played a major part in the radicalization of our population, which was essentially male and young at the time of the offenses. We may conclude that in jihadi terrorism, the issue is less the presence or absence of mental illness than the psychological mechanisms involved in radicalization and acting out. Preventive actions could be developed through understanding of these mechanisms.

Studies have suggested that there are common violence risk factors in both patients with schizophrenia and the general population, a comparison of the characteristics of these two distinct groups could allow for a better understanding. Forensic archives of criminal cases in a Chinese Forensic Centre from January 2015 to December 2019 were reviewed. The male criminal offenders were included and divided into four groups: ① violent and ② non-violent offenders with schizophrenia, and ③ violent and ④ non-violent offenders without mental illness. The sociodemographic, criminological, and clinical information were extracted from the archives, and the psychiatric symptoms, social function, and aggressive behaviors were quantified using the brief psychiatric rating scale, the social disability screening schedule, and the modified overt aggression scale. Data were compared between the four groups and the influencing factors for violence were examined. Three hundred and twenty-one male offenders with schizophrenia (234 violent, 87 non-violent) and 186 male offenders without mental illness were included. Results showed that the violent offenses committed by patients with schizophrenia were more likely to target family members and relatives, occur in rural and public areas, and have fewer quarrels before the offense. Thought disorders and hostility-suspiciousness were identified as the violence risk factors for the patients with schizophrenia. Verbal aggression was a common violence risk factor in both patients with schizophrenia and the people without mental illness. Violence prevention and intervention for patients with schizophrenia need to focus more on verbal aggression, thought disorders, and hostility-suspiciousness.

Prison populations experience disproportionately high rates of mental disorders and suicidality, often receiving inadequate care in settings primarily designed for punishment rather than treatment. Prisons, increasingly serving as de facto psychiatric institutions, present distinct ethical, legal, and clinical challenges for mental health professionals. This paper explores the ethical dilemmas in correctional mental health care, focusing on confidentiality, the principle of equivalence of care, and the dual role of clinicians. It critically examines clinical practices such as suicide prevention, psychopharmacological treatment, management of violence, and end-of-life decisions, and offers recommendations for ethical care in prison environments. A comprehensive literature review was conducted using PubMed and major journals in psychiatry and bioethics, supplemented by policy documents from WHO, UN, and WPA. Guided by expert consultation, the thematic analysis included 97 articles and 6 book chapters. Expert feedback from the EPA ethics committee informed the final recommendations. Key findings highlight tensions between institutional control and therapeutic ethics, especially regarding confidentiality breaches, consent, and coercive practices. Structural factors-Overcrowding, under-resourcing, and stigmatization-Compromise the feasibility of equivalence of care. Ethical concerns intensify around suicide, substance use, neurocorrections, solitary confinement, and the death penalty. Correctional mental health care requires ethically robust, rights-based approaches responsive to both clinical needs and institutional constraints. Implementing context-sensitive guidelines, improving training, ensuring continuity of care, and upholding patient autonomy are critical for safeguarding dignity and therapeutic integrity within prisons.

Spain's mental health system faces a critical contradiction between international human rights standards, notably the UN Convention on the Rights of Persons with Disabilities (CRPD), and the continued practice of involuntary treatment under Article 763 of the Civil Procedure Law (LEC). This law permits deprivation of liberty based on a 'mental disorder,' clashing with Spain's recent legal reforms (Law 8/2021) that champion supported decision-making. This article critically examines the coercive realities masked by Article 763's procedural rhetoric and proposes pathways for rights-based reform. Employing a sociolegal methodology, the study combines doctrinal analysis with qualitative insights from users and survivors of psychiatry and key stakeholders, including clinicians and prosecutors. Findings reveal that judicial oversight often functions as a superficial formality, while the lived experience of patients is dominated by coercive practices, regardless of the legal grounds for admission. The analysis identifies a systemic erosion of informed consent, where admission is treated as de facto consent for treatment; the illusory nature of voluntary discharge; and the persistent clinical reliance on implicit dangerousness criteria. The article advocates for a multi-layered transformation, beginning with the repeal of Article 763 and the amendment of Law 41/2002 (Patient Autonomy) to mandate written, intervention-specific consent for all psychiatric procedures. It calls for a systemic reorientation towards community-based care, strengthened judicial oversight, mandatory professional training, and a cultural shift that prioritises the dignity, will, and preferences of all persons, aligning Spanish law and practice with its international human rights obligations.

Anorexia nervosa (AN) is a serious metabo-psychiatric disorder. Despite a mortality rate approximately five times higher than that of age-matched controls, most deaths result from delayed recognition, fragmented care, and limited access to integrated, evidence-based treatment. Refusal of life-sustaining nutrition in severe or longstanding AN presents profound ethical and legal dilemmas, challenging the balance between autonomy, protection, and the duty to preserve life. This paper provides a critical narrative and normative review of how clinical uncertainty, systemic failure, and legal interpretation influence decision-making in treatment refusal. It examines capacity, futility, and best-interests determinations within mental health and capacity law in England and Wales, with comparative reference to other high-income countries. The review finds that unvalidated constructs such as "severe and enduring" and end-of-life framing of AN lack empirical and legal foundation. Their adoption risks normalising treatment withdrawal and assisted dying in a treatable psychiatric disorder that predominantly affects women. Ethical analysis grounded in autonomy, beneficence, non-maleficence, and justice demonstrates that autonomy should be supported rather than presumed absolute when reasoning is impaired by malnutrition or psychopathology. The paper concludes that aligning clinical and legal practice with the Convention on the Rights of Persons with Disabilities would strengthen supported decision-making, safeguard the right to life, and promote parity between psychiatric and physical healthcare. A shift toward the prevention of avoidable deaths, rather than acceptance of inevitability, is urgently required.

South Africa's mental health law is person-centred, has a strong human rights emphasis, and includes the appointment of mental health review boards (MHRB) to provide oversight and consider appeals against involuntary admissions. Owing to the low number of appeals, this study aimed to determine the proportion of involuntary patients who were aware of their right to appeal at two public sector psychiatric hospitals in KwaZulu Natal Province. A group of conveniently selected involuntary patients was interviewed in a descriptive study that entailed the collection of quantitative data through the administration of a study-specific questionnaire, and the Birchwood Insight Scale from June 2020 to December 2020. Of the 131 participants, most were unemployed (72.5 %) and had at least a high school level of education (61.06 %). The majority were diagnosed with a psychotic disorder (79.4 %), with a median duration of admission of 17.00 days (IQR 9.00, 69.00), and 63.4 % had good insight into their illness. Not a single patient appealed the current involuntary admission, and only one patient appealed a previous admission. Only 11.5 % of the participants were aware that they had the right to appeal their admission, and 8.4 % were aware of the existence of the MHRB. Most patients were unaware of their legal right to appeal and of the MHRB, highlighting the challenges in implementing the letter and practice of the law in underresourced settings without the necessary pre-conditions to fully realise its spirit.

This paper examines the perspective of police officers on conflictual encounters with individuals with mental illness. The study aims to identify the frequency, challenges, reasons for intervention, conflict potential, and factors contributing to escalation and deescalation in operations involving mentally ill individuals. To achieve this, a survey of N = 157 police officers was conducted, incorporating both quantitative and qualitative elements. The results indicate that operations involving mentally disturbed individuals are common and a part of them lead to conflict situations. The primary reasons identified on the part of the individuals involved were a lack of understanding of the situation, aggression, mood instability, delusions, disorder-related factors, and resistance or a lack of manageability. On the part of the police officers, impatience, time constraints, and inappropriate intervention strategies were perceived as contributing factors to these conflictual situations. The factors identified as escalating or de-escalating conflict by the police officers were consistent with those reported by individuals with mental illness in previous studies. The report of using force more frequently in deployments with individuals with mental disorders compared to other deployments was positively correlated with insecurity about how to behave during such deployments, perceiving deployments with individuals with mental disorders as particularly dangerous, and negatively correlated with the feeling of being well-prepared for such deployments, highlighting the high relevance of profound police training. The findings are discussed in the context of training approaches for improving police handling of such situations.

Anorexia Nervosa is an eating disorder typified by low body weight, restrictive eating behaviours, and body image distortion. It is associated with significant risk of medical complications, with one of the highest mortality rates of any mental illness. While the majority of patients receive treatment on a voluntary basis, a small proportion of severely ill patients refuse treatment and are treated involuntarily. The legal mechanisms used for involuntary treatment vary between jurisdictions, including mental health law, capacity-based law, guardianship, and use of inherent jurisdiction, the power of a superior court to rule on matters not included in statute. In Ireland, involuntary treatment of anorexia nervosa occurs within a legislative lacuna, not regulated by either the Mental Health Act 2001, or the Assisted Decision Making (Capacity) Act, 2015. Instead, treatment occurs under the Inherent Jurisdiction of the High Court, resulting in reliance on judicial discretion for decision-making. In this article, we explore the gaps in Ireland's current legal framework as applicable to care and treatment of anorexia nervosa, with reference to case law in England and Wales as a comparison. This includes an examination of the potential impact of the proposed changes to legislation as set out in the Mental Health Bill, 2024. We argue that these gaps mean that legislation governing the involuntary treatment of anorexia nervosa is urgently needed to safeguard the rights of this potentially vulnerable patient cohort, and ensure justice, transparency and consistency in legal approach.

The Advance Directive (AD) serves as a fundamental legal and ethical instrument for safeguarding patient autonomy, ensuring that clinical decisions align with individual values when decision-making capacity is compromised. Despite the established legal framework in Spain since 2002, its practical implementation within mental health services remains largely under-researched. The objective of our study is to describe the barriers and facilitators perceived by mental-health professionals regarding the clinical management and implementation of the Advance Directive (AD). A descriptive, cross-sectional study was executed between December 2022 and March 2023 at Parc Sanitari Sant Joan de Déu (Barcelona, Spain). The sample comprised 215 healthcare professionals across various disciplines-including nursing, psychiatry, psychology, and social work-representing a participation rate of approximately 20% of the 1035 eligible institutional staff. Results reveal a profound discrepancy between theoretical appraisal and clinical practice. Although 96.7% of professionals acknowledge the utility of the AD, practical engagement remains residual: only 20.0% of participants report direct experience with a patient's document. Critical operational barriers were identified, as 74.4% of respondents were unfamiliar with procedures for retrieving an AD from the official registry. Furthermore, 71.6% of professionals perceive an absence of adequate technical or administrative resources provided by their institution. Conversely, facilitators are rooted in ethical commitment; 88.3% maintain that a patient's anticipatory wishes should be respected even when they conflict with clinical advice. Findings underscore a significant gap between the ethical-legal ideal of autonomy and its clinical execution within the Spanish mental health context. Positive professional attitudes are insufficient without robust systemic support. Effective implementation necessitates a multidimensional strategy: strengthening specialized continuing education, streamlining access protocols within electronic health records, and fostering institutional policies that prioritize patient-centered psychiatric care.

Islamist terrorism is a major concern because of the security issues it raises. In France, magistrates call on psychiatric experts to evaluate the dangerousness and risk of recidivism of convicted individuals and to inform post-sentencing decisions. We analyzed the responses of the experts and their methodology, focusing on their methods of evaluation and the incidence of the factors observed during examination of the convicted individual. We collected quantitative and qualitative data from 100 post-sentence expert reports taken from different case files. The case files, transferred by the national anti-terrorism prosecutor's office (Parquet National Antiterroriste), related exclusively to islamist terrorist offenses. We found that a majority of experts responded to the question of dangerousness, distinguishing between psychiatric and criminal dangerousness. The evaluations were based on the search for presumed factors of risk, protection or desistance, although these factors are not all identified in the current scientific literature. Structured evaluation tools were not used, whether actuarial tools or structured professional judgment tools. Several factors identified by the experts were correlated with the group considered as dangerous or at risk of recidivism: signs of radicalization, personality structure, insight, attitude to the offenses, behavior in prison, progress since conviction and attitude to treatment. Our findings are an encouragement to improve expert evaluations by offering psychiatric experts training in criminal psychology that is based on evidence-based data, and in particular training in structured evaluation of risk of recidivism.

Coercion is a central issue in psychiatric practice, and understanding its nature is essential for developing effective coercion reduction strategies. However, the epidemiology and impact of informal coercion during a single hospitalization, as well as its relationship with formal coercion, remain unclear. This study aimed to estimate the prevalence and characteristics of informal coercion during a single hospitalization; to assess whether informal coercion was associated with the intended effect of introducing social resources; and to identify risk factors associated with its use, particularly formal coercion. This retrospective cohort study was conducted at an urban psychiatric emergency hospital. A total of 659 individuals with acute schizophrenia were examined for experiences of informal coercion in the context of social resource introduction. A quasi-experimental design using inverse probability of treatment weighting and modified Poisson regression was employed. Approximately 22 % of participants experienced informal coercion. Specifically, 9.1 % were subjected to threats, 4.7 % to inducements, and 11 % to persuasion. Threats and inducements increased the likelihood of social resource introduction but were also associated with limitations of the participants' choices regarding discharge and post-discharge life decisions. Involuntary admission was the strongest predictor of informal coercion, and condition for discharge is the most prevalent gain implied in threats. Informal coercion towards discharge was a structurally embedded practice linked to formal coercion. Two forms of informal coercion were identified: extra-legally constructed medical authority and informal legal transplantation. Reducing informal coercion requires limiting formal coercion, clarifying discharge criteria in law, and expanding non-coercive social resources.

Studies suggest that forced hospitalizations adversely affect patient satisfaction and overall quality of life. This study aimed to evaluate the trends in involuntary admission rates in a psychiatric hospital and to examine the relationships between admission status and selected socio-demographic and clinical variables, as well as length of hospital stay. The study comprised all individuals involuntarily hospitalized at the Lower Silesian Centre of Mental Health in Wroclaw, Poland, between 2016 and 2022. The following data sources were used: a) Mental Health Protection Act (UoOZP) monitoring questionnaires from 2016 to 2022; b) statistical data on admissions and patient turnover; c) essential patient information available in the hospital's system. From 2016 to 2022, there was a significant increase in the proportion of individuals admitted involuntarily to the psychiatric hospital, rising from 15.64% to 22.21%. Factors linked to a higher probability of involuntary admission included: male gender, primary or secondary education, single status, an initial diagnosis of schizophrenia or other psychotic disorders, alcohol use disorders, or admission for observation. In contrast, factors associated with longer hospital stay included female gender, secondary or higher education, single status, admission under articles 23.1, (emergency admission), 28 (emergency admission following withdrawal of consent for treatment) and 29.1 (admission by request) of the UoOZP, non-scheduled admissions, a history of previous psychiatric hospitalizations, and a diagnosis of schizophrenia. Determining the predictors of involuntary admissions is essential for understanding the effects of compulsory treatment. Compulsory treatment has the potential to bring both advantages and disadvantages, which should be considered in decision-making regarding its application.

Although the frequency of compulsory admissions (CA) to inpatient psychiatric care in Italy is low, it remains a sensitive component of psychiatric practice, together with coercion and mechanical restraint (MR). In such practices, the staff's attitude may play a role. We wanted to identify risk factors for CAs and MRs in Italian psychiatric services. A total of 18 General Hospital Psychiatric Wards (GHPWs) collected data over 12 months, reporting GHPWs' features, staff, training on CAs reduction, restrictions, protocols with Emergency, user involvement and right advocacy, number and characteristics of CAs and number of MRs. The Italian version of the Staff Attitude to Coercion Scale - SACS assessed staff attitudes. 1246 CAs (19% of all admissions) occurred in the period (median 19.2), involving 1032 individuals. No correlations between GHPW characteristics and CAs emerged. MR was used in 18% of CAs. Three GHPWs reported no MR use during the study period. MR risk was higher for males, longer CAs, personality disorder, CA confirmation in the Emergency. MRs were fewer in GHPWs with a room for meetings and no restricted access to common spaces. Total SACS score and its subscales correlated with a greater frequency of MRs. The prevalence of CAs in Italy warrants careful monitoring. Although limited acceptance of coercion among professionals, MRs remain frequent and related to contextual factors. Benchmarking would support mobilizing stakeholders' will in improving the quality of care, human rights respect and professionals' well-being in mental health settings.

The specific circumstances under which autism spectrum disorder could meet the legal standards severe mental disorder (SMD; the core Swedish legal concept underpinning sentencing to forensic psychiatric care) in criminal court cases are unclear. To explore which neurocognitive and contextual factors that have been emphasized in the assessment of SMD in cases of autism spectrum disorder. A randomized sample (N = 20) was derived from a data set of forensic psychiatric evaluations (FPEs) conducted between 2016 and 2018 on violent offenders with autism. Qualitative content analysis was used separately for offenders who did (n = 10) and did not (n = 10) meet the standard for SMD. A dimensional approach to autism-associated features was commonly used within SMD decision-making, including overall statements that autism was considered severe enough, or not, for SMD. Certain types of autism-associated features were more prominent in the SMD group, contributing to autism being considered more severe. Examples were very low psychosocial functioning, fixation on violence, few or rigid coping strategies, impaired central coherence/metacognition. Pronounced degree of idiosyncratic/atypical worldview, feelings of anxiety, insecurity, fear, or desperation were also emphasized in the SMD group. Degree of compulsive behavior could also be highlighted in the SMD group, particularly if it was considered associated with severe anxiety when routines were broken or certain stimulus was perceived. Emphasized characteristics in the no SMD group included antisocial traits, complex and/or vague psychopathology, substance abuse, intact reality monitoring, and the ability to integrate multiple perspectives. Degree of autism-symptomatology and global/psychosocial functional impairment were considered both in the SMD and no SMD groups' FPEs. The no SMD group was often described as not exhibiting sufficiently marked autism-functioning, a lower degree of psychiatric symptomatology in general, and a motivation for the crime which is not considered clearly related to a non-normative perception of reality due to autism. The vagueness in when autism severity was considered "sufficient" for SMD, emphasizes the importance of further in-depth studies to inform the development and implementation of standards or guidelines to support experts in their decision-making.

Benzodiazepines and Z-drugs are commonly prescribed medications in psychiatric treatment. Prisoners are a unique patient population due to their elevated prevalence of substance abuse and psychiatric morbidity. Given the limited data about the medical treatment for prisoners, this study aims to provide an initial exploratory overview of the prescription patterns of benzodiazepines and Z-drugs in Berlin prisons. A data set was compiled by extracting information from the documentation systems of all seven Berlin prisons. All inmates with a prescription for benzodiazepines or Z-drugs as of the cut-off date were included. Demographic characteristics, arrest circumstances, and medical histories were considered. Supplementary information on the overall prison population was obtained from officially published sources. As of August 31, 2022, the point prevalence of benzodiazepine and Z-drug prescriptions among Berlin prisoners was 3.9% (n = 136). The duration of 46 (33.8%) prescriptions exceeded six weeks. The prescription rate in female prisoners (6.8%, n = 13/190) was significantly higher than in male prisoners (4.1%, n = 123/3299). The prescription rate in default imprisoned individuals (16.5%, n = 62/376) was significantly higher compared to in convicted and remand detainees (2.1%, n = 71/3095). Benzodiazepines and Z-drugs were prescribed less frequently in Berlin prisons than in general outpatient care. Approximately 1/3 of all prescriptions exceeded the recommended maximum duration. Prescription rates in prison were higher among female inmates. Rates among remand detainees did not exceed those of convicted prisoners. Default imprisonment was identified as a factor influencing prescription practices, likely due to its strong association with homelessness and alcohol abuse.

Islamist terrorism is a major preoccupation in France as it poses a serious threat to safety. Pre-release assessment of convicted jihadi terrorists requires high-quality psychiatric expert reports to assist magistrates in deciding on post-sentence follow-up. In the literature, the quality of psychiatric expert reports in France has been questioned. This arises from a discrepancy between the number of expert reports that are requested and the number of experts available. We studied the quality of these reports, focusing on evaluation of dangerousness and the risk of recidivism. In this novel study, quantitative and qualitative data were extracted from 100 post-sentence expert reports, 15 s expert opinions and 10 supplemental reports. These reports were taken from 100 different case files exclusively concerning Islamist terrorism-related offenses. This study was carried out in partnership with the national counter-terrorism prosecutor's office, the Parquet National Antiterrorisme (PNAT). In order to study the quality of these reports, we developed conformity scores based on the general recommendations of the French National Authority for Health (Haute Autorité de Santé, HAS). These general conformity scores concerned the recommendations for all types of expert reports, while specific conformity scores related to post-sentence reports. Lastly, we proposed a list of risk factors for violent radicalization based on the data of the literature, and these enabled us to calculate conformity scores specifically related to Islamist terrorism. The mean conformity score of the expert reports was 86.7%, with scores varying between reports. The score decreased to 82.1% if criteria specific to terrorism were included. The experts often made no reference to a classification when making a diagnosis. They were reticent to use actuarial tools or structured professional judgments to assess the risk of recidivism. Their practice in searching for criteria specific to Islamist terrorism also appeared to vary. There is a need for training and working meetings between psychiatric experts to reach a consensus on the quality of expert reports. Meetings and exchanges between experts and magistrates would help clarify their respective missions.