Ethics, Risk and Recovery—Challenges in Forensic Practice

The practice of recovery-oriented care with individuals who have been found unfit to stand trial or not criminally responsible, and who are subject to review board dispositions, presents a variety of ethical tensions. The assessment and management of risk in a rehabilitative context raises issues of autonomy, confidentiality, and conflicting roles. Awareness of and, where possible, resolution of these conflicts is necessary for the success of the recovery paradigm in this context.

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A Cross-Sectional Survey of Patients and Staff on Inpatient Forensic Psychiatric Units in Canada During the COVID-19 Outbreak

Outbreaks of the coronavirus disease (COVID-19) on inpatient forensic psychiatry units present a unique challenge as early release is not possible and some facilities were not designed to achieve sustained social distancing. The enforcement of droplet and contact (D&C) precautions required by Public Health Ontario during an outbreak creates further confines and restrictions for patients that are typically subject to considerable constraints during their care. From December 2020 to January 2021, 30 clinicians and 12 patients on inpatient forensic psychiatry units under unit-wide D&C precautions during COVID-19 outbreaks completed a cross-sectional survey about their experience. We also conducted virtual focus groups to triangulate the qualitative feedback from clinicians. The survey and focus group discussions revealed similar themes of enablers, barriers, and desired changes to care provision during an outbreak. We discuss findings within the broader context of outbreak interventions and the provision of services to those living and working on forensic psychiatry inpatient units experiencing outbreaks requiring the unit-wide implementation of D&C precautions.

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Emotional Content Analysis Among People With Psychopathy During Emotional Induction by the International Affective Picture System

The emotional processes within people with psychopathy have been thoroughly investigated. Although content analysis is an interesting area for evaluating emotional characteristics, few data exist concerning the speech content of people with psychopathy in response to affective and neutral images. Our study population included male forensic inpatients (n = 47) from Centre Régional de soins Psychiatrique, Les Marronniers, Tournai, Belgium. According to their total score, as measured by the Pscyhopathy Checklist—Revised (PCL-R), the inpatients were divided into three groups: Psychopath (n = 24, PCL-R score of ≥25), Intermediate (n = 12, PCL-R score from 15.0 to 24.9), and Nonpsychopath (n = 11, score of ≤14.9). Using Tropes analyses and EMOTAIX scenario tools, we examined each narrative’s emotional characteristics. We tested the hypothesis that people with psychopathy report fewer emotional words on all International Affective Picture System images, particularly on negative-valence images. Generally, our results do not support this hypothesis, that people with psychopathy report fewer emotional words on all images, but rather suggested a specific discordance in the verbal emotional treatment (exclusively PCL-R Interpersonal factor) but not in terms of the subjective evaluation. Moreover, this interpersonal factor was positively correlated with the self-referring pronouns (i.e., I and me) setting, whereas the PCL-R Social Deviance factor was positively correlated with action verbs. Speech outputs of people with psychopathy present specificities in terms of emotional content and verbal setting. The results are congruent with the notion that psychopathy combines both functionality and subtle impairment.

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Intimate Partner Violence Among Pregnant Saudi Women: Prevalence, Risk Factors, and Attitudes

Intimate partner violence (IPV) during pregnancy has become a focus of attention in recent years, owing to its relatively high prevalence, its impact on maternal and fetal health, and its cumulative effects over time. This study aims to determine the magnitude and characteristics of IPV among pregnant Saudi Arabian women, to identify the factors that increase the risk, and to assess the willingness of abused women to report IPV. This is a cross-sectional, community-based survey of pregnant women in the Eastern Province of Saudi Arabia. A modified Abuse Assessment Score (AAS) questionnaire was used. Sociodemographic data were collected. Data related to willingness to report IPV, including reasons for declining to report IPV, were also collected. A total of 1,330 women completed the three parts of the survey. In total, 345 (25.9%) women reported emotional abuse during pregnancy, whereas 72 (5.4%) reported physical abuse and 180 (13.5%) reported sexual abuse. In emotional abuse, a significant association was found between having more children (p = .001), having a lower education (p = .05), having a lower income (p = .04), and being abused. In physical abuse during pregnancy, no significant associations were found between all variables and being abused. However, in reporting sexual abuse among women during pregnancy, a significant increase in the risk was found in those with four or more children (p = .01) and those who are employed (p = .01). More than two-thirds (71.2%) of abused pregnant women were unwilling to report the abusive acts to a medical authority. IPV is common among pregnant Saudi women. Emotional abuse is the commonest form of IPV, affecting one in four women. More than two-thirds of abused women were unwilling to report their partner’s abusive acts. Screening for IPV may encourage women to seek help and improve both maternal and fetal health.

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The Greats: Perspectives on Excellence in Forensic Psychiatry

For forensic psychiatry to thrive as a profession, practitioners need to be committed to intentional, continuous learning and development throughout their careers. However, carving their way through the challenges of practice and finding room to grow can be daunting. Research can help lessen this burden by examining the careers of experienced and skilled practitioners, identifying the factors that influenced their development, and the strategies they used to direct it. To date, little research of this kind has been conducted in forensic psychiatry. In this study, we used the deliberate practice model of elite performance as a heuristic to interpret the accounts of several experienced and distinguished practitioners, revealing and characterizing the influences and activities they identify as having been most important to their development. Semi-structured telephone interviews were conducted with six participants from across North America who started their forensic careers between 1965 and 1980. Transcripts were analyzed using directed content analysis. Participants cited little in the way of highly structured activities designed specifically to improve performance. They instead described using opportunities to learn from real casework and additional knowledge pursuits, as well as using deliberate career management to structure the conditions of their work-based learning. They also stressed the effect of entering forensic practice during a period of increasing interest, demand and investment, which yielded early opportunities to learn through practice. We discuss limitations in the deliberate practice model’s capacity to capture key learning strategies in forensic psychiatry, connections between work-based learning and the discipline’s general historical trajectory, and the role of career management in professional development strategies.

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Female Sexual Offenders and Judicial Decision-making

Background: Research examining female sexual offending is limited, and the profile of this unique offender group is not well understood. Female sexual offending has largely been identified as a rare occurrence, typically perpetrated in the context of an unhealthy relationship with a paraphilic male counterpart. Given recent changes in law and minimum sentences for sexual offences—particularly in relation to child pornography and child luring offences—it remains unknown how this has impacted sentencing of female offenders charged with sexual offences.
Objectives: The goal of this study is to better understand female offenders convicted of sexual offences and their offence characteristics. Additionally, it seeks to identify patterns in judges’ decision-making with respect to aggravating and mitigating factors that impact sentencing decisions.
Methods: A sample of 26 judges’ sentencing decisions between 2000 and 2017 were obtained to investigate the Canadian female sexual offender (FSO) as she enters the justice system.
Results: In the study sample, high rates of psychopathology and childhood trauma were important features of this offender group. Offences tended to occur over extended periods, with a male co-offender, and with a young victim that was well known to the offender. Aggravating factors related to the vulnerability of the victim, abuse of power, and lack of insight. Mitigating factors related to accepting responsibility and a desire for self-change. Offenders were generally sentenced for two to five years, with ancillary orders intended to track and restrict further offending, rather than foster rehabilitation.
Discussion: Gaining a better understanding of Canadian FSO population is the first step toward improving rehabilitation and prevention.

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Psychiatrie légale canadienne et française : application dans le domaine pénal

L’expertise psychiatrique est une des disciplines de la psychiatrie légale. Sa pratique est spécifique aux juridictions où elle s’exerce et aux ressources qui lui sont attribuées. L’évolution des connaissances en psychiatrie et psychopathologie, ainsi que les décisions politiques ont un impact majeur sur la nature et le déroulement des missions d’expertise. Il existe des différences significatives entre les pays, ce qui surprend fréquemment, puisque la pratique de la psychiatrie générale est quant à elle la même. Nous proposons dans cet article une comparaison entre la pratique de l’expertise psychiatrique pénale en France et au Canada.

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A Review on the Effectiveness of Canadian and American Mental Health Courts

Objective: This systematic review synthesizes mental health court (MHC) research across the United States and Canada. This study reviews and compares the operations and practices of MHCs across both countries, as well as their recidivism rates.

Methods: We gathered from existing literature to present common MHC practices used across the United States. However, in response to the lack of literature about Canadian day-to-day practices, we developed a questionnaire and contacted every Canadian MHC. In total, we contacted 36 Canadian MHCs, and 19 courts filled out a questionnaire. With respect to recidivism rates, we conducted a comprehensive literature search in February and March 2019 in PsycINFO, Google Scholar, Web of Science, and National Criminal Justice Reference Service Abstracts using the keywords mental health court, therapeutic justice, serious mental illness, mentally ill offenders, mental health diversion and problem-solving courts.

Results: Canadian and American MHCs have similar practices. However, American MHC’s have more robust screening measures and typically admit more participants with schizophrenia, bipolar disorder, and major depressive disorder into their programs compared to Canadian MHCs. MHC participants in both countries typically had lower recidivism rates compared to regular docket court participants.

Conclusions: MHC research should inform public policy. Additional research should move in the direction of discovering the predictors for why MHCs reduce recidivism.

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