International Journal of Forensic Mental Health

Introduction: Effectiveness of Responsive Outpatient Aggression Regulation Therapy (ReART-Outpatient) for juveniles with severe aggression problems was investigated. Methods: Re-ART-Outpatient for juveniles (n=44) was compared with a control group (n=48) receiving treatment as usual on several treatment outcome measures. Results: Re-ART-Outpatient showed significantly better results on risk of violent recidivism, impulsivity, motivation, handling anger, self-reported aggressive behavior, and cognitive distortions. Discussion: This could be explained because Re-ART is systemic and individualistic, targeting various aggression-related criminogenic risk factors. Further research with adequate sample sizes, randomized, at multiple locations, with data on actual recidivism, is recommended.

Recent findings have highlighted unique risk factors for female-perpetrated violence as well as limitations in its risk assessment. To address these shortcomings, the Female Additional Manual (FAM) was designed as a complementary tool for the gender-neutral framework of the Historical, Clinical, Risk Management-20 (HCR-20). Little research has been undertaken exploring the predictive validity of the FAM, particularly when used with the most recent version of the HCR-20 (HCR-20v3), leaving equivocal evidence in regards of its use in clinical practice. The present study compared the predictive validity of the HCR-20v3 with and without the FAM for inpatient violence. The sample consisted of 42 female forensic psychiatric patients in a low to medium secure unit in the UK. Results revealed a significant difference in the predictive validity of the HCR-20v3 compared to the FAM when assessing for physical violence and no significant differences between the instruments’ validity in predicting nonphysical and any violence. In line with existing literature, the HCR-20v3 was an overall good predictor of violence. While the FAM was less accurate than the HCR-20v3 at predicting physical violence, it achieved moderate to large effect size in predicting each category of violence. The findings provide a degree of support for using the HCR-20v3 when assessing the risk of violence in women but do not demonstrate improved predictive power when adding the FAM.

Ward atmosphere is an important aspect of forensic mental health care. Positive perceptions have been linked to satisfaction during treatment, quality of life, autonomy, involvement in care, emotional expression and lower rates of aggression. The EssenCES is one of the most widely used measures of ward atmosphere. This study sought to add to the psychometric evidence base for the EssenCES and improve our understanding of how perceptions of ward atmosphere are associated with patient-level factors. N = 233 patients in English low, medium and high security hospitals completed the EssenCES, and data were collected on patient age, length of stay in current institution, level of security, ethnicity, Mental Health Act 1983 section, and mental health diagnosis. We used Mokken scaling, confirmatory factor analysis and multiple linear regression. Our analysis supports the three-factor structure of the EssenCES but signposts areas for improvement, specifically, revising and retesting items 10, 13 and 16. We found that Black, Asian and Minority Ethnic patients report lower Experienced Safety domain scores and that patients with a personality disorder diagnosis report lower Therapeutic Hold domain and EssenCES total scores, when controlling for other variables. We suggest future lines of research and situate our findings in the wider literature.

This study aimed to authenticate the validity and reliability of the 40-item Japanese version of the Forensic Psychiatric Nursing Competence (FPNC-J) scale. We used the FPNC-J scale and conducted anonymous online surveys with 213 nurses who worked in the forensic psychiatric wards, assessed the internal consistency, test–retest reliability, and structural and convergent validities. The goodness-of-fit indices showed a poor fit. An exploratory factor analysis identified four factors. Cronbach’s a and Intraclass Correlation Coefficient indicated moderately good reliability. This suggests that the FPNC-J scale is useful for measuring competence in forensic mental health nursing practice.

The association of ideologically motivated violence with mental health disorders raises specific challenges for security agencies and clinical services. The aim of this paper is to describe the clientele of a specialized intervention program based in Montreal, Quebec, in terms of type of violent ideology and clinical presentation. We conducted a retrospective chart review of 156 individuals referred for violent extremism who received clinical services between 2016 and 2021. Univariate statistics were used to present a description of client sociodemographic and clinical characteristics. Roughly a third of clients referred for violent extremism presented non-ideologically based violence (32.6%), followed by 31.4% affiliated with far-right extremist ideology and over a quarter (25.6%) holding extremist views on gender. Over a third of these individuals had a stress-related (35.7%) and/or mood and anxiety disorder (36.9%), followed by 28% with an autism spectrum disorder diagnosis. The majority had some previous contact with mental health services. A significant number of clients displaying extremist discourses and/or actions needed psychiatric services but often failed to receive them because of the reluctance of clinicians to work with individuals perceived as high risk; in addition, individuals may be reluctant to engage in services perceived to be part of a socio-political system they reject. Specialized services are important as a means to provide mental health care to this group and also to develop knowledge and best practices for working with this clientele and provide consultation to mainstream mental health service providers.

This study aimed to explore staff and patients’ views on the violence prevention climate in civil and forensic mental health settings. We conducted a cross-sectional survey of 110 inpatients and 198 staff members from three civil mental health hospitals (including two forensic units) and one forensic mental health hospital in Canada. Staff and patients’ perceptions of the violence prevention climate on civil and forensic mental health units were measured using the modified violence prevention climate scale, French version (VPC-M-FR). Multiple analyses of variance (ANOVAs) were performed to assess differences in the VPC-M-FR total and subscale scores (staff action, patient action, therapeutic environment) between patients and staff, settings (civil vs. forensic), restrictive practices (presence vs. absence of seclusion or restraints), incidents of violence during hospitalization (presence vs. absence), and victimization (presence vs. absence). In both settings, patients’ views of the violence prevention climate were significantly more positive than those of the staff. Staff in forensic mental health settings had a more positive perception of the violence prevention climate than those in civil mental health units. The results contribute to a better understanding of the violence prevention climate among staff and patients and will guide future interventions within civil and forensic settings.

In Germany, short leave is an integral part of treatment in forensic psychiatric hospitals. It is believed that the practice has many benefits for patients’ well-being and their treatment progress. However, the risk of an incident in the form of absconding or new offenses may be especially heightened during unsupervised short leave. This study analyzes the impact of unsupervised short leave on treatment progress using a pre-post design with follow-up and a sample of 298 forensic psychiatric patients. Furthermore, incidents on short leave were considered in the analysis. The results of the study suggest that unsupervised short leave can foster treatment progress. However, they also reveal that incidents during leave can disrupt the progress of treatment.

The DUNDRUM Programme Completion (D3) and Recovery (D4) scales present a promising approach to a recovery-oriented and collaborative method of assessing risk, need, and rehabilitative tasks in forensic settings. We collected clinician- (n = 185) and patient- (n = 118) rated D3 and D4 scores across three security levels (medium, minimum, and outpatient) in a large Canadian forensic service over a 12-month period. Results supported the construct validity of the D3 and D4, showing that clinician (D3 and D4) and patient (D4 only) ratings differed across inpatient and outpatient settings, with lower outpatient scores signaling greater progress in treatment and recovery goals. Only clinician-rated scores differed across patients with moves from higher to lower levels of therapeutic security to those with no movement over the study period. Concordance analyses revealed poor to modest agreement between clinician- and patient-rated item scores, with patient self-ratings observed to be more optimistic than their clinician counterparts. However, concordance strengthened as patients progressed from higher to lower levels of security and restriction. Current findings add to the literature on the feasibility of shared approaches to care planning, and provide validation data for the DUNDRUM scales as part of available tools in collaborative, recovery-oriented forensic care.