Violence 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.

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A 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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Convergent, Discriminant and Predictive Validity of Two Instruments to Assess Recidivism Risk Among Released Individuals Who Have Sexually Offended: The SORAG and the VRAG-R

Recidivism risk assessment has played an essential role in the criminal justice system for many years. Various risk assessment tools have been developed and recalibrated over the years for the purpose. Two such instruments, the Violence Risk Appraisal Guide (VRAG) and the Sex Offender Risk Appraisal Guide (SORAG), were both revised before being combined into the VRAG-R. The aim of our study was to evaluate the convergent, discriminant and predictive validity of the SORAG and the VRAG-R in a cohort of 294 released individuals who have sexually offended in French Belgium. Results suggest that the tools have good convergent validity and the ability to discriminate the risk level of individuals who have sexually offended with victims younger than 14 years old, whether intra- or extra-familial, from that of others at higher risk for re-offending. Where predictive validity is concerned, the scores on both instruments predict nonviolent nonsexual recidivism with a large effect size, and general recidivism (any type of recidivism) and violent nonsexual recidivism with a medium effect size. Sexual recidivism is not predicted at a statistically significant level by either the SORAG or the VRAG-R. Violent recidivism (sexual and non-sexual combined) is moderately predicted by the SORAG and the VRAG. However, these predictive qualities vary by the age of the victim. Certain combinations of items can be good predictors. In this regard, the VRAG-R items “failure on conditional release” and “marital status” together constitute a predictive model for general recidivism and sexual recidivism. The addition of the item “age at index offense” improves this model for general recidivism.

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Mesures alternatives à l’emprisonnement pour les enfants en conflit avec la loi : situation au Niger

Le Niger demeure un pays avancé en termes d’élaboration et d’adoption de textes juridiques sur la justice des mineurs, mais souvent le pays est confronté à des difficultés d’application et d’applicabilité des textes. Voici un exemple de l’application des textes relatifs à la mise en œuvre des mesures alternatives à l’emprisonnement pour les enfants en conflit avec la loi.

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Participation as an Expert in Cases Involving the Production of Mental Health Records in Canadian Courts

In Canada, s. 278 of the Criminal Code sets out a two-stage procedure for the disclosure of records to the defence when there is a reasonable expectation of privacy. In this article, we summarize the nature of this legislation and the cases that directly led to its formation. We then review the implications for practice for mental health professionals. The main purpose of this article is to review a relatively new role for forensic mental health professionals: acting as experts in informing the court whether the disclosure is in the interests of justice.

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Coping with COVID-19: Pandemic Life and Problematic Sexual Behaviour

As a result of COVID-19 related restrictions around the globe, individuals have experienced a stark shift in the way we socialize and connect. This has impacted many facets of people’s lives, one being sexual experience and expression. Although the fact that sex and sexuality were affected by the pandemic and the public health measures and restrictions is no surprise, the specific impacts are proving to be quite fascinating and unexpected. On the one hand, we may predict increased intimacy among partners due to closer proximity and more time together. However, a counter point could be that all that time together combined with the stress of the pandemic suffocated desire. And what about sexual interests? How and why might those be a casualty of pandemic life?

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Examination of the Structured Assessment of Protective Factors for Violence Risk – Youth Version (SAPROF-YV) in Canadian Adolescents

The Structured Assessment of Protective Factors for Violence Risk – Youth Version (SAPROF-YV) is a new measure of protective factors. It is used with a risk-focused tool, such as the Structured Assessment of Violence Risk in Youth (SAVRY), to provide a more balanced and comprehensive assessment of violence risk in adolescents. Our study investigated the relationship between the SAPROF-YV and aggression in a sample of 69 adolescents. Using a retrospective follow-up study design, we reviewed files at an inpatient treatment centre and a probation office. The SAPROF-YV showed good convergent and discriminant validity with the SAVRY. The SAPROF-YV was predictive of the absence of minor verbal aggression. While the SAPROF-YV added incremental predictive validity to SAVRY Protective factors for minor verbal aggression, it did not add incrementally to SAVRY Risk factors in the prediction of any type of aggression. We discuss implications for future research and clinical applications.

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The Impact of the Illusory Truth Effect and Location of Testimony in Juror Deliberations

The illusory truth effect (ITE) is the tendency to believe false information as being accurate after it has been presented repeatedly over time. ITE has been shown to hold true in many different contexts; however, there have been no studies that examine the influence of ITE in jurors’ deliberation. Given the importance of weighing legally relevant facts in the decision-making process, and the potential influence of ITE, this study examined whether the repetition of key evidence in testimony matters in this context. This study also examined whether critical information would be influenced by the location of ITE. In that context, jurors may process critical information differently when introducing ITE early (i.e., primacy effect) or later (i.e., recency effect) in the vignette of a murder case. To examine this effect, 100 participants were recruited and asked to read a vignette where pertinent evidence related to a murder was strategically repeated throughout the case narrative. Participants were assigned to one of four groups: control; ITE throughout vignette; ITE at the beginning of vignette; and ITE at the end of vignette. After reading the vignette, participants were asked to complete a short questionnaire and provide a final decision about various aspects of the case. Results revealed that repetition of pertinent evidence matters. The placement of evidence also has the potential to influence jurors’ perceptions of certain case relevant details. These findings suggest that within a sensitive legal context, such as jurors weighing evidence of an accused’s culpability, ITE could alter one’s perception of the facts.

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Report on the Distribution of the Social Determinants of Health and Health Equity in a Forensic Psychiatry Program

The social determinants of health are important factors that shape a person’s well-being, life expectancy, and quality of life. The environments in which people live, work, and play are paramount in determining their overall health. As such, viewing health as an outcome, not only of individual choices and biomedical factors but also of socioenvironmental influences, can be an important lens to guide health-care practice. This report examined the social determinants of health of people admitted to inpatient units in a forensic psychiatry program in a major Canadian urban centre. Twenty health variables were collected from the Resident Assessment Instrument–Mental Health form. A deprivation scale was created to understand social and material inequality on a gradient. Findings showed that those surveyed had high rates of poor social determinant of health factors, such as low educational attainment, insecure housing, and lack of secure employment before their admission to the program. Chi-square tests showed associations between material deprivation, race, and comorbidity status. The findings may influence a multisectorial approach to mental illness prevention, management, and recovery practices.

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Forensic Psychiatry in Pakistan: An Update

Pakistan is a lower-middle income country in South Asia where forensic psychiatry is often not recognized as a distinct subspecialty of psychiatry. Although evolution toward this direction has begun, more development in this field is needed. Before Pakistan’s Mental Health Ordinance of 2001, much of the mental health legislation and institutional infrastructure pertaining to the mentally ill offender can be traced back to the Indian Lunacy Act of 1912. The past two decades have witnessed important legal developments in the role of psychiatry in Pakistan’s criminal justice system. This has been seen through the devolution of health-care provision and by an extension of psychiatric service provision from the federation (federal government) to the four provinces. Despite the sparse resources allocated to psychiatry, competent yet scarce psychiatry residents are graduating from Pakistan’s accredited residency programs with an interest in forensic psychiatry. The objective of this article is to reflect on the past, while examining the current state of existing forensic mental health in Pakistan. This article will also address the future trajectory of forensic psychiatry in Pakistan and supports the establishment of forensic psychiatry as a subspecialty in Pakistan.

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