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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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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Kratom-Induced Psychosis: Case report and literature investigation

Substance use disorder is a major concern for public health. Legal substances are often misused to get high. Beside the risk of developing subsequent mental health and physical conditions, one of major risk is related to behavioural changes leading to criminal behaviour. Some of these substances need regulation to ensure public as well as individual safety. This article is a case report describing Mitragyna speciosa (Kratom) induced psychosis in a patient suffering from Schizophrenia. We hope this article can bring attention to regulating bodies about the risks associated with readily available “legal” drugs like Kratom.

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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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Absconsion from forensic psychiatric institutions: A review of the literature

Absconding from mental health units is referred to as a patient leaving without permission and can have significant consequences for the patient, family, community, and institution. The varying definitions of absconsion involve breaching security of an inpatient unit, accessing grounds or community without permission, gaining liberty during escorted leave or being absent for longer than permitted from authorized or trial leave. While considerable literature exists on absconsion from acute psychiatric units, there is a paucity of literature specific to forensic absconsions, despite inherent differences between patients and systems. Forensic patients are offenders who are found unfit to stand trial, or not criminally responsible on account of mental disorder. The literature indicates the absconding rate within the forensic population is expected to be low, based on the fact that the level of security in forensic units is higher than general psychiatric units. Despite the rates being considered low, the outcomes of absconding in this population can potentially be serious, thus the exploration of factors surrounding these incidents is essential. Purpose: To review the literature regarding absconsion from forensic psychiatric institutions. This review will identify potential risk factors and motivations of forensic patients that have absconded. Methods: Electronic database and hand searches were conducted to locate articles pertaining to absconding specific to forensic psychiatric institutions published from 1969-present. Search terms included “abscond”, “escape”, “AWOL”, “runaway”, “psychiatric inpatient”, “forensic institution”, & variants. All full-text articles meeting inclusion & exclusion criteria were appraised for qualitative themes, limitations, and assessed for risk of bias using appropriate CASP Checklists. The review is structured following the PRISMA checklist and framework. Results: A total of 19 articles meeting literature review criteria were identified. The majority of the articles were of retrospective case-control design (n=12). Three systematic reviews were found on absconsion that included analyses from both forensic and general psychiatric populations. Definitions for absconding were omitted or varied making comparisons between studies difficult. Much research compared demographic, static and dynamic factors. History of previous absconsion, scores on validated risk-of-violence assessment tools, substance-use disorder, acute mental state, and socio-environmental factors were consistently noted as risk-factors. Four distinct motivations for absconding emerged: goal- directed, frustration/boredom, symptomatic, and accidental. Overall, the literature suggested forensic absconsion was a rare event of short duration with low risk to the public and few re- offending incidents. Conclusions: There is a paucity of literature on forensic absconsions. A consistent definition of absconsion and use of standardized reporting protocols across forensic programs would be beneficial in order to be able to compare data on absconding events. Also, prospective studies should be undertaken to better understand the motivations and dynamic risk factors of forensic patients who have absconded and would help inform a forensic absconsion risk assessment protocol.

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