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.
Read moreEmotional 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.
Read moreIntimate 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.
Read moreThe 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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