Understanding the Negative Effects of Psychological Treatments in Forensic Settings

“If we only ask whether interventions help, then we risk missing when they harm…. Safer interventions require the same scientific attention to harms as we already give to benefits.”

That was the conclusion to Dr. Lindsey Gilling’s presentation to the International Forensic Psychiatry Lecture Series.

She provided recommendations for forensic mental health practitioners, researchers, funding agencies, and journal publishers to expand the science of effectiveness to include the science of safety.

Program Shows Promise for Treating Substance Misuse in Forensic Psychiatric Setting

Substance misuse is common among patients in the forensic mental health system, and this complicates their recovery and community reintegration.

A semi-structured manualized treatment program (SSMTP) is showing promise for treating patients who misuse drugs and alcohol and have multiple mental disorders in a forensic mental health setting. Research has found that SSMTP increased recognition of a problem and steps taken toward substance use cessation in this population. However, the program may be more effective for some substances than others.

Treatment for People Who Commit Sexual Offences: What Makes It Effective?

Treatment for people who commit sexual offences is aimed at lowering the risk that they will commit offences in the future. But research studies over decades show mixed results for long-term prevention of offences. Some aspects of treatment show positive results. But more research is needed to find which elements of treatment help people who have committed sexual offences avoid that behaviour in future.
Such research could help improve treatment programs as well as avoid reoffending and the costs to the criminal justice system that sexual offences cause.

Creative Blocks and Procrastination: Treating the Artistic Patient

Creative blocks and procrastination are two of the most prominent features of artistic patients, whether they are exploring their creativity or are already successful professionals.

Often called writer’s block, creative blocks also happen to painters, composers, choreographers, and other artists. Although they are usually anxiety-provoking experiences in the moment, they often result in personal and creative growth when the artist addresses underlying self-conceptualization issues.

Procrastination allows the person to avoid the potential shame of failure by doing something considered less shameful.

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.

Is the Anticipated Consent to Treatment in Advance Directives a Solution to Compulsory Treatment in Forensic Psychiatry?

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.

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.