Static and dynamic patient characteristics as predictors of criminal recidivism: A prospective study in a Dutch forensic psychiatric sample

Objective predictors of outcome in forensic mental health services-a systematic review

This systematic review aimed to examine whether neurobiological methods, or other methods independent of clinical judgment, have been investigated to assist decision making in forensic mental health services and, if so, whether this may be a useful strategy for predicting outcomes. OVID-Medline, Embase, and PsychInfo (inception-January 2015) were searched, limiting to English and human studies, using terms relating to "predict," "outcome," "psychiatry," and "forensic" to identify primary research articles reporting on predictors of outcome in forensic mental health services not reliant on clinical judgment/self-report. Fifty studies investigating demographic, neuropsychological/neurophysiological, and biological predictors were identified, reporting on 3 broad outcomes: (i) inpatient violence, (ii) length of stay, (iii) reoffending. Factors associated positively, negatively, and showing no relationship with each outcome were extracted and compiled across studies. Of various demographic predictors examined, the most consistent associations were between previous psychiatric admissions and inpatient violence; a more "severe" offense and a longer length of stay; and young age and reoffending. Poor performance on tests of cognitive control and social cognition predicted inpatient violence while a neurophysiological measure of impulsivity showed utility predicting reoffending. Serum cholesterol and creatine kinase emerged as biological factors with potential to predict future inpatient violence. Research in this field is in its infancy, but investigations conducted to date indicate that using objective markers is a promising strategy to predict clinically significant outcomes.

Forensic mental health assessment in France: recommendations for quality improvement

The quality of forensic mental health assessment has been a growing concern in various countries on both sides of the Atlantic, but the legal systems are not always comparable and some aspects of forensic assessment are specific to a given country. This paper describes the legal context of forensic psychological assessment in France (i.e. pre-trial investigation phase entrusted to a judge, with mental health assessment performed by preselected professionals called "experts" in French), its advantages and its pitfalls. Forensic psychiatric or psychological assessment is often an essential and decisive element in criminal cases, but since a judiciary scandal which was made public in 2005 (the Outreau case) there has been increasing criticism from the public and the legal profession regarding the reliability of clinical conclusions. Several academic studies and a parliamentary report have highlighted various faulty aspects in both the judiciary process and the mental health assessments. The heterogeneity of expert practices in France appears to be mainly related to a lack of consensus on several core notions such as mental health diagnosis or assessment methods, poor working conditions, lack of specialized training, and insufficient familiarity with the Code of Ethics. In this article we describe and analyze the French practice of forensic psychologists and psychiatrists in criminal cases and propose steps that could be taken to improve its quality, such as setting up specialized training courses, enforcing the Code of Ethics for psychologists, and calling for consensus on diagnostic and assessment methods.

Substance use disorders in forensic psychiatric patients

There is a lack of detailed information on the role of substance use disorders (SUD) as a substantial factor in offences and treatment in forensic psychiatric patients. The aim of this study was to get a better understanding of these specifics. Clinical records of 193 male patients admitted to a Dutch forensic psychiatric hospital were scrutinized on anamnestic, diagnostic and risk assessment data. One of the central findings was that the prevalence of SUDs was high. Patients with an SUD had a more extensive criminal history, unstable and deviant lifestyle and higher risk of violent behavior than patients without a substance use disorder. No differences were found in duration of treatment, aggressive incidents and leave. Another important finding was that a distinction could be made between patients with substance use as a primary criminogenic risk factor and patients with substance use as a secondary risk factor. Although substance use is identified as a general risk factor, this study supports the idea of sub categorization of patients with an SUD and emphasizes the need for a different treatment approach. Further study is needed to identify specific treatment approaches, based on more differentiated profiles of these patients.

Explanations of firesetting in mentally disordered offenders: a review of the literature

This paper reviews current explanations of firesetting in adult mentally disordered offenders. In particular, attention is given to contemporary research that has examined developmental and background characteristics, personality and associated traits, motivation for firesetting, neurobiological explanations, psychiatric diagnoses, and frequency of self-injurious behavior, including suicide. The likelihood of recidivism and associated risk factors is also considered. Evaluation of the existing research has highlighted that even though a significant proportion has been conducted with psychiatric populations, little is understood about firesetting by mentally disordered offenders. In addition, little research has been conducted that compares mentally disordered firesetters to both other mentally disordered offenders and non-mentally disordered offenders. Recommendations are made for future research to further develop knowledge of this behavior.

Integrating Risk Context Into Risk Assessments

The context in which offenders are released is an important component of conducting risk assessments. A sample of 257 supervised male parolees were followed in the community ( M = 870 days) after an initial risk assessment. Drawing on community-based information, the purpose of this study was to evaluate the recently developed Risk Context Scale. Four domains from the Risk Context Scale include Resource Engagement, Social Network Presence, Integration of Care, and Social Stability. Using mediation analysis, an initial static risk probability was altered up to 26% by accounting for risk context. Implications of the present results include a broader explanation of recidivism, offering intervention strategies, and further individualizing risk assessments.

The relationship between attachment, personality and antisocial tendencies in a prison sample: a pilot study

This study examined the role of adult attachment and personality in relation to antisocial tendencies (i.e. convictions for violence and interpersonal problems in romantic relationships) in Norwegian prison inmates (N=92). Attachment styles and personality were measured using self-report questionnaires (RSQ; Griffin & Bartholomew, 1994; and NEO-FFI, Costa & McCrae, 1992a). The prison inmates scored higher on avoidant than on anxious attachment style. While age and agreeableness (negatively associated) emerged as significant predictors of violence, anxious attachment explained most of the variances in aggression in intimate relationships. The study suggests that different types of antisocial tendencies could have different attachment and general personality correlates.

Research issues in forensic psychiatry

PURPOSE OF REVIEW

Forensic psychiatry is a multidisciplinary specialty within the context of criminal and civil law. This paper reviews a broad spectrum of research areas within the forensic psychiatric field, covering publications in 2006.

RECENT FINDINGS

New developments can be divided into four subject areas. The first relates to risk assessment, the second to the epidemiology of violence, the third refers to treatment outcome studies, and the fourth relates to topics of interest within different offender groups.

SUMMARY

There seems to be a growing interest in specifying the needs of different offender groups, such as intellectually-disabled patients, adolescents and women. When it comes to effective treatment models for these subgroups, however, it is not always clear if sufficient attention is paid to the presence of comorbid disorders and their consequences, even in research publications.

Improving forensic tribunal decisions: the role of the clinician

Three empirical investigations of forensic decision-making were conducted: a study of 104 hearings by a forensic tribunal; an evaluation of which aspects of forensic patients' clinical presentation were empirical predictors of violence; and a survey of forensic clinicians to determine which factors they said they used to assess risk of violent recidivism and which they actually used. Results showed a significant correlation between actuarial risk and clinical advice to the tribunal, and a nonsignificant trend for patients higher in actuarial risk to receive more restrictive dispositions. Psychotic diagnoses and symptoms were not indicators of increased risk of violent recidivism. Clinicians endorsed some empirically valid indicators of risk, but also relied on some invalid indicators. There was also inconsistency between factors clinicians said they used and factors actually related to their hypothetical decision-making. An automated system is presented as an illustration of how the consistency and validity of forensic decisions could be enhanced.

Violent recidivism among mentally disordered offenders in Japan

BACKGROUND

A new forensic mental health law was enacted in Japan in 2003, enabling development of specialist services. Before their establishment, it is important to determine the nature, frequency and correlates of the problems they are designed to ameliorate.

AIMS

To establish rates of violent recidivism among mentally disordered offenders before the new legislation, and examine associated risk factors.

METHOD

Data were extracted from one complete annual (1980) national cohort of people judged by the Court or prosecutor to be without responsibility for a criminal offence, or of sufficiently diminished responsibility for it to be diverted for psychiatric treatment. The outcome measure was violent recidivism after community discharge and before 1991.

RESULTS

Fifty-two (10%) of 489 in the cohort were arrested or convicted of further violent offences. Violent recidivism was most strongly associated with a substance-related disorder, but histories of violence, homelessness and short index admissions were independently related.

CONCLUSIONS

Violent recidivism was so unusual that, on this outcome, it could take many years to show any effect of the new service. Desistance from substance use, compliance with treatment and maintenance of stable housing may be better indicators of success, and their achievement a good preventive strategy.