從精神鑑定書到監護處分評估與成效追蹤

From Psychiatric Identification to Custodial Protection and Outcome Evaluation

法官在審判具有精神疾病的被告，並據以主張免責時，常需要精神科醫師提出精神鑑定據以判斷；但鑑定內容通常僅著重在辨識案主案發時的精神狀態『是否受精神疾病的影響』作為有無罪責或減輕的依據，常缺乏再犯性、危險性與可治療性的評估！由於個案若受精神症狀影響而犯罪，法官在減輕或免除其刑時，常會合併宣告監護處分若干年。但對於後續需要何種監護處分，應在那裡接受處分，何時需再評估，以及追蹤個案狀況皆缺乏一定機制，以致於監護處分的成效備受質疑。本文嘗試從精神鑑定的原則、理論、程序與鑑定書內容來分析未來的需要，並且對於監護處分的個案應該定時做滾動式的再犯性、危險性與成效評估，輔以國際功能失能疾病分類概念來評估個案；另外，針對不同類型監護個案進行分類，以分艙分流的概念提供不同類型個案監護處分場所，並結合出院準備服務的精神與社會安全網的概念做出院後追蹤處遇與輔導。

"When a judge tries a defendant with a mental illness and a disclaimer based on such an illness, a psychiatrist is often required to provide a psychiatric identification of the defendant to the judge; however, the content of such a document is usually only focused on identifying the mental state of the defendant at the time of the case, i.e., whether he or she was suffering from mental illness at the time. The term ''impact'' is used as a basis for guilt or mitigation, although this term often lacks any assessment of recidivism, danger, and treatability. If a defendant was found to be affected by psychiatric symptoms when he or she committed a crime, the judge often requires him or her to be placed in custodial protection for several years when mitigating or exempting his or her sentence. However, there are issues related to what kind of custodial protection is needed in the future, the locations at which custodial protection should be accepted, when the defendants need to be reassessed, and the lack of a mechanism for tracking the situations of individual cases; thus, the effectiveness of custodial protection is called into question. This article attempts to analyze the future needs related to custodial protection based on the principles, theories, procedures and contents of psychiatric identification; for example, a rolling recidivism, risk and effectiveness evaluation should be conducted regularly in cases pertaining to guardianship, which should be supplemented by the International Classification of Functioning, Disability and Health (ICF). In addition, different types of custodial protection cases are classified, and different types of custodial protection treatment places are provided based on the concepts of sub-cabins and diversion and are combined with discharge planning services and the concept of a social safety network to develop discharge, follow-up and treatment strategies."