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 moreoriginal article
Impacts 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.
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.
Read moreConvergent, 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.
Read moreMesures 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.
Read moreExamination 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.
Read moreThe 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.
Read moreReport 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.
Read moreIntimate Partner Violence Among Pregnant Saudi Women: Prevalence, Risk Factors, and Attitudes
Intimate partner violence (IPV) during pregnancy has become a focus of attention in recent years, owing to its relatively high prevalence, its impact on maternal and fetal health, and its cumulative effects over time. This study aims to determine the magnitude and characteristics of IPV among pregnant Saudi Arabian women, to identify the factors that increase the risk, and to assess the willingness of abused women to report IPV. This is a cross-sectional, community-based survey of pregnant women in the Eastern Province of Saudi Arabia. A modified Abuse Assessment Score (AAS) questionnaire was used. Sociodemographic data were collected. Data related to willingness to report IPV, including reasons for declining to report IPV, were also collected. A total of 1,330 women completed the three parts of the survey. In total, 345 (25.9%) women reported emotional abuse during pregnancy, whereas 72 (5.4%) reported physical abuse and 180 (13.5%) reported sexual abuse. In emotional abuse, a significant association was found between having more children (p = .001), having a lower education (p = .05), having a lower income (p = .04), and being abused. In physical abuse during pregnancy, no significant associations were found between all variables and being abused. However, in reporting sexual abuse among women during pregnancy, a significant increase in the risk was found in those with four or more children (p = .01) and those who are employed (p = .01). More than two-thirds (71.2%) of abused pregnant women were unwilling to report the abusive acts to a medical authority. IPV is common among pregnant Saudi women. Emotional abuse is the commonest form of IPV, affecting one in four women. More than two-thirds of abused women were unwilling to report their partner’s abusive acts. Screening for IPV may encourage women to seek help and improve both maternal and fetal health.
Read more