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BackgroundPersons involved in compulsory mental health treatment-including clinicians, lawyers, service users, and family members-frequently express dissatisfaction with how the system is regulated and administered. Policy discussions on improving the system often fail to consider the voices of service users and family members. Policy development must also grapple with the contested values of autonomy and wellbeing, and the associated disjuncture in professional views. Community treatment orders (CTOs) are a key mechanism of compulsory mental health treatment in Ontario, and many other jurisdictions. We studied views on CTOs in Ontario to identify agreement across groups about where and how the system ought to be improved.MethodWe conducted semi-structured individual interviews followed by mixed focus groups including 72 participants: healthcare professionals, lawyers, tribunal members, service users ("clients"), family members, and advocates. Interview data were analyzed to identify recurring concerns and inform focus group discussion topics. Focus groups explored potential areas of alignment across participant groups, with particular attention to points of consensus. A lived-experience advisory panel informed study design.ResultsAcross participant groups, 6 main areas of agreement were visible. Participants identified the need for: (1) increased client involvement in treatment decisions, even within compulsory frameworks; (2) improved police involvement during CTO enforcement; (3) improved availability and quality of CTO-related data, enabling evaluation, accountability and attention to equity; (4) enhanced guidance and support for substitute decision-makers; (5) stronger oversight of medical decision-making, though preferred mechanisms varied; and (6) expanded community services-particularly housing, addiction treatment and case management-viewed as essential for CTOs to be able to have their intended benefit.ConclusionsThis study shows there is meaningful agreement on several areas requiring improvement in Ontario's CTO system. These points of convergence represent promising foundations for policy development, although translation into actionable reform will require further policy work. Shared Views on Improving Compulsory Treatment for Mental IllnessWhy was the study done?Community treatment orders (CTOs) allow people with mental illness to be required to follow treatment while living in the community. They are used in Ontario and many other places. Many people involved in the system, including healthcare professionals, lawyers, service users, and family members, have expressed concerns about how CTOs work. However, discussions about improving the system do not always include service users and families. Also, there is often disagreement between groups involved in CTOs about how they should improve. This study aimed to identify areas where different groups agree about how the CTO system could be improved.What did the researchers do?The research team conducted interviews and focus groups with 72 participants in Ontario, including healthcare professionals, lawyers, tribunal members, service users, family members, and advocates. Interviews identified key concerns about CTOs, and focus groups explored these issues further, with particular attention to areas of agreement. People with lived experience of being on CTOs also helped guide the study.What did the researchers find?Participants agreed on several important areas for improvement. These included increasing service user involvement in treatment decisions, improving police involvement during CTO enforcement, and collecting better data to evaluate CTO use. Participants also agreed that substitute decision-makers need better guidance, and that medical decision-making should have stronger oversight. Finally, participants emphasised that CTOs cannot work effectively without adequate community services, especially housing, addiction treatment, and case management.What do the findings mean?There is meaningful agreement across groups about how the CTO system could be improved. These shared priorities provide a strong foundation for policymakers seeking to improve compulsory community mental health treatment. Les personnes concernées par les soins psychiatriques imposés, y compris les cliniciens, les avocats, les usagers des services et les membres de leur famille, expriment souvent leur insatisfaction à l’égard de la réglementation et de la gestion du système. Les discussions relatives aux politiques visant à améliorer le système ne tiennent souvent pas compte de la voix des usagers des services et des membres de leur famille. L’élaboration des politiques doit également tenir compte des valeurs controversées que sont l’autonomie et le bien-être, ainsi que des divergences d’opinions qui en découlent chez les professionnels. Les ordonnances de traitement communautaires (OTC) constituent un des principaux mécanismes des soins psychiatriques imposés en Ontario et dans de nombreuses autres provinces et territoires. Nous avons étudié les points de vue sur les OTC en Ontario afin de dégager une entente entre les groupes quant aux possibilités d’amélioration du système. Nous avons mené des entrevues individuelles semi-structurées, suivies de groupes de discussion mixtes comprenant 72 participants : professionnels de la santé, avocats, membres de tribunaux, usages des services (« clients »), membres de leur famille et défenseurs des droits des usagers. Les données issues des entretiens ont été analysées pour déterminer les préoccupations récurrentes et orienter les sujets abordés dans le cadre des groupes de discussion. Les groupes de discussion ont permis d’explorer les points de convergence potentiels entre les différents groupes de participants, en accordant une attention particulière aux points de consensus. Un comité consultatif formé de personnes ayant une expérience vécue a contribué à l’élaboration du protocole de l’étude. Parmi les groupes de participants, six principaux domaines d’entente se sont dégagés. Les participants ont cerné les besoins suivants : (1) accroître la participation des clients aux décisions de traitement, même dans le cadre de traitements obligatoires; (2) améliorer la participation de la police à l’exécution des OTC; (3) améliorer la disponibilité et la qualité des données liées aux OTC, afin de procéder à des évaluations, de favoriser la responsabilisation et d’accorder de l’attention à l’équité; (4) améliorer les conseils et le soutien offerts aux mandataires; (5) superviser plus étroitement la prise de décisions médicales, bien que les mécanismes privilégiés soient variés; et (6) élargir l’accès aux services communautaires, en particulier en matière de logement, de traitement de la toxicomanie et de gestion de cas, considérés comme essentiels pour que les OTC puissent procurer les bienfaits souhaités. Cette étude montre qu’il existe un large consensus sur plusieurs domaines nécessitant des améliorations au sein du système des OTC en Ontario. Ces points de convergence représentent des bases prometteuses en vue de l’élaboration de politiques, même si la transposition en réformes concrètes nécessitera des efforts supplémentaires afin de retravailler les politiques. Soins psychiatriques imposés, ordonnance de traitement communautaire; consensus; membres de la famille; professionnels de la santé; avocats; troubles de santé mentale; usagers des services

Artificial intelligence (AI) is increasingly integrated into mental health care, legal decision-making, and forensic practice. Proponents argue that AI can augment professional judgment by improving prediction, efficiency, and consistency. Yet AI operates fundamentally differently from human reasoning: AI predicts, whereas clinicians and lawyers understand. Predictions alone cannot replace the human reasoning, contextualisation, and justification that clinical and legal decision-making require. This article examines four central tensions that arise when integrating AI into mental health and legal contexts: epistemic, ethical, relational, and legal tensions. These tensions illustrate the limits of purely algorithmic decision-making and the critical importance of maintaining meaningful human oversight. To assist clinicians, lawyers, and institutions navigate these challenges, the HUMAN framework provides a structured approach grounded in five core principles: Human judgment, Understand the model, Monitor performance, Accountability, and Narrative. Each component places human reasoning and ethical responsibility at the centre of AI-supported practice, ensuring that technological innovation strengthens rather than undermines the foundations of psychiatry and law. While AI may transform certain aspects of practice, human professionals retain overall responsibility, with particular emphasis on compassion, empathy, care, presence, and moral reasoning. Ultimately, these are the qualities that matter most.

There is a widespread perception among academics, doctors and patients that the common law can effectively drive the development and incorporation of patients' autonomy-based rights into medical practice. However, there is reason to doubt that this is correct.We present a critical analysis of this view, prompted by themes that emerged from interviews with n=31 lawyers and n=24 doctors as part of a larger interdisciplinary study. We focus on the limitations of case law in driving autonomy-respecting clinical practice. Part I examines how the development and impact of decided cases is dominated by practical and economic considerations. It also considers the lack of understanding of case law among clinicians and the extent to which this limits its ability to drive change. Part II sets out our reasons for treating these limitations as a cause for concern. In Part III, we conclude by considering different levers for supporting case law in creating or confirming autonomy-respecting norms in medical practice, suggesting ways in which these might be developed further.We argue that clinical negligence litigation is important as a guide to clinical practice and a means of enforcing autonomy-based patient rights but that it cannot be relied upon to drive changes in practice. Both professional guidance and legislation can augment case law but, for them to be effective, proper communication between doctors and legislators, courts, lawyers and insurance organizations is essential.

Voice acts as a tool of trade among professionals. Consequently, people in such professions are more likely to experience vocal problems due to their frequent use of voice. Early intervention and preventative care can help patients avoid developing more serious vocal pathologies. The study aimed to provide vocal hygiene training (VHT) and determine its impact on reducing voice-related problems and improving voice quality among professionals in Pakistan. A quasi-experimental study was conducted among teachers, lawyers, and telemarketers who screened positive on Voice Handicap Index (VHI) and were divided into two groups: experimental and control, each having 30 participants from a specific profession. Literature-based VHT designed to improve the physical, emotional, and functional aspects of voice was provided to each of the three experimental groups. The post-assessment was conducted after a total of four training sessions, 20-35 minutes each, provided fortnightly. A significant decline in VHI scores, ie, 76.60 to 48.27 among teachers, 64.54 to 38.20 among lawyers, and 57.27 to 32.77 among telemarketers, has depicted a positive impact of VHT on voice problems. The findings strongly suggest that VHT had a significant impact on improving the quality of voice. Such techniques are suggested for embedding in the daily routine of professionals.

With prosocial action, there are both benefits to society and personal costs to those who act. We document a "many-one effect" in how people weigh these costs and benefits when assessing others' actions. For example, people might believe the expected air-quality benefits outweigh the personal inconvenience to 10,000 people walking to work instead of driving, but not one person. More generally, people more often judge the combined prosocial benefits to outweigh the combined personal costs when there are many actors than when there is just one (or a few). We find support for this hypothesis across 13 experiments (N = 8,402), including samples of adults and children, individualistic and collectivistic sample populations, elected policymakers, and lawyers and judges, in both between-subjects and within-subjects designs and in both judgments of hypothetical scenarios and real decisions about how other participants should spend bonus payments. The many-one effect persists in scenarios designed to limit rational justifications, for example, when each additional actor has a smaller marginal impact (Experiments 2A-2E). We propose that this effect arises from "differential scope sensitivity." Compared to personal costs, the societal benefits can more easily be compared to the size of the societal problem (Experiment 2F), which will make people more scope sensitive to them. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Exceptions to abortion restrictions on the grounds of protecting life or health enable essential care for pregnancy complications but are often underutilized or inconsistently applied. Through a narrative study, Global Doctors for Choice (GDC) aimed to identify barriers and facilitators to implementing these exceptions. We conducted literature and desk reviews and 15 semi-structured interviews (May-August 2025) with physicians, lawyers, and advocates from six countries: Colombia, Ghana, Ireland, Peru, Rwanda, and South Korea. Interviews were transcribed, de-identified, and analyzed for common themes. Implementation depended on disparate, often narrow or incorrect, interpretations by clinicians and institutions. Barriers included lack of training, geographic obstacles, personnel and supply constraints, stigma, and logistical delays, which push patients toward unsafe abortion. Facilitators involved comprehensive training with values clarification, patient awareness campaigns, unambiguous guidelines, and committed advocacy. Ultimately, clear legal frameworks, provider education, advocacy, and patient empowerment could improve access in diverse clinical and legal settings. Les exceptions aux restrictions légales de l’avortement fondées sur la protection de la vie ou de la santé permettent de fournir des soins essentiels en cas de complications liées à la grossesse, mais elles demeurent souvent sous-utilisées ou appliquées de manière inégale. À travers une étude narrative, Global Doctors for Choice (GDC) a cherché à identifier les obstacles et les facteurs facilitant la mise en œuvre de ces exceptions. Nous avons réalisé une revue de la littérature et une analyse documentaire, ainsi que quinze entretiens semi-structurés (mai–août 2025) avec des médecins, des juristes et des acteurs du plaidoyer issus de six pays : Colombie, Ghana, Irlande, Pérou, Rwanda et Corée du Sud. Les entretiens ont été retranscrits, anonymisés et analysés afin d’identifier des thèmes récurrents. La mise en œuvre dépendait d’interprétations divergentes, souvent restrictives ou erronées, de la part des cliniciens et des institutions. Les obstacles identifiés comprennent notamment le manque de formation, les contraintes géographiques, les limitations en personnel et en ressources, la stigmatisation sociale ainsi que des retards logistiques, qui peuvent orienter les patientes vers des avortements non sécurisés. Les facteurs facilitants incluent des programmes de formation complets intégrant des démarches de clarification des valeurs, des campagnes de sensibilisation destinées aux patientes, des directives claires et sans ambiguïté, ainsi qu’un plaidoyer soutenu. En définitive, l’existence de cadres juridiques explicites, le renforcement des capacités des prestataires, le plaidoyer et l’autonomisation des femmes pourraient améliorer l’accès aux soins d’avortement dans des contextes juridiques et cliniques variés.

This research methods article provides researchers with a user-friendly, historical database and trend analysis of state-level firearm safety laws over the past 25 years. Researchers compiled 146 firearm-safety laws in all 50 states from 1999 to 2023. A team of lawyers and policy researchers coded state laws to create a binary database indicating whether each state had the law for each year, yielding 1,250 state-year observations. This database is accompanied by a descriptive analysis completed in 2025, which highlights future methodologic use cases. Fifteen states had 20 or more additional firearm-safety laws in 2023 than in 1999, whereas 14 states had fewer firearm-safety laws in 2023. The total number of laws summed across all 50 states rose from 1,771 in 1999 to 2,367 in 2023. Laws designed to keep firearms out of the hands of select individuals saw the greatest increase over the period. This resource provides granular, updated, and categorized information on the landscape of firearm-safety laws across the U.S. over a 25-year period. Researchers can use this database to rigorously analyze the relationship between firearm-safety laws and societal outcomes by pairing it with social determinant, health, demographic, and law enforcement data.

Professionals' forensic attitudes toward child abuse play a crucial role in recognition and intervention, yet culturally adapted measurement tools are limited. This study aimed to translate and adapt Child Forensic Attitudes Scale into Turkish and examine professionals' attitudes across gender, age, education, and experience. The study had two phases. In Phase 1, 309 professionals working with children from various regions of Turkey participated. In Phase 2, 431 professionals (teachers, health workers, psychologists, psychological consultants, child development specialists, social consultants, lawyers, doctors, sociologists) from one city were included. The scale was translated, back-translated, and expert-reviewed; content validity was assessed with CVI. Exploratory and Confirmatory Factor Analyses tested construct validity, while Cronbach's alpha examined reliability. In Phase 2, descriptive statistics, nonparametric tests, correlation analyses, and multiple regression analyses were conducted. Exploratory and Confirmatory Factor Analyses revealed a three-factor structure (Fear of Not Identifying Abuse, Fear of Overcalling Abuse, Skepticism) that explained 47.9% of variance. In Phase 2, 65.9% of professionals were female, 35% were aged 31-40, 81.9% had a bachelor's degree, and 92.3% had 0-5 years of experience in child abuse. Regression analysis indicated that the Gender Roles Attitude Scale and the Scale Against Children Who Were Sexually Abused scores, gender, age, doctoral degree, prior experience interviewing abused children, and training on sexual abuse were significantly associated with forensic attitudes. Findings highlight the need to integrate child abuse awareness and forensic sensitivity into professional training and policy, supporting cross-cultural research and practice.

In this article, we contribute to the literature on state violence against women (VAW) by examining the intersection of domestic violence and welfare fraud tip-off lines. Tip-off lines enable anonymous reporting of suspected welfare fraud, forming part of the punitive welfare-to-work reforms within Western democratic nation states. Via examination of interviews with victims/survivors and community lawyers, alongside analysis of social security appeal decisions, we argue that Australia's welfare system, which claims to prioritize supporting women affected by domestic violence, may instead be complicit in, intensify, and perpetrate VAW through its administrative compliance procedures as a form of state systems abuse.

De/Medicalisation has become a staple of medical sociology to make sense of social issues at the intersection of health and illness. Broadly understood as the processes through which issues assume qualities that locate them within or beyond the remit of medicine, de/medicalisation continues to inform theoretical innovation and empirical research. The emergence of law clinics for people experiencing housing instability and homelessness offers a case study of how de/medicalisation can enrich the analysis of problems at the interstices of health and social care. Law clinics, often co-located or attached to primary and tertiary health care settings, aim to augment housing, health, wellness and social care offerings. Yet, this proximity - conceptual and spatial - may inadvertently reify understandings of homelessness as an individual pathology while aiming to offer pragmatic support to people who are otherwise excluded from core institutions in society. We present findings from a Roundtable with participants from law, social and health care professions and interviews with people experiencing housing instability (n = 27), lawyers, GPs and social workers (n = 10) in an Australian urban centre. In the vexed dynamics of the law clinic in-between different professions, de/medicalisation emerges as boundary-making and boundary-crossing to negotiate responsibilities, classify problems and reconcile competing logics.

Genomic data sharing enhances efficiency in medical practice by facilitating faster data access and collaboration across settings. However, the same arrangements that enable efficiency could also raise legal inequalities, especially concerning data ownership and access. Yet these inequities are intensified in cross-border collaborations where power dynamics disadvantage low and middle income (LMIC) researchers. A qualitative phenomenological study was conducted in Uganda. Key informant interviews (KIIs) were conducted with 49 stakeholders working at different points across the genomic research landscape and four focus group discussions (FGDs) were conducted with people currently or previously enrolled in genomic studies, or their caretakers. The stakeholders who took part in the KIIs included genomic researchers (16), research ethics committee (REC) members (14), practicing lawyers (3), community advisory board (CAB) members (8) and national research regulators (8). A theory of decolonization was used to clarify rooted power imbalances and unfairness. Through thematic analysis six concerns were identified: (1) inadequate regulatory frameworks, (2) limited access to the shared data, (3) unclear data ownership (4) absence of benefit sharing frameworks, (5) contested intellectual property rights and (6) rethinking power asymmetries and struggles. The wide spread perception by research participants that the Global North collaborators owned the data, eroded community trust. There was limited clarity on data ownership, with Ugandan researchers expressing differing views, on ownership, custodianship, and shared ownership leading to calls for co-ownership. In the absence of benefit-sharing frameworks to regulate the distribution of commercial value, data commercialization disadvantaged Ugandan researchers and participants, reinforcing colonial-like inequalities. Current governance systems mirror colonial patterns in the control and sharing of genomic data in Uganda. These patterns are reinforced not only by cross-border power asymmetries but also by internal power dynamics within the country, including institutional hierarchies and regulatory gaps that limit local decision-making authority. Addressing this requires rethinking governance structures and promoting local or co-ownership models that reflect African interests and support decolonized approaches to data governance. Not applicable. This study did not involve a clinical trial.

The sources of judicial dissatisfaction with, and criticism of, expert healthcare evidence are traced to unqualified, careless, overworked and unscrupulous experts and a failure on the part of some experts to work collaboratively with their instructing lawyers during the litigation process. The suggested remedies are: adherence to the clear professional standards that already exist, appropriate training for which the foundations should be laid during undergraduate medical education, continuing professional development, credentialing complemented by instructing solicitors and counsel ensuring that the expert is appropriate for the case and aware of their duties, collaborative working between expert and instructing lawyer, peer and institutional support and quality control including peer review of reports and case-based discussion of reports.

In recent years, terms like platform work, gig work and cloud work have sparked a debate amongst labour lawyers and lawmakers. Even though the circumvention of traditional employment relationships is not a new phenomenon, technological change and the increasing flexibility of work put previously established standards on fair wages and just working conditions anew at stake. Trade Unions have traditionally played a key role in protecting those whose livelihoods depend on providing labour for others. A closer look at the existing legal frameworks in Austria and Germany shows that solo self-employed persons, meaning workers who do not have an employment contract and do not employ others, can benefit only to a very limited extent from the capacity of trade unions to bargain collectively, which is a critical instrument to ensure fair working conditions, including fair wages. This article argues that the European human rights standards require national legislators to take active steps in ensuring the right to bargain collectively for every person in need. In section I, we will start by introducing the central concepts of our analysis and discuss the extent to which the legal frameworks in Austria and Germany allow for collective bargaining on behalf of solo self-employed persons. In section II, we will look at several layers of human rights protection at the European level, with a focus on the personal scope of the right to collective representation. In the final section, we will address the interplay between human rights standards and EU law, before concluding with our recommendations for domestic legal change in Austria and Germany.

Mental health professionals (MHPs) play important roles in providing expert opinions in courts; however, dated studies indicate that legal professionals prefer psychiatrists as mental health expert witnesses as well as mental health testimony on ultimate opinions, clinical diagnosis, and interpreting the legal standard for mental conditions. This mixed-methods study surveyed 132 judges and lawyers in the United States and Canada to examine their preferences for mental health testimony elements and MHPs as expert witnesses. Updating previous research conducted between the 1980s to 2010s, respondents were presented with 11 questions describing different elements of mental health testimonies and were asked to rate the importance of these testimonies and rank their preference for psychiatrists, psychologists or social work experts. Legal professionals preferred expert testimony on clinical diagnosis, psychological testing, and descriptive testimonies. American legal professionals considered testimony on crime statistical data related to diagnosis as more essential than did Canadians, and Canadians ranked testimony on measure of dangerousness higher. Overall, American legal professionals preferred having psychologists as expert witnesses, whereas Canadian legal professionals preferred psychiatrists. Using a qualitative reflexive thematic analysis of participants' comments on factors that contribute to a useful testimony, four themes summarized the indicators of useful expert testimony: Qualified and Engaged Experts, Relevant and Useful Information, Empirical Rigor in Testimony, and Clarity and Accessibility. Results reveal that American legal professionals are increasingly understanding the value of forensic psychologists as expert witnesses, whereas Canadians hold preferences for psychiatrists.

This review examines whether mental health consumers are asked how they want legal services to be provided in studies of civil mental health jurisdictions, and the extent to which consumer researchers were involved in these studies. A Consumer-perspective Critical Reflection Tool was applied to assess consumer involvement and alignment with human rights frameworks. Consumer leadership and participation were largely absent in the studies identified. Only one study included consumer researchers, and none reported consumer leadership in setting agendas, design, data collection, analysis, or evaluation. Participants' voices were frequently missing, supported decision-making was rarely operationalised, and intersectionality received little attention. Many studies adopted paternalistic or therapeutic frames that positioned lawyers as protective rather than representative of clients' expressed preferences. Few papers articulated concrete implementation plans for change or strategies to build consumer knowledge. The findings indicate a systemic disconnect between the rights rhetoric of civil mental health law and the practices of legal representation. Legal services and research should reorient to consumer-led, CRPD-consistent approaches, embed supported decision-making, and ensure routine, meaningful elicitation and documentation of consumers' will and preferences to guide advocacy and adjudication.

The McCabe Centre for Law and Cancer's international legal training programme (ILTP) aims to raise the capacity of government lawyers from low- and middle-income countries to use the law to address noncommunicable diseases (NCDs). We used qualitative data to evaluate impacts of this long-term capacity-building programme to complement tangible impacts, such as law and policy reform found in an earlier evaluation. We undertook 17 interviews with alumni of and stakeholders involved with the ILTP over the period 2014-23. The interviewer conducted semistructured interviews. Two reviewers used inductive content analysis to code the interviews. We found that alumni and stakeholders valued the programme's role in building networks of participants with legal skills relevant to NCDs and in empowering individuals to become champions for NCDs. Interviewees also took a broader view of impact than the completion of individual law and policy reform projects, considering many law and policy changes, regional initiatives, and leadership roles of alumni beyond those formally supported as part of the programme to have been a key impact of the programme. The study highlights the need to invest in NCD legal capacity building and leadership for the long term. We find that building a community of people with the skills, confidence, and commitment to act on NCDs is a key impact of such programmes, in addition to laws and policies developed.