International Journal of Forensic Mental Health

Narcissism is a personality construct with grandiose, and vulnerable aspects, that are interconnected through antagonistic characteristics. While antagonism is strongly related to antisocial behavior, the role of narcissism remains underexplored in offender rehabilitation practice. Research in non-forensic samples has already shown promising results in the differential associations for grandiose and vulnerable narcissism in relation to violent and antisocial behavior and treatment responsiveness that could be relevant for offender rehabilitation. To research the meaningfulness of both narcissism aspects for forensic offender rehabilitation practice, we systematically reviewed the electronic literature databases CINAHL EBSCOhost, Cochrane CENTRAL, EMBASE, Medline All Ovid, PsycINFO Ovid, and Web of Science Core Collection. Subsequently, we synthesized the outcome into meaningful data classifications related to the risk of violence in offender populations and treatment responsivity. In total, 14 publications on forensic samples were included. Overall, the findings suggest that grandiose narcissism was strongly related to proactive violence and a low treatment responsiveness. Vulnerable narcissism was associated with reactive aggression, mediated by impulsivity and negative emotions, and with a moderate responsivity level. As such, both narcissism aspects seem relevant for the development of structured and focused treatment plans in offender rehabilitation practice. The implications for offender rehabilitation practice are provided.

Pro re nata (PRN, as-needed) medication is commonly used in forensic psychiatric inpatient care, but little is known about the participation of patients in its prescription and administration. This study describes patient participation in PRN medication treatment in forensic psychiatric inpatient care. Data were collected during interviews with 34 inpatients and 19 registered nurses in a Finnish forensic psychiatric hospital. The data underwent inductive content analysis. We found that patient participation in PRN was related to patients’ individual needs and health conditions, and the use of PRN involved private decisions made in the social context of the ward. PRN was an integrated part of daily care, and it involved three stakeholders, namely patients, nurses, and physicians; however, the role of patients in this collaboration was undefined. The administration events for PRN were multiform, and depended on the level of agreement between patients and nurses on the need for PRN. In the future, more attention should be paid to how to motivate patients and provide them with equal opportunities to be involved in the planning of PRN, and to optimize shared decision making so that the expertise of both patients and nurses is utilized in the administration and evaluation of PRN.

Fitness to stand trial (equivalent to competency to stand trial) requires that defendants have a basic understanding of the purpose of the trial and the trial procedures. Little is known, however, about what constitutes a basic factual understanding of the matters. This study developed a legal knowledge survey in which participants were asked to define legal concepts and respond to legal scenarios. They then rated the importance of each component of the fitness to stand trial test to achieving a fair trial. Participants (N = 393; females 69.7%) aged between 18 and 66-years (M = 31.26-years, SD = 11.48-years) from each Australian state and territory completed the online survey. Legal knowledge was high (86.5% correct) and there was no difference between participants on any clinical (e.g., current or past mental illness, neurological conditions), criminological (e.g., criminal history), or demographic variable (e.g., gender, employment, education), except age (curvilinear R² = .12). Participants under 30-years old used significantly more Americanisms on difficult items compared with participants over 30-years old. On average, participants rated almost every component of the legal test as “extremely important” to a fair trial. The legal knowledge survey had good psychometric properties (Cronbach’s α = .86, interrater reliability ĸ > .80 on most variables, single solution factor analysis). Overall, the results support the presumption underpinning the Australian test for fitness, which is that people possess a basic factual understanding of a trial and trial procedures. Further research should focus on testing knowledge in special populations (e.g., mental illness, dementia, intellectual disability).

To purpose of the current study was to inform system level decision-making about the value of integrating clinically relevant personality information with criminogenic need risk appraisal in justice-involved youth. Using a Canadian sample of youth referred for court-ordered psychological assessments (N = 201, M _age=15.62 years; 70% male), we examined the patterns of association and differentiation between youths’ Youth Level of Service/Case Management Inventory (YLS/CMI) criminogenic need/risk profiles with personality profiles derived from the personality scales of the Millon Adolescent Clinical Inventory (MACI, Millon, Millon adolescent clinical inventory. National Computer Systems, 1993). Specifically, latent profile analysis identified four MACI based personality profiles: externalizing, internalizing, dependent/followers, and complex dysregulated personality profiles. These groups varied significantly on YLS/CMI risk-need profiles. Although both externalizing and complex dysregulated sub-types represented higher criminal risk, their intervention needs diverged meaningfully. These results provide insight into the heterogeneity of justice-involved youth and point to the need for system resources that allow for appropriate intervention matching to maximize the goal of recidivism risk reduction in youth.

Waypoint Centre for Mental Health Care expanded its facility in 2014 to include a new state-of-the-art forensic hospital building, called the Atrium. Prior to moving Waypoint’s forensic programs into the Atrium, the Therapeutic Climate Study (TCS) was launched in order to monitor changes in perceived and objective safety indicators among forensic staff and patients. The present study consisted of a 5-year cross-sectional sequential design, consisting of both survey and hospital administrative data. Across all years of data collection, inpatients ( N total = 256) reported higher perceived safety when compared to staff ( N total = 932). However, changes in perceived safety were not linear and only slightly improved for staff over time. Sociodemographic characteristics and perceived recovery measures predicted perceived safety for staff and inpatients, regardless of the move. Male staff reported higher perceived quality of patient-service provider relationships and lower perceived safety, whereas female staff reported higher perceived patient cohesion and higher perceived safety. Both staff and inpatients who perceived the hospital’s principles and practices as more recovery-oriented reported higher perceived safety. Inpatients who have been at the hospital longer reported lower perceived safety, regardless of the move. Hospital administrative data showed the number of incidents in a centralized emergency response system spiked right after the move but eventually tapered off, whereas the rates of violent incidents had increased and remained higher since moving to the new building. Results from this study suggest that staffs’ and inpatients’ sense of safety is determined by multiple factors, of which physical environment seems to play a less central role.

Mentalization Based Treatment (MBT) is offered as a potential treatment for clients with Antisocial Personality Disorder (ASPD), however, research suggests that delivering MBT can often present challenges for clinicians. Furthermore, there is agreement that working with clients with ASPD can significantly impact upon staff wellbeing. This project highlights the challenges experienced by clinicians when delivering an MBT service with adult offending males with ASPD within the community. Interpretative Phenomenological Analysis was conducted following semi-structured interviews with six MBT clinicians. Findings highlight how the challenges of working with clients with ASPD presented a significant threat to clinicians’ professional identity. These challenges were compounded by confusion surrounding the MBT model, lack of support from multidisciplinary staff and insufficient service infrastructure. MBT clinicians’ attempts to overcome these barriers led to them striving and breaching time boundaries, leaving them at risk of burnout. These findings contribute to existing literature surrounding clients with ASPD and provide new insight into implementation barriers when delivering a community based MBT service with this client group.

In Belgium, when forensic patients infringe their conditional release, they are remitted to prison. Given the poor conditions of detention and the current lack of alternatives, revoking conditional releases has a high impact. However, little is known about which patients are remitted to prison and why. In this article, we compared a sample of remitted patients (n = 50) to a matched control group (n = 48). We found that patients with high actuarial risk factors (as assessed by the Violent Risk Appraisal Guide, VRAG), antisocial personality disorder traits (measured by the Comprehensive Assessment of Psychopathic Personality, CAPP), and substance abuse disorder were more likely to be remitted. New acts of violence and substance abuse are the most prevalent reasons for revoking a conditional release, at 71% and 65%, respectively. The current results are independent of living conditions, and highlight the need for future research regarding this subgroup of forensic patients, who are more likely to be set back in their rehabilitative processes.

Mentally Disordered Offenders (MDOs) who have been declared not criminally responsible for their offense due to their mental condition should be admitted to settings with lowest possible level of security to support their social reintegration. In the context of the reorganization of care for MDOs in Belgium, we assessed the predictors and retrospective appropriateness of 3529 MDO admissions in 2017 according to security needs. Although there was a positive association between the security needs of MDOs and the level of security of the settings to which they were admitted, there was a gap between high and lower security levels. Medium-security settings made up 46% of all admissions, covering a variety of security need profiles. Half the sample of MDOs with high security needs was found in low- and medium-security settings, while a significant proportion of MDOs with low security needs was found in medium-security settings. Clinical characteristics predicted admissions more strongly than custodial characteristics. Decision-makers should refine criteria and procedures for MDOs’ care access. Indeed, the mixed results in relation to admission appropriateness in medium-security services may result from the lack of formal guidelines.