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
In providing the care and control of individuals found not criminally responsible on account of mental disorder (NCRMD), forensic psychiatry attempts to balance the protection of society with the treatment of mental illness. A new approach in mental health care is the recovery model, which centres on the understanding that there should be a recovery in, not a recovery from serious mental illness. In clinical practice, this means that treatment decisions should be made in collaboration with patients and include their personal circumstances, such as criminality and aspirations. Concepts that intersect with these goals are elements like choice, hope, personal responsibility and empowerment. This paper examines the implementation of the recovery model in forensic mental health settings and provides an in-depth exploration and evaluation of the model as it is practised at a forensic psychiatric outpatient clinic with individuals found NCRMD. Ten participants, including both individuals found NCRMD and psychiatric professionals, took part in semi-structured interviews. Qualitative data analysis of the interview transcripts identified the following six themes: choice, recovery, hope, responsibility, agency, and risk. This paper examines the experiences, perceptions, and challenges of implementing the recovery model in a forensic psychiatric setting and compares its strategies to the predominant risk-based forensic practices. The analysis suggests that it is difficult to implement the recovery model in a forensic setting without compromising either the recovery model or the risk management approach.Read more
The aim of this article is to examine the current state of the battered woman syndrome (BWS) defence in Canada and propose an update to the list of factors considered by experts evaluating the applicability of the defence to individual cases. The history and current legal definition of the defence are presented, and theories relating to BWS are summarized. Factors required of expert testimony in BWS cases are presented; cases relevant to the development of the defence that highlights these assessment factors are discussed. In a subsequent section, limitations of the defence and the role of the expert are explored. The PTSD Checklist (used in clinician diagnosis) is summarized before an updated, BWS-specific expert checklist is proposed. The updated checklist proposes six elements to be considered by an expert assessing a BWS case: 1. environmental factors, 2. attempts to leave or alter the situation, 3. risk factors of the abuser, 4. risk factors of the victim, 5. triggers for violence, and 6. contrary evidence. It is hoped that using this checklist will help experts to cover all the essential elements they must consider in order to conclude that a woman satisfies the criteria for BWS. In particular, this updated checklist will help experts to prepare comprehensive testimony that addresses the five issues defined by Justice Wilson as the expert’s duty to assess. In addition, this checklist will help experts present a firm foundation for a defence regarding the critical question of why the night of the offence was different from all other nights.Read more
The Structured Assessment of PROtective Factors for Violence Risk (SAPROF) is an assessment tool that examines protective factors when assessing violence risk. There is limited research on clinicians’ perceptions of the use and implementation of risk assessment tools, and this study aimed to examine the experiences of clinicians using the SAPROF in a low secure forensic rehabilitation inpatient unit in Canada. An exploratory research design was used, and five clinicians participated in semi-structured interviews. Data was analyzed using a thematic approach and three central themes were identified: “understanding of the patient from a strengths-based point of view, providing clinicians with a focus on how to help the patient, and bringing in opportunities to collaborate as a team”. The findings highlight the additional value of the SAPROF as a tool in helping forensic teams to adopt strengths- based approaches to risk assessment, enhancing treatment planning, and inter- professional collaboration.Read more
Les Cercles de Soutien et de Responsabilité (CSR), nés il y a 24 ans à Hamilton au Canada pour répondre à l’inquiétude du public provoquée par le retour des délinquants sexuels dans la société après leur libération, se développent partout dans le monde. Ils proposent l’accompagnement de l’agresseur dans sa réinsertion sociale. Efficaces dans les pays étrangers, ces dispositifs se développent lentement en France. L’objectif de cet article est de tenter d’expliquer les freins à l’implantation des CSR en France au regard des difficultés rencontrées lors des expériences françaises passées et actuelles, mais aussi des différences interculturelles entre la France et le Canada.Read more
As a result of a German Federal Constitutional Court decision on compulsory treatment, in its state Law the federal state of Hesse has newly regulated the possibility of compulsory treatment (Section 7 Paragraph 2 of the Hesse Law on the Enforcement of Court-ordered Hospital Treatment) and expressly incorporated the observance of a patient’s advance directive as defined by Sections 1901a and 1901b of the German Civil Code (Bürgerliches Gesetzbuch [BGB]). Having been sentenced to a hospital treatment order under section 63 of the Ger- man Criminal Code (Strafgesetzbuch [StGB]) in the Vitos Haina Forensic Psychiatric Hospital, thirteen patients with schizophrenia stated in a patient’s advance directive that they wished to be treated with certain antipsychotic medication in case of a recurring psychotic episode. In particular, the patient’s advance directive stated that this treatment should be compulsory if necessary. Based on a case vignette this article delineates both the motivation of the patients for such a patient’s advance directive, as well as the legal limitations and the enforceability of such a patient’s advance directive. There is no prevailing view in the jurisdiction or literature on the utilization of a patient’s advance directive to guarantee an explicitly desired treatment in case of incapacity for consent. This article wishes to highlight the perspectives of those directly affected and to encourage discussion. While of special interest for forensic psychiatry, these considerations may also be of importance for treatment considerations in general psychiatry.Read more
Forensic psychiatry is defined as a specialty of psychiatry in which clinical and scientific knowledge is applied to the legal system, both with regard to civil and criminal law. Nowadays, the largest security ward is in Coimbra, at the University Hospital. It comprises 111 patients: 91 males and 20 females. The aim of the security measures, according to the penal code, is the protection of legal assets and psychosocial rehabilitation. In our sample, the most frequent diagnosis was Schizophrenia (37.8%); Moderate Intellectual Disability (23.4%) and Mild Intellectual Disability (14.4%) were the second and third most frequent diagnoses. The criminal acts accounting for the most prevalent security measures fell under domestic violence (19.8%) first, followed by attempted murder (16.2%), and theft (14.5%). The elaboration of a therapeutic and rehabilitation plan is essential, and its aim is to diminish the person’s dangerousness. It is fundamental to think of the safety ward as a health production space and not as a place of mere disease management or “dangerous states”, thus trying to solve the patient’s problems.Read more
Enhancements in the treatment of sexual of-fenders have been taking place for over four decades. The development of pharmacological therapy has helped to reduce the risk of re-offense and has demonstrated its utility in com-bination with psychotherapy. However further studies to demonstrate the efficacy of these therapies are required. We conducted a retrospective study in a unit, Erios, that provides care for sexual offenders (court ordered treatment or voluntary treatment). Among the 224 patients who were seen in the Erios unit over the past 15 years, we identified 23 patients who had received anti-libidinal treatment (ALM) at some point in their care. The results, obtained from 22 files, indicate that 16 patients presented no evidence of deviant fantasy or behavioral relapse under medication. This study also highlights the comorbidities and offers a perspective regarding the improvement in prescribing this type of pharmacological therapy.Read more