International Journal of Forensic Mental Health

The need for effective mental health interventions for specific offender populations has become clear in recent decades. In particular, individuals who engage in stalking and harassment have increasingly attracted the attention of the public and mental health and criminal justice professionals, however no evidence-based treatment currently exists for this population. We adapted Dialectical Behavior Therapy (DBT) for the treatment of this offender group, in part because of the high prevalence of personality disorders. This study describes the application of a 6-month treatment program to a sample of 29 individuals, 14 of whom completed treatment. Treated offenders were significantly less likely to re-offend with another stalking offense (0 of 14) compared to treatment drop-outs (26.7%) or to published recidivism data (47%). Measures intended to help determine the nature of changes revealed increased thought suppression, but are qualified by the high degree of defensive responding. These preliminary data suggest that DBT holds promise for reducing stalking behaviors and warrants further study.

Involuntary psychiatric treatment is sometimes necessary and beneficial, but may also exert negative effects. The impact of involuntary commitment on subsequent mental health treatment experience is poorly understood. We examined whether history of involuntary commitment was associated with current perceptions of coercion in a sample of voluntarily hospitalized veterans (N = 205). In adjusted analyses, perceived coercion during the voluntary admission was significantly associated with prior history of involuntary commitment (Rate Ratio = 1.60, p = .05). Perceived coercion was also higher among participants who were married/cohabiting (Rate Ratio = 1.83, p = .01) and among those with greater functional impairment (Rate Ratio = 0.97, p = .04). Although frequently unavoidable, the current results underscore the potential negative effects of coercive practices such as involuntary commitment, and support the importance of policies that aim to minimize coercive treatment experiences among psychiatric patients.

Although it is generally presumed that there will be an association between the levels of security at which clients are held in a forensic hospital and the formal ratings of violence risk ascribed to them, such a relationship is seldom demonstrated. One measure in this study was the security level of 218 inpatients held in a German forensic hospital. The other measure was the C- and R-score of the HCR-20 (CR-10). The results were clear in showing an orderly correspondence between the two measures (C-scale: r = .37; Rscale: r = .52). The CR-10 part of the HCR-20 seems to be a useful measure to gauge progress in forensic psychiatric inpatient treatment.

Despite theoretical speculation suggesting psychopaths have superior memory for their autobiographical experiences in comparison to nonpsychopaths, little published research has directly assessed this issue. This lack of research formed the impetus for the present investigation. As part of a larger study investigating variables associated with episodic memory in adult male offenders, 150 violent crime perpetrators were interviewed at two federal penitentiaries in British Columbia, Canada. The participants' memories for three different acts of perpetrated violence were elicited (i.e., acts of instrumental and reactive violence and a poorly remembered act of violence) and exhausted for detail. The sample was dichotomized by psychopathy status via the Psychopathy Checklist-Revised (PCL-R; Hare, 1991, 2003). Consistent with certain assumptions of Hervé, Cooper, and Yuille's (2007) biopsychosocial model of eyewitness memory, the pattern which emerged indicated that psychopathic participants reportedly had better memory for their acts of violence in comparison to nonpsychopathic participants. The results are discussed in terms of how the present research supports the extant research and theories. Future directions for empirical investigations and implications for the criminal justice system are offered.

Drawing on recent advances in the violence risk assessment literature, this study tested the predictive validity of two structured measures designed to support risk related decision making, the HCR-20 and the Dynamic Appraisal of Situational Aggression (DASA), for the prediction of imminent aggression and self-harm in personality disordered patients of a high secure psychiatric hospital. For four months nursing staff completed daily assessments of patients using the DASA and the Clinical scale items from the HCR-20. On the following day they documented whether patients had behaved aggressively and/or self-harmed. Results revealed modest predictive validity, significantly better than chance, for both the prediction of imminent self-harm and aggression for both measures. Furthermore, these results suggest that personality disordered patients in a negative psychological state characterized by irritability, impulsivity and disagreeableness are at an increased risk of aggression and self-harm during involuntary psychiatric inpatient treatment and that this state is sensitive to structured risk assessment.

The ability of the MMPI-2 validity scales to differentiate mentally ill defendants who denied being mentally ill from mentally ill defendants who acknowledged their illness and those without mental illness was investigated. A stepwise logistic regression analysis (LGA) was utilized to identify the most parsimonious set of predictors among the MMPI-2 validity measures. The F and K scales and the Es-K index significantly differentiated the denying mental illness group from those acknowledging their psychiatric difficulties with a high degree of accuracy. An ROC curve utilizing the prediction scores from the LGA yielded an area under the curve of .89. An attempt to validate the model by differentiating the denial participants from those with no mental illness resulted in a marked decline in classification accuracy. The results are discussed in terms of the utility of the MMPI-2 in the detection of under reporting of psychiatric difficulties.

During the past 15 years, a small body of literature has accumulated regarding the temporal relationship between schizophrenia and crime. Many forensic patients have a history of psychiatric care before committing an offense, but such care was often inadequate. Comorbid disorders such as substance abuse and an antisocial personality disorder and/or psychopathy may be responsible for earlier referral of psychotic patients to psychiatric care in connection with the resultant early behavioral problems. In connection with the inadequate care for forensic patients, it is possible that a period of untreated psychosis occurs more often and is of longer duration. The purpose of the present study was to assess these findings. We considered three groups: two groups of forensic patients with a psychotic disorder, with or without a comorbid personality disorder, who have committed a serious violent offense, and a third group of psychotic patients from the general psychiatric population who have not committed a serious violent offense. Retrospective data were collected and the sociodemographic, substance abuse, diagnostic (DSM-IV) and psychiatric history variables were compared. The score on the PCL-SV was taken into account. Psychotic patients detained under the Dutch Entrustment Act (i.e., TBS-detainees) with a comorbid personality disorder began their psychiatric career before committing a violent offense. A long time was found between the first admission and the TBS-offense. Psychopathy and substance abuse influenced these intervals. No difference was found between psychotic TBS-detainees and psychotic patients in general psychiatry with regard to the duration of untreated psychosis. The recognizability of the various groups of psychotic patients in general psychiatry could have a preventive effect if the comorbidity is examined.

Until recently few empirically supported treatments for patients with personality disorders were available. Schema Focused Therapy (SFT) has recently shown efficacy in (non-forensic) outpatients with Borderline Personality Disorder, raising the question if it may also be effective in forensic PD patients. For the past two years, we have been collaborating with Dutch forensic hospitals to adapt the SFT approach to meet the challenges posed by this population. In this article, we present our forensic modification of the SFT theoretical model, and make recommendations for the implementation of SFT in forensic clinical practice.

The present study aimed at describing and evaluating the effectiveness of a comprehensive aggression management program in an adolescent forensic unit. Six-month trends in figures for aggressive behaviors against staff, and rates and characteristics of physical interventions to control aggression were studied over 2 years using irregularity reports from the study unit, and structured forms filled in by the nursing staff immediately after each event. Events of verbal and physical aggression decreased as the implementation of the aggression management program stabilised. Physical interventions became shorter over time. Injuries to the staff became less frequent. A systematic and comprehensive aggression management program allows improvement of aggression management without increasing use of coercion. As the use of coercion decreases, the staff injuries decrease.

This article compares civil law issues associated with involuntary hospitalization in psychiatric establishments of 12 European countries, and comments on differences important for clinical practice. A cross-validated methodology based on original legal texts was used. Major cross-national differences appeared for basic conditions as well as additional criteria for involuntary admission, time periods for making decisions, the association between involuntary placement and treatment, patients' rights to register complaints, roles of relatives, and safeguard procedures of these processes. Suggestions for cross-national harmonization focus on: simplification of the legal decision process, standardization of time periods for judicial decisions, transparency of regulations to lodge appeals and to involve persons from the patient's environment into the judicial procedures, and establishment of permanent and active monitoring of safeguard measures.