Showing papers in "Journal of Forensic Psychiatry & Psychology in 2009"

Can pedophiles be reached for primary prevention of child sexual abuse? First results of the Berlin Prevention Project Dunkelfeld (PPD)

Abstract: The Berlin Prevention Project Dunkelfeld (PPD) aims to prevent child sexual abuse (CSA) by targeting men who fear they may sexually abuse children, and who seek help without being mandated to do so. This article aims to demonstrate that a pedophilic or hebephilic sexual preference is very common among these men, to show how these men can be reached, and to document their determination to find help. The target group was informed of the project and encouraged to respond via a media campaign. A telephone screening was conducted over the first 18 months. Of the 286 who completed the screening (60.1% of the respondents), 84.3% (N = 241) were interviewed by a clinician. Of the interviewees, 57.7% (N = 139) and 27.8% (N = 67) expressed a sexual preference for prepubescent and pubescent minors, respectively, and 10.8% (N = 26) for mature adults. The remaining 3.7% (N = 9) could not be reliably categorized. As (potential) child molesters with a respective sexual preference can be reached via a media campaign, effo...

False inflated self-esteem and violence: a systematic review and cognitive model

Abstract: Traditionally, much research into violence has focussed on risk factors rather than on perpetrators' perspectives on their violent acts and the powerful psychological influences on those individuals' violent behaviour. In forensic settings, the most popular model for working with violence has been anger management, which uses a cognitive behavioural approach to explain how triggers may cause anger and violence via a series of information processing biases. Interestingly, an area that receives less attention in the cognitive behavioural literature on violence and anger is the role of embarrassment and humiliation (‘dis’respect), and their opposites respect and pride (or healthy self-esteem). However, psychodynamic perspectives put humiliation at the centre of causes of violence, coupled with coping and social problem-solving deficits resulting from disrupted attachments. Despite the absence of a focus on self-esteem in models of and treatments for aggression and violence, there is some recent research evid...

Prevalence of pervasive developmental disorder in juvenile court cases in Japan

Abstract: The aim of the study is to survey the prevalence of pervasive developmental disorder (PDD) in juvenile cases encountered in the family courts of Japan by examining the characteristics of juvenile cases with PDD. We investigated family court juvenile cases (N = 428) in terms of sex, age (14–19 years), type of crime, background, and environmental factors such as adverse childhood experiences (ACE). Cases encountered in four family courts in Japan between April 2006 and March 2007 were studied. Of the total number of investigations or randomized trials, 1.3% to 6.7% were encountered at three family courts. In addition, 18.2% of the cases came from the section dealing with unique crimes. Juvenile delinquents with PDD had more severe environmental factors than general population in Japan. In the PDD group, the rate of sex-related crimes was significantly higher than in the general population referred to family courts.

Homicide followed by suicide: a cross-sectional study

Abstract: Background: Approximately 30 incidents of homicide followed by suicide occur in England and Wales each year. Previous studies have not examined mental health characteristics in any detail. Aims: This study aims to identify the social, clinical, and criminological characteristics of a national sample of perpetrators, to identify any previous contact with mental health services and to establish risk of suicide after homicide. Method: A national cross-sectional study of perpetrators in England and Wales 1996–2005. Results: 203 incidents were recorded over 9 years. The median age of perpetrators was 41 years (range 18–88 years); most were male. Men more often killed a spouse/partner, whilst women more commonly killed their children. Eighty-four (42%) perpetrators died by suicide on the day of the homicide. The most common method of homicide was sharp instrument (44, 23%). Fifty-nine (29%) used hanging as a method of suicide. Twenty (10%) had previous contact with mental health services, 14 were seen within a ...

The fixated and the pursuit of public figures

Abstract: This paper considers the problem created by those who harbour unusually intense fixations on public figures. It examines the nature of such pathological fixations and how they differ from the wide range of normal concerns which lead people to communicate with, and even occasionally harass, politicians and other prominent persons. In those harbouring a pathological fixation, there often emerges a pattern of stalking-type behaviour, with repeated attempts at communication and/or contact which create concern. In a small number, the fixation either remains hidden or leads to attempts to communicate about, rather than to, the subject. Occasionally, such a fixation will come to attention with some dramatic approach, or even attack, on the individual with whom the fixated person has been preoccupied. Fixated people are of concern, not just because they create problems for public figures and their security systems, but because many are seriously mentally ill individuals in need of care, who in most cases cause ha...

A systematic review of research on the epidemiology of mental health disorders in prison populations: a summary of findings

Abstract: Brooker et al. (2002) conducted a systematic review of research into the mental health of prisoners. Their final report included a review of the epidemiology of the prison population, an overview of the interventions used to treat the major mental health disorders in both the general and prison populations, and a review of service delivery and organisation for prisoners with mental health disorders. The review found a high prevalence of mental health disorders in prison populations, with up to 15% of prisoners having four or five co-existing mental disorders. This review has been updated, using the same methodology, to include literature dated from 2002 to August 2006. This paper presents findings from the epidemiology section of the updated review, which includes 18 new studies. The recent studies largely reflect the findings of earlier research. However, some studies in the updated review focus on countries where little of this type of research has previously been conducted. The prevalence of mental hea...

Perception of facial expressions of fear: comparative research with criminal and non-criminal psychopaths

Abstract: A group of criminal psychopaths (n = 22) was compared against three control groups – non-criminal psychopaths (n = 16), criminal non-psychopaths (n = 11), and non-criminal non-psychopaths (n = 13) – on a go/no-go paradigm to test whether criminal psychopaths' poor ability to recognise facial expressions of fear can be generalised to non-criminal psychopaths and to other non-psychopathic criminals. Both criminal and non-criminal psychopaths showed significantly worse performance than non-psychopaths in the detection and discrimination of fear in facial expressions. These results suggest that psychopathy, independently of its manifestation in criminal behaviour, seems to be related to poor ability to identify and discriminate facial expressions of fear. Additionally, inhibition deficits or, at least, an impulsivity response pattern seem to be common to all criminal groups that were investigated.

The youth psychopathic trait inventory: factor structure and antisocial behaviour in non-referred 12-17-year-olds

Abstract: This paper extends previous research into the psychometric qualities of the Youth Psychopathic Trait Inventory (YPI) and the relationship of YPI scores with age, gender, and self-reported antisocial behaviour in a community sample. The results of a confirmatory factor analysis are in line with the former research, as they support a three-factor structure with good fit indices for 12-17-year-olds, thus suggesting that the YPI is useful for these age categories. The present findings also reveal a strong positive association between self-reported delinquency and psychopathic traits, as the latter are associated with serious and versatile antisocial behaviour in both genders. Gender and age differences emerged in the prevalence of psychopathic traits and the dynamics underlying antisocial behaviour.

Custody vs care: attitudes of prison staff to self-harm in women prisoners—a qualitative study

Abstract: Self-harm rates amongst the UK female prison population are disproportionately high. Prison staff potentially have a crucial role in the identification and management of female prisoners at risk; despite this there has been little focus on the attitudes of prison staff towards female prisoners who self-harm. This paper presents such an explanation; qualitative methods were used, with semi-structured interviews with eight prison officers and five healthcare staff from one female prison in the North of England. Interviews were tape recorded, transcribed verbatim, and analysed iteratively, until category saturation was achieved. The data suggests that prison staff labelled self-harm as either ‘genuine' or ‘non-genuine.’ Women whose self-harm was perceived as non-genuine by staff were viewed as ‘rational manipulators,’ self-harming to achieve particular ends. Staff described feelings of resentment towards these women. Most staff reported that balancing their welfare and security functions was difficult, feeli...

Recidivism and dangerousness in arsonists

Abstract: Psychiatric morbidity is high among arsonists compared to those guilty of other serious offences, and the courts are anyway inclined to refer those convicted of arson for psychiatric assessment. There is, however, very little research that informs the assessment of future arson risk and, sometimes, the concepts of recidivism and dangerousness appear to be treated interchangeably. The current study aimed to examine dangerousness in terms of both recidivism and offence severity. The case notes of N = 167 adult arsonists referred for forensic psychiatric assessment over a 24-year period were examined for differences between (i) one-time only and multiple firesetters, and (ii) for characteristics of those who had set serious fires causing serious injury, loss of life or extensive damage. Findings largely support those in the literature with repeat arsonists being younger, single and having a number of attributes suggesting childhood disturbance. Personality disorder and previous time in prison were also associated with repeat firesetting. Recidivism was not associated with the setting of serious fires. Very few variables were able to predict whether subjects had set a serious fire although intentional behaviours such as multiple-point firesetting and the use of fuel and accelerants appear to indicate highly dangerous firesetting behaviour. These indicators differ from those previously reported by psychiatrists as most indicative of future dangerousness.

Self-harm among UK female prisoners: A cross-sectional study

Abstract: Psychiatric morbidity and suicide rates in prisoners are high. The detection of mental illness and its associated risks in prison are low. The aim of this study was to ascertain the prevalence of psychiatric symptomatology, needs and self-harming behaviour among UK female prisoners and to identify differences between individuals with and without a history of self-harm. We conducted a cross-sectional study including 638 female prisoners from two prisons in the North-West of England. Outcome measures used were the Prison Screening Questionnaire (PriSnQuest), a questionnaire on self-harming behaviour and suicidal ideation and the Camberwell Assessment of Need – Forensic Version (CANFOR). 241 women (37.8%) screened positive on the PriSnQuest; 281 women (45.9%) had a history of self-harm. An average of 8.5 needs was identified with more than half of those needs classified as unmet. Differences between women with and without history of self-harm were identified on offending history, PriSnQuest scores and the CA...

Utility of the Structured Inventory of Malingered Symptomatology (SIMS) and the Assessment of Depression Inventory (ADI) in screening for malingering among outpatients seeking to claim disability

Abstract: A sample of 56 disability seekers were administered the Structured Interview of Reported Symptoms (SIRS), the Structured Inventory of Malingered Symptomatology (SIMS), and the Assessment of Depression Inventory (ADI). Individuals were classified as honest or suspected malingerers based on their SIRS scores. Additionally, 60 individuals from the community completed the SIMS and the ADI honestly or as if they were malingering depression. Both malingering groups had significantly higher mean scores on the SIMS total and ADI feigning scales than both honest groups. The scores of the malingering groups did not significantly differ. The utility of various cut-off scores on these scales is presented and discussed. In the clinical sample, previously recommended SIMS total cut-off scores (>14 or >16) had excellent sensitivity, but low specificity. Conversely, the recommended ADI feigning cut-off score (>13) had excellent specificity, but low sensitivity. Increasing the SIMS total cut-off score to >19 and decreasin...

Community services and people with intellectual disabilities who engage in anti-social or offending behaviour: referral rates, characteristics, and care pathways

Abstract: Provision of health and social support to people who engage in anti-social or offending behaviour and have intellectual disabilities (ID) remains a challenge to services Numerous population studies have produced contradictory findings with reviews calling for the development of more fruitful approaches and recommending investigation of the care pathways operating within ID services This study reports on the pathways through services encountered by adults with offending or anti-social behaviour referred to 15 UK community ID services in 2002 Pathways through services were tracked for 24 months post referral Referral rates, demographic characteristics, and associations with anti-social or offending behaviour were statistically analysed for 237 cases Most referrals originated from the local community (66%); a high proportion were female (405%) Community services appeared encapsulated, serving adults with offending behaviour over the long term, but predominantly (74%) those already known to local ID services Implications for services and future research strategies are considered

Risk assessment in female forensic psychiatric patients: a quasi-prospective study into the validity of the HCR-20 and PCL-R

Abstract: This study examined the postdictive validity of the HCR-20 and the PCL-R in a sample of 45 female ex-patients of Dutch forensic psychiatric hospitals. For this purpose the HCR-20 and PCL-R were coded using documented information. Recidivism data were collected from the Dutch Ministry of Justice. Interrater reliabilities for the HCR-20 and PCL-R were excellent. Recidivists and non-recidivists differed significantly in terms of their mean scores on the H (historical) scale of the HCR-20. Their mean scores on the other subscales and their total scores on the HCR-20 and the PCL-R showed no significant differences. The base rate for violent recidivism was 16%. Subscale scores and total scores on the HCR-20 and the PCL-R did not postdict violent recidivism. Risk judgments based on these instruments demonstrated the same poor predictive validity. There are indications that historical items, notably substance abuse and a history of violence, have some predictive value for violent outcome in female forensic psychi...

The psychology of female violence: crimes against the body

Abstract: The psychology of female violence: crimes against the body (2nd ed), by Anna Motz, London, Routledge, 2008, 388 pp, £1999 (paperback) This short book is an excellent introduction to working with

An assessment of change in negative relating in two male forensic therapy samples using the Person's Relating to Others Questionnaire (PROQ)

Abstract: This study tests the hypothesis that the negative relating of men with a forensic history can be reduced by psychotherapeutic intervention. The Person's Relating to Others Questionnaire (PROQ), a measure of negative relating, was administered to two male forensic therapy samples, one in a medium secure unit and one in a prison therapeutic community. In the first it was given at assessment prior to admission, at three and nine months after admission, and at follow-up, one year after discharge. In the second it was given on admission, after nine months, and after 18 months. There were significant improvements in mean scores on a number of scales in both samples. Over a fifth of both samples demonstrated reliable improvement. In both samples the major improvement in mean scores occurred relatively early in the period of stay, and thereafter the improvement was sustained. In the first sample, it was still apparent at follow-up.

The use of psychiatric and psychological evidence in the assessment of terrorist offenders

Abstract: The present paper focuses on the prediction of violent recidivism among individuals convicted of politically motivated violence – terrorism. We argue that the assumptions of general violence prediction models, used in risk assessment procedures with other offenders, do not necessarily apply to terrorist offenders. Subsequently we discuss the assumption of general expertise in mental health professionals in such cases. Furthermore, we describe the role of professionals in this field, their expertise, and the use of psychological and psychiatric evidence. We are particularly concerned about the use of psychometric testing. Finally we make some recommendations about the approach to be used and the expertise required in assessing risk in politically motivated offenders.

The second national survey of mental health in-reach services in prisons

Abstract: The prevalence of mental disorder among prisoners is considerably higher than that in the general population. Historically, mental healthcare in prisons has been criticised for being under-funded and provided by the Prison Service. The 2001 policy Changing the Outlook envisaged multi-professional prison mental health teams funded by the local primary care trusts. Such teams are now in place, managing offenders with severe mental illness, but they have faced challenges. The second mental health in-reach team survey was conducted in 2007 and aimed to capture a variety of data, including: workforce features; connections with primary care services; the role of in-reach services, their caseload, the interventions provided, and barriers to successful operation; and the relationship with the wider NHS. It was found that the role and activities of in-reach teams had changed considerably since the first in-reach survey was undertaken in 2005.

Cognitive therapy for violence : reaching the parts that anger management doesn't reach

Abstract: In forensic clinical settings, the most popular model for working with violence has been anger management, which uses a cognitive behavioural approach to explain how stimuli may cause anger via a series of information processing biases. There seem to be a variety of cognitions and thinking processes that are either more common or more extreme in individuals who behave violently. Despite concerns about meta-analytic reviews of treatment effectiveness, and reservations about the relevance of anger management for reducing violence and reoffending, its use is widely advocated in prison and secure settings. We have suggested that low self-esteem is central to violence rather than high self-esteem, but that self-esteem may appear high. Combining cognitive behavioural and psychodynamic approaches produces a formulation that can be used for treatment incorporating not only emotional and behavioural work but also reconstruction of core beliefs and dysfunctional assumptions (rules). It is proposed that because important cognitions relating to violence also relate to self-esteem and the protection of (false inflated) low self-esteem in the face of humiliation, any intervention for violence must also account for a fragile inner sense of self-esteem which, it is proposed, has a causal relationship (along with other factors) with violence. The approach presented here includes a number of core therapeutic tasks. A case study is described to demonstrate its application. It offers a structured but flexible and individually tailored approach to working clinically with violence.

The assessment of dangerous and severe personality disorder: lessons from a randomised controlled trial linked to qualitative analysis

Abstract: Randomised controlled trials are difficult to carry out in high security prisons and very few have succeeded. We describe here a randomised controlled trial of early versus late assessment for the pilot phase of the new DSPD programme for dangerous and severe personality disorder, which assessed prisoners (n = 75) at baseline, then six months, and then one year after randomisation. The trial enjoyed 100% success in getting records and obtained useful qualitative data that helped to explain the findings, but the trial was compromised by repeated protocol violations on grounds that were seldom acknowledged openly but which we conclude were primarily due to ignorance of the purpose of such trials. This led to such contamination of the two arms of the trial that no clear conclusions could be drawn from the trial itself, except that relative costs showed expected differences. However, the trial also showed that the assessment programme was associated with better quality of life in terms of social relationships...

The ethics of forensic psychiatry: moving beyond principles to a relational ethics approach

Abstract: Forensic psychiatry has been described as a ‘moral minefield’. The competing obligations at the interface of the justice and healthcare systems raise questions about the very viability of an ethical framework for guiding practice. The explicit need for security and detention, and the implicit ‘untrustworthiness’ of forensic patients shape practitioners' everyday reality. Suspicion colors client–practitioner relationship and fundamental care concepts, such as patient advocacy, take on different nuances in this milieu. Despite the complex ethical demands of this unique practice area, it has received little attention within mainstream bioethics. There is, however, a growing imperative to find a theory of ethics for the specialty. In this article, the ethics of forensic psychiatry is examined, and it is argued that relational ethics is a fitting framework for forensic practice and, further, that forensic settings are the very place to test the validity of such an ethic.

Defining high, medium, and low security in forensic mental healthcare: the development of the Matrix of Security in Scotland

Abstract: As differing levels of security in forensic mental healthcare have evolved, there has been no clear or concise agreed definition of high, medium, or low secure care. This paper reviews the historical use and abuse of security as treatment. More recent attempts to define security level and purpose are reviewed, and the trinitarian model of relational procedural and physical security is described. In Scotland there has been a need to define security levels for the purpose of private sector registration, service development, and, most particularly, appeals against excessive security made under new mental health law. The Matrix of Security which has been developed in Scotland, and those aspects of physical and procedural security that differ between security settings, are described.

The assessment of dangerous and severe personality disorder: service use, cost, and consequences

Abstract: The dangerous severe personality disorder (DSPD) programme in England provides high security services for offenders with a personality disorder who have a high risk of re-offending. The cost and economic value of the programme is unknown. The aims of this study were to examine patterns in the service use of prisoners in assessment, to evaluate the cost and outcomes of prisoners in DSPD assessment compared to controls, and to identify the clinical and personal characteristics of prisoners with high costs. Individual-level service use data were collected from prisoner files and individual total costs estimated. Prisoners in DSPD assessment had contact with a variety of professionals and group activities. The DSPD group cost £3,500 more on average than those in the control prisons over six months (£25,150 vs. £21,963; p = .094). There were no significant differences in outcome, although there was a consistent trend for the DSPD assessment group to have worse outcomes than controls. In a cost-function analysi...

Recidivism in pedophiles: an investigation using different diagnostic methods

Abstract: The relationship between pedophilia and recidivism was examined in a sample of 206 extra-familial child molesters assessed at a university teaching hospital between 1982 and 1992. To address definitional issues, pedophilia was defined in one of four ways: (1) a DSM diagnosis made by a psychiatrist; (2) a deviant phallometric profile; (3) a combination of DSM diagnosis and deviant phallometric results; and, (4) high scores based on the Screening Scale for Pedophilic Interest (SSPI; Seto & Lalumiere, 2001). Of the various definitions for pedophilia only phallometric assessment (PAI) distinguished between sexual recidivists and nonrecidivists. Overall recidivism rates were 22.8%, 33.9%, and 45.6% for sexual, violent, and any reoffence, respectively. No differences were found between pedophiles and nonpedophiles with respect to recidivism rates, regardless of how pedophilia was defined. Based on these results, the utility of the DSM diagnosis of pedophilia for the purpose of predicting future reoffending is d...

Increasing subjective well-being in long-term forensic rehabilitation: evaluation of well-being therapy

Abstract: There is increasing awareness of the value of approaches that focus on developing human growth and potential, both within the general population and within clinical settings. The objective of the present study was to evaluate the effectiveness of a new, empirically derived, well-being intervention in a forensic setting. The intervention focused on developing goal setting and planning skills, both of which are known to be linked to well-being. Fourteen male mentally disordered offenders, detained under conditions of medium security, attended six, one-hour group sessions. There was a significant effect of treatment on well-being and symptoms of mental illness. By the end of treatment (and maintained at two-month follow-up), participants reported reduced hopelessness and negative affect and increased positive future thinking. They were also rated as presenting with fewer negative symptoms of psychosis. Participants also reported higher levels of satisfaction with life two months post-intervention compared to...

Suicides by foreign national prisoners in England and Wales 2007: mental health and cultural issues

Abstract: Self-inflicted deaths in prisons in England and Wales were at a 10-year low in 2006 but rose in 2007, largely attributed to an unexpected increase in self-inflicted deaths by foreign national (FN) prisoners. All deaths were reviewed in detail using prison and clinical records and interviews with prison staff. This paper reports findings for the deaths of the 20 FN prisoners from non-EU countries. Similarities were found between these deaths and self-inflicted deaths of UK nationals in terms of method, location of death, index offence, and prevalence of mental illness. Additional factors found in the FNs included early anxiety, trauma symptoms in refugees from conflict, language issues, deportation fears, and cultural concepts of shame. These findings are discussed in relation to the entrapment model of suicide and the need for specialised mental health service provision.

Violence risk assessment: the use of the PCL-SV, HCR-20, and VRAG to predict violence in mentally disordered offenders discharged from a medium secure unit in Scotland

Abstract: Risk assessment tools are increasingly used in the management of mentally disordered offenders in Scotland, but there has been limited research into their validity among this population. The aim of this study was to examine the validity of risk assessment tools in predicting violence following discharge from a Scottish medium secure unit. The PCL-SV, the VRAG, and the historical subset of the HCR-20 were completed on 96 patients. Follow-up information regarding post-discharge violence and clinical factors was collected for two years. Four (4.2%) patients from the sample committed five serious violent offences, while 38 (40.6%) patients committed more than 100 minor violent offences. The risk assessment tools were found to have moderate predictive accuracy for violent outcomes. Thus this study provides useful evidence supporting the validity of risk assessment tools in Scotland. Individual clinical factors such as substance abuse, personality disorder, treatment non-compliance, and symptom relapse are also relevant in risk assessment and management.

Harassment of Members of Parliament and the Legislative Assemblies in Canada by individuals believed to be mentally disordered

Abstract: Politicians may be more vulnerable to episodes of stalking than the general population, due to their public personas. Research indicates that perpetrators of such stalking episodes frequently suffer from a mental disorder. This study surveyed how often Canadian Federal and Provincial politicians, who held office in March 1998, had been harassed by individuals believed to be suffering from a mental disorder, as well as the form of the harassment. Four hundred and twenty-four politicians responded to the questionnaire (41.3%). Harassment was experienced by 29.9% of the respondents, with 87% believing their harassers to be suffering from a mental disorder. Both Federal and Provincial politicians were harassed, and overt threats against politicians were frequent. No association between threats in communications and subsequent physical approach was found. In fact, harassers who did not overtly threaten, or who both telephoned and wrote frequently, were shown to more often approach the politicians.

Shameless yet angry: shame and its relationship to anger in male young offenders and undergraduate controls

Abstract: The purpose of this study was to explore shame and its relationship to anger in male young offenders (n = 56) and male undergraduates of similar age (n = 60). It was hypothesised that there would be group differences in levels of shame, and that shame and anger would be differentially related in the two groups. Shame, anger, and the control variables depression and defensiveness were measured. Despite significantly higher levels of anger and depression, the young offenders displayed significantly lower levels of shame than the undergraduates. Furthermore, while there was a significant relationship between shame and anger in the undergraduates, this was not apparent in the offenders. Neither defensiveness nor depression could account for these differences. Possible explanations, including the social dynamics of inner-city youth subcultures, are drawn upon in considering why shame is low and uncorrelated with anger in young offenders. These can guide the future research necessary to identify the precise way...

Experimental simulation: type of malingering scenario makes a difference

Abstract: Using a simulation design, we tested in 486 undergraduates whether different case vignettes differentially affect the sensitivity of a self-report instrument designed to detect malingering (the Wildman Symptom Checklist). One group of participants (n = 387) was instructed to respond honestly, while three groups instructed to malinger (each n = 33) each received a different case vignette: in the manslaughter and the wrongful death vignettes malingering of symptoms was for the purpose of reducing criminal responsibility, while in the personal injury vignette malingering would lead to the acquisition of compensation money. The criminal case vignettes elicited malingering behaviour that was easier to detect than the civil case vignette, sensitivity rates being .82/.73 and .55, respectively. Thus, when testing the diagnostic qualities of such instruments it may be wise to rely on multiple case vignettes, including civil cases.