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 more
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 more
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 more
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 more
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 more
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 more
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
For forensic psychiatry to thrive as a profession, practitioners need to be committed to intentional, continuous learning and development throughout their careers. However, carving their way through the challenges of practice and finding room to grow can be daunting. Research can help lessen this burden by examining the careers of experienced and skilled practitioners, identifying the factors that influenced their development, and the strategies they used to direct it. To date, little research of this kind has been conducted in forensic psychiatry. In this study, we used the deliberate practice model of elite performance as a heuristic to interpret the accounts of several experienced and distinguished practitioners, revealing and characterizing the influences and activities they identify as having been most important to their development. Semi-structured telephone interviews were conducted with six participants from across North America who started their forensic careers between 1965 and 1980. Transcripts were analyzed using directed content analysis. Participants cited little in the way of highly structured activities designed specifically to improve performance. They instead described using opportunities to learn from real casework and additional knowledge pursuits, as well as using deliberate career management to structure the conditions of their work-based learning. They also stressed the effect of entering forensic practice during a period of increasing interest, demand and investment, which yielded early opportunities to learn through practice. We discuss limitations in the deliberate practice model’s capacity to capture key learning strategies in forensic psychiatry, connections between work-based learning and the discipline’s general historical trajectory, and the role of career management in professional development strategies.Read more
Background: Research examining female sexual offending is limited, and the profile of this unique offender group is not well understood. Female sexual offending has largely been identified as a rare occurrence, typically perpetrated in the context of an unhealthy relationship with a paraphilic male counterpart. Given recent changes in law and minimum sentences for sexual offences—particularly in relation to child pornography and child luring offences—it remains unknown how this has impacted sentencing of female offenders charged with sexual offences.
Objectives: The goal of this study is to better understand female offenders convicted of sexual offences and their offence characteristics. Additionally, it seeks to identify patterns in judges’ decision-making with respect to aggravating and mitigating factors that impact sentencing decisions.
Methods: A sample of 26 judges’ sentencing decisions between 2000 and 2017 were obtained to investigate the Canadian female sexual offender (FSO) as she enters the justice system.
Results: In the study sample, high rates of psychopathology and childhood trauma were important features of this offender group. Offences tended to occur over extended periods, with a male co-offender, and with a young victim that was well known to the offender. Aggravating factors related to the vulnerability of the victim, abuse of power, and lack of insight. Mitigating factors related to accepting responsibility and a desire for self-change. Offenders were generally sentenced for two to five years, with ancillary orders intended to track and restrict further offending, rather than foster rehabilitation.
Discussion: Gaining a better understanding of Canadian FSO population is the first step toward improving rehabilitation and prevention.
L’expertise psychiatrique est une des disciplines de la psychiatrie légale. Sa pratique est spécifique aux juridictions où elle s’exerce et aux ressources qui lui sont attribuées. L’évolution des connaissances en psychiatrie et psychopathologie, ainsi que les décisions politiques ont un impact majeur sur la nature et le déroulement des missions d’expertise. Il existe des différences significatives entre les pays, ce qui surprend fréquemment, puisque la pratique de la psychiatrie générale est quant à elle la même. Nous proposons dans cet article une comparaison entre la pratique de l’expertise psychiatrique pénale en France et au Canada.Read more