International Journal of Forensic Mental Health

Healthcare professionals in secure psychiatric services are frequently exposed to service user distress and aggression. Consequently, staff trauma services (STS) have been developed to mitigate the detrimental impact of these experiences. Whilst the increased focus on occupational wellbeing is welcomed, such services have typically evolved in the absence of robust investigations exploring the breadth of the trauma-related needs of healthcare professionals (HCPs). This study explored the profiles of staff referred to an STS and the sequelea of physical and psychological incidents, with a view to improving understanding of need and informing the provision of STSs. Retrospective analyses of demographic characteristics, incident details and psychosocial impacts were conducted. Participants were staff from a secure psychiatric hospital who had received 1:1 support from a dedicated STS. Overall, approximately 4.6% (n = 154) of the workforce accessed the STS. Both clinical (n = 142, 92.2%) and non-clinical staff (n = 12, 7.8%) received support for physical and psychological incidents, occurring in and outside of the workplace. Compared to the general UK population, people who were referred to the STS were less likely to have social support. Staff most frequently accessed the service for work-based physical (n = 65, 42.2%) and psychological (n = 63, 40.9%) incidents. Whilst staff referred following a psychological incident were less likely to be absent from work, they presented with significantly higher levels of psychological distress. This study provides novel insight into factors associated with adverse psychosocial outcomes following trauma exposure, in an understudied occupational population.

Lifespan is reduced by approximately 15 years in individuals suffering from severe mental illnesses such as schizophrenia spectrum disorders. Contributing to this is an increased prevalence of metabolic syndrome, an assortment of factors that confer risk of diabetes type 2 and cardiovascular disease. Body Mass Index (BMI) is predictive of metabolic syndrome. Previous research indicates that the BMI of incarcerated individuals not suffering from a major mental disorder increase during incarceration, especially amongst females. However, information on the development of BMI during forensic psychiatric care is scarcer, and follow-up periods have been short. Thus, the authors extracted data from the Swedish National Forensic Psychiatric Register regarding the longitudinal development of BMI in 3389 individuals who received court mandated forensic psychiatric care in Sweden during 2009–2020. A significant increase in BMI by 1.1% per year was observed during the first four years of care. After this, changes were no longer significant. Factors associated with a larger increase in BMI were female gender, being prescribed antipsychotics, young age at admission, receiving outpatient care, and access to an external support person. There was an inverse association between BMI and symptom severity. Substantial heterogeneity was observed in longitudinal changes in individual BMI and in comparisons between individuals receiving care at different clinics.

Many people treated in secure inpatient services have a serious mental illness and are obese. This study aimed to assess the predictive power of demographic, clinical and pharmacological factors on secure inpatient weight gain during the initial stages of treatment. Retrospective data pertaining to body weight, sex, diagnosis, and prescribed medication was collected for 209 secure psychiatric inpatients. Lower admission bodyweight and non-antipsychotic medication with a low risk of inducing weight gain were the only significant predictors of weight gain (R² = .050). Clinical implications of these findings are discussed.

Restrictive interventions, such as physical restraint, should be a last resort for managing imminent risk. There has been growing recognition of the harmful effects of them, for both staff and service users. Limited research has considered the impact of physical restraint on the therapeutic relationship between staff and service users. The aim of this research was to address this gap in the literature and explore both service user and staff perspectives of the therapeutic relationship after physical restraint, in a UK-based service that provides low and medium secure care for adults. Ten semi-structured interviews were conducted with five service users and five staff members. All participants had been involved in at least one incident of physical restraint. Interpretative Phenomenological Analysis was used to analyze the data. Three master themes emerged from the service user experiences: emotional impact; changes to the therapeutic relationship; and appraisal of the necessity of physical restraint. A further three master themes were produced from the staff member experiences: emotional response; balancing professional roles and responsibilities within the relationship; and moving forward with the therapeutic relationship after physical restraint. Findings support the need to continue to reduce restrictive interventions including physical restraint in secure mental health services and consider the impact upon those involved, both emotionally and relationally. Contemporary approaches to reducing power imbalances between staff and services users, as well as those that would reduce the likelihood of (re)traumatising service users, are also recommended.

In a study undertaken to examine the content validity of the French-language version of the Comprehensive Assessment of Psychopathic Personality (CAPP), a lexically-based conceptual model and clinical assessment of psychopathy, 204 French-speaking mental health professionals rated the symptoms covered by the CAPP for prototypicality. The majority of the symptoms were deemed to be “moderately” to “highly” prototypical of psychopathy. Of the model’s six domains, Dominance, Attachment and Self were considered more prototypical than Emotional, Behavioral and Cognitive. Results were consistent with those of other prototypicality studies. Descriptives analyses suggested that the ratings of English-speaking mental health professionals were higher than their French-speaking counterparts. However, the effect sizes were small according to the Cohen’s d analyses. Confirmatory factor analysis revealed that Attachment was the only unidimensional domain. Finally, exploratory factor analysis yielded three factors—Egotism, Interpersonal rigidity, and Lack of responsibility. These factors were primarily underpinned by symptoms that entailed interpersonal and social cognitive traits.

There is limited evidence in the literature that hostility, anger, and aggression are involved with social anxiety. The present study examined the relationship of personality traits and aggression with social anxiety and social skills in forensic psychiatric outpatients convicted of a violent crime. Social anxiety was mainly contributed to by neuroticism, state anger, and social skills, while neuroticism and social anxiety were the main contributors to social skills. Anger, next to neuroticism and social skills, appeared to be involved in the outpatients’ social anxiety. Neuroticism and social anxiety were found to be the main contributors to social skills.

We examine the psychometric properties of the Weinberger Adjustment Inventory (WAI) from a modern psychometric perspective, including second-order models, better estimation of reliability, and measurement invariance, among a sample of young adults (N = 610, M = 21.33 years, SD = 3.09 years) from Portugal. Results indicated that only the four-factor intercorrelated confirmatory models of the WAI Distress and Restraint scales, and the two-factor intercorrelated confirmatory models of the WAI Defensiveness scales showed adequate fits. The WAI showed good reliability and distinctive correlates with other psychometric measures and criterion variables. Cross-gender measurement invariance was established. Our findings support the WAI as a valid and reliable measure.

Adverse childhood experiences (ACEs) have been consistently linked to interpersonal violence and are highly prevalent in correctional populations, particularly in men who perpetrate (sexual) violent behavior. Although exposure to ACEs is common in men who perpetrate interpersonal violence, less is known about the differences between men who commit sexual versus non-sexual violence. This cross-sectional study reports on the differences in prevalence of adverse childhood experiences in Dutch men who committed sexual offenses (N = 29) versus those who committed (non-sexual) violent offenses (N = 29), all who have been mandated to forensic clinical care. Drawing on data from a RCT-study among male forensic psychiatric inpatients with cluster B personality disorders from seven forensic hospitals in the Netherlands, the study explored potential differences in ACEs, and its relationship to treatability in the first year of forensic treatment. No significant differences were found in prevalence of childhood abuse and neglect among men convicted for sexual offenses versus those convicted for violent offenses. In our study, ACEs were not predictive of risk relating to treatability at the start of forensic treatment. Our findings suggest that taking into account trauma histories is of equal importance for both offending groups. Implications regarding trauma-informed forensic care are discussed.