Violence risk profile of medium- and high-security NGRI offenders in Belgium

Under Belgian law, offenders not guilty by reason of insanity (NGRI) are committed by the courts to forensic mental health treatment. The use of violence risk assessment tools has become routine in these settings. However, there are no national statistics regarding violence risk assessment in the Belgian forensic population. A study was undertaken to collect risk assessment data (PCL-R, VRAG, HCR-20) on a large cohort of forensic patients committed to Medium Security units in the Flanders region and in High-Security units in the Walloon region. Flemish patients were expected to present a lower risk compared with their Walloon counterparts. Instead, data yielded by a structured risk assessment method demonstrate the opposite. Moreover, the majority of patients in Flemish facilities had committed violent offenses and were institutionalized for shorter periods whereas the majority of Walloon patients had committed sexual offenses and were institutionalized for markedly longer periods.     

Determining security level in forensic psychiatry: a tug of war between the DUNDRUM toolkit and the HoNOS-Secure

ABSTRACT

Criteria to determine in which level of security forensic patients should receive treatment are currently non-existent in Belgium. Research regarding the assessment of security level is minimal, and limited instruments are available. This study investigated the instruments that measure the need for security level: DUNDRUM-1 and the HoNOS-Secure. The psychometric properties of the DUNDRUM-1, DUNDRUM-2 and the HoNOS-Secure were investigated.

A random selection was made of 100 male forensic patients in prison. The DUNDRUM-1, DUNDRUM-2 and the HoNOS-Secure were scored retrospectively. A subsample of the files was rated by four researchers (n?=?38). Comparisons were made with the security level as decided by the court.

The DUNDRUM-1 achieved excellent inter-rater reliability, and the HoNOS-Secure and DUNDRUM-2 got a moderate score. The internal consistency was highest for DUNDRUM-1 followed by the HoNOS-Secure and was low for the DUNDRUM-2. Both the DUNDRUM-1 and the HoNOS-Secure predicted allocations by the court to high security.

The DUNDRUM-1 outperforms the HoNOS-Secure on psychometric properties and provides clear instructions with regard to the assessment of the security level. Training seems to be important for scoring the DUNDRUM-1. The current study provided more evidence for the applicability of the DUNDRUM-1 in Belgian settings with regard to determining the need for security.     

Forensic mental health law reform in Japan: from criminal warehousing to broad-spectrum specialist services?

Since the 1980s Japan has undergone a number of mental health law reforms culminating in the 2005 forensic law. This added to its enactments on involuntary commitment, long-term aged care and substitute decision making, bringing Japan into focus as an industrialized state now possessed of a full package of civil and forensic provisions. This article seeks to demonstrate that the new forensic law cannot achieve its own stated goals without seeking to put into place financial and administrative supports aimed to integrate the myriad of patient populations that will be inevitably affected by the new forensic system. In order to avoid the widespread syndrome that has already been experienced internationally of warehousing mentally ill offenders in jails, it is critical that the Japanese government develop effective and culturally sensitive techniques for dealing with low risk populations through a diversionary process. Furthermore, although the legislation addresses serious crimes, it is imperative that policies be put into place to avoid directing young offenders, violent patients from the general hospital system, the developmentally handicapped, already convicted persons found in hospital settings and problematic cases in the correctional system, to the new forensic units established by the legislation. It is only though contemplating unintended outcomes of the legislation that the Japanese government will be able to avoid the ongoing stigmatization and prolonged institutionalization of mentally ill populations. Despite apparent cultural differences internationally vetted human rights requirements must be properly protected, not only in the forensic context, but throughout the mental health system at large. The coordination of services and the development of specialty training are necessary conditions for the realization of improved and humane conditions for mentally ill persons in Japan.     

Clinical and demographic characteristics of elderly offenders at a maximum-security forensic hospital

The purpose of the study was to determine the clinical and demographic characteristics of the male elderly offenders admitted to a maximum-security forensic hospital. Charts of male elderly patients were reviewed to obtain clinical and demographic data. Seventy-seven percent of geriatric felons were involved in violent crime, 41% of which had psychotic symptoms. Forty-five percent of offenders with a history of head trauma/neurologic disorder were charged with violent offenses. Fifty-nine percent had previous psychiatric hospitalization. Most elderly male offenders involved in violent crimes had primary psychotic and mood disorders, cognitive impairment, and a history of head trauma/neurologic disorder. The small number of subjects precludes clear conclusions and needs further study.     

Homicides with Mutilation of the Victim's Body

Abstract:  Information on homicide offenders guilty of mutilation is sparse. The current study estimates the rate of mutilation of the victim's body in Finnish homicides and compares sociodemographic characteristics, crime history, life course development, psychopathy, and psychopathology of these and other homicide offenders. Crime reports and forensic examination reports of all offenders subjected to forensic examination and convicted for a homicide in 1995–2004 ( n  = 676) were retrospectively analyzed for offense and offender variables and scored with the Psychopathy Check List Revised. Thirteen homicides (2.2%) involved mutilation. Educational and mental health problems in childhood, inpatient mental health contacts, self-destructiveness, and schizophrenia were significantly more frequent in offenders guilty of mutilation. Mutilation bore no significant association with psychopathy or substance abuse. The higher than usual prevalence of developmental difficulties and mental disorder of this subsample of offenders needs to be recognized.     

Relationships between legal and clinical factors among forensic hospital patients

Recognizing that established relationships enhance understanding and therefore improve clinical intuition and inference, the authors examined clinical and legal characteristics of a legally and clinically heterogeneous population of maximum security forensic hospital patients (n = 380). Several findings serve to substantiate outcomes of previous studies of subgroups of offenders. Some new relationships among legal and clinical variables are established. The relationship between admission legal status and Axis I diagnosis is dependent upon the Axis II diagnosis. Those admitted for competency evaluations have the lowest percentage of psychotic diagnoses and the highest IQ. Kidnapers have the highest percentage of psychotic diagnoses and there is a relationship between previous incarceration and drug treatment refusal. The authors discuss clinical implications, generalizability, and the needs for further investigation.     

Validity and reliability of the VRAG in a forensic psychiatric medium security population in Flanders

Since the development of the Violence Risk Appraisal Guide (VRAG), one of the most widely used actuarial risk assessment instruments, numerous replication studies have shown its usefulness in predicting (violent) recidivism among various offender populations. It is not clear, however, whether these findings can be generalized to forensic psychiatric patients admitted to a medium security forensic psychiatric unit in the Flemish part of Belgium. Therefore, the main aim of this study was to test the predictive validity and reliability of the VRAG in a sample of 191 Flemish medium security patients. The mean follow-up period was 2.4 years. Contrary to the expectations, the VRAG was unable to significantly predict any kind of outcome. Possible explanations are discussed and further research with the VRAG in Flanders, and its recently revised version, is recommended.     

‘Wasn't me!’ A field study of the relationship between deceptive motivations and psychopathic traits in young offenders

Purpose. Evaluating truthfulness is an integral part of any forensic assessment. Unfortunately, the motives underlying the use of deceptive strategies by offenders and how these may be mediated by personality are not well established, particularly in adolescent samples. Accordingly, the aim of the present study was to identify different deception‐related motivations in a sample of juvenile offenders, with special emphasis placed on the relationship between these motivations and psychopathic traits. Methods. Archived file and videotaped information for 60 Canadian federal juvenile offenders were reviewed in order to identify real‐life (spontaneous) patterns of deceptive motivations. Results. It was found that there were significant differences between the low, medium, and high groups across psychopathic traits for the motivations of (1) lies to obtain a reward; (2) to heighten self‐presentation; and (3) for duping delight. Conclusions. Not only were juvenile offenders found to lie for a variety of reasons, but also psychopathy was found to mediate the specific motivational patterns leading to offender perpetrated deception. The relevance of these findings to the assessment of truthfulness in offender populations is discussed.     

Criminal law and mentally ill offenders in comparative perspective

Abstract

In this stick we compare legal arrangements dealing with mentally disordered offenders in the criminal law systems ct Belgium, Canada, Germany, the Netherlands, Norway, Sweden, and the United Kingdom. To describe relevant diffesenoes and similarities in the arrangemeats, we used a checklist containing antral aspects of adjudication, assessment and treatment of mentally ill offenders. These aspects concern: (1) the legal classifications of mental illnesses that can lead to exclusion of criminal responsibility: (2) the acceptance of diminished capacity as a partial excuse; (3) the possibilities for imposing security measures of compulsory treatment instead of or next to criminal punishment; (4) the conditions for their imposition in terms of seriousness of crimes committed and dangerousness of offenders; (5) the available hospitals or special clinics for executing security measures; (6) the role and task of forensic mental health professionals in assessing the offender's state of mind and in advising compulsory treatment; (7) the rules for duration, prolongation and termination of the measures. The findings of this comparative analysis are evaluated in light of legal protection for mentally disordered offenders.     

Construct validity,reliability and predictive validity of the dynamic risk assessment and management system (DRAMS) in offenders with intellectual disability

Background. There have been a number of developments in the assessment of dynamic risk in the criminological literature. The dynamic risk assessment and management system (DRAMS) has been developed to facilitate the measurement of dynamic factors of risk for offenders with intellectual disability. Method. The study was designed to assess the construct validity, reliability and predictive utility of the DRAMS in 23 male forensic patients in a high secure setting. Predictions were made against independently collected incident data. Concurrent validity was assessed against the Ward Anger Rating Scale (WARS). Results. A reformulation of the individual section variables according to convergent and discriminant correlational analysis revealed Cronbach's alpha levels of >.8 for all sections apart from mood (alpha .750) and items retained to facilitate clinical information (alpha ?.017). Two hundred pairs of WARS and DRAMS assessments revealed orderly sectional correlations. The sections of mood, antisocial behaviour, and intolerance/agreeableness predicted incidents with a medium effect size as did total DRAMS score. There were highly significant differences between assessments taken 1 or 2 days prior to an incident and control assessments conducted at least 7 days from an incident. Conclusions. The reformulated DRAMS has good construct and concurrent validity. It appears to be a reliable assessment tool and informs on risk levels relating to stable and acute proximal factors. It appears as an important addition to the utility of risk assessments for this population.     

Assaultive behavior in state psychiatric hospitals: differences between forensic and nonforensic patients

Forensic patients are occupying an increasingly large number of beds in state psychiatric hospitals. The presence of these mentally ill offenders has raised concerns about the risk they present to nonforensic patients. This study compared the rate of assaults and factors associated with assaultive behavior among 308 nonforensic patients and two groups of forensic patients including 469 patients found not guilty by reason of insanity and 76 pretrial patients. Consistent with other studies, nonforensic patients had higher rates of assaults than either group of forensic patients. However, being a forensic patient did not affect the odds of assault when controlling for the effects of demographic and clinical variables in a multivariate logistic regression analysis. Factors associated with assaults in each of the three patient groups were identified using multivariate analyses. Implications are presented for treatment of assaultive behavior, mixing of forensic and nonforensic patients within state hospitals, forensic release policies, and future research.     

The relationship between schemas and offence supportive attitudes in mentally disordered sexual offenders

Abstract

The study of schemas in sexual offenders is a relatively new approach in attempts to understand the deviant beliefs and attitudes of sexual offenders. Emerging findings suggest that offence supportive attitudes may be the product of an offender's underlying schemas. This study aims to establish the relationship between offence supportive attitudes and schemas in a sample of mentally disordered sexual offenders (MDSOs). Thirty-one male sexual offenders held within low through high security forensic mental health units were assessed using the Young Schema Questionnaire - Short Version 3 and the Questionnaire on Attitudes Consistent with Sex Offending. Correlational analyses suggested a pattern of relationships in which Insufficient Self-control, Entitlement and Enmeshment arose as the schemas associated with most offence supportive attitudes. This supports a relationship between schemas and offence supportive attitudes in MDSOs and is consistent with the literature to date. Implications for further research and treatment are considered.     

Management of crime scene units by Quebec police senior managers: Insight on forensic knowledge and understanding of key stakeholders

What do policing leaders think and know of forensic science? Beyond crime scene investigators or detectives, how do police senior managers perceive the role, utility and limitations of forensic science? Very few empirical studies have addressed the issue. Forensic scientsts should be concerned about the perception that law enforcement senior managers have of their discipline for two reasons. First, strategic and financial decision-makers are obviously key players in the overall administration and provision of forensic science, either as a supervisor, money provider or as a customer. Second, literature has highlighted that other actors involved in forensic science underestimate the scope and possibilities offered by forensic science, hence limiting its exploitation and potential. Following interviews with 18 police senior managers from Quebec (Canada), this study shows that they generally restrict forensic science to a reactive discipline whose role and utility is to identify offenders and support the Court. This understanding of forensic science, like that of many others including a significant share of forensic scientists, differs from the perception of other police activities in modern law enforcement agencies where proactive action is sought. Considering these findings and the growing body of literature which calls for forensic science to connect more tightly with policing and security, we advocate a more extensive education of police leaders regarding the scope of forensic science.     

Self-deception and other-deception among admissions to a maximum security hospital and a medium secure unit

Abstract

Other-deception and self-deception are important variables to consider when conducting a forensic psychological evaluation. The main aim of the present study was to investigate the effects of setting on other-deception and self-deception scores. It was hypothesised that patients at a maximum security hospital (Broadmoor) would score lower on an other-deception questionnaire than similar patients at a medium secure unit (Denis Hill Unit). All the patients completed the other-deception (ODQ) and self-deception (SDQ) questionnaires of Sackeim and Gur (1979) on admission to the two security hospitals. The Broadmoor patients (N = 46) obtained significantly lower ODQ score than the Denis Hill Unit (N = 52) patients, after controlling for differences in ethnic background and diagnosis among the two populations. No significant difference in setting was found for the SDQ score. The ODQ and SDQ scores were significantly associated with the type of diagnosis and the ethnic background of the patient, with patients diagnosed as mentally ill scoring higher than those with a diagnosis of personality disorder, and ethnic minority patients scoring higher than Caucasian patients.     

Domestic Homicide: Neuropsychological Profiles of Murderers Who Kill Family Members and Intimate Partners

Domestic homicide is the most extreme form of domestic violence and one of the most common types of homicide. The objective was to examine differences between spontaneous domestic homicide and nondomestic homicide offenders regarding demographics, psychiatric history, crime characteristics, and neuropsychological status, utilizing neuropsychological test data from forensic examinations of 153 murderers. Using standard crime classification criteria, 33% committed spontaneous domestic homicides (SDH) and 61% committed nondomestic homicides (NDH). SDH offenders were more likely to manifest psychotic disorders, but less likely to be diagnosed with antisocial personality disorder or to have prior felony convictions. SDH offenders manifested significantly worse neuropsychological impairments than NDH offenders. The mean number of victims was lower for the SDH than the NDH group and only 14% of SDH offenders used a firearm, whereas 59% of NDH offenders used a firearm. These findings corroborate the notion that spontaneous domestic homicide may represent a discernible criminological phenotype.     

Are DNA data a valid source to study the spatial behavior of unknown offenders?

Studying the spatial behaviour of unknown offenders (i.e. undetected offenders) is difficult, because police recorded crime data do not contain information about these offenders. Recently, forensic DNA data has been used to study unknown offenders. However, DNA data are only a subset of the crimes committed by unknown offenders stored in police recorded crime data. To establish the suitability of DNA data for studying the spatial offending behaviour of unknown offenders, we examine the concentration and spatial similarity of detected but unsolved crimes in police recorded crime data (N?=?181,483) and DNA data (N?=?1913) over 27 Belgian judicial districts for four crime types. We established spatial similarity for certain crime types (in some districts). This offers opportunities for DNA data to be used to study unknown offenders' spatial offending behaviour. Implications for theory and research are discussed.     

A community forensic intellectual disability service: Twelve year follow up of referrals,analysis of referral patterns and assessment of harm reduction

Background. Previous reports on the outcome of services for offenders with developmental disabilities have found recidivism rates of between 40% and 70% with an elevated prevalence of sex offending, fire‐raising, and aggression. Studies have also reported that female offending rates in the intellectual disability population are broadly similar to those found in mainstream populations. All reports have been conducted on in‐patient or prison samples. The present report is of a community forensic intellectual disability service. Method. Two male cohorts of sex offenders (N = 121) and other types of offenders (N = 105) and female offenders (N = 21) are studied and compared. Data is reported on characteristics of the cohort, problems identified at referral, criminal justice disposal trends, index offences at time of referral, reoffending rates of up to 12 years after index offence, patterns of referral in the first 6 and second 6 years of the study period and the extent of harm reduction. Results. There were no differences between the groups on IQ and the sex offender cohort tended to be older. Female offenders had higher rates of mental illness although rates for the male cohorts were generally high at around 32%. The sex offending cohort had fewer problems with anger and aggression and alcohol abuse but a higher level of daily living problems and relationship problems. Female offenders had high rates of all problems studied except daily living problems. Unlike certain previous studies, sex offences predominated in the sex offender cohort while other types of offences predominated in the other two cohorts. Average age was lower for more recent referrals. Among recidivists only, a considerable amount of harm reduction was recorded. Conclusions. Fire raising and offences against children are not overly represented when compared with mainstream offenders. When compared with previous studies, it appears that a community forensic intellectual disability service may have an impact in reducing the number of offences committed over a 12 year follow up period.     

Compulsory psychiatric care in Sweden: development 1979-2002 and area variation

As in many other countries, the Swedish legislation on compulsory psychiatric care has been revised several times during the last four decades. Great regional differences within the country in the use of compulsory psychiatric care have been reported. The aims of this study were to describe the development of compulsory psychiatric care in Sweden 1979-2002, and to analyse differences between two groups of counties, one group with high and one with low civil commitment rates, in terms of psychiatric care structure, resources and processes. Data on civil commitments and forensic psychiatric care in Sweden 1979-2002 were collected from public statistics. At least one responsible person in leading position (administrative manager or chief psychiatrist) in each of the included counties was interviewed. The total number of involuntarily hospitalised patients decreased about 80% between censuses in 1979 and 2002, but the rates of forensic patients were unchanged. No clear-cut differences were found in the analyses of structure, resources and processes of psychiatric services between counties with high and counties with low levels of compulsory care. The equality before the law may be questioned. The importance of leadership is emphasised for future analyses.     

Comparison of HoNOS and HoNOS-Secure in a forensic mental health hospital

The Health of the Nation Outcome Scale (HoNOS) is a widely used tool for monitoring consumer outcomes within mental health services. However, concern about its suitability in forensic mental health settings led to the development of a forensic version of this tool (HoNOS-Secure). To date, no direct comparison of these versions has appeared in the empirical literature. In the present study, a cohort of forensic mental health consumers was rated using the HoNOS and HoNOS-Secure. Pearson correlations were generated to compare the tools at a total score and item level. Logistic regression was employed to evaluate how well these tools categorise patients on a range of measurable outcomes. HoNOS scores were also compared against civil mental health consumers to evaluate differences between these populations. The HoNOS/HoNOS-Secure correlated strongly at the total score level, but demonstrated variable correlations at the item level. Logistic regression suggested that the HoNOS-Secure ‘clinical and social functioning scale’ adds little to the HoNOS in a forensic setting; however, the HoNOS-Secure ‘security scale’ added significant benefit to both versions. Results remained stable when re-evaluated over time. Forensic and civil mental health patients were found to demonstrate the same degree of psychopathology at the point of admission; however, they differed at review and discharge collection occasions. Implications for clinical practice and policy are explored.