International Journal of Forensic Mental Health

Racialized people are over-represented in the forensic mental health system, yet little is known about how ethnoracial status and associated proxies (country-of-birth, citizenship, and official language fluency) relate to care trajectories and length of time spent in the system. This study investigates the associations of ethnoracial status, country-of-birth, citizenship status, and official language fluency with the forensic mental health trajectories of 283 people found Not Criminally Responsible on account of Mental Disorder (NCRMD) in Ontario, Canada. A majority (54%) of patients were not White, 41% of the sample was born outside of Canada, 28% were not Canadian citizens, and 6% were not fluent in either of Canada's official languages (English and/or French). Being born outside of Canada, not being a Canadian citizen, and not being fluent in an official language were associated with longer times spent under the care of the forensic system. Being born outside of Canada and a lack of official language fluency continued to be significant correlates of time spent in the forensic system even after accounting for relevant factors including violence risk, primary diagnosis, and index offense severity. Results are discussed within the context of optimizing forensic mental health services that are effective, equitable, and just.

Forensic psychology has historically focused on assessing and managing deficits that contribute to offending. Recently, there has been a push across fields towards focusing on strengths in both assessment and treatment, which may have therapeutic benefits for clients (e.g. emotional well-being, positive identity, therapeutic alliance). As this has yet to be tested, we conducted a pre-registered experiment to examine the effects of strength- and risk-focused interviews on a number of therapeutic process variables. A sample of individuals on probation were randomly assigned to have a strength-focused (n = 51) or risk-focused interview (n = 50). Immediately after and 1 month later, participants completed measures of affect, alliance, engagement, motivation to change and identity. Contrary to our pre-registered hypotheses, participants who had a strength-focused interview did not report more positive affect (p = .46, η² [95% CI] = .027 [.000, .077]), a stronger alliance with the interviewer (p = .92, η² [95% CI] = .005 [.000, .051]), more engagement (p = .58, η² [95% CI] = .020 [.000, .071]), or greater readiness to change (p = .19, η² [95% CI] = .061 [.000, .092]) than those having a risk-focused interview immediately or 1 month later. However, participants who had a strength-focused interview perceived themselves as less likely to reoffend in the future (p = .02, η² [95% CI] = .051 [.000, .154]), which remained significant 1 month later when we controlled for interviewer adherence to condition (p = .04, η² [95% CI] = .052 [.000, .17]). We offer minimal initial support for the unique benefits of strength-focused (vs. risk-focused) interviews. Future research should use larger samples with adequate power to detect small effects and examine if strength-focused interviews are beneficial for culturally and linguistically diverse groups.

Research suggests traumatic brain injury (TBI) may be a potential risk factor for reoffending. However, prior research has rarely accounted for other criminogenic risk factors to evaluate incremental predictive utility of TBI for recidivism. The current investigation was a secondary analysis of data from a sample of 95 men incarcerated at a secure reentry facility; 73 had complete data concerning demographics, criminogenic needs, TBI history, and recidivism for analysis. The observed TBI prevalence rate was within the range of prior studies, and there was some evidence to suggest that persons with a history of TBI exhibited increased rates of recidivism. Only age and a history of TBI were predictive of recidivism at approximately 1 year follow-up. The consistency of these tentative findings with prior research is discussed. Suggestions for future research to overcome limitations that impacted the current investigation's aims, and a tentative practice suggestion for correctional intervention services, are offered.

Knowledge about females who commit lethal violence is limited compared to what we know about their male counterparts. The overall aim of this study was to investigate links between psychopathy, type of violence, and severe mental disorder (SMD), among Swedish female offenders of lethal violence. All records for female offenders (N = 175) who underwent a court-ordered forensic psychiatric investigation in Sweden charged with lethal/attempted lethal violence, between 2000 and 2014, were included. Structured assessments were done based on the Psychopathy Checklist-Revised (PCL-R) concerning psychopathy, and the Violent Incident Coding Sheet (VICS) concerning instrumental/reactive aspects of the crime. Overall, the female offenders were characterized by relatively low levels of psychopathy and acted based on reactive rather than instrumental motives. Modest associations appeared between psychopathy and instrumental, rather than reactive, features of the crime. However, the SMD group (n = 84) scored lower on PCL-R total and interpersonal facet 1, somewhat higher on VICS arousal and planning (<24 h vs. no planning), while showing inconsistent but generally lower scoring on provocation. PCL-R facet 1, and the secondary VICS classifications appeared as covariates associated with an SMD. These results contribute to our understanding of the driving mechanisms and complexity behind female lethal violence, where the SMD group showed a somewhat unexpected multifaceted pattern, including reactive and instrumental VICS aspects. This has especially consequences for the assessment and handling of female offenders of lethal violence within forensic psychiatry and correctional services, also calling for further research focusing on this population.

There is a growing body of literature that describes patients, carer and staff experiences of restrictive practices used to manage incidents of violence and aggression in general mental health, however, there is little empirical work exploring the issues in adult forensic mental health in-patient care. This is despite forensic mental health settings reporting higher use of restrictive practices than other mental health settings. This study aimed to explore the experiences of patients, carers and staff exposed to incidents of violence and aggression where restrictive practices were used, and to identify opportunities to enhance the prevention and management of violence and aggression. A purposive sample was recruited from five adult forensic mental health in-patient clinical settings. Semi-structured interviews were conducted with 46 participants; eight patients, three carer co-ordinators and 35 staff. Thematic analysis was used to analyse data, identifying three themes: Tension Between Three Standpoints; The Will To Get It Right; and Outside Looking In. The study identified a chasm exists between policies and practice that espouse collaboration, inclusion and experiences of patients, carers and staff. Opportunities were identified to bridge this chasm such as implementing policy and practice standards that enhance communication and collaboration between patients, carers and staff.

The growing role of the justice system in the care of individuals with mental illness has led to concerns about access to adequate and timely mental health services, particularly for persons with severe mental illness whose behaviors increase their risk of justice involvement. This study investigated the perceptions of people found not criminally responsible, their loved ones, peer support workers, and other mental health professionals and managers regarding access to effective and relevant mental health services. Semi-structured interviews and focus groups were conducted with 25 participants, and data analyses were carried out according using thematic analysis. The findings highlighted how past experiences of stigma, trauma, inefficiency, and discrimination within a hospital-centric system influenced service users’ and caregivers’ ability to seek and engage with care. Current access mechanisms, such as police intervention and emergency room visits, were described as unacceptable and often viewed as options of last resort. Consequently, service users frequently entered the healthcare system only when their needs had escalated in complexity, making them difficult to address within the scope of standard clinical practice. Implications for policy and service organization are discussed.