The association between the offender–victim relationship,severity of offence and attribution of blame in mentally disordered offenders

Abstract

The aim of this research was to investigate the association between the offender–victim relationship, severity of violence and attribution of blame for a violent act. Data were collected from 65 male psychiatric inpatients from two secure units. Participants were divided into three groups according to how well they knew their victim: victim well-known, victim acquaintance and victim stranger. Violent acts were further ranked according to offence severity. Participants were administered the Quick Test (QT) and the Gudjonsson Blame Attribution Inventory (GBAI). Although there was a trend towards higher guilt attributions when the victim was well-known to the perpetrator, this relationship was complicated by the severity of the violent act. The most severe ranking of offence (i.e. murder/manslaughter) was most common in the offender group who knew their victim well. Furthermore, guilt-feeling attributions were highest in the most severe ranking of offence. The implications of these findings for assessment and intervention programmes are considered.     

Inpatient aggression by mentally ill offenders: a retrospective case-control study

A retrospective case-control study was conducted examining relationships between patients’ socio-demographic, clinical and admission characteristics and inpatient aggression. Patients aged 18–64?years with a recent offence episode, who were admitted to a regional acute mental health unit, were included as cases (N?=?82), while controls comprised the next available admission, matched for age and gender (N?=?82). The prototypical patient was a young, single male, with a diagnosis of schizophrenia, a history of substance use and previous psychiatric admissions. The majority of cases had a history of aggression and recent offences against public order. They also revealed a higher likelihood of involvement in ‘less serious’ aggressive incidents (e.g. verbal threats or demands) during the index admission. Clinically, knowledge of each patient’s recent offence history, arrival mode and observed characteristics on admission (including any verbal aggression) may be important in the management of subsequent inpatient aggression.     

Incorporating index offence analysis into forensic clinical assessment

Purpose. Assessment is a core skill of clinical and forensic psychology practice and forms the basis of all ongoing engagements with offender/patients. In forensic settings, assessment involves the systematic gathering of reliable data on the characteristics of offenders and the offences which they have committed in order to develop understanding of the dynamics of offending and relevant intervention strategies. However, whilst the assessment process is aided by various protocols, no such instrument appears to exist for the assessment of an offender/patient's index offence. This paper presents a draft ‘index offence analysis guide’ designed by the present authors for this purpose and which has been piloted on prisoners and patients in secure settings. Argument. Evidence suggests that for various reasons, many clinicians do not routinely review crime scene data while working with offenders. However, this practice is arguably questionable, because how can decisions about admission, amenability to treatment, risk of reoffending, and discharge be made if there is limited awareness of what the offender/patient has done? The present authors argue that knowledge of the index offence is important to understanding the offender and suggest this can be obtained using a guide such as the one presented here. This is illustrated with an anonymous case. Conclusion. Index offence analysis should be a core task of any forensic clinician engaged in the assessment of offender/patients as it can provide a better understanding of crime scene actions and offence motivations. This can help guide treatment planning and improve risk assessments.     

Is sexually abusive behaviour in personality disordered inpatients analogous to sexual offences committed prior to hospitalization?

Abstract

Sexually abusive behaviour by personality disordered patients presents a serious threat to the integrity of staff–patient relationships and the safety of other residents. The occurrence of such behaviour is also problematic for the offending patient, as it may impact on perceived treatment needs and their access to the community. This paper reports on a study of sexually abusive behaviour in a high security psychiatric hospital. It also examines the relationship between these behaviours and patients’ history of sexual offending. The results showed a high frequency of low-severity sexually abusive behaviour and no significant associations between sexually abusive behaviour during hospitalization and sexual offence history. These findings imply that low-severity sexually abusive behaviour within secure settings may be determined, partly, by environmental conditions. This sexual abuse may also be functionally dissimilar to severe sexual abuse perpetrated in the community. The meaning and determinants of sexual abuse within secure settings must be scrutinized carefully and comprehensively before they are considered analogous to previous sexual offences.     

Violence ratings of female patients in broadmoor hospital

Abstract

A study is described which characterised the female population of Broadmoor Special Hospital on a scale (Robertson et al., 1987) which rates violence associated with the index offence and previous episodes of violence both in terms of prosecuted violence and unprosecuted incidents. This scale has been applied recently to the male population of Broadmoor (Wong et al., 1993). The findings here confirm the notion that the female population of a Special Hospital are less violent than the males in terms of rating of violence associated with the index offence and in previous convictions for violent offending. The females contain a larger proportion of patients convicted of the offence of Arson (index offence) and patients transferred from other hospitals because of being unmanageable in these settings (under Section 3 of the Mental Health Act). Extreme ratings of violence amongst the females is associated with a diagnosis of personality disorder rather than schizophrenia or psychosis.     

A case study of a male sex offender with zoosexual interests and behaviours

Abstract

This paper reviews assessment, treatment and supervision issues in relation to a high-risk, borderline functioning, male sex offender with zoosexual interests and behaviours. Mr Z was convicted of multiple sexual offences including rape, indecent assault and indecent exposure as well as actual and threatened bodily harm. He was convicted for two counts of attempted buggery of horses and he received a Probation Order to engage in group and individual work, as deemed appropriate. Significant treatment challenges emerged due to his cognitive/intellectual difficulties, coping problems (including anger management issues) and dissimulation. Further, continuing evidence of high-risk behaviours associated with his index offence as well as previously identified patterns of offending were reported. Ongoing concerns prompted a referral for a polygraph examination to gain additional information about Mr Z's offence history and to achieve a better understanding of his treatment needs. These findings are discussed and specific attention is focused on Mr Z's zoosexual behaviours.     

The neuropsychology of offending

Abstract

Structural damage or abnormality of the brain may be related to offending. What is known about the consequences of lesions to the frontal and temporal lobes and of the results of head injury, suggests psychological changes that might well enhance the risk of offending, and in particular violent offending. Evidence from two sources is reviewed, that based on studies of offender groups and that based on those follow-up studies of clinically defined samples of head injury victims which have reported offence related outcomes. Despite some methodological limitations, the balance of evidence is that frontal damage and possibly temporal lobe damage is related to offending, particularly violent offending, and that head injury can act to precipitate offence related behaviour. It is suggested that future research needs to concentrate more on the factors that mediate the link between brain damage and offending behaviour.     

Understanding how sexual offenders compare across psychiatric and correctional settings: examination of Canadian mentally ill sexual offenders

Abstract

Much of what is known about sexual offenders is based on correctional samples and then applied across settings based on the assumption that this group is homogeneous. In this study, 149 files were compared, including 108 cases from the forensic mental health system (FMH) and 41 cases from the correctional system (COR). Although many similarities were observed between the FMH and COR groups, the results also revealed important differences. The FMH group was characterised by more frequent hospitalisations, higher rates of major mental illness and single status. The COR group was characterised by a history of physical and sexual abuse, family history of addictions, more intrusive sexual offences and higher rates of offending. These results highlight different profiles for sexual offenders in forensic mental health and correctional settings and challenge us to consider the implications for assessment, treatment and risk management of this unique group of sexual offenders.     

Mental disorder in violent women in secure settings: Potential relevance to risk for future violence

The relevance to women of common violence risk factors identified in men has in many instances yet to be established. Consequently, there is a reluctance to accept without question the application to women of practices relating to violence risk assessment and management developed from research into men. This study examines mental disorder in women who are violent in order comment on its relevance to the practice of violence risk assessment and management. A sample of 95 violent women in high secure prison and forensic psychiatric care were assessed. Structured assessments of Axis I and II mental disorders and psychopathy were undertaken on all women and conviction histories were recorded. Very high levels of psychiatric morbidity were noted and patterns in comorbidity were detected. Among Axis I conditions, psychotic disorders and disorders of mood co-occurred at a very high rate. Among the Axis II conditions, dimensional ratings of borderline personality disorder (PD) correlated with dimensional ratings of avoidant, dependent and paranoid PDs while ratings of antisocial PD correlated with those of narcissistic, histrionic and obsessive–compulsive PDs. Women who had been incarcerated for a major violent offence were four times more likely to have a diagnosis of borderline PD than women whose index offence was one of minor violence. A number of the findings reported are in contrast to those reported in similar studies of men. Findings suggest that practitioners are right to question the application to women of knowledge derived from research into men. The practice of violence risk assessment and management with women should emphasise the development of individual risk formulations and responding to psychiatric comorbidity should be the rule rather than the exception with this population.     

Promoting work-related activities in a high secure setting: exploration of staff and patients’ views

Introduction: Adults diagnosed with mental disorders, in particular those who have a history of offending, have low employment rates. Here we explore staff and patients’ views on the importance of work and vocational activities offered at a high secure hospital. Method: Two hundred seventy-six patients and 106 staff were approached; 54.3% of the patients and 58% of staff completed the questionnaire. Results: Educational achievement in patients was low but nearly two-thirds of patients had been engaged in some form of work prior to admission. Staff and patients felt that vocational opportunities offered in the hospital should more closely resemble ‘real work’ and they broadly agreed on the areas of activities of potential benefit. Staff felt more strongly than patients that patients lose work-related skills during admission. Both groups recognised the importance of work for mental health and in preventing reoffending. Conclusion: Detention in such settings provides an opportunity for patients to maintain as well as expand on skills aiding their future reintegration into work settings.     

Victim age,attractiveness and,abuse history as factors in the perception of a hypothetical child sexual abuse case

Abstract

This study examines the effect of victim age, victim attractiveness, the victim's abuse history and respondent gender have on attributions of blame and credibility towards a female victim in a hypothetical child sexual abuse case. A total of 397 respondents from a community sample read a hypothetical child sexual abuse (CSA) scenario in which victim age, victim attractiveness and the victim's abuse history were manipulated. Respondents then completed a 16-item blame attribution questionnaire. Several predictions were made. First, a 10-year-old victim would be deemed less blameworthy and more credible than a 15-year-old victim. Secondly, an attractive victim would be viewed more positively, and attributed less blame, than an unattractive victim. Thirdly, a victim with previous history of being sexual abused—either by the same or different perpetrators—would be deemed more culpable for their own CSA than a first time victims. Finally, female respondents were expected to take a more pro-victim and anti-perpetrator stance than males. Whilst comparatively few differences were found across victim attractiveness and abuse history. Overall findings were broadly in line with predictions. It was concluded that victim age and respondent gender play particularly important roles in the attribution of blame towards victims and perpetrators of child sexual abuse.     

Behind closed doors: the effect of pretrial publicity on jury deliberations

Abstract

Effective treatment of aggressive behaviour and accurate release decision making are necessary components of adequate clinical practice in forensic psychiatric units. Unfortunately, methods to identify treatment targets and ameliorate aggressive behaviour have developed at a slower pace than risk assessment technologies. Recent progress on the identification of offence paralleling or functionally equivalent behaviour offers a framework for individually tailored treatment and idiographic release decision making, although empirical scrutiny of this approach is inadequate. This paper describes an examination of the relationship between aggressive behaviour prior to admission with aggression during inpatient psychiatric treatment, and reconviction for violent offending following discharge. Results showed a relationship between pre- and post-admission aggression but no relationship between aggression during inpatient psychiatric treatment with either pre-admission aggressive behaviour or violent recidivism. These findings indicate the importance of state psychological variables, specifically those states affected by symptoms of psychiatric illness, as well as environmental activators and inhibitors of violence that operate within the hospital. These require inclusion in an adequate functional analysis of aggressive behaviour for forensic psychiatric patients.     

The attribution of blame and type of crime committed: transcultural validation.

This study examines the relationship between type of offence and the attributions offenders make about their criminal act. The subjects were 98 Icelandic criminals who had completed the Gudjónsson Blame Attribution Inventory. Significant differences in attribution were found between offender groups. Sex offenders and those who had committed acts of interpersonal violence reported most guilt about their offence and they attributed cause for their offence more to mental factors (eg, loss of self-control) than other types of offender. Violent offenders had the highest external attribution and sex offenders the lowest. The findings with regard to the three attributions are remarkably similar to those found previously for British offenders.     

Profile of forensic state patients at a psychiatric unit in KwaZulu Natal,South Africa: demographic,clinical and forensic factors

State patients are mentally ill offenders whose charges involved serious offences. Research on association between psychiatric morbidity and offences is important however data from Southern Africa is limited. To examine the demographic, clinical and forensic characteristics of state patients, and to evaluate the determinants of offending by an investigation of the association between mental illness and other variables (offence, comorbidity). Retrospective record review of state patients admitted to a forensic unit in KwaZulu-Natal from the 1 June 2013 to the 31 May 2016. Most patients were male (n = 90, 98.90%), single (n = 89, 97.8%), unemployed (n = 89, 97.80%) and had a diagnosis of intellectual disability (n = 33, 36.26%). Majority of participants had comorbid diagnoses (n = 70, 76.92%) and most of them (n = 52, 57.14%) had substance use disorder. Forty (43.96%) patients had past forensic history and 18 (72.5%) were non-adherent with treatment. Offences were predominantly against persons (n = 80, 87.91%), and rape was the most common offence (n = 50, 54.95%). Findings regarding diagnosis and offence were not consistent with the literature and suggest the need to explore the differences further. A better understanding of the association between mental health and crime in resource restrained settings may assist in developing appropriate prevention and rehabilitation programmes.     

The endorsement of cognitive distortions: comparing child pornography offenders and contact sex offenders

This study examined the endorsement of cognitive distortions in child pornography offenders (CPOs), using an established assessment tool, the Abel and Becker Cognition Scale. The scale was expanded to include cognitions specific to child pornography offending, extracted from Howitt and Sheldon's Children and Sexual Activities Inventory (C&SA). Three samples of CPOs, child sex offenders and offenders with both offence types responded to the cognition items. An exploratory Principal Component Analysis suggested six main components of the scale. CPOs were significantly less likely to endorse these statements in general, and this was more pronounced on items that project blame onto the child or other people, describe a need for power and consider children as sexually active. The statements extracted from C&SA did not differentiate between the groups. These findings are discussed under consideration of the relationship between cognitive distortions and contact sex offending, and in reference to the general criticism concerning the definition and appropriate measurement of cognitive distortions.     

Are they different? A comparison of risk in Dangerous and Severe Personality Disordered and Personality Disordered hospitalized populations

Abstract

There has been considerable interest internationally in the assessment and treatment of individuals who have a severe personality disorder and who might pose a high risk of future recidivism. In the UK, the Dangerous and Severe Personality Disorder (DSPD) programme was initiated to deal with just this group. It is unclear, yet, whether those admitted to these services are different from those admitted to conventional personality disorder (PD) services. In the present study, 60 patients admitted to DSPD services, under DSPD criteria, were compared with 44 patients admitted to personality disordered (non-DSPD) services within the same high secure psychiatric hospital, on risk measures, including (1) an index of predicted future violence, (2) previous offending behaviour and (3) ‘pre-treatment’ levels of institutional risk-related behaviour. Results indicated that DSPD patients do pose a greater clinical and management risk, have a higher number of ‘pre-treatment’ risk-related behaviour, and have a greater number of convictions and imprisonments after age 18, relative to PD patients. The implications and limitations of these results are discussed.     

Clinical psychologists’ perceptions of barriers and facilitators to engaging service users in index offence assessment and formulation within a medium secure unit

Index offence assessment and formulation (IOAF) helps service users (SU) in secure units to make sense of their index offence, provides detailed understanding of risk and contributes to treatment planning and discharge decisions. Clinical psychologists’ perceptions of barriers and facilitators to engaging SUs in IOAF within the men’s and women’s services of one medium secure unit were explored through focus groups. Thematic analysis identified two relevant domains: person-specific factors and the organisational context. Person-specific barriers included challenges in working with fragmented narratives, conflicting motivations to engage, SU defences and distorted perceptions of clinical psychologists’ roles. Giving clarity and choice to SUs facilitated engagement with the work. Regarding the organisational context, clinical psychologists within both services identified the importance of having adequate resources and care-team support to complete this work. Findings highlight the importance of developing an evidence-based framework for IOAF to be embedded within clear ‘risk’ care pathways through secure services.     

An investigation of the relationship between anger and offence-related shame and guilt

Abstract

A number of accounts of shame and guilt emphasise an association between shame and anger difficulties, and it has been suggested that shame and rage may promote one another. The shame–anger relationship may be particularly relevant to the study of forensic populations, as the fact of having committed a criminal offence has the potential to be a highly shame-provoking experience. The current study investigates the prediction that shame and guilt reactions to an offence are differentially related to the propensity to experience and ability to control anger. A measure of offence-related shame and guilt and a measure of anger experience and control was completed by 60 men detained in forensic psychiatric units. The results supported the prediction that offence-related shame is associated with elevated levels of anger difficulties, whilst offence-related guilt is associated with ability to control anger. The findings of the current study are consistent with those of previous investigations of shame, guilt and anger. Specific implications for the understanding and prevention of violent offending are discussed.