Typology development entails systematically clustering related attributes among individuals or groups to examine trends that might explain complex human interactions and behaviours. This approach has demonstrated its usefulness in behavioural sciences with important implications for policy, etiology, course, and treatment. Our review article provides an overview of terrorism typologies and examines their implications for clinical practice. We argue that the theoretical nature and heterogeneity of existing terrorism typologies limit their clinical usefulness, highlighting the need to develop empirically driven typologies.
Read moreSexually Motivated Homicide: Descriptive Characteristics and Empirical Evidence
The assessment of individuals charged with a sexual offence has evolved over many years and has become more specialized. The most comprehensive evaluation is available in specialized centres for assessing and treating sexual deviations. Sexually motivated homicide is an extremely rare event. Empirical studies have provided evidence-based characteristics of those who commit sexual homicide and the nature of sexual homicide offences, particularly in the last 10 years. This has assisted in defining whether a sexually motivated homicide has occurred. It can also be incorporated into sexual behaviour evaluations when factors associated with a sexually motivated homicide may be recognized before the person acts out violently. This paper reviews evidence-based research on sexual homicides and how this is used to classify whether a homicide is sexually motivated. Risk factors associated with sexually motivated homicides are reviewed.
Read moreEthical Issues in the Assessment of Terror Subjects
The psychiatric evaluation of people who have committed acts of terrorism requires a unique sensitivity to cultural and political context. This is because terrorism has multiple definitions and can be used to silence political and ethnic minorities. There- fore, professional appraisals of risk and threat may require an ethics approach that intertwines individual and community factors, considering history and culture along- side individual risks. Narrative ethics using root cause and liberation theories may be one method to assess both contextual and personal contributions to terrorist behaviour, and provide a robust account of the cultural and contextual realities of terrorism.
Read moreReflections at Five Years and Post COVID-19
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 morePatients’ and Family Members’ Experiences of Recovery in a Forensic Psychiatry Program
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 moreImpacts of Implementing a Forensic Treatment Mall: A Program Evaluation
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 moreAlexithymie, distorsions cognitives et violence sexuelle sur mineurs : une étude exploratoire
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.
The Psychiatric Aspects of Terrorism: Prevention and Rehabilitation
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 moreViolence Risk Assessment of Older Adults
The forensic psychiatric and psychological arena has long been tasked to understand the correlates of aggression and provide opinions about an individual’s risk to commit a violent act. Violence can be physical, sexual, psychological, or any combination. It is an act that is intended to harm another. Our understanding of the factors that contribute to violence has certainly evolved over the past two to three decades. And, with this, the introduction of risk assessment methods has served to improve our ability to make predictions about someone’s risk to act out violently. Most tools currently available to assist in the prediction of violence, however, are largely intended for youth and working-aged adults who have justice involvement. At the current time, there are no tools available that assess the risk of violence posed by older adults.
Read moreA Conceptual Framework for the Management of a COVID-19 Outbreak on a Secure Forensic Inpatient Unit
Responses to outbreaks of the novel coronavirus SARS-CoV-2 (COVID-19) in secure forensic settings have included several interventions, such as cohorting, assertive testing, isolation units, and infection control practices. The design of forensic facilities and the psychiatric impairment inherent to the patient population can make compliance with pandemic protocols challenging. In this study, we report on a COVID-19 outbreak on a low secure forensic inpatient unit in a large mental health hospital. For the 17 patients on the unit, we compared data from the 22-day COVID-19 outbreak period with the 30 days before the outbreak. We developed patient profiles that informed decision-making in COVID-19 outbreak management and developed a conceptual framework to identify interventions to effectively respond to and manage the outbreak. Patients had a decrease in as-needed nicotine replacement therapy during the outbreak. The average Dynamic Appraisal of Situational Aggression score increased slightly across all patients during the outbreak, though these differences were not statistically significant. Although forensic settings present challenges in outbreak management, leveraging therapeutic alliance, highlighting the importance of working together, communicating the rationale for measures, and providing staff information and tools such as a conceptual framework can support patients’ following protocols and effective management of an outbreak.
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