Judicial Encounters of Young Adults with Congenital Heart Disease

Abstract

Background: Adolescents with CHD are often marginalised. They need coping strategies for emotional problems and for boosting self-esteem. To compensate for restricted physical, social and academic prowess adolescents may utilise denial, substance abuse or risk-taking behaviour. This study aimed to explore the connection between congenital heart disease (CHD), psychosocial disadvantage and law-breaking behaviour. Methods: The Adult Congenital Heart Unit data base was reviewed for patients with judicial encounters or criminal conviction. We recorded cognitive, psychological and social impairments, together with health outcomes. Detailed psychological case studies were done by interview, regarding lived experience of CHD and forensic exposure. Quantitative measures of quality of life, personality traits, psychological disorder and cognitive capacity were administered to form theories for transgressions. Results: Fifteen patients had court appearances and all were male. Seven served jail sentences, two Indigenous adolescents. A cardiologist's letter outlining medical and psychological problems was helpful to the court in four cases. Three of the young adults are now deceased and one has received a heart transplant. Six had cardiac pacemakers and/or defibrillators. Many had multiple operations over their lifetime extending from infancy, through adolescence and into adulthood. Conclusions: Males with CHD can manifest anti-social behaviours due to cognitive and emotional problems, placing them at risk of criminal convictions. Correspondence defining patients’ problems may mitigate sentences. Providing cardiac advice for detained patients may be an increasing challenge as more youths with CHD abuse substances. They need psychological interventions to reduce risk-taking behaviours, manage anxiety associated with forensic exposure, and improve rehabilitation upon prison release.