Assessing change in dynamic risk factors in forensic psychiatric inpatients: relationship with psychopathy and recidivism

This study explored change in dynamic risk for violence using the Clinical and Risk Management subscales of the Historical Clinical and Risk Management-20 version 3 (HCR-20 v3) and sought to determine whether change was associated with violent recidivism. The association between the magnitude of change and psychopathy was also assessed. Participants were 40 male (n = 32) and female (n = 8) forensic psychiatric inpatients discharged from a secure forensic mental health service. Results showed that participants significantly improved on the HCR-20v3 Clinical subscale but significantly worsened on the Risk Management subscale. Psychopathy was unrelated to change in Clinical and Risk Management subscales. The hypothesis that changes in dynamic risk would predict recidivism over and above total pre-treatment risk (HCR-20v3 Total score) and psychopathy was not supported. These results suggest that improvements in mental state risk factors alone are insufficient with regard to lowering violence risk.     

Violence prevention in psychiatry: an umbrella review of interventions in general and forensic psychiatry

Relative risks of violence in psychiatric patients are high compared to the general population and existing evidence in non-psychiatric populations may not translate to reductions in violence in psychiatric populations. We searched 10 databases including Medline, EMBASE, CINAHL and Scopus, from inception until August 2015 for systematic reviews and meta-analyses of violence prevention interventions in psychiatry. Reviews were included if they used a hard outcome measure (i.e. police or hospital recorded violence, or reincarceration) and contained randomized or non-randomized controlled studies. Five reviews met our inclusion criteria (n = 8876 patients in total), of which four received a GRADE rating of ‘low’ or ‘very low’. Three randomized studies (n = 636) reported that therapeutic community interventions may reduce reincarceration in drug-using offenders with co-occurring mental illness (‘moderate’ GRADE rating). The lack of intervention research in violence prevention in general and forensic psychiatry suggests that interventions from non-psychiatric populations may need to be relied upon.     

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.     

Sequential angulation,spatial dispersion and consistency of distance attack patterns from home in serial murder,rape and burglary

Abstract

Three related measures of spatial movement (sequential angulation, spatial dispersion and consistency of distance in attack target) were compared across three serial offence types: serial homicide (n=35), serial rape (n=41) and serial burglary (n=30). In each case, each offender had committed at least five offences. “Spatial dispersion”, defined as the extent to which an offender distributes his offences across either a focused or relatively more evenly distributed area, revealed that burglary was less evenly distributed (i.e. more focused) than rape and murder. “Sequential angulation”, defined as the degree of rotational movement around the home of the offender from one offence to the next, revealed that serial murderers have higher angulation scores than do rapists who, in turn, have higher angulation scores than burglars. Lastly, a comparison of the offender's consistency in the relative distance travelled from home to each attack site (“consistency of distance in attack target”) was relatively similar across the three groups. This was despite the comparison of different serial offence types from disparate geographical areas. The supposition that differences in dispersion and sequential angulation scores across crime types are related to the perceived risk of the crime has been confirmed. The specificity and the mobility of the targets are also discussed.     

Imprisonment and co-offending: results from a 10-year follow-up study

A recurring question in criminological research is whether prisoners meet new accomplices in prison. This article’s objective is to study co-offending among individuals who have served prison sentences. The frequency of co-offending among individuals who have been in the same prison at the same time will be examined. If gender, age, type of prison, offence type and prior experience of co-offending are significant for this type of co-offending will also be examined. The study population comprised all inmates released from a Swedish prison during a half year in 2001–2002 (n = 3.930). The follow-up period is 10 years. The results show that only 3% of those who have been in the same prison at the same time are suspected of committing offences together subsequent to release. The likelihood of being suspected of committing an offence together following the conclusion of a joint stay in the same prison is higher for those released from a closed prison who are aged 31–40, and who had committed large proportion of their offences together with others prior to the relevant prison sentence. The results suggest that the concept of criminal capital is not important for future co-offending after a joint stay in prison.     

Validation of the full and brief Externalizing Spectrum Inventory in Dutch forensic inpatients

The Externalizing Spectrum Inventory (ESI) was designed for assessing a broad spectrum of externalizing problems, including impulsive-aggressive behavior and substance abuse. After translation of the ESI into Dutch, a computerized version of the full Dutch ESI (ESI-NL) was administered to a mixed sample consisting of inpatients in forensic and addiction care (n = 99) and non-psychiatric community participants (n = 104). Internal consistencies, test–retest reliabilities, ‘predictive’ validity of the full and 160-item ESI-NL total scores and subscales were examined, along with the correlations between these two versions. The results indicated high reliability and predictive validity for both versions and a strong similarity between the two in direct comparisons. The 160-item Dutch ESI is recommended for clinical studies on violence proneness and externalizing problem behavior.     

The relationship between the detection of acquisitive crime by forensic science and drug-dependent offenders

Drug- and nondrug-related acquisitive crime offences such as burglary, theft, and motor vehicle theft, were compared to assess whether drug abusers were more likely to be apprehended via forensic science techniques. Data were all acquisitive offences committed over a 6-year period within a police force area in England. Drug-dependent offenders committed a wider range of offence types than nondependent offenders, and they were significantly more likely to be detected via their DNA or fingerprints (p < 0.01). A logistic regression (n > 14,000) revealed a number of predictors that influence the detection of the crime by forensic techniques. The results indicate that a number of these predictors are of statistical significance; the most significant of these being drug use by the offender with sex, ethnicity, and employment status also being relevant. Age of the offender and number of offences committed were found not to be significant. Of the four hypotheses considered to explain this, the most likely was thought to be the physical and mental impact of drug use on crime scene behavior. Consideration is given to the disciplines of forensic science and forensic psychology working closely together to distinguish factors that influence crime scene behavior.     

Homicide by a Forensic Female Sample in Brazil: A Preliminary Study

The objective of the study was to evaluate the mental status of all women (n = 14) who were acquitted by reason of insanity of charges of murder or attempted murder and committed to a forensic psychiatric hospital in the state of Rio de Janeiro, Brazil. All cases were retrospectively examined, including medical files, technical records, and forensic experts' official reports. A conclusive psychiatric diagnosis was established using the Structured Clinical Interview for DSM‐IV Axis I and II Disorders and clinical and forensic records. The most common diagnosis was schizophrenia/schizoaffective disorders (n = 8; 57.3%). Most victims (n = 12; 75%) were close relatives of the patients. We found that 43% (n = 6) of the patients had a previous history of violent behavior. According to the initial psychiatric forensic evaluation, 5 patients (35.7%) had psychotic symptoms. It is expected that a growing understanding of motivational factors underlying homicidal behavior in mentally disturbed female offenders may further the implementation of effective preventive and therapeutic interventions.     

Low recidivism rates of child sex offenders in a Finnish 7-year follow-up

ABSTRACT

This study examines the recidivism rates of Finnish child sex offenders convicted in 2010 (n = 361) over a follow-up period of seven years. The results indicate that while reoffending for other types of offences was common (34%), offenders had very low sexual crime recidivism rates (1%). In terms of more persistent criminal careers, less than a quarter of the offenders had both a previous criminal history and at least one subsequent offence during the follow-up period. Offenders with child sexual abuse material-related crimes reoffended more rarely than did others. Study limitations and implications for policymaking, media and rehabilitation are discussed.     

Head banging as a form of self-harm among inpatients within forensic mental health and intellectual disability services

Introduction: ‘Head banging’ is a common form of self-harm, linked to numerous negative outcomes including significant brain damage. However, little research has investigated head banging behaviour and its correlates in clinical populations. Method: Head banging episodes were identified from the incident records (n = 5417) of two inpatient forensic services (one intellectual disability and one mental health), using relevant search terms. Rates were compared between individual patients, by gender, diagnosis and level of security. Incident accounts were analysed qualitatively using thematic analysis. Results: Head banging incidents occurred approximately every 3 days in each service, with 229 incidents recorded in 1 year. Individual patient rates varied widely, ranging from 1 to 38 incidents within 1 year. Women, and patients in higher levels of therapeutic security, were significantly more likely to engage in head banging. Qualitative incident reports indicated that head banging was associated with mental distress, anger and psychotic experiences. Discussion: Head banging occurs frequently in forensic services, and has documented associations with traumatic brain injury in affected individuals, thus negatively impacting progress through the care pathway and treatment outcomes. Further research should investigate short- and long-term management strategies and treatment approaches, in order to minimise harm.     

Predicting discharge in forensic psychiatry: the legal and psychosocial factors associated with long and short stays in forensic psychiatric hospitals

In Germany, both the number of patients treated in forensic psychiatric hospitals and the average inpatient treatment period have been increasing for over thirty years. Biographical and clinical factors, e.g., the number of prior offences, type of offence, and psychiatric diagnosis, count among the factors that influence the treatment duration and the likelihood of discharge. The aims of the current study were threefold: (1) to provide an estimate of the German forensic psychiatric patient population with a low likelihood of discharge, (2) to replicate a set of personal variables that predict a relatively high, as opposed to a low, likelihood of discharge from forensic psychiatric hospitals, and (3) to describe a group of other factors that are likely to add to the existing body of knowledge. Based on a sample of 899 patients, we applied a battery of primarily biographical and other personal variables to two subgroups of patients. The first subgroup of patients had been treated in a forensic psychiatric hospital according to section 63 of the German legal code for at least ten years (long-stay patients, n=137), whereas the second subgroup had been released after a maximum treatment period of four years (short-stay patients, n=67). The resulting logistic regression model had a high goodness of fit, with more than 85% of the patients correctly classified into the groups. In accordance with earlier studies, we found a series of personal variables, including age at first admission and type of offence, to be predictive of a short or long-stay. Other findings, such as the high number of immigrants among the short-stay patients and the significance of a patient's work time before admission to a forensic psychiatric hospital, are more clearly represented than has been observed in previous research.     

Court outcomes among female juveniles with sexual offences

ABSTRACT

Female juveniles with sexual offences (FJSOs) are an understudied population. The current study compares FJSOs with their male counterparts and evaluates whether male and female juveniles with sexual offences from different family types have similar charges and court outcomes. Data were obtained from a statewide court dataset in Alabama from 2004 to 2014 (n?=?205 females, 2816 males). Participants were categorised by offence category, family type, and court outcome. Chi-square tests and hierarchical logistic regressions were conducted to test for differences in offence patterns and court outcomes by gender and family type, respectively. Females committed less severe offences and received less severe punishments for a given offence compared with males. Family type and two-way interactions between family type, gender, and offence severity played limited roles in offence patterns and in court sentencing. Disposition patterns in females point towards the feasibility of providing more services for all juveniles with sexual offences.     

The Treatment Engagement Rating scale (TER) for forensic outpatient treatment: Description,psychometric properties,and norms

Abstract

The Treatment Engagement Rating scale (TER) is a Dutch therapist rating instrument for treatment engagement (TE) of forensic outpatients. It yields scores for nine components of TE, which are aggregated in a total score. Following an analysis of the concept of TE, the TER is described, and various psychometric analyses of data from a forensic outpatient sample are reported. The nine component scores were found to constitute a homogeneous scale with good internal consistency (α=0.93, n=328) and adequate inter-rater reliability (intraclass correlation coefficient (ICC)=0.76, n=99). The validity of the TER is supported by correlations of 0.47, 0.66, and 0.91 (n=328) with measures for the motivation to engage in treatment. Applications for the TER in clinical practice and research are suggested.     

Brief mental health screening of prison entrants: psychiatric history versus symptom screening for the prediction of in-prison outcomes

While prisoners are known to suffer very high rates of mental illness, evidence is often lacking to inform the development of effective approaches to prison mental health service provision, including the approach to mental health screening. In addition, research to date has been dominated by prevalence studies and little is known about the mental health needs of prisoners over time. A random sample of prison entrants was recruited from a large remand and reception prison in New South Wales, Australia (n = 707) for the completion of a brief health survey. A second survey was completed during the subsequent six months (n = 317) in order to examine the effect of timing of assessment on mental health status. Those followed up within three months (n = 182) were further included in an analysis of predictive validity comparing the performance at baseline of self-reported history of previous diagnosis versus current symptom screening for psychological distress, in predicting subsequent mental illness. When assessed over six months from prison entry, mental health status was found to vary by timing of assessment. At prison entry, self-reported history of previous diagnosis of a mental health disorder was found to be a better predictor of mental illness over three months than screening for psychological distress.     

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.     

Social ties and short‐term self‐reported delinquent behaviour of personality disordered forensic outpatients

Purpose. In community‐based forensic psychiatry, patients' social ties are considered as protective factor in a risk management strategy. However, it is unknown whether these ties actually assist patients to refrain from re‐offending. We hypothesised a protective role for social ties in re‐offending behaviour. Methods. In a sample of forensic outpatients with a personality disorder (N = 55), the relationship between social ties (social contacts and participation in social institutions) and short‐term self‐reported re‐offences was studied within a prospective study design with a 6‐month follow‐up period. Results. Our results provide evidence for a protective function of club participation. For violent re‐offences, social institutions were protective and this protective function remained, even when a patient had network members with a criminal background. Except for work‐related contacts, social contacts did not provide protection. Conclusions. The protective effect of social ties, especially club participation, on desistance from re‐offending in forensic psychiatric patients merits further attention from researchers and clinicians.     

Examining the Traumatic Effects of Sexual Victimization on the Health of Incarcerated Women

Data from the 2004 Survey of Inmates in State Correctional Facilities were used to examine the effects of sexual abuse on the physical and mental health of incarcerated women. This nationally representative sample consisted of a cross-section of 2,885 female inmates ranging in age from 16 to 74. Using bivariate analysis, we made comparisons between sexually abused (n = 1,205) and non–sexually abused (n = 1,680) inmates. Abused women were more likely to report increases in health problems and mental health diagnoses, as well as other self-reported mental health conditions, such as paranoia, depressive symptoms, anger, and lifestyle changes. Respondents with extensive sexual abuse histories (multiple and across the life cycle) were also more likely to suffer higher levels of paranoia, depression, chronic health problems, and attempted suicide.     

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.     

Criminal Recidivism After Forensic Psychiatric Treatment. A Multicenter Study on the Role of Pretreatment,Treatment-Related,and Follow-Up Variables

This study examined associations between criminal recidivism after discharge from forensic treatment and variables related to either the time before the current forensic treatment, or the current forensic treatment, or the follow-up after discharge. Participants were treated in 12 forensic clinics according to section 63 of the German penal code. A patient was classified as a criminal recidivist when the patient or the aftercare reported that the patient was delinquent at follow-up. Patients without criminal recidivism were patients for which both perspectives (patient and aftercare) reported no delinquency at follow-up. Mann–Whitney U-tests and Fisher's exact tests were performed. Data to classify patients were available for N = 249 patients. Fifteen patients (6%) were classified as criminal recidivists. The follow-up was M = 12.58 (SD = 1.84) months, and the criminal acts occurred M = 6.00 (SD = 5.55) months after discharge. Differences between patients with and without criminal recidivism were found in pretreatment (young age at first crime, early onset of mental disorder, previous forensic treatments), treatment-related (disorder due to psychoactive substance use, gradual release abuses, outbreaks, assaults against staff, criminal act during treatment, type of discharge, outcome ratings), as well as follow-up variables (no specified housing situation, not being abstinent from psychoactive substances, inpatient readmission, course of outpatient treatment, course of mental disorder) (all p < 0.05). To conclude, it is important to consider variables related to the time before the current treatment, treatment-related variables, and variables related to the follow-up to identify the patients at risk of criminal recidivism after discharge from forensic treatment.     

Recidivist criminal behaviour and executive functions: a comparative study

This study sought to analyse the relation between executive functions and criminal recidivism. We assessed a set of cognitive abilities associated with executive functioning in a group of recidivist offenders (n = 19), primary offenders (n = 25) and non-offenders (n = 30). Our results, tested with nonparametric statistics and Monte Carlo method, revealed that there were no executive differences between both groups of offenders but, when compared with non-offenders, the recidivists showed a worse performance in Trail Making Test part B, and the primary offenders presented a significant lower score on Porteus Maze Test Age score. This study suggests that there can be a different pattern of executive functioning deficits associated with the offenders’ criminal record: recidivism may be more related to mental flexibility impairments and primary offenders’ antisocial behaviour may be aggravated by planning deficits.