精神疾病之「症」與「病」對責任能力評估與後續處遇的影響──兼論我國司法精神鑑定人制度

The Impact of Symptoms and Diagnosis of Mental Disorders on the Assessment of Criminal Responsibility and Subsequent Treatment—Also Commenting on the Forensic Psychiatric Assessment System in Taiwan

精神障礙犯罪者的評估與處遇，隨著2022年間刑事訴訟法與刑法的修正，有更多的選擇。然而，不論在責任能力的判斷，或是監護處分的決定上，可能都需要司法精神鑑定的協助，以往都是機關鑑定，即法院或地檢署委託機關，再由機關找鑑定人鑑定。而台灣司法精神醫學會在2017年11月5日成立，目前已有通過認證之司法精神醫學專科醫師，是否將來可能改採鑑定人的方式，更有利於科際整合，並且對於精神疾病犯罪者之人權能更有保障？本文透過整理精神疾病之症狀與診斷、論述症與病可能對責任能力與後續處遇的影響，以及鑑定人在這些評估與處遇過程中的角色，提出在司法精神鑑定中，改以鑑定人取代機關鑑定之建議。

Assessment and treatment of offenders with mental disorders offer more options following the amendments to the Criminal Procedure Code and the Penal Code in 2022. However, whether in determining criminal responsibility or being sentenced to custodial protection, assistance from forensic psychiatric evaluations may be required. Traditionally, these evaluations were conducted by appointed institutions commissioned by the courts or district prosecutors. With the establishment of the Taiwan Academy of Psychiatry and the Law on November 5, 2017, and the certification of forensic psychiatrists, there is a possibility of transitioning to the use of Expert Witness. This shift could facilitate technological integration and provide better protection for the human rights of individuals with mental disorders who are involved in criminal activities. This article organizes symptoms and diagnoses of mental disorders, discusses how symptoms and illnesses may impact criminal responsibility and subsequent treatment, and proposes the replacement of institutional evaluations with Expert Witness in forensic psychiatric assessments.