Creating a State‐Academic Partnership to Advance a Forensic Teaching Service: Benefits and Barriers

In Washington State, like many states, there is a shortage of forensically trained mental health clinicians to work with criminal justice‐involved individuals. At the direction of the state legislature, a collaborative project was undertaken by the University of Washington, the state Department of Social and Health Services, and a state psychiatric hospital to develop a proposal for a jointly sponsored forensic teaching service. The authors reviewed the literature, surveyed and interviewed forensic psychiatry and psychology training directors, and conducted site visits of selected training programs that offer multidisciplinary training or have affiliations with state hospitals. The authors conducted focus groups of additional stakeholders, including clinicians and patients in forensic settings, to better understand the needs in Washington. The authors report on several common benefits and barriers to establishing forensic teaching services. Other states and forensic programs may find this article useful in identifying common considerations for forensic mental health teaching services.     

Racial Bias in the Criminal Justice System: Shifting the Focus from Outcome to Underlying Causes

Abstract Over-representation of minority offenders in all phases of the criminal justice system has been recognized as a problem in the United States. Much controversy surrounds the question of whether the criminal justice system is “racist.” This inquiry goes beyond the traditional emphasis on the symptoms of racial disparity within the system, and asks whether differences exist between racial groups in their exposure to psychosocial factors that are found to relate to delinquency. The purpose of the study was to expose possible personal, familial, and societal causes of racial over-representation rather than merely place blame on the criminal justice system. The study examined institutionalized delinquent offenders. Among the findings are ones that indicate that blacks report significantly less access to intermediary treatment resources such as psychiatric and drug treatment facilities, community treatment referrals, and placement in foster homes. Blacks were over-represented in the more serious offense levels for both current and prior offenses. Whites were over-represented in mental dysfunction measures of chronic alcohol and drug abuse, suicide attempts, institutionalization in psychiatric or drug treatment facilities, and running away from home. The difference in racial representation raises some critical questions of possible inequality in exposure to environmental factors related to criminal behavior and unequal access and referral to intermediate treatment services prior to incarceration.     

Gender differences in violent offending: results from a multicentre comparison study in Dutch forensic psychiatry

ABSTRACT

The past two decades, a disproportionate growth of females entering the criminal justice system and forensic mental health services has been observed worldwide. However, there is a lack of knowledge on the background of women who are convicted for violent offenses. What is their criminal history, what are their motives for offending and in which way do they differ from men convicted for violent offenses? In this study, criminal histories and the offenses for which they were admitted to forensic care were analyzed of 218 women and 218 men who have been treated between 1984 and 2014 with a mandatory treatment order in one of four Dutch forensic psychiatric settings admitting both men and women. It is concluded that there are important differences in violent offending between male and female patients. Most importantly, female violence was more often directed towards their close environment, like their children, and driven by relational frustration. Furthermore, female patients received lower punishments compared to male patients and were more often considered to be diminished accountable for their offenses due to a mental illness.     

The forensic examination of structural fires in Victoria,Australia: Decision-making processes and impact on judicial outcomes

There is a body of published research that has evaluated the contribution of forensic science to the criminal justice system, but many disciplines of forensic science remain unexplored in this regard. The aim of this study was to examine the contribution that forensic fire examination services provide to criminal investigations and court processes in arson cases. Forensic fire examination services differ in a number of ways to the disciplines covered in previous research on the impact of forensic evidence on justice outcomes. Forensic fire examinations involve a combination of scene examination and laboratory analyses, and the results can provide critical evidence of whether an incident that has occurred is a criminal offence (i.e. whether a fire has occurred as the result of an act of arson). Forensic fire examination is also a discipline that has faced challenges and undergone development in recent decades regarding its scientific basis and the issue of contextual bias. In this study, data were collated for 273 structural fires that were examined by the forensic fire services in Victoria, Australia. In this jurisdiction, scene and laboratory forensic services are delivered within short time frames with a focus on providing impartial scientific and investigative services to assist criminal investigations conducted by police. The current dataset was highly skewed in terms of criminal justice outcomes and was not suitable for conducting the planned statistical analyses. Nonetheless, the pattern of findings obtained suggested that the inclusion of forensic evidence which supported the prosecution of arson may be associated with an increased likelihood of suspects being charged and defendants found guilty. Examination of the decision-making process of the forensic fire examiners has provided insight into the variety of evidence that is considered by forensic experts in reaching the important conclusion about the origin and cause of structural fires.     

Medicaid program; use of restraint and seclusion in psychiatric residential treatment facilities providing psychiatric services to individuals under age 21. Health Care Financing Administration (HCFA), HHS. Interim final rule with comment period

This interim final rule with comment period establishes a definition of a "psychiatric residential treatment facility" that is not a hospital and that may furnish covered Medicaid inpatient psychiatric services for individuals under age 21. This rule also sets forth a Condition of Participation (CoP) that psychiatric residential treatment facilities that are not hospitals must meet to provide, or to continue to provide, the Medicaid inpatient psychiatric services benefit to individuals under age 21. Specifically, this rule establishes standards for the use of restraint or seclusion that psychiatric residential treatment facilities must have in place to protect the health and safety of residents. This CoP acknowledges a resident's right to be free from restraint or seclusion except in emergency safety situations. We are requiring psychiatric residential treatment facilities to notify a resident (and, in the case of a minor, his or her parent(s) or legal guardian(s)) of the facility's policy regarding the use of restraint or seclusion during an emergency safety situation that occurs while the resident is in the program. We believe these added requirements will protect residents against the inappropriate use of restraint or seclusion.     

‘You May Kiss the Bride,But You May Not Open Your Mouth When You Do So’: Policies Concerning Sex,Marriage and Relationships in English Forensic Psychiatric Facilities

In 1996, the Royal College of Psychiatrists recommended that all psychiatric facilities in the UK develop policies concerning sexuality and sexual expression for persons contained in those facilities. This paper analyses the prevalence and content of such policies in English forensic psychiatric facilities. While the College recommends an individualised approach to sexual and emotional relationships, most hospitals in fact either prohibit or actively discourage such expression as a matter of policy. The paper considers the advantages and disadvantages of that approach. The paper also considers the legal issues surrounding these policies, and in particular the legal authority for governing the sexual and emotional expression of hospital residents and the relevant human rights implications.     

The New Trial by Ordeal: Rape Kits,Police Practices,and the Unintended Effects of Policy Innovation

One of the most highly touted improvements in the criminal justice response to rape has been the wide‐scale adoption of sexual assault nurse examiner (SANE) programs that provide specialized medical care and forensic evidence collection to victims. Though previous studies have emphasized the benefits of SANE programs in improving criminal case outcomes, this study illustrates how the post‐rape forensic examination can also discourage reporting, investigation, and prosecution. Interviews with local rape care advocates across the United States show how the increasing emphasis on forensic evidence collected through rape kits may provide an opportunity to reflect and enact persistent law enforcement stereotypes toward sexual assault complainants. Unless police resistance to taking rape seriously is confronted and addressed, even well‐intentioned policy reforms such as SANE programs may end up undermining—rather than enhancing—fair and thorough investigation of sexual assault allegations.     

Explanations for violent behaviour—An interview study among forensic in-patients

The alleged relation between mental disorder and violent criminal behaviour has been investigated mainly from an epidemiological perspective. Population-based registry studies have shown that violence occurs more frequently among people with mental disorders, like schizophrenia and bipolar disorder, compared with control subjects, but that the increased risk is largely mediated by drug abuse and socio-economic deprivation. The aim of this study was to explore how patients who have committed violent or sexual crimes and have been sentenced to forensic psychiatric care by a Swedish court of law construed their criminal actions in terms of causes. Forty-six participants from six different Swedish forensic psychiatric clinics were included in the study. A semi-structured interview study was conducted and the data was analysed using a thematic analysis. A large group of the participants did not believe that the mental disorder played any role in the criminal events. Contributing causes that were mentioned were drug abuse and social factors.     

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE program; nonavailability statement requirements--DoD. Final rule

This final rule revises certain requirements and procedures for the TRICARE Program, the purpose of which is to implement a comprehensive managed health care delivery system composed of military medical treatment facilities and CHAMPUS. Issues addressed in this rule include priority for access to care in military treatment facilities and requirements for payment of enrollment fees. This rule also includes provisions revising the requirement that certain beneficiaries obtain a non-availability statement from a military treatment facility commander prior to receiving certain health care services from civilian providers.     

Interdisciplinary approaches to the teaching of forensic science in the Forensic Science Undergraduate Program of the National Autonomous University of Mexico,before and after COVID-19

In 2013, the Forensic Science Undergraduate Program (FSUP) at the National Autonomous University of Mexico was created in response to an alarming criminal situation in Mexico, as well as to the radical reform of its criminal justice system. Its mission is to educate and train ethical, critical, and humanistic forensic scientists capable of conducting inquiries that meet scientific quality standards and assist the justice system in firmly linking legal rulings to the available evidence. At the time, it was the first such program in the country, and the contributions that interdisciplinary forensic scientists could make to criminal investigations were largely unknown among forensic and legal practitioners. During its existence, providing an interdisciplinary, competence-based education to students has been one of the main challenges. To overcome it, teaching and assessment approaches—centered on the achievement of specifically forensic competencies as learning outcomes and the integration of forensic disciplines towards the resolution of simulated cases—have been devised to help develop the professional skill set expected of graduates. The COVID-19 pandemic led to adapting these approaches to distance or hybrid modes of learning, increasing their versatility and enriching the pedagogic repertoire of the FSUP. Currently, the main impact of the program lies in the successful incorporation of some of its graduates to agencies belonging to or related to the criminal justice system, such as the National Prosecutor’s Office, the Commission for Truth and Justice for the Ayotzinapa Case, and the National Commission for the Search of Missing and Disappeared Persons, among others.     

英国法庭科学服务部的市场化变迁及其启示

英国法庭科学服务部市场化发展历史体现出竞争性市场有利于提升效率和为买方节约成本，这说明纯公益性刑事司法服务的某些法庭科学服务项目是可以市场化的；但其最终因超高的营运成本被迫关闭也说明商品化的服务市场承载不了法庭科学全面发展所需要的科学性要求。英国采用价格竞争的方式将法庭科学服务市场化，相比之下，真正的竞争性在中国当前的司法鉴定制度下却不存在，对司法鉴定制度进行改革已经刻不容缓。     

A tale of two cultures: examining patient-centered care in a forensic mental health hospital

Several questions remain unanswered regarding the extent to which the principles and practices of patient-centered care are achievable in the context of a forensic mental health hospital. This study examined patient-centered care from the perspectives of patients and providers in a forensic mental health hospital. Patient-centered care was assessed using several measures of complementary constructs. Interviews were conducted with 30 patients and surveys were completed by 28 service providers in a forensic mental health hospital. Patients and providers shared similar views of the therapeutic milieu and recovery orientation of services; however, providers were more likely to perceive the hospital as being potentially unsafe. Overall, the findings indicated that characteristics of patient-centered care may be found within a forensic mental health hospital. The principles of patient-centered care can be integrated into service delivery in forensic mental health hospitals, though special attention to providers' perceptions of safety is needed.     

Attitudes toward hiring applicants with mental illness and criminal justice involvement: The impact of education and experience

Individuals with mental health diagnoses, as well as those involved in the criminal justice system, experience a number of barriers in the recovery and reintegration progress, including access to stable, prosocial employment opportunities. Employment for these populations is important for establishing financial security, reducing unstructured leisure time, increasing self-worth, and improving interpersonal skills. However, research has demonstrated that individuals with psychiatric and/or criminal backgrounds may experience stigmatizing attitudes from employers that impede their ability to find adequate work. This study aimed to evaluate stigmatizing beliefs toward hypothetical applicants who indicated a mental health history, a criminal history, or both, as well as the effectiveness of psychoeducation in reducing stigma. Participants consisted of 465 individuals recruited from a large university who completed a series of online questions about a given applicant. Results of this study varied somewhat across measures of employability, but were largely consistent with extant research suggesting that mental illness and criminal justice involvement serve as deterrents when making hiring decisions. Overall, psychoeducation appeared to reduce stigma for hiring decisions when the applicant presented with a criminal history. Unfortunately, similar findings were not revealed when applicants presented with a psychiatric or a psychiatric and criminal history. Implications and limitations of these findings are presented, along with suggestions for future research.     

Collection from third party payers of reasonable costs of healthcare services--DoD. Final rule

This final rule establishes a new rule under the Third Party Collection program for determining the reasonable costs of health care services provided by facilities of the uniformed services in cases in which care is provided under TRICARE Resource Sharing Agreements. For purposes of the Third Party Collection program such services will be treated the same as other services provided by facilities of the uniformed services. The final rule also lowers the high cost ancillary threshold value from $60 to $25 per 24-hour day for patients that come to the uniformed services facility for ancillary services requested by a source other than a uniformed services facility. The reasonable costs of such services will be accumulated on a daily basis. The Department of Defense is now implementing TRICARE, a major structural reform of the military health care system, featuring adoption of managed care practices in military hospitals and by special civilian contract provider networks. Consistent with TRICARE, as part of the Third Party Collection Program, DoD is transitioning to a billing and collection system in which all costs borne by DoD Medical Treatment Facilities (MTFs) will be billed by the MTF providing the care. Thus, all care performed within the facility, plus an added amount for supplemental care purchased by the facility, will be billed by the MTF. Conversely, care provided outside the MTF under other arrangements will be billed by the provider of that care.     

Medicaid program; revision to Medicaid upper payment limit requirements for hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services. Health Care Financing Administration (HCFA), HHS. Final rule

This final rule modifies the Medicaid upper payment limits for inpatient hospital services, outpatient hospital services, nursing facility services, intermediate care facility services for the mentally retarded, and clinic services. For each type of Medicaid inpatient service, existing regulations place an upper limit on overall aggregate payments to all facilities and a separate aggregate upper limit on payments made to State-operated facilities. This final rule establishes an aggregate upper limit that applies to payments made to government facilities that are not State government-owned or operated, and a separate aggregate upper limit on payments made to privately-owned and operated facilities. This rule also eliminates the overall aggregate upper limit that had applied to these services. With respect to outpatient hospital and clinic services, this final rule establishes an aggregate upper limit on payments made to State government-owned or operated facilities, an aggregate upper limit on payments made to government facilities that are not State government-owned or operated, and an aggregate upper limit on payments made to privately-owned and operated facilities. These separate upper limits are necessary to ensure State Medicaid payment systems promote economy and efficiency. We are allowing a higher upper limit for payment to non-State public hospitals to recognize the higher costs of inpatient and outpatient services in public hospitals. In addition, to ensure continued beneficiary access to care and the ability of States to adjust to the changes in the upper payment limits, the final rule includes a transition period for States with approved rate enhancement State plan amendments.     

Forensic science and criminal justice: An analysis of curricular models

The multi-disciplinary field of forensic science frequently finds its academic home within criminal justice programs. After examining the reasons for this academic linkage, an analysis of criminal justice curricular models and courses was undertaken to assess their applicability to forensic science education and careers. The authors concluded that the relationship between criminal justice and forensic science can be mutually beneficial; however, most criminal justice programs do not provide adequate preparation for meaningful careers in forensic science.     

Incompetent misdemeanants--pseudocivil commitment

Prior to Jackson v. Indiana, psychiatric hospitalization of those found to be incompetent to stand trial often led to an inordinately long confinement, a particularly invidious consequence if the patient had been accused only of a misdemeanor. After a highly publicized murder perpetrated by a patient originally in this category, New York State instituted a rather cumbersome set of procedures designed to assure several layers of review, including involvement of the legal system, prior to increasing privileges or discharging someone committed pursuant to a criminal court order. The effect of this new law on patient care is examined by looking at the hospital course of 52 incompetent misdemeanants at one state facility. They are demographically and clinically quite similar to a control group of persons civilly committed, except for an increased length of inpatient stay. When compared with those sent to the county penitentiary after conviction, the study population differs on several important parameters. Looking like a patient, the incompetent misdemeanant is, however, treated more as a criminal with no indication that public safety is thereby increased or that individual therapeutic objectives are enhanced.     

Short-term outcomes for offenders with mental illness released from incarceration

Using data on 247 offenders with mental illness, this analysis seeks to identify characteristics that distinguish those who are returned to prison or a psychiatric hospital with those who remain in the community. Sociodemographic, mental health, criminal history, and service variables are compared across a range of outcome categories with a focus on those reinstitutionalized and those reincarcerated. Those returning to institutions have somewhat different mental health service and criminal justice histories than the engaged/community group. In particular, the group that is reincarcerated is more likely released from misdemeanor sentences, and the group being released from felony sentences is more likely to be found in a psychiatric hospital after release from correctional custody. These findings have implications regarding the cumulative effects of engagement with the criminal justice system and the process through which persons with mental illness and a criminal history cycle through institutions.