International Journal of Forensic Mental Health

This article identifies research priorities for the field of forensic mental health. What is known about the association between mental disorders, retardation, brain damage and offending and violence is briefly reviewed. It is noted that while some of the correlates of offending are common to both non-disordered and disordered offenders, others characterize specific subgroups of mentally disordered offenders. The evidence is consistent in showing that most mentally disordered offenders have multiple problems that have been present, in many cases, since childhood. Knowledge about effective treatments for mentally disordered, mentally retarded, and brain damaged offenders is highlighted. It is concluded that there is a lack of information about the organization, legal powers, and content of treatment, management, and rehabilitation programs that have been shown to impact on recidivism, relapse, and autonomous functioning. Almost nothing is known about the impact of various social services. Future research should be designed to contribute to (1) improving the efficacy of models of service organization; (2) improving the efficacy of treatment, management, and rehabilitation programs; (3) improving the efficacy of the multiple components included in treatment, management, and rehabilitation programs; (4) integrating risk assessment of violent behavior into treatment, management, and rehabilitation programs and improving the accuracy of prediction; (5) identifying the etiologies of offending and violence among persons with mental disorders, mental retardation, and brain damage; and (6) preventing offending and violence among children at risk for mental disorders.

This study focuses on the foundational issue of change in violence risk factors in forensic psychiatric patients across multiple assessment periods using the HCR-20 scheme. HCR-20 assessments performed on 150 forensic psychiatric patients at two special (forensic) hospitals in Sweden were studied in relation to the patients' time at institution, with the aim to investigate a possible relation between level of risk and time at institution. A sub-group was followed across an 18-month period of institutionalization to investigate possible changes in risk factors over time. The latter patients were assessed with the HCR-20 three times, with six months between the assessments. Patients with longer treatment times had lower scores on the HCR-20 Clinical and Risk Management sub-scales, compared to patients who had been admitted to the hospitals for a shorter period of time. This finding was particularly evident on the cross-sectional analyses with respect to the R scale. The clinical risk factors in the C scale also dropped overall in connection with treatment time across both cross-sectional and prospective analyses, although not as substantially as the R scale. The results are consistent with and provide support for the HCR-20 system's proposition that the C and R scales are dynamic, or prone to change.

Although there has been extensive research on violence risk assessment in the past decade, it has not been examined whether clinicians in actual practice consider violence risk factors that researchers suggest should be utilized. The purpose of this study was to investigate clinicians' perceptions of factors derived from research on violence risk assessment. One hundred thirty-four clinicians from four psychiatric facilities completed surveys in which they rated the relevance of research risk factors as well as additional behavioral variables. The analyses indicated that while clinicians perceived research risk factors to be relevant, they perceived behavioral variables not subjected to empirical scrutiny as significantly more relevant for violence risk assessment. The findings have implications for dissemination of risk assessment research and the development and implementation of risk assessment measures.

The present study compared the utility of two measures of psychopathic traits, the Antisocial Features scale of the Personality Assessment Inventory (Morey, 1991) and the Psychopathy Checklist-Revised (Hare, 1991), to postdict serious institutional misbehavior among incarcerated sex offenders. Archival disciplinary infraction data for 92 offenders were coded as major acts of physical aggression, major acts of verbal aggression/ defiance, or non-aggressive major offenses. Receiver Operating Characteristic (ROC) analyses indicated that ANT performed comparably to the PCL-R in terms of predicting the occurrence of these infractions during the prior two years, although there was a trend for PCL-R scores to be associated somewhat more strongly with physically aggressive offenses. Regression analyses indicated that each measure accounted for unique variance in the criterion variables, suggesting that both may evidence incremental validity in terms of their relation to disciplinary infractions.

Researchers and clinicians have devoted increasing attention to Asperger's syndrome during the past two decades. Although Asperger's syndrome is a developmental disorder, professionals in a variety of settings have begun to consider the diagnosis among adults who manifest social and communication abnormalities. Case studies (e.g., Baron-Cohen, 1988; Kohn et al., 1998) and prevalence research (Scragg & Shah, 1994) from forensic settings indicate that a small subset of Asperger's syndrome patients come into contact with the legal system due to their social impairments and idiosyncratic interests. We provide case histories of individuals with Asperger's syndrome encountered in forensic contexts and discuss the implications of this disorder for forensic clinicians. Our six cases were notable for certain commonalties, including deficient empathy. The cases also revealed ways in which Asperger's patients tend to differ from most individuals in forensic settings.

This article presents findings from a national postal survey of mental health practitioners' views about key aspects of current legislation and proposed law reform regarding the use of compulsion in England and Wales. Differences between psychiatrists, general practitioners, approved social workers, and Mental Health Act Commissioners were examined. Data from 2022 respondents revealed strong areas of agreement between practitioner groups about the circumstances where legal compulsion (the use of forcible treatment; abridgement of the right to refuse treatment; the use of detention) should be available. The results also demonstrated, however, considerable attitudinal distance between practitioners and core aspects of the reforms proposed by the government. Given that the governmental proposals appear to be at odds with the prevailing views of practitioners, there is likely to be substantial resistance to implementing core aspects of the reforms. The contentious areas include over-riding refusal of treatment by patients who retain their capacity to decide for themselves, as well as the preventive detention of those with untreatable personality disorder.

Terbeschikkingstelling (TBS) is a provision in the Dutch criminal code that allows for a period of treatment following a prison sentence for mentally disordered offenders. This article describes the legal criteria as well as the actual treatment environment of the TBS. Discussion focuses on the selection of patients and the indications for treatment, quality improvement in treatment programs and their evaluation, and the exchange of knowledge about the TBS approach and its effectiveness.

This article describes the case of a hospitalized psychiatric patient who colluded with hospital police in a “sting” operation designed to catch a hospital employee selling drugs. The patient had failed a drug test and was told that he could avoid criminal charges by cooperating in the “sting.” We argue that the patient was asked to enter into a contract with the hospital police when he was pressed to collude with them in the “sting” operation and that his competence to enter into that contract should have been formally assessed. Although there are no explicit legal criteria that must be met for a person to be competent to collude with police, recognized criteria exist for determining a person's competence to enter into a contract. Our position is that hospitalized patients should only be permitted to collude with police when they are competent to enter into a contract and can enter into the contract voluntarily. Research pertaining to psychiatric patients' abilities to meet these criteria is reviewed, and implications for mental health practitioners with patients who may be asked to collude with police are discussed.