Almost five years ago, the first issue of the International Journal of Risk and Recovery (IJRR) arrived in an already crowded medical journal market (Chaimowitz, 2018). It strove to both address key forensic psychiatry issues and to make the articles readily accessible for forensic psychiatry clinicians. The journal aimed to focus not only on the myriad of risk issues but also on the rehabilitation of forensic psychiatry patients and especially the application of recovery principles to this patient population (Simpson & Penney, 2011). Finding and maintaining the balance between risk and recovery was key.Read more
The introduction of a recovery approach to forensic psychiatry services has been embraced in recent years. The recovery approach moves patient care beyond the domains of symptom reduction and aggression management. It places the importance on the patient’s personal experiences and values, and instills hope for a future with meaningful activities and supportive social relationships. As an initial step to integrating a recovery approach, we sought to better understand patients’ and family members’ perspectives and experiences of recovery in a forensic psychiatry program (FPP). This project involved one family member and two patient focus groups. All groups were asked what recovery meant to them and what we could do to support their recovery in the FPP. The focus groups were audio recorded and transcribed. A thematic analysis approach identified themes from the transcripts. Family themes included the patient returning to their original identity, opportunities to address the past, developing positive connections with others, balancing rehabilitation in the forensic environment, and maintaining communication with staff. Patient themes included developing positive connections, developing better communication about the forensic system, balancing rehabilitation in the forensic environment, and progressing with their lives. Patients and family members described their experiences of recovery in our FPP. Some areas for improvements were identified, which can form the groundwork for future improvement initiatives in our FPP.Read more
Psychiatric in-patients need programming and clinical interventions to support recovery and gradual re-integration into the community. Treatment malls are designed to meet these needs by offering psychosocial, person-centred rehabilitation groups in a centralized setting. Evidence suggests this treatment model increases patient engagement, broadens social networks, and improves functioning. Given this, our hospital implemented a treatment mall in our forensic services department in 2018. Because this was a new initiative at our hospital and the lack of outcome data on treatment malls in Canada, we conducted a program evaluation to explore the effects of the treatment mall and identify possible areas of improvement. Guided by a logic model, this evaluation used a retrospective chart review. Variables of interest included patient engagement, psychotropic pro re nata (PRN) administration, recovery scores, time spent off unit, elopement, use of restraints and seclusion, and patient activity levels. We assessed whether these changed post-implementation of the treatment mall. The results provide preliminary evidence of the positive effects of the treatment mall. Patient engagement and time spent off unit increased. Maintenance of changes and long-term outcomes remain to be seen; however, this evaluation provides support for the continued use and investigation of the treatment mall for our forensic services department.Read more
Cette étude porte sur le traitement de l’information chez des auteurs de violence sexuelle (AVS) sur mineurs à la fois sur le plan cognitif, avec les distorsions
cognitives, et sur le plan émotionnel, avec l’alexithymie. La recherche a été menée sur 20 hommes auteurs de violence sexuelle sur mineurs. Un questionnaire auto-
rapporté a servi à mesurer l’alexithymie et les distorsions cognitives. Les résultats soulignent des niveaux élevés d’alexithymie et de distorsions cognitives. Les AVS en milieu fermé ont un score significativement plus élevé sur le facteur émotionnel de l’alexithymie que les AVS en milieu ouvert. Les données semblent indiquer des déficits dans le traitement de l’information sociale chez les AVS sur mineurs. Cette étude souligne l’importance d’adapter l’offre de soins en fonction des déficits, mais également du lieu de prise en charge et des ressources des patients.
Preventing terrorism has thus far been in the domain of national security and law enforcement agencies. The expectation that psychiatry has a primary role to play in the rehabilitation of those involved in terrorism remains controversial, although the significance of certain mental disorders has been highlighted among lone-actor terrorists. This paper provides an overview of the motivating factors for radicalization to terrorism at both community and individual levels, as well as preventive and rehabilitative approaches to terrorism. We argue that psychiatry may have a role to play in these approaches with the goal of preventing violence in select cases.Read more