International Journal of Forensic Mental Health

With the development of new instruments that formally measure psychopathy in juveniles, questions regarding the negative associations with the psychopathy label have emerged. Using a vignette design, we examined whether the psychopathy label and several characteristic traits elicited punitive sanctions with regard to transfer to adult court, amenability to treatment, punishment, and dangerousness. Five groups were examined; undergraduate college students, law students, judges, clinicians, and developmental experts. We hypothesized that the traits and the label would result in negative associations, with the strongest effect resulting from the presence of both the psychopathy label and its associated traits. Results demonstrated: (1) undergraduate college students believed individuals were more dangerous when psychopathic traits were present; (2) clinicians were less likely to believe the youth was amenable to treatment if the label was present; (3) developmental experts focused on both the label and its corresponding traits in their decision making; and (4) no significant results emerged for either the law students or judges. The psychopathy label had some decision making impact on those familiar with the diagnosis but not with legal experts or undergraduate college students.

The literature on differences between aggressive individuals exhibiting reactive and proactive aggression raises the issue whether different treatment programs should be developed for violent forensic psychiatric patients with a conduct disorder or an antisocial personality disorder. In order to study this issue, aggressive behavior of 133 inpatients and of 176 outpatients was analyzed in detail for four subgroups, composed on the basis of the two factors of the Psychopathy Checklist-Revised. Contrary to expectations, there were no differences found in scores on self-report questionnaires for disposition to anger, hostility and aggressive behavior between the four subgroups. Minor differences were found, however, between these four subgroups in the relationship to aspects of aggressive behavior on the one hand, and neuroticism, social anxiety and social skills on the other hand. To some extent, this explorative study appears to confirm recommendations to distinguish between individuals who exhibit reactively aggressive behavior, and those who primarily display proactively aggressive behavior. In line with our clinical experiences and with our findings, it seems advisable to focus especially on anger management and social skills in the reactively aggressive group and on moral reasoning and prosocial thinking styles in the proactively aggressive group.

Sex offenders (N = 468) were released from custody and recidivism outcome recorded. The Violence Risk Appraisal Guide (VRAG) and Sex Offender Risk Appraisal Guide (SORAG) were scored for each offender. Results indicated that, for the majority of actuarial items contained in the VRAG and SORAG and for VRAG and SORAG bin scores, offenders with lower actuarial scores were released from custody at a significantly older age. Actuarial scores were regressed on age-at-release and residuals saved as age-corrected actuarial scores. Using ROC analysis, predictive accuracy was evaluated comparing original actuarial scores with age-corrected scores. For most item scores and both bin scores, the ability to predict recidivism was significantly reduced after the effects of age-at-release had been removed.

Autonomic measures move beyond self-reports of psychological functioning and may be less prone to bias and measure related errors. This study examined physiological reactions of 64 male offenders diagnosed as personality disorders. According to order by the local court they were subjected to an extensive psychological and neuropsychiatric assessment with regard to release decision making. The results show that violence risk of the PCL-SV, especially Factor 2 (antisocial life style), correlates with the characteristic physiological and cognitive deficits of psychopathy. The predictive relevance of these correlating deficits was also investigated and confirmed in a follow-up study. We conclude that the definition of a personality specific action and life style may be of great assistance in risk assessment. The role of the basal ganglia as neurobiological substrate is also discussed.

Research highlights the distorted nature of print media reporting of both mental illness and homicide. However there are few studies that focus exclusively on the media depiction of homicide perpetrated by mentally ill offenders. The aim of this study was to compare the print media coverage of homicides involving mentally disordered offenders found ‘not guilty by reason of insanity’(NGRI) with a matched sample of homicides involving convicted offenders who did not have a mental illness at the time of the offence. Articles covering twenty cases of NGRI homicide and convicted homicide between 1996 and 2000 in New Zealand were analyzed (N = 207). Coverage of NGRI homicide was more inclined to be highlighted with bold sensationalized titles and photographs; and to attract comments by the friends and relatives of the victims close to the time of the homicide. Furthermore, the past private life of the mentally ill offender was more likely to be revealed and partial blame apportioned to external agencies linked to the event. We conclude that such revelations profile the NGRI offender giving the person a public identity, which assists in etching the event in the public mind.

Schizophrenia is associated with an elevated risk for violence. The response has been to incarcerate people with schizophrenia and to increase the number of forensic beds. Most of these beds are filled by men with schizophrenic disorders with long histories of offending and of treatment in general psychiatry. Outcome from forensic, as compared to general psychiatric services, is unknown. The present study compared outcome defined as levels of positive and negative symptoms, readmission, and aggressive behavior for 248 men with schizophrenic disorders (150 discharged from forensic hospitals and 98 from general adult wards) during a two-year period after discharge from forensic and general psychiatric services. Patients were intensively assessed at discharge and four times during the subsequent two years. Illicit drug use was assessed both objectively and by self-report. More of the forensic than the general patients had failed to complete high school, had displayed a stable pattern of antisocial behavior since at least mid-adolescence, and had convictions for non-violent and violent offences. At discharge and throughout the follow-up period, general patients displayed higher levels of positive and negative symptoms than forensic patients, and more of them engaged in aggressive behavior towards others. Aggressive behavior was associated with positive symptoms and Antisocial Personality Disorder. Rates of readmission were similar for the two groups. The forensic approach that includes assessing and managing the risk of violence as well as treating symptoms of schizophrenia led to better outcome than that of general psychiatry.

Individuals who are treated in mandated forensic psychiatry often spend considerable amounts of time in inpatient treatment. In spite of the fact that there is prescriptive literature identifying how to treat offending issues and substance abuse the study found that treatment addressing this was scarce. The present study examined how time was used by mapping patients' time use in 48 randomly selected days. Information on activities from a 24 hour period divided into 15 minutes segments was recorded. In total, 122 different activities were found and they were grouped into 5 categories, sleep and rest, unstructured activities, daily routines, structured activities, and treatment. Average time use in the different categories was 9.07 hours of sleep and rest, 8.60 hours of unstructured activities, 4.42 hours of daily routines, 1.60 hours of structured activities, and 0.31 hours of treatment. No significant differences in time use on treatment between subgroups of individuals such as diagnoses of substance use, psychotic disorders, personality disorder or assessed as high or low violence risk were found.

This article describes the Community Forensic Mental Health Services in Australia and their different service models. It discusses the service models used and why they have developed this way. The interface between CFMHS, mainstream mental health and secure inpatient forensic mental health services needs to be clear and common issues are outlined. The future directions for CFMHS are suggested, which include demonstrating that CFMHS are effective in delivering what they profess to do.