Terrorism and Mental Health

This issue of the International Journal of Risk and Recovery presents three of four papers that delve into key issues on the categorization of terrorism, psychiatric assessment of individuals involved in terrorism, ethical issues in the assessment of those involved in terrorism, and preventive and rehabilitative approaches. The fourth paper was published in the previous issue. The themes are diverse though equally important, and the authors offer unique insights into the psycho-social, geopolitical, and ideological underpinnings of terrorism.

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Reflections 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.

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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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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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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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Vicarious trauma and occupational hazard for forensic mental health professionals

Vicarious trauma or vicarious traumatization is the effects on a health-care worker that results from the empathic engagement or therapeutic relationship with clients or patients and their reports of traumatic experiences. The term was coined in response to the experience of psychotherapists working with trauma survivors and is widely attributed to McCann and Pearlman 1990 [1]. They developed a constructivist self-development theory discussing therapist reactions to clients’ traumatic material. They described that vicarious trauma can be understood as related to the graphic and painful material trauma clients portray to the therapists as well as the therapists unique cognitive schemas or beliefs and assumptions about self and others [1]. This theory has developed, has subsequently been described as compassion fatigue and has been subject to a considerable amount of research since this early description [2-18]. It has also focused on various professionals, including mental health professionals, and their vulnerability from working with a variety of clients or patients [4-6,8-10,12-14,19]. In this context, forensic mental health professionals are not specifically mentioned, although it is quite clear that the nature of the work that they do would make them vulnerable to vicarious trauma and “compassion fatigue.”

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Jail segregation today, hospital seclusion tomorrow

There has been a lot of attention given to the use of segregation in correctional facilities, sufficient that a number of class action lawsuits have been launched, and in many cases, they have been settled. Psychiatrists and psychiatry in general have mostly watched these issues play out from the sidelines. Segregation occurs in correctional facilities and few psychiatrists work in jails and prisons. Although mental health professionals watched with interest and concern, it remained an issue in correctional settings, not in our house. In the last few decades psychiatry has done a lot of work in reducing seclusion in hospitals. The tracking of seclusion, the requirements for reassessment and seclusion justification, along with improved training of staff about the traumatic effects of seclusion have helped in reducing seclusion rates and the length of individual seclusions. Psychiatry has done well in this regard and hence it would not be surprising that many may think that the issues associated with seclusion have been dealt with. This may be an error for the following reasons.

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Evidence-based practice in the evaluation and treatment of sexual offenders

This editorial addresses evidence based medical practice in forensic psychiatry and particularly in the field of paraphilia. John Bradford is a Professor in the Department of Psychiatry and Behavioural Neurosciences, McMaster University. He is an Emeritus Professor at the University of Ottawa where he was a founder of the Royal Ottawa Institute of Mental Health Research. He is a Founder of Forensic Psychiatry, granted by the Royal College of Physicians and Surgeons of Canada. Abdullah Alqahtani is an Assistant Professor and Consultant Psychiatrist at King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. He is currently completing a clinical fellowship in forensic psychiatry at McMaster University – St. Joseph’s Healthcare Hamilton. Andrew Olagunju is an aca-demic psychiatrist with a Senior Lecturer position at the College of Medicine, University of Lagos, Nigeria. He is also completing a clinical fellowship at McMaster University – St. Joseph’s Healthcare Hamilton.

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