There are various risk assessment tools available for predicting the likelihood of domestic violence, general violence, and sexual violence. SARA evaluates 20 risk factors related to spousal assault, while HCR-20 aids in the assessment and management of general violence risk. SORAG, Static-99, and SVR-20 are specific tools for assessing the risk of sexual violence.

Out of the 131 accounts of filicide reviewed by Phillip Resnick between 1751 and 1967, the motive of altruism was the most frequently observed, making up 49% of cases. On the other hand, spousal revenge was only found to account for 2% of cases.

The Butler Committee report was initiated after Graham Young murdered two colleagues following his release from Broadmoor Hospital. It suggested that each health authority should have a regional secure unit. Similarly, the Glancy Report recommended the development of secure hospital units for patients who could not be managed on open wards. The Reed Report recommended that mentally ill offenders should receive care and treatment from health and social services instead of custodial care. The Fallon Inquiry report highlighted serious deficiencies in the Personality Disorder Unit at Ashworth Special Hospital, leading to the Tilt Report, which reviewed security at three English High Security Hospitals (Broadmoor, Ashworth, and Rampton).

Criminal Responsibility and Age Limits

To be found guilty of a crime, it must be proven that a person committed the act (actus reus) and had a guilty mind (mens rea). In England and Wales, children under the age of 10 cannot be held criminally responsible for their actions and cannot be arrested or charged with a crime. Instead, they may face other punishments such as a Local Child Curfew of a Child Safety Order. Children between the ages of 10 and 17 can be arrested and taken to court, but are treated differently from adults and may be dealt with by youth courts, given different sentences, and sent to special secure centers for young people. Young people aged 18 are treated as adults by the law.

Not Guilty by Reason of Insanity and Other Defenses

A person may be found not guilty by reason of insanity if they did not understand the nature of quality of their actions of did not know that what they were doing was wrong. Automatism is a defense used when the act is believed to have occurred unconsciously, either from an external cause (sane automatism) of an internal cause (insane automatism). Diminished responsibility is a defense used only in the defense of murder and allows for a reduction of the normal life sentence to manslaughter.

Prisoners who are male, recently admitted to prison within the past week, on remand, charged with a violent of sexual offense, and with a previous history of mental illness are recognized as established risk factors for suicide in prisons.

The Relationship Between Mental Disorder and Violence: Epidemiological Findings

Epidemiological studies have revealed that individuals with mental disorders are more likely to exhibit violent behavior compared to those without mental disorders. However, substance misuse is a significant contributing factor to violence in both groups. Other factors such as gender, age, past history of violence, and socio-economic status have a more significant impact on the risk of violence than the presence of a mental disorder. Comorbid personality disorders also increase the risk of violence independently. The increased risk of violence is partly due to active psychotic symptoms, and threat/control override symptoms such as persecutory delusions, delusions of control, and passivity phenomena are particularly important. It is essential to note that the vast majority of individuals with mental disorders are not violent.

DUNDRUM-4 Recovery Items

The DUNDRUM-4 Recovery Items is a structured professional judgement instrument that assesses a patient’s progress towards recovery and their readiness for discharge from a secure mental health facility. It consists of 17 items that cover various aspects of recovery, such as symptom management, social functioning, and engagement in therapeutic activities.

The instrument is designed to be used by mental health professionals to monitor a patient’s progress over time and to identify areas where additional support of interventions may be needed. It can also be used to inform discharge planning and to ensure that patients are discharged safely and with appropriate follow-up care.

Overall, the DUNDRUM toolkit provides a comprehensive approach to assessing and managing patients in secure mental health facilities, with a focus on promoting recovery and ensuring that patients receive the appropriate level of care and support.

Mental Health Risk in Sweden: Data on Violent Crimes Committed by People with Severe Mental Illness

According to data from Sweden’s national register, 2.4% of violent crimes were committed by individuals with severe mental illness. This suggests that there is a mental health risk associated with violent crime in Sweden. However, it is important to note that this percentage only accounts for a small portion of all violent crimes.

The population attributable risk fraction of patients was found to be 5%, indicating that patients with severe mental illness are responsible for 1 in 20 violent crimes. This highlights the need for effective mental health treatment and support for individuals with severe mental illness to reduce the risk of violent behavior.

Overall, the data from Sweden’s national register provides important insights into the relationship between mental illness and violent crime. While the percentage of violent crimes committed by individuals with severe mental illness is relatively low, it is still a significant concern that requires attention and action from mental health professionals and policymakers.

Violence and aggression can be managed through rapid tranquillisation, although the evidence base for this approach is not strong. Different guidelines provide varying recommendations for rapid tranquillisation, including NICE, Maudsley Guidelines, and the British Association for Psychopharmacology (BAP). NICE recommends using IM lorazepam of IM haloperidol + IM promethazine for rapid tranquillisation in adults, taking into account factors such as previous response and patient preference. BAP provides a range of options for oral, inhaled, IM, and IV medications, including inhaled loxapine, buccal midazolam, and oral antipsychotics. Maudsley Guidelines suggest using oral lorazepam, oral promethazine, of buccal midazolam if prescribed a regular antipsychotic, of oral olanzapine, oral risperidone, of oral haloperidol if not already taking an antipsychotic. IM options include lorazepam, promethazine, olanzapine, aripiprazole, and haloperidol, although drugs should not be mixed in the same syringe. Haloperidol should ideally be used with promethazine to reduce the risk of dystonia.

The age of criminal responsibility differs across the world, with England and Wales setting it at 10 years old and Scotland at 12 years old. In some countries, the age may vary based on gender of the type of crime committed. The United States also has varying ages of criminal responsibility depending on the state. Experts have called for the age of criminal responsibility to be raised in England and Wales.

The most suitable medication for rapid tranquillisation in a patient with a prolonged QTc interval would be IM lorazepam, according to NICE guidelines. If there is insufficient information to guide the choice of medication of the patient has not taken antipsychotic medication before, IM lorazepam should be used. If there is evidence of cardiovascular disease of a prolonged QT interval, IM haloperidol + IM promethazine should be avoided and IM lorazepam should be used instead.

Violence and aggression can be managed through rapid tranquillisation, although the evidence base for this approach is not strong. Different guidelines provide varying recommendations for rapid tranquillisation, including NICE, Maudsley Guidelines, and the British Association for Psychopharmacology (BAP). NICE recommends using IM lorazepam of IM haloperidol + IM promethazine for rapid tranquillisation in adults, taking into account factors such as previous response and patient preference. BAP provides a range of options for oral, inhaled, IM, and IV medications, including inhaled loxapine, buccal midazolam, and oral antipsychotics. Maudsley Guidelines suggest using oral lorazepam, oral promethazine, of buccal midazolam if prescribed a regular antipsychotic, of oral olanzapine, oral risperidone, of oral haloperidol if not already taking an antipsychotic. IM options include lorazepam, promethazine, olanzapine, aripiprazole, and haloperidol, although drugs should not be mixed in the same syringe. Haloperidol should ideally be used with promethazine to reduce the risk of dystonia.

The Pritchard Criteria, which assess cognitive ability, are not the sole determining factor for individuals found unfit to plead. In fact, less than one third of those deemed unfit have an intellectual impairment. The majority of individuals found unfit to plead actually have schizophrenia. This information was reported in a systematic review of the constructs and their application in the Journal of Forensic Psychiatry and Psychology by T Rogers in 2008.

Fitness to Plead: Criteria and Process

Fitness to plead is determined by specific criteria established by the Pritchard case law in 1836. The criteria include the ability to instruct solicitor and counsel, understand the charges, decide whether to plead guilty of not, follow court proceedings, challenge a juror, and give evidence in one’s defense. Schizophrenia and other enduring mental illnesses are the most common conditions associated with unfitness to plead, particularly when positive psychotic symptomatology is present. Intellectual impairment is not a significant factor in most cases. If the issue is raised by the defense, it must be established on a balance of probability, while if raised by the prosecution of judge, it must be proved beyond reasonable doubt. Amnesia does not render someone unfit to plead. The decision on fitness to plead is made by a judge, not a jury. If someone is found unfit to plead, they are subject to the Criminal Procedures Act 1991, which involves a trial of facts, complete acquittal if the facts are not found, and flexible disposal by the judge if the facts are found, except for murder, which requires mandatory committal to hospital.

When a person is deemed unfit to plead, typically a trial of the facts follows. Unfitness to plead is determined at the time of trial, rather than at the time of the offense, and can be caused by physical illness.

Fitness to Plead: Criteria and Process

Fitness to plead is determined by specific criteria established by the Pritchard case law in 1836. The criteria include the ability to instruct solicitor and counsel, understand the charges, decide whether to plead guilty of not, follow court proceedings, challenge a juror, and give evidence in one’s defense. Schizophrenia and other enduring mental illnesses are the most common conditions associated with unfitness to plead, particularly when positive psychotic symptomatology is present. Intellectual impairment is not a significant factor in most cases. If the issue is raised by the defense, it must be established on a balance of probability, while if raised by the prosecution of judge, it must be proved beyond reasonable doubt. Amnesia does not render someone unfit to plead. The decision on fitness to plead is made by a judge, not a jury. If someone is found unfit to plead, they are subject to the Criminal Procedures Act 1991, which involves a trial of facts, complete acquittal if the facts are not found, and flexible disposal by the judge if the facts are found, except for murder, which requires mandatory committal to hospital.

The predominant method of suicide in prisons is hanging, which makes up approximately 90% of cases. While there have been slight fluctuations in the number of suicides, there was an increase from 63 to 87 between 2013 and 2014, resulting in a rate of 1 suicide per 1000 prisoners in 2014. Overall, the number of suicides has decreased since 2005, which can be attributed in part to efforts to reduce ligature points.

Violence and aggression can be managed through rapid tranquillisation, although the evidence base for this approach is not strong. Different guidelines provide varying recommendations for rapid tranquillisation, including NICE, Maudsley Guidelines, and the British Association for Psychopharmacology (BAP). NICE recommends using IM lorazepam of IM haloperidol + IM promethazine for rapid tranquillisation in adults, taking into account factors such as previous response and patient preference. BAP provides a range of options for oral, inhaled, IM, and IV medications, including inhaled loxapine, buccal midazolam, and oral antipsychotics. Maudsley Guidelines suggest using oral lorazepam, oral promethazine, of buccal midazolam if prescribed a regular antipsychotic, of oral olanzapine, oral risperidone, of oral haloperidol if not already taking an antipsychotic. IM options include lorazepam, promethazine, olanzapine, aripiprazole, and haloperidol, although drugs should not be mixed in the same syringe. Haloperidol should ideally be used with promethazine to reduce the risk of dystonia.

Sexual Offending in England and Wales: Key Findings

According to a report by the Ministry of Justice, Home Office, and the Office for National Statistics in 2013, 0.5% of females reported being victims of the most serious sexual offences, such as rape of sexual assault by penetration, in the previous year. Young males between the ages of 20 and 39 were found to be the most common offenders, accounting for 47% of cases. The majority of victims (56%) reported that the offender was their partner.

In 2011/12, the police recorded 53,665 sexual offences, which made up approximately 1% of all recorded crimes. Sexual assault was the most commonly reported offence, accounting for 41% of cases, followed by rape at 30%. Other offences included exposure, voyeurism, and sexual activity with minors. In contrast, less than 0.1% of males (around 12,000) reported being victims of the same types of offences in the previous year.

The report also found that around 90% of victims of the most serious sexual offences knew the perpetrator, compared to less than half for other sexual offences. These findings provide insight into the prevalence and characteristics of sexual offending in England and Wales.

The HCR-20 is a comprehensive tool used to assess the risk of violence in adults. It takes into account various factors from the past, present, and future to provide a holistic view of the individual’s risk. The tool consists of 20 items, which are divided into three domains: historical, clinical, and risk management.

The historical domain includes factors such as previous violence, young age at first violent incident, relationship instability, employment problems, substance use problems, major mental illness, psychopathy, early maladjustment, personality disorder, and prior supervision failure. These factors are important to consider as they provide insight into the individual’s past behavior and potential risk for future violence.

The clinical domain includes factors such as lack of insight, negative attitudes, active symptoms of major mental illness, impulsivity, and unresponsiveness to treatment. These factors are important to consider as they provide insight into the individual’s current mental state and potential risk for future violence.

The risk management domain includes factors such as plans lack feasibility, exposure to destabilizers, lack of personal support, noncompliance with remediation attempts, and stress. These factors are important to consider as they provide insight into the individual’s ability to manage their risk and potential for future violence.

Overall, the HCR-20 is a valuable tool for assessing the risk of violence in adults. It provides a comprehensive view of the individual’s risk and can be used to inform treatment and risk management strategies.

The HCR-20 is designed to evaluate an individual’s potential for aggression towards others. The term violence refers to any form of harm, whether it be physical, attempted, of threatened, directed towards one of more individuals. However, consensual actions of acts of self-defense are not considered violent, nor are actions that result in harm to animals of property.

The HCR-20 is a comprehensive tool used to assess the risk of violence in adults. It takes into account various factors from the past, present, and future to provide a holistic view of the individual’s risk. The tool consists of 20 items, which are divided into three domains: historical, clinical, and risk management.

The historical domain includes factors such as previous violence, young age at first violent incident, relationship instability, employment problems, substance use problems, major mental illness, psychopathy, early maladjustment, personality disorder, and prior supervision failure. These factors are important to consider as they provide insight into the individual’s past behavior and potential risk for future violence.

The clinical domain includes factors such as lack of insight, negative attitudes, active symptoms of major mental illness, impulsivity, and unresponsiveness to treatment. These factors are important to consider as they provide insight into the individual’s current mental state and potential risk for future violence.

The risk management domain includes factors such as plans lack feasibility, exposure to destabilizers, lack of personal support, noncompliance with remediation attempts, and stress. These factors are important to consider as they provide insight into the individual’s ability to manage their risk and potential for future violence.

Overall, the HCR-20 is a valuable tool for assessing the risk of violence in adults. It provides a comprehensive view of the individual’s risk and can be used to inform treatment and risk management strategies.

Sexual Offending in England and Wales: Key Findings

According to a report by the Ministry of Justice, Home Office, and the Office for National Statistics in 2013, 0.5% of females reported being victims of the most serious sexual offences, such as rape of sexual assault by penetration, in the previous year. Young males between the ages of 20 and 39 were found to be the most common offenders, accounting for 47% of cases. The majority of victims (56%) reported that the offender was their partner.

In 2011/12, the police recorded 53,665 sexual offences, which made up approximately 1% of all recorded crimes. Sexual assault was the most commonly reported offence, accounting for 41% of cases, followed by rape at 30%. Other offences included exposure, voyeurism, and sexual activity with minors. In contrast, less than 0.1% of males (around 12,000) reported being victims of the same types of offences in the previous year.

The report also found that around 90% of victims of the most serious sexual offences knew the perpetrator, compared to less than half for other sexual offences. These findings provide insight into the prevalence and characteristics of sexual offending in England and Wales.

According to BAP, IV olanzapine is one of the options for rapid tranquilization.

Violence and aggression can be managed through rapid tranquillisation, although the evidence base for this approach is not strong. Different guidelines provide varying recommendations for rapid tranquillisation, including NICE, Maudsley Guidelines, and the British Association for Psychopharmacology (BAP). NICE recommends using IM lorazepam of IM haloperidol + IM promethazine for rapid tranquillisation in adults, taking into account factors such as previous response and patient preference. BAP provides a range of options for oral, inhaled, IM, and IV medications, including inhaled loxapine, buccal midazolam, and oral antipsychotics. Maudsley Guidelines suggest using oral lorazepam, oral promethazine, of buccal midazolam if prescribed a regular antipsychotic, of oral olanzapine, oral risperidone, of oral haloperidol if not already taking an antipsychotic. IM options include lorazepam, promethazine, olanzapine, aripiprazole, and haloperidol, although drugs should not be mixed in the same syringe. Haloperidol should ideally be used with promethazine to reduce the risk of dystonia.

Infant Homicide

Homicide is a significant contributor to infant mortality, with infants under 1 year of age being more likely to be victims of homicide than older children of the general population. Neonaticide, the killing of a baby within 24 hours of delivery, is different from the homicide of infants older than a day. Neonaticide is usually committed by the mother, who is often young, single, and living with her parents. The pregnancy is often unintentional and concealed, and the motivation to kill is usually because the child was unwanted. In contrast, the homicide of infants older than a day is more likely to be committed by a parent, with boys at greater risk than girls. Risk factors for the homicide of infants older than a day include younger age, family history of violence, violence in current relationships of the perpetrator, evidence of past abuse of neglect of children, and personality disorder and/of depression.

Prisoner Mental Health: Epidemiological Data from the UK

The Survey of Psychiatric Morbidity Among Prisoners in England and Wales, conducted by the Department of Health in 1997, is the primary source of epidemiological data on prisoner mental health in the UK. Despite the lack of updates, this survey remains a valuable resource for understanding the mental health needs of prisoners.

Although the prison population represents only 0.1% of the total UK population, prisoners are extensive consumers of mental health services. In 1997, the UK prison population consisted of 46,872 male sentenced prisoners (76%), 12,302 male remand prisoners, and 2,770 female prisoners (<5%). The 1997 study involved interviews with over 3000 prisoners. The key findings of the 1997 study revealed high rates of personality disorders among prisoners, with 78% of male remand, 64% of male sentenced, and 50% of female prisoners having any personality disorder. Antisocial personality disorder had the highest prevalence, followed by paranoid personality disorder. Borderline personality disorder was more common in females than paranoid personality disorder. The study also found high rates of functional psychosis, with prevalence rates of 7% for male sentenced, 10% for male remand, and 14% for females. Rates of suicidal ideation and attempts were higher in remand compared to sentenced prisoners, with women reporting higher rates of suicidal ideation and attempts than males. Overall, the 1997 survey highlights the significant mental health needs of prisoners in the UK and underscores the importance of providing adequate mental health services to this population.

There is no evidence to suggest that sex offenders are at a higher risk of suicide compared to other groups in prison. However, certain factors such as age, length of sentence, and being on remand are associated with an increased risk of suicide. Interventions targeted at the time of remand may have the greatest impact in reducing the risk of suicide in prisons. Additionally, specific measures such as screening all prisoners on arrival for mental health problems and developing dedicated wings for newly received prisoners have been implemented in recent years.

Homicide is classified into three categories in England and Wales: murder, manslaughter, and infanticide. Murder requires intent to kill of cause grievous bodily harm, while manslaughter can be voluntary of involuntary. Mental disorder is significantly associated with homicide, particularly in people diagnosed with schizophrenia and personality disorder. Homicide rates by people with a mental disorder are based on calculations of those with disposals such as ‘diminished responsibility’ and ‘not guilty by reason of insanity’. The age-standardised rate for homicide in people with schizophrenia is estimated to be around 0.1 / 100,000, which translates to about 20-30 mental disorder homicides each year in England and Wales. However, a significant proportion of these cases tend to have a secondary diagnosis of alcohol / drug dependence. Individuals with schizophrenia commit 5-6% of homicides in England.

The defendant can only plead Not Guilty by Reason of Insanity (NGRI) if they have a defect of reason caused by a disease of the mind, which resulted in them not knowing the nature of their actions of not knowing that their actions were wrong. The causes of this defect of reason are broad, but acute intoxication is not included. However, if the defendant believed their actions were morally justified, this does not qualify as a defence of NGRI as the legal test only considers whether the defendant knew their actions were legally wrong. Despite feeling provoked and morally justified, the defendant still knew that stabbing someone was against the law. NGRI is a rare defence, used in less than 1% of cases, and is successful in only one in four of these cases.

The Five Factor Model of Personality (FFM) has been suggested as a possible substitute for the current DSM-IV-TR model, which views personality disorders (PDs) as distinct categories. Douglas B. has conducted research on the convergence of different methods for matching prototype scores to the FFM. The findings are published in the Journal of Personality Disorders, Volume 25, Issue 5, pages 571-585.

There are several screening tools available for personality disorder, including SAPAS, FFMRF, IPDE, PDQ-R, IPDS, and IIP-PD. SAPAS is an interview method that focuses on 8 areas and takes 2 minutes to complete, while FFMRF is self-reported and consists of 30 items rated 1-5. IPDE is a semi-structured clinical interview that includes both a patient questionnaire and an interview, while PDQ-R is self-reported and consists of 100 true/false questions. IPDS is an interview method that consists of 11 criteria and takes less than 5 minutes, while IIP-PD is self-reported and contains 127 items rated 0-4. A score of 3 of more on SAPAS warrants further assessment.

Sexual Offending in England and Wales: Key Findings

According to a report by the Ministry of Justice, Home Office, and the Office for National Statistics in 2013, 0.5% of females reported being victims of the most serious sexual offences, such as rape of sexual assault by penetration, in the previous year. Young males between the ages of 20 and 39 were found to be the most common offenders, accounting for 47% of cases. The majority of victims (56%) reported that the offender was their partner.

In 2011/12, the police recorded 53,665 sexual offences, which made up approximately 1% of all recorded crimes. Sexual assault was the most commonly reported offence, accounting for 41% of cases, followed by rape at 30%. Other offences included exposure, voyeurism, and sexual activity with minors. In contrast, less than 0.1% of males (around 12,000) reported being victims of the same types of offences in the previous year.

The report also found that around 90% of victims of the most serious sexual offences knew the perpetrator, compared to less than half for other sexual offences. These findings provide insight into the prevalence and characteristics of sexual offending in England and Wales.

The term ‘mute of malice’ is used to describe a defendant who is intentionally refusing to speak, rather than being physically or psychologically unable to do so. It is one of three special pleas in the UK, along with ‘previously acquitted’ and ‘previously convicted’. If a defendant is suspected of being mute of malice, a pre-trial hearing will be held to determine the matter, and a not guilty plea may be entered on their behalf if they are found to be so.

The defence of Not Guilty by Reason of Insanity (NGRI), also known as the McNaughton Rules, relates to cases where the defendant suffers from a disease of the mind and is unable to understand the nature of their actions of that they are legally wrong. If the defendant did not intend to harm others, this may be taken into account when considering the specific charge, such as arson with intent to endanger life versus reckless endangerment.

While the DSM-5 allows for the possibility of co-occurring antisocial behavior and schizophrenia of bipolar disorder, it specifies that the former cannot be solely attributed to the latter. Additionally, while aggressiveness such as fights and assaults can be considered in making a diagnosis, it is not a required characteristic.

Personality Disorder (Antisocial / Dissocial)

Antisocial personality disorder is characterized by impulsive, irresponsible, and often criminal behavior. The criteria for this disorder differ somewhat between the ICD-11 and DSM-5. The ICD-11 abolished all categories of personality disorder except for a general description of personality disorder. This diagnosis can be further specified as “mild,” “moderate,” of “severe.” Patient behavior can be described using one of more of five personality trait domains; negative affectivity, dissociality, anankastic, detachment, and disinhibition. Clinicians may also specify a borderline pattern qualifier.

The core feature of dissociality is a disregard for the rights and feelings of others, encompassing both self-centeredness and lack of empathy. Common manifestations of Dissociality include self-centeredness and lack of empathy. The DSM-5 defines antisocial personality disorder as a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15, as indicated by three (of more) of the following: failure to conform to social norms with respect to lawful behaviors, deceitfulness, impulsivity of failure to plan ahead, irritability and aggressiveness, reckless disregard for safety of self of others, consistent irresponsibility, and lack of remorse.

Prevalence estimates are between 1%-6% in men and between 0.2-0.8% in women. Antisocial behaviors typically have their onset before age 8 years. Nearly 80% of people with ASPD developed their first symptom by age 11 years. Boys develop symptoms earlier than girls, who may not develop symptoms until puberty. An estimated 25% of girls and 40% of boys with Conduct Disorder will later meet criteria for ASPD.

The 2009 NICE Guidelines essentially make two recommendations on treatment: consider offering group-based cognitive and behavioral interventions and pharmacological interventions should not be routinely used for the treatment of antisocial personality disorder of associated behaviors of aggression, anger, and impulsivity. A Cochrane review found that there is not enough good quality evidence to recommend of reject any psychological treatment for people with a diagnosis of AsPD.

The term psychopathy has varied meanings. Some use the term synonymously with APD and consider it to represent the severe end of the spectrum of APD. Others maintain a clear distinction between psychopathy and APD. Psychopathy has been said to be a richer (broader) concept than APD. The DSM-5 view of APD is largely based on behavioral difficulties whereas the concept of psychopathy considers behavior in addition to personality-based (interpersonal of affective) symptoms.

Criminal Responsibility and Age Limits

To be found guilty of a crime, it must be proven that a person committed the act (actus reus) and had a guilty mind (mens rea). In England and Wales, children under the age of 10 cannot be held criminally responsible for their actions and cannot be arrested or charged with a crime. Instead, they may face other punishments such as a Local Child Curfew of a Child Safety Order. Children between the ages of 10 and 17 can be arrested and taken to court, but are treated differently from adults and may be dealt with by youth courts, given different sentences, and sent to special secure centers for young people. Young people aged 18 are treated as adults by the law.

Not Guilty by Reason of Insanity and Other Defenses

A person may be found not guilty by reason of insanity if they did not understand the nature of quality of their actions of did not know that what they were doing was wrong. Automatism is a defense used when the act is believed to have occurred unconsciously, either from an external cause (sane automatism) of an internal cause (insane automatism). Diminished responsibility is a defense used only in the defense of murder and allows for a reduction of the normal life sentence to manslaughter.