Evaporative sample preparation for forensic and diagnostic clinical tests must be performed scrupulously. Genevac systems are used by clinical biochemists and forensic scientists for a number of testing methodologies, such as vitamin D or K analysis, neonatal screening and forensic toxicology.
Mass Spectrometry (MS) is replacing radio-immunoassay (RIA) in Clinical biochemistry analysis, removing the need to use radioactive reagents. One of the Steroid assays performed by hospital clinical labs is for Vitamin D analysis where there is a need to identify the relative abundance of vitamin D2 and D3. Samples are typically extracted into Hexane, concentrated (e.g. using a miVac) and analysed by MS (avoiding ion suppression problems often seen with RIA).
Clinical and forensic toxicology investigations also utilise MS methodology, typically with solid phase extraction and evaporation as part of the sample preparation process. Blood and urine analysis can be utilised as part of a medico-legal investigation into drug-related deaths and drug-facilitated crimes and in the clinical assessment of alcohol/drug consumption. Hair analysis can also provide evidence over time of drug or alcohol abuse, as part of programme compliance for those participating in drug or alcohol dependency treatment or for workplace or health insurance screening. The EZ-2 has been used to streamline the sample preparation process whilst maintaining sample integrity and improving sensitivity.
Tandem MS is also used to identify metabolic disorders which include aminoacidemias, urea cycle disorders, organic acidurias, and fatty acid oxidation disorders. Samples can be presented as plasma, urine, and blood spots or urine on filter paper. Sample preparation techniques can include solvent extraction, acid derivitisation and evaporation prior to reconstitution in a suitable medium for injection to MS. Evaporation of butanolic HCl used for derivatisation using blowdown techniques results in corrosion of the system especially pins/needles/jets which can lead to contamination of samples and erroneous results. The EZ-2 with HCI resistance commonly used for these sample preparation stages. One example would be the test for CAT (carnitine acyl carnitine translocase deficiency) in neonates, an inborn error of metabolism. Lack of this enzyme prevents the body from converting fats into energy. Labs do the initial test on Guthrie cards (dried blood spots). The cards are punched and extracted with 200ul of Methanol. The supernatant is placed into microtitre plates and dried. Samples are then derivatised using approx 100ul 3N HCl in anhydrous Butanol and dried again. Finally, samples are re-suspended in Water & acetonitrile for analysis by MS.
miVac concentrators have been used by the Australian Sports Drug Testing Laboratory to improve the testing for synthetic insulin analogues in athletes’ blood samples. Using the miVac’s ability to control conditions during the concentration step the analyst has more confidence that they are seeing the true blood concentration of potential drugs of abuse in the athlete’s sample.
Mental illness
Mental illness is an umbrella term that refers to many different illnesses that affect the mind. Around one in five Australians will experience some form of mental illness – mild, moderate or severe – at some time in their lives.
Mental illnesses can be divided into two main groups:
- Non-psychotic illness – symptoms include overwhelming feelings of sadness, tension or anxiety, and difficulties coping with everyday life. Depression and anxiety disorders like phobias and obsessive compulsive disorders are examples of non-psychotic illnesses.
- Psychotic illness – symptoms include delusions, hallucinations and a distorted view of reality. Schizophrenia and bipolar disorder (manic depression) are examples of psychotic illnesses.
People in the criminal justice system have significantly higher rates of mental illness and mental disorders than people in the general community. People with a mental illness are also more likely to be detained in custody, sentenced to imprisonment, or to become a victim of crime. Young men are overrepresented in Australia’s prison population and are therefore more likely than others to be referred to forensic mental health specialists or services.
‘Forensic’ means related to, or associated with, legal issues. Forensic mental health services provide assessment and treatment of people with a mental disorder and a history of criminal offending, or those who are at risk of offending.
People may be referred for assessment by the police, courts, prison, other health or mental health services, or justice agencies, and may have a mental illness or mental disorder. Treatment may be provided in the community, in hospital or in prison.
The mental state of some offenders, or alleged offenders, may need to be assessed for a variety of reasons, including:
- Whether or not they are capable of making a plea in court
- Their state of mind at the time of the offence
- Their current need for mental health treatment.
Mental disorders
Mental disorders include:
- Organic brain disorders – damage to brain tissue caused by diseases such as alcoholism or dementia
- Personality disorders – enduring disturbances in the way in which a person interacts with others
- Intellectual disability – caused by problems with brain development.
Support for people with forensic mental health issues
The type of person seen by forensic mental health clinicians may include:
- Prisoners who need inpatient treatment
- Prisoners requiring assessment or management of a mental illness
- People who are accused of crimes, but are considered unfit to plead because of their mental impairment
- People who are found not guilty of crimes because of mental impairment
- Offenders or alleged offenders who are referred by courts or other agencies (for example, the Adult Parole Board) for assessment
- People unable to be managed safely in mainstream mental health services
- People living in the community who have a serious mental illness and have offended, or are at high risk of offending.
Forensic mental health referral agencies
Offenders or alleged offenders may be referred to a forensic mental health service or practitioner by a range of organisations, including:
- Police
- Courts
- Prisons
- Community corrections
- Other justice and mental health services.
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Treatment for offenders with mental health issues
Treatment options for people with forensic mental health issues may include:
- Medication – such as antidepressants, antipsychotics and other medications to control some of the symptoms of particular mental illnesses or mental disorders
- Counselling – one-on-one or group therapy
- Rehabilitation – involvement in a program directed at enabling people to live safely within the community.
There are services available to support offenders with mental health issues. The Department of Health funds a range of public general and forensic mental health services. The Department of Justice funds prison-based mental health services, court-based assessment and diversion programs, and community-based support programs. Private forensic psychologists and psychiatrists offer treatment and counselling services.
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Things to remember
- Forensic mental health services provide assessment and treatment of people with a mental disorder and a history of criminal offending, or those who are at risk of offending.
- There are services available to support people found not guilty of an offence on the grounds of mental impairment, mentally ill offenders and people at risk of offending.