International Journal of Forensic Mental Health

A critical issue for public policy and professional forensic practice is whether Sexually Violent Predator commitment is an empirically-validated determination. Utilizing a mixed factorial design, forensic psychologists and graduate students were asked to make predictions about offenders' likelihood of future sexual violence and their appropriateness for Sexually Violent Predator commitment. Forensic psychologists demonstrated adequate application of the relevant psycholegal standard, but made accurate predictions approximately one half of the time. Surprisingly, graduate students demonstrated a greater ability to discriminate between types of violent behavior (nonsexual versus sexual), but applied the relevant legal standard with less precision than forensic psychologists. Finally, the current results suggest that emotionallyevocative information in the form of victim statements biased psychologists' and students' predictions of future sexual violence and resulted in students' increased support for the offender's involuntary commitment. Implications are discussed in terms of professional practice and admissibility of psychological testimony in Sexually Violent Predator commitment cases.

Mandating professionals with mental disorder to adhere to psychological or psychiatric treatment in order to maintain their professional license frequently occurs and is rarely controversial. We survey current practices in using a professional license as “leverage” to assure adherence to treatment, and compare mandated treatment for professionals with other, more controversial forms of mandated treatment. Our analysis raises two questions. First, if the same level of high quality treatment now available to licensed professionals with mental or addictive disorders were made readily available to others with these disorders, would the positive outcomes experienced by the former also be experienced by the latter? Second, if the same intensive level of monitoring were applied to others as is now applied to licensed professionals, would rates of treatment adherence between the two groups tend to converge?

Although clinical decisions of future risk are often criticized for being less accurate than actuarial predictions, clinical realities dictate their continued use. The current study assessed mental health professionals' ability to make clinical decisions in an analog context while relying on the data from a previous in-vivo study (Zeiss, Tanke, Fenn, & Yesavage, 1996) in which future violence had been successfully predicted. Results of this study indicate that across multiple violence risk prediction strategies, individual clinicians consistently demonstrated poor ability to predict violence but are much improved when aggregated as “group” decision makers. In addition, clinicians showed consistent ability to assess the severity of future violence accurately

This retrospective study examined the predictive validity of the HCR-20, a violence risk assessment instrument. The HCR-20 as well as the Psychopathy Checklist-Revised (PCL-R) were coded on the basis of file information of 120 patients discharged from a Dutch forensic psychiatric hospital between 1993 and 1999 (average follow-up period 72.5 months). The patients were divided into four groups according to type of discharge: 1) discharge by the court in line with the hospital staff's advice and after a transmural phase; 2) discharge by the court in line with the hospital staff 's advice, but without a preceding transmural phase; 3) discharge by the court against the hospital staff's advice; and 4) readmission to another institution. Recidivism data (reconvictions) from the Ministry of Justice were related to the risk assessments. The base rate for violent recidivism was 36%, and 52% for general recidivism. The HCR-20 and PCL-R total scores demonstrated good predictive validity for violent recidivism (AUC = .82 and .75, respectively). The HCR-20 was a significantly better predictor of violent recidivism than unstructured clinical judgment stated in hospital staff 's advice to the court. In addition, the HCR-20 total score predicted significantly better than the PCL-R total score, although the difference in AUC values was no longer significant when the item ‘Psychopathy’ was removed from the HCR-20 total score.

In British Columbia, Canada, the challenge of caring for mentally disordered inmates in jails has been met with a two-tiered assessment approach: screening followed by comprehensive assessments. Intake interviewers evaluate mental disorder and risk for violence, suicide, self-harm, and victimization. The screening and risk management procedures were published in the Jail Screening Assessment Tool (JSAT). The results of two prospective studies of mental health screening with the JSAT in two samples of women inmates are presented. The first study reports the prevalence of mental health needs among female inmates based on results from JSAT and the Brief Psychiatric Rating Scale-Expanded (BPRS-E). The second study tested the validity of referrals to the mental health program based on ∼20 min. semi-structured intake interviews using the JSAT (includes the BPRS-E) compared to independent evaluations of mental disorder with the Structured Clinical Interview for DSM-IV Non-Patient Edition (SCID-I/NP). Results of both studies indicated a high rate of substance abuse and other serious mental illnesses among female inmates. In the second study, intake interviewers using the JSAT were in agreement with independent SCID assessments at a rate significantly better than chance; yielding a sensitivity of 70.6% and a specificity of 75.0%. These preliminary results suggest the JSAT is a potentially effective tool for identifying female inmates in need of mental health services and specialized placement.

The aim of this study was to identify psychological risk markers for violent female offenders. Victimization experiences, stressful life events, personality disorders and cognitive ability of 61 offenders and 30 nonoffenders were examined by a structured interview and an intelligence test. First-time offenders and repeat violent offenders were also compared on the Hare Psychopathy Checklist-Revised. Offenders had had more adverse experiences in childhood and adulthood than non-offenders, and reported partner related difficulties prior to the index offense. Cluster B personality disorders and more limited cognitive functioning characterized offenders who indulge in substance abuse and had received psychiatric treatment more often than nonoffenders. A comparison of repeat violent offenders and first-time offenders produced no differences in experiences of abuse, whereas domestic violence and parental divorce were more common in families of recidivists than in those of first-time offenders. Antisocial personality disorder, psychopathic traits, substance abuse and non-violent criminality also proved to be more frequent among the recidivists. A comparison of those whose victim was a partner and those whose victim was not a live-in companion did not reveal any significant difference in physical abuse in the partner relationship. The findings revealed that a great majority of women who pose a risk for violent behavior have personality disorder and substance abuse problems. Treatment implications are discussed.

Anger can present as a significant component in the expression of aggression and violence. Anger management is one therapeutic approach that has recorded some success in reducing levels of anger. However, there is a lack of studies that examine the efficacy of anger management with mentally disordered offenders. The present study reviews the development and implementation of an anger management program specifically designed for mentally disordered offenders in a high security setting. Eight male patients who exhibited aggressive behavior within the hospital and had a significant anger problem participated in a 36-week treatment program. The design of the program was successful in ensuring a low dropout rate. Patients were assessed in relation to the frequency and intensity of anger incidents and on a number of psychological variables. Repeated assessment showed positive changes on these measures both during the program and at follow-up. There was a significant reduction in both the frequency and intensity of anger incidents during treatment, which was maintained at 4-week follow-up. The findings are preliminary but encouraging in suggesting that both the style of the program and the evaluation strategy may be appropriate for aggressive mentally disordered offenders within high security settings.

We examined the association between mental disorder and homicide in a developing country. Specifically, we studied culpable homicide offenders referred for psychiatric evaluation in Northern Nigeria, including their psychiatric diagnoses and their relationship with victims. A semi-structured questionnaire was used to collect forensic, demographic, and clinical information from 12,500 patients who underwent court-ordered psychiatric evaluations at the Jos University Teaching Hospital. Of all patients evaluated at the hospital, 1.3% had committed a homicide. Schizophrenia was the most common diagnosis among homicide offenders; there were relatively low rates of antisocial personality disorder and substance dependence. Most offenders knew their victims. The mean duration of time between arrest and psychiatric assessment was 24 months, with a range between 6 to 192 months. We discuss the implications of these findings with respect to motivations for homicide, the evaluation of offenders, and the need for treatment and follow-up of patients.