[The situation in the German forensic commitment-Results of a survey by the DGPPN]

BACKGROUND AND OBJECTIVE

In German forensic psychiatry detention under Sections 63 and 64 of the German Penal Code have been repeatedly reformed over the past years; however, despite the most recent amendments to the law on detention, clinics and state authorities warn of insufficient capacities and worrying conditions. Media reports paint a defiant picture. At the same time, there is a lack of valid data that would allow an objective description of the situation in forensic psychiatry. Against this background the management of institutions in Germany has been surveyed.

MATERIAL AND METHODS

The survey was conducted as an online survey and sent to all 78 forensic hospitals in Germany. The survey covered topics such as structural data of the facilities, the occupancy and staffing situation, incidents, support from supervisory authorities and funding agencies, and patient characteristics. The results are presented descriptively.

RESULTS

Of the 78 facilities contacted, 45 (approximately 60%) participated at least partially in the survey. Many of the clinics (68.5%) complained of significant overcrowding. A clear lack of staff and rooms was reported, at the same time it was stated that patients do not receive adequate treatment. Approximately 1 in 5 patients have a length of stay for more than 10 years and one third of the clinics reported an increasing number of physical assaults by patients.

CONCLUSION

This overview shows that the forensic psychiatric hospitals are in very different but generally strained situations. A significant number of clinics are under great pressure. Financial, structural, spatial and personnel resources were described as insufficient to properly and professionally fulfill the legal mandate. The treatment standards presented by the DGPPN in 2017 are not met in many clinics.

Offender Rehabilitation: The Middle Way of Maimonides to Mental and Social Health

Traditional religious and spiritual texts offer a surprising wealth of relevant theoretical and practical knowledge about human behavior. This wellspring may contribute significantly to expanding our current body of knowledge in the social sciences, and criminology in particular. In Jewish religious texts, specifically by Maimonides, we can find profound analyses of human traits and guidelines for a normative way of life. Among other things, modern criminological literature attempts to link certain character traits and divergent behaviors. Using the hermeneutic phenomenological approach, this present study analyzed Maimonidean writings, mainly Laws of Human Dispositions, in order to understand Moses ben Maimon (1138-1204) and his view of character traits. The analysis yielded four themes: (1) Human personality between nature and nurture; (2) The complexity of human personality, imbalance and criminality; (3) Extremism as a way to achieve balance; and (4) The Middle Way, flexibility and common sense. These themes can serve therapeutic purposes, as well as inform a rehabilitation model. Grounded in a theoretical rationale about the nature of humans, this model is designed to direct individuals to balance their traits by self-reflection and constant practice of the Middle Way. The article concludes by proposing that implementing this model may promote normative behavior and thus contribute to rehabilitating offenders.

Effectiveness of interventions to improve employment for people released from prison: systematic review and meta-analysis

BACKGROUND

People released from prison experience complex health challenges in addition to challenges resettling into the community. Consequently, employment rates are low. Participating in good quality employment can support good health and is protective against future reoffending. Multiple interventions are provided to support people into employment on release. The effectiveness of interventions for improving employment outcomes has not previously been evaluated in a meta-analysis.

AIM

Our objective was to examine the effectiveness of interventions to improve employment following release from prison.

METHOD

We searched seven databases and three trial registries for peer reviewed randomised controlled trials (RCTs), published since 2010, that included adults and measured an employment outcome(s). We conducted meta-analysis using random effects models with sub-group and sensitivity analyses. We appraised bias risk per outcome, and incorporated this into an assessment of the certainty estimates for each outcome. A group of people with experience of imprisonment met with us throughout the project to inform our search strategy and interpretation of results.

RESULTS

We included 12 RCTs (2,875 participants) which were all conducted in the USA. Few outcomes were of low risk of bias. Intervention participants were 2.5 times more likely to work at least one day (95% CI:1.82-3.43) and worked more days over 12 months (MD = 59.07, 95% CI:15.83-102.32) compared to controls. There was no effect on average employment status or employment at study end. There is moderate certainty in these estimates.

CONCLUSION

Interventions can improve some employment outcomes for people released from prison. More evidence is required to establish effective interventions for sustaining quality employment, particularly outside the USA, and which consider outcomes for different groups of people released, such as women or those with health or substance use needs.

The association between self-reported traumatic brain injury, neuropsychological function, and compliance among people serving community sentences

BACKGROUND

Traumatic brain injury is overrepresented in incarcerated samples and has been linked to a number of poor correctional outcomes. Despite this, no research has explored the impact of a recent TBI on compliance outcomes for individuals serving community-based.

METHOD

We screened for a history of TBI in 106 adults on community sentences and collected compliance (arrests, sentence violations) and related variables (e.g., risk scores, substance use) over 6 months. Sixty-four participants also completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Comprehensive Trail Making Test and Color-Word Inference Test.

RESULTS

A TBI in the last year predicted a significantly higher likelihood of arrest, even when controlling for risk of reconviction and current substance use, but was not associated with non-compliance with sentence conditions nor with performance on the neuropsychological tests. In addition, no significant associations were found between performance on neuropsychological tests and measures of non-compliance.

CONCLUSIONS

TBI in the last year was an independent predictor of arrest. This result suggests that those with a recent TBI on a community sentence may need additional monitoring or support to reduce the risk of reoffending.

Childhood maltreatment and impulsivity in offenders: Examining the mediating roles of self-compassion and cognitive reappraisal

BACKGROUND

The higher impulsivity of offenders in prison is a challenge for prison intervention. Childhood maltreatment, one of the factors closely related to the generation and development of impulsivity, is also prevalent in offenders. Therefore, it is critical to investigate the underlying paths that generate impulsivity in offenders who have experienced childhood abuse.

OBJECTIVE

Targeting positive protective factors, this study aimed to probe the mediating roles of self-compassion and cognitive reappraisal in the relationship between childhood maltreatment and impulsivity in offenders.

METHODS

The participants included 2643 offenders, 1534 males and 1109 females. Each participant completed the appropriate questionnaires to measure childhood maltreatment, impulsivity, self-compassion, and cognitive reappraisal. The PROCESS macro was used to perform the mediation analysis and hypothesis testing.

RESULTS

The findings showed that childhood maltreatment indirectly affected offenders' impulsivity through self-compassion and cognitive reappraisal, and the mediating effect of self-compassion was stronger than that of cognitive reappraisal. Further analyses found that sexual abuse indirectly affected impulsivity through self-compassion, and the remaining types of childhood maltreatment were associated with impulsivity in indirect pathways through self-compassion and cognitive reappraisal.

CONCLUSIONS

The results suggest that reinforcing practical training in self-compassion and cognitive reappraisal, especially the former, might facilitate the reduction of impulsive symptoms among offenders with backgrounds of childhood maltreatment.

Exploration of Adverse Childhood Experiences (ACEs) and Health Risk Behaviors (HRBs) in Male Recidivist Violent Offenders: Indian Scenario

Aggression and violent behavior are widespread in the world and cause serious threats to public safety. Violent criminal recidivism rates remain very high among certain groups of offenders. In India, the quantum of total violent crimes is continuously increasing from 2009 to 2019. Adverse childhood experiences can affect the development of a child in many ways, leading to highly maladaptive behaviors, such as serious, violent, and chronic (SVC) delinquency. This study was done as a case-control method among recidivist violent offenders and controls to examine the effects of adverse childhood experiences (ACEs) on violent criminality. The questionnaire included the World Health Organization Adverse Childhood Experiences International Questionnaire (ACE- IQ) and standardized measures of Health Risk Behaviors (HRBs). Thirteen categories of adverse childhood experiences of the recidivist violent offenders and controls were measured. Bivariate analysis showed that there was a significant relation (p < 0.001) between ACEs and violent criminality in cases (M = 72.14, SD = 6.80, N = 35) and controls (M = 44.91, SD = 5.39, N = 32). The largest correlation was found between collective violence and household violence (r = 0.813). Bivariate correlation analyses were highly significant between total ACE score and criminality (r (35) = 0.927, p < 0.001). The results reveal that household violence, community violence and collective violence experienced by recidivist violent offenders were nearly double the rate of the control group. Findings emphasize the need for evaluations of ACEs in recidivist offenders for better rehabilitation strategies and also the necessity for preventive efforts at all levels.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-021-00434-1.

The phenomenon of overkill in northern Greece: A descriptive forensic psychiatric study between 2015 and 2020 on criminal offenders found not guilty by reason of insanity

The purpose of this descriptive study was to investigate overkill in a representative sample of Greek psychiatric patients found not guilty by reason of insanity (NGRIs) from a forensic psychiatric - criminological standpoint and explore possible correlations of the phenomenon with socio-cultural or psychiatric factors. Overall, 24 forensic psychiatric records of overkill offenders were identified throughout the 5-year records of the national forensic psychiatric service in northern Greek mainland. The pattern that has emerged from the statistical results of the present study on the victims of overkill within the Greek borders was generally in line with global literature on homicide perpetrators. The mean age of overkill offenders (at the time of enactment of the crime) was estimated at 36.3 years ranging from 19 to 55 years (variance = 146.72; standard deviation = 12.11). The number of male single-offence killers was ten-times larger compared to their female counterparts, while the number of male multiple-offence killers were three-times larger compared to their female counterparts. Male offenders were averagely 15 years younger (mean 33.7; variance = 81.69; standard deviation = 9) in comparison to female offenders, and single-offence killers were averagely ten years younger compared to multiple-offence killers (mean 40.2; variance = 185.19; standard deviation = 13.6). The phenomenon correlated more strongly with homicides in the context of schizophrenia spectrum disorders (80-100%) as well as domestic violence. Overall, males outnumbered females both as offenders (approximately five-times) and victims (approximately three-times), but regarding domestic violence, the sad majority of overkill victims stood for females murdered by their male relatives. Close female relatives (especially mothers and grandmothers) were most often victimized. Female-perpetrated overkill was directed against male individuals with whom offenders shared a relationship (intimate partners and minors). An important finding was the fact that three-quarters of the overall perpetrator sample were under prescribed medication at the time of offence, but with a very low compliance rate (5.6%). This last particular finding of the present study demonstrated that mental health services within community in Greece may unfortunately have been ineffective in addressing issues requiring risk assessment and timely intervention.

The association between victim-offender relationship and the age of children and adolescents who suffer sexual violence: a cross-sectional study

OBJECTIVES

Sexual violence is a problem that affects children and adolescents regardless of social class, age, origin, religion, education level, marital status, race, or sexual orientation. This study aimed to analyze the associations between victim-offender relationships and the victim's age in cases of sexual violence involving female victims.

METHODS

This cross-sectional, retrospective observational study used data from the Brazilian Ministry of Health's Department of Public Health Surveillance in Brasília regarding the reportable crime of rape as informed by female victims in the Federal District between January 1, 2012, and December 31, 2018. The age of the victim was classified as <15 years or 15-19 years. The offenders were classified into eight different categories according to their relationship with the victim: father, stepfather, brother, husband, boyfriend, friend, stranger, and others. The association between the victim-offender relationship and the victim's age was assessed.

RESULTS

Overall, there were 4,617 reported cases of sexual violence, with 78.3% of these (n = 3614) corresponding to children under 15 and 21.7% to adolescents 15-19 years old (n = 1003). Close relatives, including brothers, and friends were the main perpetrators in cases of girls < 15 years old. Strangers and friends were the principal perpetrators in the group of girls 15-19 years old.

CONCLUSIONS

Children under 15 are the group most affected by sexual violence. Strategies must be developed to prevent the sexual abuse of children and adolescents and to facilitate the rehabilitation of victimized children.

Heart-wired to be cold? Exploring cardiac markers of callous-unemotional traits in incarcerated offenders

Elevated callous-unemotional (CU) traits have been repeatedly identified in a subgroup of offenders that displays severe antisocial behavior; establishing physiological markers may help improve early identification and treatment efforts. This study examines to what extent baseline-resting heart rate (HR) and heart rate variability (HRV) can be used as markers of CU in incarcerated juvenile and adult offenders. CU traits were assessed using the Inventory of Callous-Unemotional traits. Results of the multiple hierarchical regression tests indicated that there was a small yet significant positive association between baseline HR and CU and negative association between HRV and CU in juvenile offenders with medium model effect sizes (R² = 0.115 for HR-CU; R² = 0.126 for HRV-CU). The cardiac markers were unrelated to CU in adult offenders. These findings are important because they demonstrate that impaired cardiac autonomic activity is related to CU traits in juveniles, suggesting that socioemotional processing difficulties should be considered in understanding these deficits. Future research should be conducted in large samples, under reactive and static conditions, while including cardiac covariates, to get more clarity on the interplay between biological systems and behavioral expression.

Online sexual harassment and depression in Chilean adolescents: Variations based on gender and age of the offenders

BACKGROUND

Online sexual harassment in adolescence is associated with depressive symptoms. There is, however, a dearth of research investigating variability of symptom profiles in this population in relation to offender gender and age.

OBJECTIVE

To identify the proportion of adolescents reporting online harassment by different types of offenders and compare their levels of depression.

PARTICIPANTS AND SETTING

Participants were 18,872 Chilean students aged 12 to 17 years (3.063 of them online sexually harassed).

METHODS

The study involved a secondary analysis of self-report data on online sexual harassment, poly-victimization, and depression collected as part of the National Poly-victimization Survey.

RESULTS

In 37.6% of the cases the offender was male under 18, in 22.4% an adult male, in 14.5% a female under 18, and in 2.9% an adult female. In 22.5% of cases the offender could not be identified. An ANCOVA demonstrated levels of poly-victimization across the lifespan and frequency of online sexual harassment in the last year to predict depressive symptomatology. In females, higher levels of depressive symptoms were observed among those sexually harassed by either a female under 18, an offender whose age and gender the victim could not identify, or an adult male. In males, higher levels of depression were observed among those harassed by either an adult male, an offender whose age and gender the victim could not identify, or a male under 18.

CONCLUSIONS

The current study highlights the importance of offender's age and gender in predicting depression levels in adolescent victims of online sexual harassment.

Eyes wide open: A systematic review of the association between insomnia and aggression in forensic contexts

Sleep quality has been highlighted as a significant predictor of violent behavior through lifespan and across pathologies and a causal link has also been suggested. Despite the high prevalence of insomnia and its potential impact as a modifiable risk factor for aggressive behavior, a comprehensive synthesis of the literature is lacking. We aimed to systematically review the published works exploring the role of sleep in aggressive behaviors, especially focusing on forensic contexts. We performed a systematic review searching the electronic databases PubMed and Scopus through December 2020 and selected articles that compared sleep of offenders and controls and articles that studied the association between sleep and aggression. Ten articles were selected: 2 compared sleep in offenders and controls and 8 studied the association between sleep and aggression. Offenders showed worse sleep features than control both objectively and subjectively measured. Sleep quality was associated with aggression, but sleep quantity was less studied. Sleep seems to have a prominent role in aggressive behaviors but studies concerning this topic are few; samples and methods were highly heterogeneous and most studies were cross-sectional. Future studies are needed to clarify the association between sleep disturbances and aggression, adopting a more systematized approach. Sleep assessment and treatment and might be particularly useful, especially in high-risk populations.

Interpersonal transgressions and psychological loss: Understanding moral repair as dyadic, reciprocal, and interactionist

Following interpersonal transgressions, both victims and offenders can experience psychological loss owing to threatened needs for agency and moral-social identity. Moral repair is the process by which these losses are restored. Rather than involving only intraindividual static processes, research is starting to recognize that moral repair is dyadic, reciprocal, and interactionist. It involves the victim and offender coengaging with one another, reciprocally responding to the other's psychological needs, and coconstructing a shared understanding of what has occurred, their relationship, and a way forward. Each of these steps represents periods of vulnerability where the losses of a transgression can be repaired - or exacerbated.

Altered power spectra in antisocial males during rest as a function of cocaine dependence: A network analysis

Abnormalities in the spectral power of offenders' neural oscillations have been noted within select Resting-State Networks (RSNs); however, no study has yet evaluated the influence of cocaine dependence, drug use severity, and psychopathic traits on these abnormalities. To this end, the present study compared rest-related power spectral characteristics between two groups of offenders (with and without a DSM-IV-TR cocaine-dependence diagnosis) and a non-offender control group. Results indicated that both offender groups presented with lower low frequency power ratio (LFPR) scores (i.e. across all RSNs) than non-offenders. These differences in LFPR scores were due to both higher high-frequency power (0.15-0.25 Hz; within seven (in non-dependent offenders) and five (in cocaine-dependent offenders) of eight investigated networks) and decreased low-frequency power (0.01-0.10 Hz; within six (in non-dependent offenders) and one (in cocaine-dependent offenders) of eight investigated networks) compared to non-offenders. Thus, both cocaine-dependent and non-dependent offenders displayed abnormal neural oscillations, suggesting that these oscillatory abnormalities could exist as neurobiological features associated with offender status. Offenders' LFPR levels correlated with lifetime years of cocaine use, but not with the level of psychopathic traits. These findings supplement our knowledge regarding the influence of substance use on resting-state activity in offenders; moreover, they provide further indication of the importance of evaluating shared/unique variance associated with drug use and pyschopathic personality traits.

Public Attitudes Towards Offenders with Mental Illness Scale (PATOMI): Establishing a Valid Tool to Measure Public Perceptions

This paper focuses on investigating public attitudes towards mentally disordered offenders (MDOs), by considering if the Police and Community Attitudes towards Offenders with Mental Illness (PACAMI-O; Glendinning and O'Keeffe in J Mental Health Train Educ Pract 10(2):73-84, 2015) is a valid tool. An opportunity sample of the general public (N = 504) read a fictional vignette depicting an individual with schizophrenia, then answered the PACAMI-O. An exploratory factor analysis revealed a 4 factor solution: Social distance & location of Services, Mental Health Spending, Attitudes towards Psychiatric Facilities and Community Acceptance. The results suggested that 12 items in the PACAMI-O did not contribute towards measuring public attitudes. Therefore 28 items were retained for the new, more concise, valid scale; Public Attitudes towards Offenders with Mental Illness (PATOMI). PATOMI can be used in future research to effectively assess public attitudes. Application, limitations and suggestions for future research are discussed.

The effect of a peer-led problem-support mentor intervention on self-harm and violence in prison: An interrupted time series analysis using routinely collected prison data

BACKGROUND

Levels of mental disorder, self-harm and violent behaviour are higher in prisons than in the community. The purpose of this study was to determine whether a brief peer-led problem-support mentor intervention could reduce the incidence of self-harm and violence in an English prison.

METHODS

An existing intervention was adapted using a theory of change model and eligible prisoners were trained to become problem-support mentors. Delivery of the intervention took two forms: (i) promotion of the intervention to fellow prisoners, offering support and raising awareness of the intervention but not delivering the skills and (ii) delivery of the problem-solving therapy skills to selected individual prisoners. Training and intervention adherence was measured using mentor log books. We used an Interrupted Time Series (ITS) design utilizing prison data over a 31 month period. Three ITS models and sensitivity analyses were used to address the impact across the whole prison and in the two groups by intervention delivery. Outcomes included self-harm and violent behaviour. Routine data were collected at monthly intervals 16 months pre-, 10 months during and six months post-intervention. Qualitative data measured the acceptability, feasibility, impact and sustainability of the intervention. A matched case-control study followed people after release to assess the feasibility of formal evaluation of the impact on re-offending up to 16 months.

FINDINGS

Our causal map identified that mental health and wellbeing in the prison were associated with environmental and social factors. We found a significant reduction in the incidence of self-harm for those receiving the full problem-solving therapy skills. No significant reduction was found for incidence of violent behaviour.

INTERPRETATION

Universal prison-wide strategies should consider a series of multi-level interventions to address mental health and well-being in prisons.

FUNDING

Research Champions Fund and the Economic and Social Research Council Impact Acceleration Account Fund, University of York, UK.

Mentalization for Offending Adult Males (MOAM): study protocol for a randomized controlled trial to evaluate mentalization-based treatment for antisocial personality disorder in male offenders on community probation

Background

Antisocial personality disorder (ASPD), although associated with very significant health and social burden, is an under-researched mental disorder for which clinically effective and cost-effective treatment methods are urgently needed. No intervention has been established for prevention or as the treatment of choice for this disorder. Mentalization-based treatment (MBT) is a psychotherapeutic treatment that has shown some promising preliminary results for reducing personality disorder symptomatology by specifically targeting the ability to recognize and understand the mental states of oneself and others, an ability that is compromised in people with ASPD. This paper describes the protocol of a multi-site RCT designed to test the effectiveness and cost-effectiveness of MBT for reducing aggression and alleviating the wider symptoms of ASPD in male offenders subject to probation supervision who fulfil diagnostic criteria for ASPD.

Methods

Three hundred and two participants recruited from a pool of offenders subject to statutory supervision by the National Probation Service at 13 sites across the UK will be randomized on a 1:1 basis to 12 months of probation plus MBT or standard probation as usual, with follow-up to 24 months post-randomization. The primary outcome is frequency of aggressive antisocial behaviour as assessed by the Overt Aggression Scale – Modified. Secondary outcomes include violence, offending rates, alcohol use, drug use, mental health status, quality of life, and total service use costs. Data will be gathered from police and criminal justice databases, NHS record linkage, and interviews and self-report measures administered to participants. Primary analysis will be on an intent-to-treat basis; per-protocol analysis will be undertaken as secondary analysis. The primary outcome will be analysed using hierarchical mixed-effects linear regression. Secondary outcomes will be analysed using mixed-effects linear regression, mixed-effects logistic regression, and mixed-effects Poisson models for secondary outcomes depending on whether the outcome is continuous, binary, or count data. A cost-effectiveness and cost-utility analysis will be undertaken.

Discussion

This definitive, national, multi-site trial is of sufficient size to evaluate MBT to inform policymakers, service commissioners, clinicians, and service users about its potential to treat offenders with ASPD and the likely impact on the population at risk.

Trial registration

ISRCTN 32309003. Registered on 8 April 2016.

Attention-Deficit/Hyperactivity Disorder (ADHD), antisociality and delinquent behavior over the lifespan

Attention-Deficit/Hyperactivity Disorder (ADHD) is closely linked to the development of conduct problems during socialization in early life and to an increased risk for antisocial activities and delinquency over the lifespan. The interaction between ADHD and common comorbid disorders like substance use disorders as well as changing environmental conditions could mediate the course of antisocial and delinquent behavior with increasing age. However, this complex interaction is only partially understood so far. This review presents current knowledge about the association of ADHD with antisociality and the development of delinquent behavior. Thereby, the relationships between ADHD, conduct disorder and antisocial personality disorder in offenders are discussed, as well as the impact of comorbid psychiatric disorders and psychosocial conditions on offending behavior. Also, treatment studies in offender populations with ADHD are presented. Although our understanding of the role of ADHD in the development of criminal behavior has substantially improved during the last two decades, more research is needed to further elucidate the mechanisms generating unfavorable outcomes and to engender adequate treatment strategies for this population at risk. Moreover, more attention is needed on children with conduct problems in order to avoid antisocial or delinquent behaviors over the lifespan.

Mental disorders and risk of suicide attempt in prisoners

BACKGROUND

Mental disorders are overrepresented in prisoners, placing them at an increased risk of suicide. Advancing our understanding of how different mental disorders relate to distinct stages of the suicidal process-the transition from ideation to action-would provide valuable information for clinical risk assessment in this high-risk population.

METHODS

Data were drawn from a representative sample of 1212 adults (1093 men) incarcerated across 13 New Zealand prisons, accounting for 14% of the national prison population. Guided by an ideation-to-action framework, three mutually exclusive groups of participants were compared on the presence of mental disorders assessed by validated DSM-IV diagnostic criteria: prisoners without any suicidal history (controls; n = 778), prisoners who thought about suicide but never made a suicide attempt (ideators; n = 187), and prisoners who experienced suicidal ideation and acted on such thoughts (attempters; n = 247).

RESULTS

One-third (34.6%) of participants reported a lifetime history of suicidal ideation, of whom 55.6% attempted suicide at some point (19.2% of all prisoners). Suicidal outcomes in the absence of mental disorders were rare. Whilst each disorder increased the odds of suicidal ideation (OR range 1.73-4.13) and suicide attempt (OR range 1.82-4.05) in the total sample (n = 1212), only a select subset of disorders was associated with suicide attempt among those with suicidal ideation (n = 434). Drug dependence (OR 1.65, 95% CI 1.10-2.48), alcohol dependence (OR 1.89, 95% CI 1.26-2.85), and posttraumatic stress disorder (OR 2.09, 95% CI 1.37-3.17) distinguished attempters from ideators.

CONCLUSION

Consistent with many epidemiological studies in the general population, our data suggest that most mental disorders are best conceptualized as risk factors for suicidal ideation rather than for suicide attempt. Once prisoners consider suicide, other biopsychosocial factors beyond the mere presence of mental disorders may account for the progression from thoughts to acts of suicide.

Effectiveness of vehicle impoundment for high-range speeding offences in Victoria, Australia

Speeding behaviour has been shown to account for a large number of deaths and serious injuries on Australian roads. Vehicle impoundment is one countermeasure which has been implemented to discourage drivers from engaging in high-range speeding. Despite this countermeasure being used as a sanction in all Australian jurisdictions to combat high-range speeding offences, limited research has examined the effectiveness of vehicle impoundments in Australia. The purpose of this research was to examine the effectiveness of vehicle impoundment for high-range speeding offences on subsequent offence and crash rates. Data were collected from drivers with an eligible excessive speeding offence in Victoria, Australia between 1 July 2006 and 31 December 2014. During this time, there were 17,440 impoundment eligible offences, 6,883 (41.8 %) of which resulted in vehicle impoundment. The analysis revealed that drivers who had a vehicle impounded were more likely to be male, younger, hold a probationary licence, and to have a court offence. In terms of the effectiveness of vehicle impoundment, among high-range offenders, re-offence rates for those who had their vehicle impounded were statistically significantly lower for all licence periods compared with offenders who did not have their vehicle impounded. There was evidence of an effect of impoundment on reducing speeding re-offence rates during the impoundment period as well as some evidence that the impact of licence suspension was greater for those who experienced impoundment. Given that vehicle impoundment is a sanction which aims to discourage and/or incapacitate drivers from engaging in on-road risk taking behaviour, in this case high-range speeding behaviour, the longer-term positive effects of this sanction may assist with the on-going effort to reduce on-road risk taking behaviours.

Effectiveness of a brief motivation enhancing intervention on treatment initiation, treatment retention and abstinence: Results from a multi-site cluster-randomized trial

The aim of this study was to test the effectiveness of a brief motivational enhancing intervention (MEI) as an add-on to supervision-as-usual (SAU) in reducing time to treatment initiation in offenders with substance use disorders (SUDs) under probation supervision. We also tested the effectiveness in enhancing treatment retention and abstinence of primary substance rates. The study was designed as a multi-site, cluster randomized trial (CRT) in six addiction probation offices. We randomized 73 probation officers (37 to intervention, 36 to control) and followed 220 substance-abusing repeat offenders during their supervision (111 intervention, 109 control). Individualized SAU was compared with supervision with MEI. We report time to treatment initiation, treatment retention rate during the 12 months follow-up, and primary substance abstinence rate in the 30 days before follow-up. Results show that time to treatment initiation (χ2(1) = 1.817, p = .178), and the proportion of treatment retention (OR = 1.980, p = .213) and primary substance abstinence (OR = 0.945, p = .886) did not significantly differ between offenders that received SAU plus MEI and those that received SAU at 12 months follow-up. Our findings provide no evidence that supervision plus a brief manual-base MEI is more effective than SAU.

Improving the psychometric properties of the dissociative experiences scale (DES-II): a Rasch validation study

BACKGROUND

The Dissociative Experiences Scale-II (DES-II) is a self-report questionnaire that measures dissociative experiences such as derealization, depersonalization, absorption and amnesia. The DES-II has been prevalently used as a screening tool in patients suffering from psychotic disorders or schizophrenia. However, dissociative experiences can also be part of normal psychological life. Despite its popularity, the most problematic aspect of the DES-II is the inconsistency in its factor structure, which is probably due to the tendency to treat ordinal responses as responses on an interval scale, as it is assumed in the Classical Test Theory approach. In order to address issues related to the inconsistency of previous results, the aim of the present study was to collect new psychometric evidence to improve the properties of the DES-II using Rasch analysis, i.e. analyzing the functioning of the response scale.

METHODS

Data were obtained on a sample composed by 320 Italian participants (122 inmates and 198 community-dwelling individuals) and were analyzed with the Rasch model. This model allows the estimation of participants' level of dissociation, the degree of misfit of each item, the reliability of each item, and their measurement invariance. Moreover, Rasch estimation allows to determine the best response scale, in terms of response modalities number and their discriminant power.

RESULTS

Three items of the scale had strong misfit. After their deletion, the resulting scale was composed by 25 items, which had low levels of misfit and high reliability, and showed measurement invariance. Participants tended to select more often lower categories of the response scale.

CONCLUSIONS

Results provided new knowledge on the DES-II structure and its psychometric properties, contributing to the understanding and measurement of the dissociation construct.

Cortisol stress response predicts 9-year risky driving convictions in male first-time driving-while-impaired offenders

BACKGROUND

With driving while impaired by alcohol (DWI) representing a persistent burden on global health, better understanding and prevention of recidivism following a first-time DWI conviction are needed. Progress towards these goals is challenged by the marked heterogeneity in offender characteristics and a traffic safety literature that relies on subjective self-report measures and cross-sectional study designs. The present study tested the hypothesis that an objective neurobiological marker of behavioural maladjustment, the cortisol stress response (CSR), predicts future DWI and other traffic convictions over a 9-year follow-up period.

METHODS

One hundred thirty-two male first-time DWI offenders and 31 non-offender comparators were recruited and assessed at intake for their substance use, psychosocial and psychological characteristics and CSR. Traffic conviction data were obtained from provincial driving records. Survival analysis estimated the association between CSR and risk of a traffic conviction over time.

RESULTS

In support of our hypothesis, blunted CSR predicted traffic convictions during the follow-up duration. This effect generalized to both DWI offenders and non-DWI drivers. While CSR was lower in DWI offenders compared to non-offenders, it did not specifically predict recidivism in DWI offenders. Modelling results indicated that blunted CSR, along with DWI offender group membership, experience seeking and drug use frequency, may demarcate a high-risk driver phenotype.

CONCLUSIONS

CSR is a neurobiological marker of a driver phenotype with elevated generalized driving risk. For drivers with characteristics consistent with this phenotype, expanding the focus of intervention to address multiple forms of risky driving may be necessary to curb their overall threat to traffic safety.

Outcomes of administrative involuntary hospitalization: A national retrospective cohort study in Japan

BACKGROUND

Treatment for offenders with mental disorders is a key concern in public mental health. Provision of adequate psychiatric treatment is important for the offender and their community. An approach used in Japan to address this issue is administrative involuntary hospitalization. Under this scheme, a person at risk for harming themselves or others because of a mental disorder can be involuntarily hospitalized in a designated psychiatric hospital. However, this scheme does not include tracking of these patients after discharge. Although some data for administrative involuntary hospitalizations are available, it remains unclear what happens to these patients after discharge.

AIM

To evaluate follow-up of patients under administrative involuntary hospitalization after discharge and obtain data for later comparisons with outcomes.

METHODS

We used a retrospective design and conducted a national survey of administrative involuntary hospitalizations. Questionnaires were distributed to 939 facilities across Japan. The questionnaire collected data for selected involuntary hospitalization cases in the hospital on June 30, 2010 (census date), and the prognoses of each patient on a specified date in 2011 and 2012. We also asked about the treatment provided to each patient. We stratified patients by prognosis (good or poor), and used logistic regression analysis to examine the relationship between treatment and prognosis.

RESULTS

We received completed questionnaires from 292 facilities (response rate 31.1%); 105 facilities had no relevant patients. Our analysis included data for 394 patients with valid data. Official statistics indicated 1503 patients were under administrative involuntary hospitalization as at June 30, 2012, meaning the capture rate was 27.2%. Approximately a fourth (104/394) at 1 year, and a third (137/294) at 2 years after the census had unknown prognosis. Treatment content included multi-disciplinary team meetings (78.2% of patients), counseling by public workers (59.9%), and discussion with external specialists (32.5%). Overall, 116 patients were categorized as having a good prognosis at 1 year, and 168 had a poor prognosis. At the 2-year point, 102 patients had a good prognosis and 150 had a poor prognosis. “Discussion with external specialists” was positively associated with a good prognosis at both 1 year (P = 0.016) and 2 years (P = 0.036).

CONCLUSION

We found that facilities in Japan currently have limited ability to track the prognoses of patients who were hospitalized involuntarily. Discussion with external specialists is associated with a good prognosis.

"Who needs secure services for personality disorder?" Results of an expert Delphi study with professional staff

BACKGROUND

Personality Disorder (PD) is an enduring, multi-faceted mental disorder, associated with adverse health effects, difficulties with interpersonal relationships and in some cases increased risk to others. A limited number of dedicated forensic mental health services are available for serious offenders with severe personality disorder. The recent Offender Personality Disorder (OPD) strategy aims to ensure that most such offenders are treated in prison rather than secure psychiatric services, except in highly complex cases where this is not possible. While the strategy sets out very broad criteria relating to this, greater clarity is needed to support decisions about appropriate transfer and hence enhance public protection. This study explored which characteristics professional experts associate with appropriate transfer from prison to forensic mental health services for high-risk offenders with PD.

METHOD

A modified Delphi survey distributed through an online survey system was conducted in two-rounds with a group of professional experts recruited from forensic mental healthcare; criminal justice and specialist commissioning.

RESULTS

Fifty-one (56%) respondents completed stage one of the Delphi and 34 (61%) of these completed stage two. Consensus was reached for a total of 22 items indicating complexity, including co-morbid mental illness, high level of risk, lack of progress in prison and high motivation for treatment. A preliminary checklist for these factors was developed. Panel members consistently emphasised the importance of the individual's presenting need, the overall clinical picture and formulation in their free text responses.

CONCLUSIONS

Professionals face a complex picture when making decisions regarding suitability for hospital admission for high-risk male offenders with PD, with varied opinions amongst professional experts as to priorities for intervention and a focus on individual needs through formulation. It was, nevertheless, possible to condense these views into a set of consistent variables that can be used to highlight the need for transfer into hospital-based treatment services.

A pilot randomised controlled trial of a programme of psychosocial interventions (Resettle) for high risk personality disordered offenders

BACKGROUND

Offenders with personality disorder experience significant co-morbid mental health problems and present with an increased risk of offending. The evidence for the effectiveness of interventions for personality disordered offenders in the community is limited. This study was a pilot study to determine the feasibility of a randomised controlled trial (RCT) of an intervention known as Resettle for personality disordered offenders and to explore the possible effects of this intervention.

METHODS

Potential participants were recruited from referrals of male prisoners to Resettle. Those consenting underwent baseline assessments before being randomised to Resettle or treatment as usual. Officially recorded and self-report offending was assessed over two years following release from custody. Of the 110 eligible participants, 72 (65%) participated in the study of whom 38 were randomised to Resettle and 34 to treatment as usual. The two groups had a similar psychiatric and offending profile.

RESULTS

Analysis of officially recorded offences at two years found mixed results, but whether adopting an intent-to-treat approach or including only those who received the intervention there was no clear evidence of an effect of the intervention. A comparison of self-report offending found no effect of Resettle in an intent-to-treat analysis, but there was an effect when the analysis involved only those participating in the intervention.

CONCLUSIONS

This study demonstrated that with some adjustments it was possible to carry out an RCT of a complex intervention for personality disordered offenders in a criminal justice setting. Some, but not conclusive, evidence was found in favour of the intervention.

An updated picture of the mental health needs of male and female prisoners in the UK: prevalence, comorbidity, and gender differences

PURPOSE

Epidemiological data on the mental health needs of prisoners are essential for the organisation, planning, and delivery of services for this population as well as for informing policy and practice. Recent reports by the National Audit Office and NICE call for new research to provide an updated picture of the mental health needs of men and women in prison in the UK. This study aimed to measure the prevalence and comorbidity of mental health needs across a representative sample of both men and women across 13 prisons in one UK region.

METHOD

Participants completed a standardised battery of psychometric assessments which screened for a range of mental health difficulties including: mental disorders, personality disorder, and substance misuse.

RESULTS

469 participants were included in the final sample (338 males, 131 females). A high number of participants reported having had previous contact with mental health services and/or a pre-existing diagnosis of a mental disorder. High rates of current mental disorder were detected across the range of disorders screened for. Levels of comorbidity were also high, with nearly half of participants screening positive for two or more types of mental disorder. Gender differences were noted in terms of previous contact with mental health services, having a pre-existing diagnosis, prevalence of current mental disorder, and levels of comorbidity; with women reporting higher rates than men.

CONCLUSIONS

Rates of pre-existing and current mental illness continue to be high amongst prisoners. Women report significantly higher levels of mental health need compared to men.

Gambling Disorder in Male Violent Offenders in the Prison System: Psychiatric and Substance-Related Comorbidity

Gambling disorder is an addiction that can cause major suffering, and some populations seem to be more vulnerable than others. Offender populations have a remarkably high prevalence of gambling problems and they are also over-represented in a number of diagnoses related to gambling disorder, like substance use disorders and antisocial personality disorder. Yet, there are few studies investigating gambling disorder prevalence and related psychiatric comorbidity in this group. This study aims to investigate the prevalence of, and association between, gambling disorder and other psychiatric diagnoses in a sample of young, male violent offenders. Two hundred and sixty-four male offenders, all serving sentences for violent crimes (recruited between 2010 and 2012) participated in this study and went through comprehensive psychiatric evaluation, including assessment for Diagnostic and Statistical Manual of Mental Disorders 4th Edition criteria. Sixteen percent of the participants met criteria for gambling disorder. Antisocial personality disorder, cannabis, cocaine and anabolic steroids abuse were significantly more common among participants with gambling disorder. The gambling disorder group also showed significantly lower educational attainment. Cocaine abuse and failure to graduate elementary and middle school in expected time were independently associated with gambling disorder in a regression analysis. This study confirms the previously described high prevalence of gambling disorder in offenders. The psychiatric comorbidity was high and the problems had started early, with lower educational attainment in the gambling disorder group. The findings stress the importance of increased awareness of gambling problems among convicted offenders and of gambling research on young people with delinquent behavior. There is a need of more research to investigate this further, in order to develop preventive strategies and treatment.

Attention Deficit Hyperactivity Disorder (ADHD) in the Prison System

PURPOSE OF REVIEW

To examine recent advances in the understanding of attention deficit hyperactivity disorder (ADHD) among the prison population.

RECENT FINDINGS

Efforts have been made to develop useful tools for assessing ADHD among prisoners. Prisoners with ADHD demonstrate incremental vulnerability due to comorbid psychiatric disorders, neurodevelopmental disorders and traumatic brain injury. Compared with prisoners without ADHD, prisoners with ADHD become involved in the criminal justice system at a younger age and have higher rates of recidivism in adulthood. Recent studies demonstrate the effectiveness of extended release stimulant medication and psychological interventions. Early identification and treatment of prisoners with ADHD have the potential to demonstrate health economic benefits. Our understanding of ADHD among prisoners continues to develop. However, further research is needed, particularly among neglected groups such as females. Much more attention is needed by the prison service to engender better outcomes for this at-risk population.

Evaluating the Impact of a Targeted Brief HIV Intervention on Multiple Inter-Related HIV Risk Factors of Knowledge and Attitudes among Incarcerated Drug Users

Increases in HIV prevalence indicate ongoing need for HIV interventions. A brief manualized intervention called TCU WaySafe, which addresses multiple HIV risks, was further evaluated to determine how it addressed individual's knowledge deficiencies in the assessed risks. The sample of 1256 offenders in 8 correctional substance abuse treatment programs participated either in treatment as usual (TAU) or TCU WaySafe. From multivariate multi-level analysis, WaySafe was more effective in improving the greatest need area, whether knowledge, motivation, or confidence regarding HIV risky behaviors. Findings underscored the importance of addressing HIV risk areas with greatest need for change and strengthens previous findings of the intervention's potential for individuals with varying HIV risks.

Emotion recognition in young male offenders and non-offenders

The study of facial emotional expressions not only gives information about communicative and adaptive processes, but also provides valuable knowledge about some aspects of human behaviour, such as emotions and intentions. Taking into account the proved evidence that deficits in processing emotional information shows difficulties in executive functions and social behavior, the present work aims to compare the perceptual and dimensional similarities between the emotions transmitted by the faces (facial emotions) and those typically associated with two particular emotional contexts (offenders and non-offenders). To evaluate the contextual influence on emotional face categorization, the emotional recognition in 69 male young (35 offenders (17.22 ± 1.5 years) and 34 non-offenders (16.90 ± 1.56 years) from Barranquilla (Colombia) was analyzed. Experimental results displayed significant differences among the two groups, mainly focused in the recognition of anger and disgust faces. In this sense, the analysis of abovementioned data may lead to the development of more specific and cost-effective therapeutic treatments for offender population.

Offenders' perceptions of the UK prison smoking ban

PURPOSE

Despite overall reductions in levels of smoking in the UK, rates of offender smoking remain high. In 2016, it was announced that prisons in England and Wales would gradually introduce a smoking ban. The purpose of this paper is to explore offenders' perceptions around the upcoming smoking ban.

DESIGN/METHODOLOGY/APPROACH

A total of eight focus groups were conducted in four prisons across the North of England. Both smoking and non-smoking offenders participated in the focus groups, and thematic analysis was used to explore the findings.

FINDINGS

Themes generated from the data were "freedom and rights", "the prison environment" and "guiding support". Participants discussed how the smoking ban was viewed as a punishment and restricted their freedom, with perceptions as to why the ban was being implemented centring around others trying to control them. Participants expressed concerns around the financial implications of the smoking ban on already stretched prison resources. Participants also recommended improving the nicotine replacement therapy on offer, and increasing the range of leisure activities within the prison to prepare for the smoking ban.

ORIGINALITY/VALUE

Overall, it was apparent that participants' awareness of the smoking ban was generally poor. It is recommended that offenders need to be made more aware of the smoking cessation support they will receive and given the opportunity to ask questions about the smoking ban. Increasing offenders' awareness of the ban may reduce stress associated with a perceived lack of choice around their smoking behaviours.

A Systematic Review and Meta-Analysis of Decision-Making in Offender Populations with Mental Disorder

Decision-making has many different definitions and is measured in varied ways using neuropsychological tasks. Offenders with mental disorder habitually make disadvantageous decisions, but no study has systematically appraised the literature. This review aimed to clarify the field by bringing together different neuropsychological measures of decision-making, and using meta-analysis and systematic review to explore the performance of offenders with mental disorders on neuropsychological tasks of decision-making. A structured search of PubMed, Embase, PsycINFO, Medline, Cinahl was conducted with additional hand searching and grey literature consulted. Controlled studies of decision-making in offenders with evidence of any mental disorder, including a validated measure of decision-making were included. Total score on each relevant decision-making task was collated. Twenty-three studies met inclusion criteria (n = 1820), and 10 studies (with 15 experiments) were entered into the meta-analysis (n = 841). All studies included in the meta-analysis used the Iowa Gambling Task (IGT) to measure decision-making. Systematic review findings from individual studies showed violent offenders made poorer decisions than matched offender groups or controls. An omnibus meta-analysis was computed to examine performance on IGT in offenders with mental disorder compared with controls. Additionally, two sub-group meta-analyses were computed for studies involving offenders with personality disorder and psychopathy, and recidivists who were convicted of Driving While Intoxicated (DWI). Individual studies not included in the meta-analysis partially supported the view that offenders make poorer decisions. However, the meta-analyses showed no significant differences in performance on IGT between the offender groups and controls. Further research is required to ascertain whether offenders with mental disorder have difficulty in making advantageous decisions. An analysis of cause and effect and various directions for future work are recommended to help understand the underpinning of these findings. Trial Registration: CRD42018088402.

The development of the Brain Injury Screening Index (BISI): A self-report measure

The aim of this study was to investigate the psychometric properties and screening accuracy of the Brain Injury Screening Index (BISI), a self-report questionnaire designed to identify a history of acquired brain injury. The study was conducted in a closed male prison in the UK. The purposive sample comprised 55 male prisoners who arrived at the establishment during the study. A repeated measures design was used, where the Brain Injury Screening Index (BISI) was administered on three occasions. Inter-rater reliability was poor to moderate, but test retest reliability was moderate to good. Medical records were not available for all participants, but the limited number obtained resulted in a sensitivity of .38 to .71 and specificity of .47 to .70 across the three screening administrations of the BISI. The limitations of the present findings are discussed in the context of the use of the tool in custodial environments. It is argued that these results suggest that, when used as recommended, the BISI has acceptable reliability and validity as an initial screen for identifying individuals who should receive support and a comprehensive neuropsychological assessment, and it merits further investigation and development.

Forensic psychiatry in Kuwait - characterization of forensic psychiatry patients evaluated over year duration in the only available forensic psychiatry unit

INTRODUCTION

The offending behavior arising from a mental disorder invokes criminal responsibility doctrines or insanity defenses and calls for legislative framework ensuring availability of care and treatment for the patient and protection of the public from harm from the offender. The conviction of mentally disordered offenders varies depending upon the local legislation and its socio-cultural context, so do the principles, procedures and guidelines for forensic assessments between different countries. The criminal Act of Kuwait, which governs the work of forensic psychiatrists remain unchanged, from a psychiatric point of view, since it was enacted in the early 1960's.

OBJECTIVES

To shed some light on the forensic psychiatry services running in Kuwait and describe forensic psychiatry patients evaluated in the only-available forensic psychiatry unit.

METHODS

Retrospective chart review of all cases referred for criminal forensic psychiatric assessments during the period from January 1st, 2016 to May 31st, 2017. The demographics, types of offences, psychiatric diagnoses, and details of psychiatric evaluations were retrieved and characterized.

RESULTS

A total of 95 case-notes were reviewed. Most of them were males (90%), Kuwaiti nationals (77%), primary or intermediate school education (74%), and were aged 20-39 (69%). Almost all (97%) of the referrals required ascertainment of 'responsibility' for the alleged offence. Eighty-six percent (N = 81) of the offenders were referred from the police or the public prosecutor office. Eighty-three percent (N = 79) of the offenders were found to have a mental disorder while 55% (N = 52) were found to be criminally responsible. The males (57%) outnumbered the females (33%) as criminally responsible.

CONCLUSIONS

The number of mentally ill offenders referred for criminal responsibility and fitness to stand trial is very small compared to western countries. One reason behind this could be that a substantial number of the mentally disordered offenders pass undetected through the legal system. It is then incumbent that psychiatrists and forensic mental health workers might need to provide better awareness and education about mental health to legal authorities in Kuwait.

Comparison of Offender and Non-offender Young Men to Setting Goals for Life and Attributing Meaning to Life

The main goal of the present study is to compare male offenders and non-offenders in terms of how they attribute meaning to life and set life goals. The samples were chosen from among offenders (n = 50) and non-offenders (n = 50) who were between ages 19-26. Mixed method was used in this study. The scale of setting life goals and interview form were used to collect data. To analysis of the data, the content analysis technique and t test and were used. Findings of the present study show that offenders tend to have troubles setting life goals when compared to non-offenders. Furthermore, the results of this study could be used in rehabilitating offenders and preventing those at risk of committing criminal acts from doing so.

The Sense of Quality of Life and Religious Strategies of Coping with Stress in Prison Inmates

The aim of the presented research was to analyze differences in religious strategies of coping with stress in a group of prison inmates characterized by different levels of the sense of quality of life-general, psychophysical, psychosocial, personal, and metaphysical. The participants were 390 males, aged 19-68 years, serving sentences in prisons in Poland. The measures used were the Sense of Quality of Life Questionnaire by M. Straś-Romanowska and K. I. Pargament's RCOPE Questionnaire. As expected, individuals with a high sense of quality of life-both general and pertaining to specific dimensions-more often chose positive religious strategies, whereas participants with a low sense of quality of life more often chose negative strategies. The exception was the metaphysical aspect of the quality of life: individuals with a high intensity of this dimension more often chose some of the positive as well as negative religious strategies.

Do impression management and self-deception distort self-report measures with content of dynamic risk factors in offender samples? A meta-analytic review

Self-report measures provide an important source of information in correctional/forensic settings, yet at the same time the validity of that information is often questioned because self-reports are thought to be highly vulnerable to self-presentation biases. Primary studies in offender samples have provided mixed results with regard to the impact of socially desirable responding on self-reports. The main aim of the current study was therefore to investigate-via a meta-analytic review of published studies-the association between the two dimensions of socially desirable responding, impression management and self-deceptive enhancement, and self-report measures with content of dynamic risk factors using the Balanced Inventory of Desirable Responding (BIDR) in offender samples. These self-report measures were significantly and negatively related with self-deception (r = -0.120, p < 0.001; k = 170 effect sizes) and impression management (r = -0.158, p < 0.001; k = 157 effect sizes), yet there was evidence of publication bias for the impression management effect with the trim and fill method indicating that the relation is probably even smaller (r = -0.07). The magnitude of the effect sizes was small. Moderation analyses suggested that type of dynamic risk factor (e.g., antisocial cognition versus antisocial personality), incentives, and publication year affected the relationship between impression management and self-report measures with content of dynamic risk factors, whereas sample size, setting (e.g., incarcerated, community), and publication year influenced the relation between self-deception and these self-report measures. The results indicate that the use of self-report measures to assess dynamic risk factors in correctional/forensic settings is not inevitably compromised by socially desirable responding, yet caution is warranted for some risk factors (antisocial personality traits), particularly when incentives are at play.

Self-regulation and the specificity of autobiographical memory in offenders

Certain clinical populations exhibit an Overgeneral Autobiographical Memory (OAM), characterized by difficulty remembering specific events. One study has observed OAM for positive events in a group of offenders. This study analyzed the stability of the valence effect in the OAM of offenders, the executive control impairments facilitating OAM in offenders, and the relationship of self-esteem and social desirability with AM specificity. The specificity (Autobiographical Memory Test) and emotional properties of the AMs of 59 prisoners (30 men, 29 women) and a control group (29 men, 30 women) were compared. Social desirability, depression symptoms, self-esteem and executive functions (Mazes, Stroop, Verbal Fluency) were assessed. The offenders recalled fewer specific positive AMs than controls, and did not perceive the emotional intensity of their negative AMs to decrease over time, unlike the controls. The offenders' recall of specific negative AMs seemed to influence negatively their performance in the subsequent executive control tasks. Dysfunctional coping strategies in offenders were related to OAM, but not social desirability or self-esteem.

General practitioner contributions to achieving sustained healthcare for offenders: a qualitative study

BACKGROUND

Offenders frequently have substantial healthcare needs and, like many other socially marginalised groups, often receive healthcare in inverse proportion to their needs. Improved continuity of healthcare over time could contribute to addressing these needs. General Practitioners need to be able to support people with complex social and medical problems, even in systems that are not specifically designed to manage individuals with such degrees of complexity. We aimed to examine offenders' perspectives on factors that contributed to, or worked against, creating and sustaining their access to healthcare.

METHODS

From a sample of 200 participants serving community or prison sentences in South West (SW) and South East (SE) England, who were interviewed about their health care experiences as part of the Care for Offenders: Continuity of Access (COCOA) study, we purposively sampled 22 participants for this sub-study, based on service use. These interviews were transcribed verbatim. A thematic analytic approach initially applied 5 a priori codes based on access and different components of continuity. Data were then examined for factors that contributed to achieving and disrupting access and continuity.

RESULTS

Participants described how their own life situations and behaviours contributed to their problems in accessing healthcare and also identified barriers created by existing access arrangements. They also highlighted how some General Practitioners used their initiative and skills to 'workaround' the system, and build positive relationships with them; feeling listened to and building trust were particularly valued, as was clear communication. Limitations faced by General Practitioners included a lack of appropriate services to refer people to, where the offender patients would meet the access criteria, and disagreements regarding medication prescriptions.

CONCLUSIONS

General Practitioners can make a positive contribution to supporting access to healthcare for an under-served population by facilitating more flexible and less formal access arrangements, by using their relationship skills, and by problem-solving. General Practitioners should recognise their potential to transform people's experience of healthcare whilst working in imperfect systems, particularly with vulnerable and marginalised groups who have complex medical and social needs.

Mental Health Assessment of South Korean Adults on Probation

OBJECTIVE

The association of offender mental illness (including those on probation) with crime has long been the subject of social interest; however, systematic management has been insufficient. The study purpose was to analyze mental illness prevalence, proportion of first offenses and recidivism with the mental illness of those on probation.

METHODS

A total of 206 adults on probation were divided into groups (first offenders and repeat offenders) and they completed self-report instruments and clinical interviews designed to diagnose mental illness.

RESULTS

The mental illness prevalence among those on probation was considerably higher than that of the general population, and having mental illness was related to re-sentencing probation or recidivism. In particular, alcohol use disorder, major depressive episode, manic/hypomanic episode, and antisocial personality disorder were shown to affect recidivism.

CONCLUSION

To achieve the ultimate purpose of probation, social and systematic intervention on a mental health and medical basis may be required.

Visual attention in violent offenders: Susceptibility to distraction

Impairments in executive functioning give rise to reduced control of behavior and impulses, and are therefore a risk factor for violence and criminal behavior. However, the contribution of specific underlying processes remains unclear. A crucial element of executive functioning, and essential for cognitive control and goal-directed behavior, is visual attention. To further elucidate the importance of attentional functioning in the general offender population, we employed an attentional capture task to measure visual attention. We expected offenders to have impaired visual attention, as revealed by increased attentional capture, compared to healthy controls. When comparing the performance of 62 offenders to 69 healthy community controls, we found our hypothesis to be partly confirmed. Offenders were more accurate overall, more accurate in the absence of distracting information, suggesting superior attention. In the presence of distracting information offenders were significantly less accurate compared to when no distracting information was present. Together, these findings indicate that violent offenders may have superior attention, yet worse control over attention. As such, violent offenders may have trouble adjusting to unexpected, irrelevant stimuli, which may relate to failures in self-regulation and inhibitory control.

Evidence-based treatment and supervision practices for co-occurring mental and substance use disorders in the criminal justice system

BACKGROUND

Over seven million persons in the United States are supervised by the criminal justice system, including many who have co-occurring mental and substance use disorders (CODs). This population is at high risk for recidivism and presents numerous challenges to those working in the justice system.

OBJECTIVES

To provide a contemporary review of the existing research and examine key issues and evidence-based treatment and supervision practices related to CODs in the justice system.

METHODS

We reviewed COD research involving offenders that has been conducted over the past 20 years and provide an analysis of key findings.

RESULTS

Several empirically supported frameworks are available to guide services for offenders who have CODs, including Integrated Dual Disorders Treatment (IDDT), the Risk-Need-Responsivity (RNR) model, and Cognitive-Behavioral Therapy (CBT). Evidence-based services include integrated assessment that addresses both sets of disorders and the risk for criminal recidivism. Although several evidence-based COD interventions have been implemented at different points in the justice system, there remains a significant gap in services for offenders who have CODs. Existing program models include Crisis Intervention Teams (CIT), day reporting centers, specialized community supervision teams, pre- and post-booking diversion programs, and treatment-based courts (e.g., drug courts, mental health courts, COD dockets). Jail-based COD treatment programs provide stabilization of acute symptoms, medication consultation, and triage to community services, while longer-term prison COD programs feature Modified Therapeutic Communities (MTCs).

CONCLUSION

Despite the availability of multiple evidence-based interventions that have been implemented across diverse justice system settings, these services are not sufficiently used to address the scope of treatment and supervision needs among offenders with CODs.

Life satisfaction and perceived stress among young offenders in a residential therapeutic community: Latent change score analysis

Recent rehabilitation frameworks underscore the importance of strength-based interventions for young offenders who may lack internal and external resources to manage their stress and plan for their life. This multi-wave longitudinal study investigated the dynamic relationship between perceived stress and life satisfaction among a group of young ex-offenders in a residential therapeutic community. Four waves of data were collected from 117 Hong Kong youths (24.0% female, mean age = 17.7) over one year. Latent change score analysis was employed to examine the univairate and bivariate changes of their perceived stress and life satisfaction. Results suggest a positive growth trajectory in life satisfaction over time. The results of perceived stress were less conclusive. Bivariate models indicated that the previous level of life satisfaction was negatively linked to the subsequent perceived stress level but not vice versa. The findings suggest that improvement in life satisfaction may reduce perceived stress in young ex-offenders.

[Neurological and psychiatric journals during the Third Reich : National socialistic and racist contents]

The aim of this study was to investigate scientific articles in three German journals for national socialist and racist contents. The three journals evaluated for the period of the Third Reich were the Der Nervenarzt, Deutsche Zeitschrift für Nervenheilkunde and the Archiv für Psychiatrie und Nervenkrankheiten. The specialist disciplines of neurology and psychiatry were united in the year 1935 and Ernst Rüdin, a neurological geneticist, was appointed as president (Reichsleiter) of the society. The universal idea of a degenerative development, which was believed to exert a negative influence on public health, was widely accepted in this time period; therefore, in some articles measures were called for, such as termination of pregnancy, sterilization and castration of diseased people and also of criminals. National socialist ideals became part of articles on nervous diseases, works of art of the mentally ill and suicidal tendencies. The recruitment of volunteers and informed consent for participation in human experiments were not described in scientific publications.

Interventions for drug-using offenders with co-occurring mental health problems: a systematic review and economic appraisal

BACKGROUND

Drug-using offenders with co-occurring mental health problems are common in the criminal justice system. A combination of drug use and mental health problems makes people more likely to be arrested for criminal involvement after release compared to offenders without a mental health problem. Previous research has evaluated interventions aimed broadly at those with a drug problem but rarely with drug use and mental health problems. This systematic review considers the effectiveness of interventions for drug-using offenders with co-occurring mental health problems.

METHODS

We searched 14 electronic bibliographic databases up to May 2014 and five Internet resources. The review included randomised controlled trials designed to reduce, eliminate, or prevent relapse of drug use and/or criminal activity. Data were reported on drug and crime outcomes, the identification of mental health problems, diagnoses and resource information using the Drummond checklist. The systematic review used standard methodological procedures as prescribed by the Cochrane collaboration.

RESULTS

Eight trials with 2058 participants met the inclusion criteria. These evaluated: case management (RR, 1.05, 95 % CI 0.90 to 1.22, 235 participants), motivational interviewing and cognitive skills, (MD-7.42, 95 % CI-0.20.12 to 5.28, 162 participants) and interpersonal psychotherapy (RR 0.67, 95 % CI 0.3 to 1.5, 38 participants). None of these trials reported significant reductions in self-report drug misuse or crime. Four trials evaluating differing therapeutic community models showed reductions in re-incarceration (RR 0.28, 95 % CI 0.13 to 0.63, 139 participants) but not re-arrest (RR 1.65, 95 % CI 0.83 to 3.28, 370 participants) or self-report drug use (RR 0.73, 95 % CI 0.53 to 1.01, 370 participants). Mental health problems were identified across the eight trials and 17 different diagnoses were described. Two trials reported some resource information suggesting a cost-beneficial saving when comparing therapeutic communities to a prison alternative.

CONCLUSIONS

Overall, the studies showed a high degree of variation, warranting a degree of caution in the interpretation of the magnitude of effect and direction of benefit for treatment outcomes. Specifically, tailored interventions are required to assess the effectiveness of interventions for drug-using offenders with co-occurring mental health problems.

Endorsement of Criminal Behavior Amongst Offenders: Implications for DSM-5 Gambling Disorder

The fifth edition of the diagnostic and statistical manual (DSM) has changed the scoring threshold for a gambling disorder (GD) from five criteria to four and eliminated the illegal acts criterion. The impact of these changes was examined with data from a correctional population (N = 676) in Ontario, Canada. The offenders completed a self-report survey that included the Canadian problem gambling index, the South Oaks Gambling Screen and the DSM-IV criteria. Changing the threshold from 5 to 4 improved the convergent validity for GD and resulted in an increase in the percentage of offenders diagnosed with a GD from 7.4 to 10.2 %. The results also indicate that the illegal acts criterion contributes to the convergent validity of GD. The evidence supports the change in the threshold from five to four, but also reinforces the importance of examining illegal acts when dealing with an offender population. The incorporation of illegal acts into the “lying to others” criteria appears to make up, to some extent, for the removal of the illegal acts criterion.

Exposure to violence, typology, and recidivism in a probation sample of domestic violence perpetrators

The present study investigated the predictive utility of self-reported domestic violence perpetrators' exposure to violence in their family of origin and patterns related to this exposure through the use of longitudinal analyses on a sample of 228 men on probation in Lake County, Illinois. Differences in typology, recidivism, recidivism frequency, and violent behavior survival patterns in men with a history of domestic violence perpetration and with varying levels of family of origin violence exposure were examined. Findings suggest that those who witnessed interparental violence (either alone, or in combination with experiencing violence) were most likely to be classified as Generally Violent offenders (e.g., perpetrators who direct violence toward their family and others), compared to those who did not report experiencing or witnessing violence. In addition, results also indicate that men who experienced both witnessing interparental violence and receiving physical abuse in childhood were more likely to recidivate more frequently compared to those who did not report experiencing or witnessing violence. No significant findings for typology and recidivism were noted. Clinical and policy/practice implications are discussed.

Individual placement and support (IPS) for patients with offending histories: the IPSOH feasibility cluster randomised trial protocol

INTRODUCTION

People with involvement in forensic psychiatric services face many obstacles to employment, arising from their offending, as well as their mental health problems. This study aims to assess the feasibility of conducting a randomised controlled trial (RCT) to evaluate the effectiveness of individual placement and support (IPS), in improving employment rates and associated psychosocial outcomes in forensic psychiatric populations. IPS has been found consistently to achieve employment rates above 50% in psychiatric patients without a history of involvement in criminal justice services.

METHODS/DESIGN

This is a single-centre feasibility cluster RCT. Clusters will be defined according to clinical services in the community forensic services of Nottinghamshire Healthcare NHS Foundation Trust (NHCT). IPS will be implemented into 2 of the randomly assigned intervention clusters in the community forensic services of NHCT. A feasibility cluster RCT will estimate the parameters required to design a full RCT. The primary outcome is the proportion of people in open employment at 12-month follow-up. Secondary outcome measures will include employment, educational activities, psychosocial and economic outcomes, as well as reoffending rates. Outcome measures will be recorded at baseline, 6 months and 12 months. In accordance with the UK Medical Research Council guidelines on the evaluation of complex interventions, a process evaluation will be carried out; qualitative interviews with patients and staff will explore general views of IPS as well as barriers and facilitators to implementation. Fidelity reviews will assess the extent to which the services follow the principles of IPS prior, during and at the end of the trial.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the East Midlands Research Ethics Committee-Nottingham 1 (REC reference number 15/EM/0253). Final and interim reports will be prepared for project funders, the study sponsor and clinical research network. Findings will be disseminated through peer-reviewed journals, conferences and event presentations.

TRIAL REGISTRATION NUMBER

NCT02442193; Pre-results.

Older offenders deemed criminally irresponsible in Flanders (Belgium): Descriptive results from a retrospective case note study

INTRODUCTION

In Belgium, offenders who are deemed criminally irresponsible for their criminal actions because of mental illness or intellectual disability are subject to a specific safety measure with the dual objective of protecting society and providing mandated care to the offender. While Belgian law requires that offenders who are deemed criminally irresponsible should be in a hospital, clinic or other appropriate institution outside of prison, in practice, about one-third of all such offenders still reside in prison. Whether imprisoned or living in settings outside prison, there is a dearth of knowledge on the characteristics of the aging population among the criminally irresponsible offenders.

OBJECTIVE

This paper aimed to explore the characteristics of older offenders categorized as criminally irresponsible in Flanders (northern Belgium) with a focus on the differences between imprisoned older offenders deemed criminally irresponsible and their peers who are residing outside prison.

METHOD

A retrospective case note study of all offenders deemed criminally irresponsible, >60years of age (n=174), was conducted in the four Commissions of Social Defense, which implement the procedure in the case of those deemed criminally irresponsible in Flanders. The files were screened for (1) demographic characteristics, (2) criminal history as well as (3) mental and physical health issues.

RESULTS

One-fourth of the population were >70years of age. A total of 30.5% were in prison. Compared to their non-imprisoned peers, the imprisoned offenders had a history of having committed more serious violent crimes towards persons, such as homicides and sexual crimes. In addition, imprisoned older offenders categorized as criminally irresponsible are characterized more explicitly by personality traits that are likely to reduce their chances of being transferred to more appropriate settings in the community.

IMPLICATIONS

A comprehensive and systematic screening of all older offenders deemed criminally irresponsible with regard to health needs and social functioning, including age-related deterioration, alcoholism, and other causes of social disadvantages, is warranted to detect potentially hidden problems.