A profile of mentally disordered offenders admitted to inpatient psychiatric services in the United States

This research note presents data about mentally disordered offenders (MDOs) treated in inpatient psychiatric services. Data are derived from 1980 admission surveys by the Survey and Reports Branch, National Institute of Mental Health (NIMH). These data report for the first time inpatient services provided to MDOs by non-Federal general and private hospitals. A total of 31,773 MDOs were admitted, with 85% going to state and county mental hospitals. The largest group, including admissions for evaluation, was ISTs (58%), followed by mentally disordered prisoners (32%), NGRIs (8%), and MDSOs (3%). Women and whites tended to be overrepresented among MDOs as compared to prison and jail inmates. Clear diagnostic differences by legal status were found, with schizophrenia predominant among NGRIs (81%) and alcohol and drug abuse disorders more frequent among ISTs. Overall, state and county hospitals in both 1967 and 1980 were the primary locus of care for mentally disordered offenders.     

Screening for severe mental disorder in jails

Despite the demonstrated prevalence of severe mental disorder among jail detainees and the legal mandate to provide mental health services, most jails do not have the resources to incorporate traditional, time-consuming psychological assessment techniques into their routine intake process. As a result, a number of mentally ill jail detainees remain undetected and untreated. This study outlines the development of the Referral Decision Scale (RDS), which detects persons who have a high probability of having a severe mental disorder so that they can be given a complete diagnostic evaluation. The 14-item RDS was statistically derived using discriminant analysis from data collected via the NIMH Diagnostic Interview Schedule on 728 randomly selected male jail detainees and then validated on 1,149 prison inmates. The final validated version of the RDS had an overall sensitivity of 0.791, specificity of 0.987, and positive and negative predictive value of 0.791 and 0.013, respectively. Since these statistics far exceed current detection rates, the RDS is likely to facilitate the diversion of mentally ill detainees in situations where it is impractical to administer psychological examinations to all incoming inmates. Training requirements for the RDS and directions for future research are discussed.This research was supported in part by National Institute of Mental Health under grant No. R01MH37988. We would like to thank Karl Kilgore, Stuart Michaels, John Lyons, Karen Abram, Richard White, and Christine Davidson for their statistical insights and helpful comments. James Collins is due special thanks for making his North Carolina prison data available. We are also grateful to Philip Hardiman, Thomas Monahan, and Ronald Simmons for their cooperation with the data-collection process.     

Elaborating on the Construct Validity of the Levenson Self-Report Psychopathy Scale in Incarcerated and Non-Incarcerated Samples

The Levenson Self-Report Psychopathy Scale (LSRP) is a promising, efficient measure of the psychopathic personality. Previous examinations of its latent structure have yielded inconsistent results; therefore, the goal of the current study was to evaluate previously reported two- and three-factor models in three separate groups of male correctional inmates (n = 573), male college students (n = 202), and female college students (n = 200). Confirmatory factor analyses revealed that the best-fitting model across all the three groups was the three-factor model proposed by Brinkley et al. (Assessment 15:464–482, 2008). The convergent and discriminant validity of this three-factor structure as well as a revised 19-item total score were elaborated on in terms of predicting scores on conceptually relevant external criteria. The LSRP total and factor scales evidenced good convergent and discriminant validity with a few notable exceptions. Implications for theory and future research are discussed.     

Prison misconduct among female inmates with mental disorders,substance abuse/dependence,and co-occurring disorders in Taiwan

This survey study attempted to address two research questions: (1) whether female inmates with either singular mental illness or singular substance abuse/dependence disorders were more likely to break institutional rules in prison than their disorder-free counterparts; and (2) whether female inmates with both mental illness and substance abuse/dependence disorders (CODs) were more likely to engage in misbehaviour than either disorder-free or singularly disordered women during the course of their confinement. The current study employed a sample of 643 female inmates and the data for analyses contained information on inmates’ CODs, mental and substance abuse/dependence disorders, and pre-prison and prison experiences. The results showed that female inmates with CODs committed the most misconduct in prisons, but no significant effect was found on prison misconduct among inmates with singular disorders and disorder-free female inmates. Possible explanations for these results were suggested, and public policy implications were discussed in the concluding section.     

The referral decision scale

We examined the validity of the Referral Decision Scale (RDS), a test designed to screen for mental disorder in jail inmates, in a sample of 790 men admitted to an urban pretrial jail. Our results indicated that, in general, the RDS had excellent reliability and acceptable validity as a screening measure for serious mental disorder in jail settings, despite making a large number of false positive errors relative to both contemporaneous and subsequent assessments of mental disorder. Although the RDS is well suited for use in research, more information is needed before the test is used for clinical purposes. We discuss some potential problems with the use of the RDS in correctional systems.     

Psychiatric disorders and personality characteristics of prisoners at regular prison wards

BackgroundDutch correctional officers are trained to observe prisoners with severe mental disorder. This ‘behavioural’ approach is assumed to detect psychiatrically disordered prisoners with striking symptoms. On the basis of this screening procedure about 10% of the Dutch prison population is classified as needing special care or control. In the current study, what psychopathology can still be found among the remaining 90% prisoners residing at regular wards is investigated and which personality traits characterize them. When the prevalence of major mental illness would still turn out to be high in this group, the question arises whether the current, rather unstandardized, way of screening prisoners is sufficient.AimsTo assess the prevalence of psychiatric disorders among adult Dutch prisoners on regular wards, and to determine the concurrent and convergent validity of self-report measures and their screening characteristics in such a sample.Method191 randomly selected prisoners admitted to the general wards were administered a number of tests (SCL-90, NEO-PI-R, MINI) during the first weeks of their incarceration.ResultsIncluding substance abuse, 57% of the participants suffered from one or more Axis I disorders. About seven out of ten detainees with psychopathology as assessed with the MINI did not receive professional help. The concurrent and convergent validity of the SCL-90 and the NEO-PI-R turned out to be reasonable. The predictive validity of self-report measures in detecting prisoners with an Axis I disorders or suicide risks was moderate.ConclusionsThe Dutch ‘behavioural approach’ seems to be quite accurate in detecting prisoners with psychotic disorders. Most prisoners with other mental disorders on regular wards, however, did not receive professional help. The current study suggests that self report scales such as the SCL-90 and the NEO-PI-R may be helpful in screening detainees on important DSM-IV disorders.     

Validation of the Sexual Assault Symptom Scale II (SASS II) using a panel research design

To examine the utility of a self-report scale of sexual assault trauma, 223 female victims were interviewed with the 43-item Sexual Assault Symptom Scale II (SASS II) at 1, 3, 7, 11, and 15 months postassault. Factor analyses using principal-components extraction with an oblimin rotation yielded 7 common factors with 31 items. The internal consistency was high for 4 factors and moderate for 2 factors. The multitrait-multimethod matrix, correlating the factor subscale scores of self-reported trauma and clinical assessment ratings, demonstrated both convergent and discriminant validity, indicating that the SASS II has construct validity. Correlations between the SASS II subscales and the intrusion subscale of the Impact of Events Scale also indicated the convergent and discriminant validity of the SASS II. Significant positive correlations between current and prior trauma levels further evidence the validity of the SASS.     

Assessing Jail Inmates' Proneness to Shame and Guilt: Feeling Bad About the Behavior or the Self?

This study of 550 jail inmates (379 male and 171 female) held on felony charges examines the reliability and validity of the Test of Self Conscious Affect -Socially Deviant Version (TOSCA-SD; Hanson & Tangney, 1996) as a measure of offenders' proneness to shame and proneness to guilt. Discriminant validity (e.g., vis-à-vis self-esteem, negative affect, social desirability/impression management) and convergent validity (e.g., vis-à-vis correlations with empathy, externalization of blame, anger, psychological symptoms, and substance use problems) was supported, paralleling results from community samples. Further, proneness to shame and guilt were differentially related to widely used risk measures from the field of criminal justice (e.g., criminal history, psychopathy, violence risk, antisocial personality). Guilt-proneness appears to be a protective factor, whereas there was no evidence that shame-proneness serves an inhibitory function. Subsequent analyses indicate these findings generalize quite well across gender and race. Implications for intervention and sentencing practices are discussed.     

An electrocortical correlate of a history of alcohol abuse in criminal offenders

Abstract

This study tested the hypothesis that a history of chronic alcohol abuse is the key variable underlying the previously reported association between criminal recidivism, impulsivity and differentiation of the Go/NoGo contingent negative variation (CNV). Forty male Singaporean prison inmates were assessed for presence of antisocial personality disorder (APD), a history of alcohol and other substance abuse, and psychopathy. CNV was recorded in the Go/NoGo paradigm in groups comprising inmates with (ALC+: N = 29) and without (ALC?: N = 11) a history of alcohol abuse. As predicted, the ALC+ group showed significantly degraded Go/NoGo CNVs (poor differentiation). This suggests that the “high risk” group of mentally disordered found to recidivate in studies by Howard and Lumsden (1996; 1997) may have shared a history of alcohol abuse. Results are discussed in the context of a developmental biopsychosocial model of risk for engaging in criminal behaviour.     

Measuring criminal thinking styles: The construct validity and utility of the PICTS in a Dutch prison sample

Purpose. Criminal thinking and thinking styles are important areas in the assessment and treatment of offenders. The Psychological Inventory of Criminal Thinking Styles (PICTS: Walters, 2005) is designed to assess such criminal thinking styles. In the current study, the associations between criminal thinking styles on the one hand, and criminal histories, personality traits, and mental disorders of Dutch prisoners on the other, were explored. The aim is to test the reliability and construct validity of the PICTS in a population of male Dutch detainees. Methods. A sample of 191 randomly selected male prisoners of a large Dutch correctional institution were assessed by means of the PICTS, NEO‐PI‐R, and the MINI psychiatric interview. Prison inmates with very severe psychiatric symptoms and severe disruptive behaviours were excluded. Results. The psychometric qualities of the PICTS were found to be fair‐to‐good. The construct validity of the PICTS was supported by various convergent results with the criminal antecedents of the offenders, as well as with the scores on the scales measuring personality traits and psychiatric disorders. Conclusions. The associations between criminal thinking styles on the one hand and personality traits, antisocial personality disorder, and mental disorders on the other were rather strong. The current results suggest that the PICTS may be a valid and useful tool for assessing criminal thinking styles.     

Mental disorders and request for psychiatric intervention in an Italian local jail

The issue of the prevalence of psychiatric illnesses in Italian prison samples has not received the same attention paid at an international level. The aims of the present study were to evaluate the prevalence of psychiatric disorders diagnosed according to DSM-III-R criteria among an Italian prisoner population, and to examine prisoners' requests for psychiatric intervention in relationship to the presence or absence of different psychiatric disorders. One hundred forty-two Italian male subjects from the Casa Circondariale of Messina, Italy, were evaluated using the Structured Clinical Interview for DSM-III-R Non-Patient Version - SCID I and SCID II. A very high rate of disorders was found among inmates: 85.2% (n=121) of the sample were affected by a psychiatric disorder. Of the total sample, 51.4% (n=73) had requested psychiatric treatment during detention. The detection, diagnosis and treatment of the mentally ill prisoners is a primary goal for a better organization of services and prison settings; screening procedures for evaluating the presence of psychiatric disorders, with the aim to promote differential strategies for the care and rehabilitation of inmates, are needed.     

Personality traits,personality disorders and sensational interests in mentally disordered offenders

Purpose. Sensational interests (e.g. an interest in the occult or the methods of violence) in mentally disordered offenders are claimed to signify greater risk of psychopathology, but evidence to support this view is slight. Methods. The relationships between self‐reported DSM‐IV personality disorder (PD), general personality traits and sensational interests were examined in 155 of 167 consecutively referred offenders to a forensic psychology service. The subscales of the PD and personality trait measures were reduced to the four basic PD/trait dimensions (asocial, antisocial, anxious and anankastic) using confirmatory factor analysis. Results. Those high on the ‘antisocial’ factor (which was primarily defined by low Agreeableness, low Conscientiousness, and substantial elements of Paranoid, Antisocial and Borderline PD) were more interested in ‘violent‐occult’ and militaristic topics. Conclusions. The aspects of the antisocial factor primarily associated with an interest in sensational and potentially violent topics cover a wide range of putative disorders. However, the factors reflecting asocial, anxious or anankastic disorders do not show a reliable association with measures of sensational interests. These results suggest that the personality dimensions reflecting an interest in ‘sensational’ topics in mentally disordered offenders are relatively specific.     

Characteristics that predict firesetting in male and female mentally disordered offenders

Few studies have adequately explored the characteristics of male and female mentally disordered firesetters and compared these to those of non-firesetting mentally disordered offenders. Furthermore, there is a paucity of research examining the characteristics which can predict repeat firesetting within this population. The current study aimed to examine similarities and differences in the characteristics of (1) male and female mentally disordered firesetters, (2) male and female mentally disordered firesetters compared to non-firesetting offenders, and (3) one-time and repeat firesetters. Furthermore, the ability of these characteristics to predict offence status (i.e. firesetter or non-firesetter) and repeat firesetting was explored. Information was collected from patient hospital records for 77 (43 firesetters, 34 non-firesetters) mentally disordered offenders; including sociodemographic, family and personal background, psychiatric, and offence history factors. The findings suggest that mentally disordered firesetters are similar to their non-firesetting counterparts on key characteristics; however, firesetters are more likely to have an expressed interest in fire/explosives and a diagnosis of a schizophrenic disorder and female firesetters are more likely to have a higher number of firesetting incidents than males. Furthermore, findings suggest that fire interest is the largest predictor of repeat firesetting. Clinical implications in terms of treatment and risk assessment are discussed.     

A symptom level examination of the relationship between Cluster B personality disorders and patterns of criminality and violence in women

The psychometric properties and structure of the Cluster B Personality Disorder criteria (Antisocial, Borderline, Histrionic, and Narcissistic) are examined in a sample of 261 female inmates using a self-report screen followed by a full diagnostic interview. The results of the structural analyses in this sample demonstrated good internal consistency and convergence, but poor discriminant validity between disorders. An exploratory factor analysis found that the structure of these disorders was best accounted for by a four-factor solution that paralleled the Diagnostic and Statistical Manual (DSM-IV-TR; APA, 2000) classification scheme with some significant and notable exceptions. Using the factor scores generated from the factor analysis, the personality profiles of the women were compared with several behavioral indices, including instant offense, institutional infractions, and self-report violence and victimization within the prison. Of particular importance was the consistent relationship observed between narcissistic personality traits and threatening and violent behavior within the prison combined with the impulsive but less malignant presentation of antisocial personality traits among this sample of women. Results are discussed as they inform our understanding of the structural integrity of the four Cluster B diagnostic categories and the relationship of these personality disorders to different types of criminality and violence.     

Collateral report of psychopathy: convergent and divergent validity of the psychopathic personality inventory-short form

Psychopathy is a personality syndrome comprised of interpersonal, affective, and behavioral features that has emerged as a correlate of intimate partner violence perpetration. One commonly used self-report measure of psychopathy is the Psychopathic Personality Inventory-Short Form (PPI-SF). The current study employed a multi-trait, multi-method approach to test convergent and discriminant validity of the measure in partner-violent couples by comparing males’ self-report of psychopathy to the informant report of their female partner (N = 114). It was hypothesized that the female partner report of the male’s psychopathy would be highly correlated with the male report of his own psychopathy, thus providing evidence for the construct validity and interrater reliability of the PPI-SF. Analyses found that male and female reports were correlated significantly on the two major factors of the PPI-SF. Furthermore, the female report explained a significant amount of variance over and above men’s self-report on PAI scales designed to indicate antisocial personality traits.     

Psychometric properties of the inventory of callous-unemotional traits short version (ICU-12) among detained female juvenile offenders and community youths*

The presence of callous-unemotional (CU) traits delineates a subgroup of male youth with severe conduct problems and antisocial behavior. To date however, existing research into these features among females is markedly limited. Drawing on 377 female adolescents (103 selected from forensic settings and 274 selected from school settings) from Portugal, the current study is the first to simultaneously examine the psychometric properties of the 12-item shortened version of the Inventory of Callous-Unemotional Traits (ICU-12) in incarcerated and community female youth. Results provide support for the construct validity and reliability of the ICU-12 among this unique sample. Findings from this study also reveal evidence of convergent and discriminant validity with a number of theoretically relevant constructs (e.g. psychopathic features, aggression, and substance use). Clinical implications for using the ICU-12 with females are discussed.     

Effects of a Dog-Assisted Intervention Assessed by Salivary Cortisol Concentrations in Inmates of a Japanese Prison

Physiological effects of a dog-assisted, stress management and communication training program conducted in a prison were investigated by assessing salivary cortisol concentrations of prison inmates before and after the sessions. The program was conducted with groups of inmates with psychiatric and/or developmental disorders. In the program, male inmates interacted with trained pet dogs and their volunteer handlers. Inmates evaluated their mood states before and after each session by using a questionnaire. Moreover, handlers evaluated the quality of the interaction with inmates after each session. Results indicated that the inmates’ cortisol values in most cases decreased following their participation in the sessions. The inmates who demonstrated stress reduction by decreasing cortisol values were diagnosed only psychiatric disorders, were aware of their mood improvement, and were evaluated by the handlers as having interacted well during the sessions. This indicated the validity of psychiatrists’ diagnoses, inmates’ self-evaluation, and handlers’ evaluation of inmates. Also, inmates who experienced a medium mood without mood changes had decreased cortisol values. It is suggested that these results are useful for predicting and selecting inmates who are expected to obtain effects by participating in the program. Moreover, it is suggested that providing feedback to inmates about changes in their salivary cortisol levels could help them better understand their psychophysical state, which could result in more effective stress management.     

Involuntary detention and treatment of the mentally ill: China's 2012 Mental Health Law

The long-awaited Mental Health Law of China was passed on 26 October 2012 and took effect on 1 May 2013. Being the first national legislation on mental health, it establishes a basic legal framework to regulate mental health practice and recognizes the fundamental rights of persons with mental disorders. This article focuses on the system of involuntary detention and treatment of the mentally ill under the new law, which is expected to prevent the so-called “Being misidentified as mentally disordered” cases in China. A systematic examination of the new system demonstrates that the Mental Health Law of China implicitly holds two problematic assumptions and does not provide adequate protection of the fundamental rights of the involuntary patients. Administrative enactments and further national legislative efforts are needed to remedy these flaws in the new law.     

Integrating risk,the Good Lives Model and recovery for mentally disordered sexual offenders

Abstract

Personality disordered and mentally disordered sexual offenders (MDSOs) with complex diagnoses such as schizophrenia, developmental disorders and mood disorders face challenges of restoring their mental health, living more safely with personality- and offence-related risks, while addressing concerns about their capacity to reintegrate into society; this has been termed “secure recovery”. This paper reviews the literature on recovery, demonstrating its commonality with the Good Lives Model (GLM) as applied to MDSOs' offending treatment. GLM appears to provide a better fit with the recovery needs of MDSOs than the Risk–Need–Responsivity model because it emphasises approach goals, enhanced responsivity and skills acquisition. Recovery needs to integrate coping with mental disorders with risk management and a healthy, future lifestyle. Both secure recovery and GLM support the need for client–clinician collaboration, promoting self-determination and a shared narrative about coping with enduring risk and the hope of sustained well-being.