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Objective: By providing a structured assessment of specific risk factors, risk assessment tools allow statements to be made about the likelihood of future recidivism in people who have committed a crime. These tools were originally developed for and primarily tested in men and are mainly based on the usual criminological background of men. Despite significant progress in the last decade, there is still a lack of empirical research on female offenders, especially female forensic psychiatric inpatients. To improve prognosis in female offenders, we performed a retrospective study to compare the predictive quality of the following risk assessment tools: PCL-R, LSI-R, HCR-20 v3, FAM, and VRAG-R., Method: Data were collected from the information available in the medical files of 525 female patients who had been discharged between 2001 and 2017. We examined the ability of the tools to predict general and violent recidivism by comparing the predictions with information from the Federal Central Criminal Register., Results: Overall, the prediction instruments had moderate to good predictive performance, and the study confirmed their general applicability to female forensic psychiatric patients., Conclusion: The LSI-R proved to be particularly valid for general recidivism, and both, LSI-R and HCR-20 v3, for violent recidivism., (Copyright © 2024. Published by Elsevier Inc.)

A systematic review of the literature on restoration of competence to stand trial identified a predominance of retrospective case studies using descriptive and correlational statistics. Guided by National Institutes of Health (NIH) quality metrics and emphasizing study design, sample size, and statistical methods, the authors categorized a large majority of studies as fair in quality, underscoring the need for controlled designs, larger representative samples, and more sophisticated statistical analyses. Implications for the state of forensic research include the need to use large databases within jurisdictions and the importance of reliable methods that can be applied across jurisdictions and aggregated for meta-analysis. More sophisticated research methods can be advanced in forensic fellowship training where coordinated projects and curricula can encourage systematic approaches to forensic research., (© 2024 American Academy of Psychiatry and the Law.)

WHAT IS KNOWN ON THE SUBJECT?: Nurses' observation of patients in seclusion is essential to ensure patient safety. Patient observation in seclusion assists nurses in adhering to the requirements of mental health legislation and hospital policy. Direct observation and video monitoring are widely used in observing patients in seclusion. Coercive practices may cause distress to patient-staff relations. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We add detailed information on specific observation methods in seclusion and compare them from the perspective of patients. Nurses communicating with patients ensures relational contact and that quality care is provided to patients even in the most distressed phase of their illness. Providing prior information to patients on observation methods in seclusion and the need for engaging patients in meaningful activities, while in seclusion are emphasized. Observation via camera and nurses' presence near the seclusion room made patients feel safe and gave a sense of being cared for in seclusion. Pixellating the video camera would give a sense of privacy and dignity. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The overarching goal is to prevent seclusion. However, when seclusion is used as a last resort to manage risk to others, it should be done in ways that recognize the human rights of the patient, in ways that are least harmful, and in ways that recognize and cater to patients' unique needs. A consistent approach to relational contact and communication is essential. A care plan must include patient's preferred approach for interacting while in seclusion to support individualized care provision. Viewing panels (small window on the seclusion door) are important in establishing two-way communication with the patient. Educating nurses to utilize them correctly helps stimulate relational contact and communication during seclusion to benefit patients. Engaging patients in meaningful activities when in seclusion is essential to keep them connected to the outside world. Depending on the patient's presentation in the seclusion room and their preferences for interactions, reading newspapers, poems, stories, or a book chapter aloud to patients, via the viewing panel could help ensure such connectedness. More focus should be placed on providing communication training to nurses to strengthen their communication skills in caring for individuals in challenging care situations. Patient education is paramount. Providing prior information to patients using a co-produced information leaflet might reduce their anxiety and make them feel safe in the room. When using cameras in the seclusion room, these should be pixelated to maintain patients' privacy. ABSTRACT: Introduction A lack of research investigating the specific role that various observational techniques may have in shaping the therapeutic relations in mental health care during seclusion warranted this study. Aim The aim of the study was to explore patients' experience of different methods of observation used while the patient was in seclusion. Method A retrospective phenomenological approach, using semi-structured interviews, ten patients' experiences of being observed in the seclusion room was investigated. Colaizzi's descriptive phenomenological method was followed to analyse the data. Results Communicating and engaging patients in meaningful activities can be achieved via the viewing panel. The camera was considered essential in monitoring behaviour and promoting a sense of safety. Pixelating the camera may transform patient view on privacy in seclusion. Discussion The mental health services must strive to prevent seclusion and every effort should be made to recognise the human rights of the patient. The study reveals numerous advantages when nurses actively engage in patient communication during the process of observation. Implications for Practice Different observation methods yield different benefits; therefore, staff education in using these methods is paramount. Empowering the patient with prior information on seclusion, engaging them in meaningful activities and proper documentation on patient engagement, supports the provision of individualised care in seclusion., (© 2023 The Authors. Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.)

Although psychopathy is a well-established risk factor for recidivism among those who have committed sexual offenses, there are nonetheless some individuals with sexual offense histories who are high in psychopathy but do not recidivate. This population-nonrecidivating psychopathic sex offenders (NRP-SOs)-was the focus of the current investigation. Data from 111 individuals with sexual offense histories who received a Hare Psychopathy Checklist-Revised (PCL-R) rating of at least 25 (suggesting the presence of psychopathy) were analyzed. With recidivism operationalized as the accrual of any new serious-that is, violent or sexual-charges, 39 recidivated (RP-SOs), whereas 72 did not (NRP-SOs). A logistic regression was conducted to assess whether NRP-SOs could be differentiated from RP-SOs. Being older at the time of release, a lesser criminal history, and being married predicted nonrecidivism. PCL-R factor scores and sexual deviance were not predictive. These findings highlight the heterogeneity that exists, even among those high in psychopathy.

Comic books have been part of popular culture since the 1930s. Social activists quickly became concerned about the risk that comic books posed for youth, including that their content was a cause of juvenile delinquency. Dr. Fredric Wertham, a forensic psychiatrist, led efforts to protect society's children from comic books, culminating in multiple publications, symposia, and testimony before a Senate subcommittee on juvenile delinquency in 1954. During the course of his activities, and quite possibly as a backlash, comics started to represent psychiatrists and particularly forensic psychiatrists as evil, clueless, and narcissistic characters (e.g., Dr. Hugo Strange went from being a mad scientist to a mad psychiatrist). Clinical forensic psychiatrists who were not necessarily evil were often portrayed as inept regarding rehabilitation. There are very few positive portrayals of forensic psychiatrists in the comic book universe, and when they do occur, they often have severe character flaws or a checkered history. These negative characterizations are woven into the fabric of contemporary comic book characters, whether represented in comic books or other media offshoots such as films and television., (© 2020 American Academy of Psychiatry and the Law.)

The Cal-DSH Diversion Guidelines provide 10 general guidelines that jurisdictions should consider when developing diversion programs for individuals with a serious mental illness (SMI) who become involved in the criminal justice system. Screening for SMI in a jail setting is reviewed. In addition, important treatment interventions for SMI and substance use disorders are highlighted with the need to address criminogenic risk factors highlighted.

Background: Suicide is a severe public health problem, in 2008 the Italian ministerial recommendation n° 4 on the management of suicide defined key areas for the identification of suicidal risk in hospital wards. The guidelines are important in defining professional liability issues, in line with Law 24 of 8/3/2017 'Gelli-Bianco'. Our study aimed to investigate the appropriateness of the official documents on suicide prevention delivered by Italian hospitals and their compliance with the ministerial recommendation. Methods: The Italian hospitals' public procedures on suicide prevention issued between 2008 and 2019 ( n  = 33) were retrieved thorough web search and further evaluated according to their compliance with the 2008 Italian ministerial recommendations. Results: The guidelines documents were generally in line with the ministerial recommendation. However, we found a lack of implementation in the specific training of health professionals. Most guidelines provided no risk stratification, nor specific procedures for different risk degrees or diagnoses. More than half of the documents did not report standardised tools for the assessment of suicidal risk. Conclusions: The public procedures on suicide prevention in Italian hospitals present general indications, leaving room for interpretation. Public procedures should be implemented with greater attention to the elements of judgement in the assessment of suicidal risk.KEY POINTSProcedures for suicide prevention are of uttermost importance for psychiatrist working in hospital.Standards in suicide risk evaluations are needed.Comparison between procedures can improve risk assessment and evaluation.

Ward-based violence is the most significant cause of reported safety incidents at East London NHS Foundation Trust (ELFT). It impacts on patient and staff safety, well-being, clinical care and the broader hospital community in various direct and indirect ways. The contributing factors are varied and complex. Several factors differentiate the forensic setting, which has been identified as a particularly stressful work environment. Staff must constantly balance addressing therapeutic needs with robust risk management in a complex patient cohort. ELFT identified reducing inpatient physical violence on mental health wards as a major quality improvement (QI) priority. The aim was to use a QI methodology to reduce incidents of inpatient violence and aggression across two secure hospital sites by at least 30% between July 2016 and March 2018. Collaborative learning was central to this project. It sought to foster a culture of openness within the organisation around violence and to support service users and staff to work together to understand and address it. A QI methodology was applied in medium and low secure inpatient settings. A change bundle was tested for effectiveness, which included: safety huddles, safety crosses and weekly community safety discussions. Operational definitions for non-physical violence, physical violence and sexual harassment were developed and used. Reductions of 8% and 16.6% in rates of physical and non-physical violent incidents, respectively, were achieved and sustained. Compared with baseline, this equated to one less incident of physical and 17 less of non-physical violence per week averaged across seven wards. Three wards achieved at least a 30% reduction in incidents of physical violence per week. Five wards achieved at least a 30% reduction in incidents of non-physical violence per week. This collaborative brought significant improvements and a cultural shift towards openness around inpatient violence., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The current study evaluated the predictive validity of the Juvenile Sex Offender Assessment Protocol-II (J-SOAP-II) scores in a sample of juveniles who recidivated sexually or nonsexually as adults. Participants included 166 juveniles who had previously sexually offended and were followed into adulthood for an average of 10.75 years. Results of area under the receiver operating characteristic curve (AUC) analyses supported the predictive validity of the J-SOAP-II Total Score, Scale 1, and Static Score in regard to adult sexual recidivism, and predictive validity was found for all J-SOAP-II scores (except Scale 1) in regard to adult nonsexual recidivism. Implications for future research on the assessment of risk factors and treatment needs for adolescents who commit sexual offenses are discussed.

The article discusses the key aspects of the guidance of the European Psychiatric Association (EPA) on forensic psychiatry and the required actions to implement guidance into clinical practice. The authors pay attention to the discrepancies between the recommendations resulting from the guidance and clinical practice and current systemic solutions. The basic difficulties were discussed in relation to the implementation of the guidelines in the clinical practice in Poland as regards providing services as an expert by psychiatrists and psychologists, risk assessment and management, psychiatric therapy in detention centers, implementation of protection measures in inpatient and outpatient treatment conditions, efficiency of pharmacological and non-pharmacological interventions. We hope that discussing the content of the guidance will help to deepen the knowledge of clinicians in the field of work as court expert witnesses and persons responsible for the implementation of the preventive measure. Based on the clinical experience measures were proposed that enable implementation of the guidance, and thus improvement of the quality of care exercised over the mentally ill criminal offenders.

Background: Patients suffering from severe mental disorders and who have an increased risk of violent behavior, tend to be insufficiently cared for until committing a violent offense leads to compulsory placement in a forensic psychiatric clinic., Objective: The concept of the preventive outpatient clinic has been recently published in this journal. The aim of the study was to evaluate whether treatment in the outpatient clinic is preventive with respect to violence and whether there is a positive therapeutic outcome., Method: The study design was quasi-experimental and longitudinal. The control group consisted of comparable patients from an adjacent healthcare catchment area. Measurements were taken on admission (t 0 ) and after 6 and 12 months of treatment (t 1 and t 2 , respectively). Dynamic risk factors, i.e. subscales C and R of the history clinical risk-20 version 2 (HCR-20 V2) scale and global assessment of functioning (GAF) scale were used as indicators of treatment success, involving both clinician ratings and self-reports. Multiple imputed data for 70 subjects in the experimental group and 51 in the control group were analyzed by mixed effects models with group as a fixed effect., Results: The interaction effect between time and group was statistically significant for the R (risk management) subscale and the GFA values but not for the C (clinical risk) value (after Bonferroni correction), whereby controls were made for multiple testing., Conclusion: The hypothesis with respect to the efficacy of the treatment could be maintained regarding risk markers and global assessment of functioning. With respect to clinical parameters there was a positive tendency in the expected direction. The data therefore indicate a positive effect of the preventive outpatient clinic for the patients treated.

De-institutionalization of mental health patients has evolved, over nearly 3 generations now, to a status quo of mental health patients experiencing myriad contacts with first-responders, primarily police, in lieu of care. The current institutions in which these patients rotate through are psychiatric emergency units, emergency rooms, jails, and prisons. Although more police are now specially trained to respond to calls that involve mental health patients, the criminalization of persons with mental illness has been steadily increasing over the past several decades. There have also been deaths. The Crisis Intervention Team (CIT) model fosters mental health acumen among first responders, and facilitates collaboration among first responders, mental health professionals, and mental health patients and their families. Here, we review some modern, large city configurations of CIT, the co-responder model, the mitigating effects of critically situated community-based programs, as well as barriers to the success of joint efforts to better address this pressing problem.

This article reviews the development of forensic psychiatry and mental health services in Australia for the international reader. It covers the legacy of a series of colonial systems that have contributed to a modern health service that interacts with justice systems. The development of relevant legislation, hospitals, prison services, community, and courts services is reviewed. The training and academic development of professionals is covered. Gaps in service delivery and future directions are considered.

One of the major concerns in present-day psychiatry is the criminalization of persons with serious mental illness (SMI). This trend began in the late 1960s when deinstitutionalization was implemented throughout the United States. The intent was to release patients in state hospitals and place them into the community where they and other persons with SMI would be treated. Although community treatment was effective for many, there was a large minority who did not adapt successfully and who presented challenges in treatment. Consequently, some of these individuals' mental condition and behavior brought them to the attention of law enforcement personnel, whereupon they would be subsequently arrested and incarcerated. The failure of the mental health system to provide a sufficient range of treatment interventions, including an adequate number of psychiatric inpatient beds, has contributed greatly to persons with SMI entering the criminal justice system. A discussion of the many issues and factors related to the criminalization of persons with SMI as well as how the mental health and criminal justice systems are developing strategies and programs to address them is presented.

An unprecedented number of individuals with mental illness are represented in the criminal justice system. The unending growth of mentally ill populations in the justice system has led to jails and court dockets being increasingly overwhelmed with cases involving mental illness, state hospitals devoting far more beds and resources to forensic cases, and people without a criminal commitment left waiting for mental health services as forensic cases are prioritized. Although a forensic mental health evaluation is only one component of this larger system, common problems with forensic mental health evaluations can exacerbate the criminalization of persons with mental illness in many ways. This article reviews the current literature regarding issues of quality, reliability, and validity of forensic mental health evaluations, discusses the broader impact of these issues, and offers potential solutions for the field.

Criminalizing those with mental illness is a controversial topic with a long and complex history in the United States. The problem has traditionally been dichotomized between criminals (i.e., "bad") in need of placement in jails and prisons and the mentally ill (i.e., "mad") who are need of treatment in psychiatric facilities. Recent trends demonstrate significant increases in the rates of mental illness in jails and prisons, as well as increased rates of violence within psychiatric hospitals. This would suggest that there are a group of justice involved individuals who are "indistinguishable" within the traditional dichotomous categories of dangerousness and mental illness. The authors argue for a more nuanced model that dimensionally conceptualizes dangerousness and mental illness; increased attention to situational factors that create facilities appropriate for those who are dangerous and mentally ill and more diversion programs for those inappropriate for incarceration or hospitalization.

Whereas risk assessment literature on sexual offending has primarily focused on prediction of subsequent sexual crimes, and not the severity of those crimes, the first aim of the present study was to identify variables that predict the amount of damage to victims in sexual crimes compared with those that predict general aggressiveness. The second aim was to ascertain whether adding emotional instability measurements, as in borderline personality disorder (BPD), would add incremental variance to that captured by the facets of the Psychopathy Checklist-Revised (PCL-R). Trained raters assessed on the PCL-R, BPD, and measures of severity of sexual and nonsexual violence 302 adults who had sexually offended. PCL-R's Antisociality and two externalizing BPD factors (one from the standard and one from the alternative criteria) were significant predictors of violence both in sexual and nonsexual crimes. In contrast, deficits in the PCL-R's Affective facet (2) predicted victim damage in sexual contexts only, whereas the Lifestyle Impulsivity facet (3) of the PCL-R predicted violence in nonsexual contexts only. These findings suggest that adding measures of emotional dysregulation to commonly used instruments like the PCL-R, which assesses callousness and antisociality, may be beneficial for predicting violence.

This article contextualizes new knowledge about forensically interviewing and assessing children when there are concerns about child abuse. The article references the impact of the Child Abuse Prevention and Treatment Act and the circumstance in the 1980s where investigators and clinicians had little guidance about how to interview children about alleged sexual abuse. It further speaks to the consequences of lack of interview guidelines and how videotaped interviews in the McMartin Pre-school cases served as the catalyst for the backlash against child interviewers and their interview techniques. Painful as the backlash was, it led to research and evidence-based practice in interviewing children about child sexual and other abuse. Principal among the practice innovations were forensic interview structures to be used when there is alleged child sexual and other abuse and the strong preference for one interview by a skilled interviewer, who is nevertheless a stranger to the child. Although these innovations satisfied many professionals in the child maltreatment field and critics of child interviewers, the new practices did not address a number of abiding issues: 1) how to meet the needs of children who are unable to disclose maltreatment in a single interview, 2) how to determine which children are suggestible in a forensic interview, and 3) how decisions are made about the likelihood of abuse, based upon the child's information during the interview. The articles in this special section address these cutting-edge issues.

This study examined the assessment approach interviewers use while conducting interviews to assess truth as narratives are gathered in children's disclosure statements by examining 100 forensic interviews completed at a Children's Advocacy Center. A descriptive review was used to examine the steps engaged by interviewers as they followed a protocol and content analysis was used to identify interviewers' questioning strategies as they assessed children's disclosure narratives during interviews. Findings indicate that interviewers apply a protocol in order to support advancing to a phase of eliciting details in children's narratives. Questioning strategies included using a variety of question types to progress from general to specific, incorporating interview aids sparingly as necessary, and integrating multidisciplinary team feedback. Findings suggest that an assessment approach is inherent to the process of actively conducting a forensic interview. Rather than assessment beginning strictly upon completion of children's narratives, this paper describes how interviewers incorporate an assessment framework throughout interviewing.

Multiple session forensic interviews (MSFI) are a useful tool in the field of child sexual abuse forensic interviewing given the complexity of disclosures and the variety of child-centered needs observed in practice. This paper focuses on the Children's Advocacy Centers of Texas (CACTX) model for conducting MSFIs, illustrated by a description of the statewide training models offered to member centers and enumeration of the MSFI protocol guidelines implemented by one center. A brief history and review of the single session forensic interview (SSFI) is provided followed by considerations for MSFIs in order to establish the development of current and new practices. Clarification of terms are outlined with examples of cases to distinguish between multiple sessions and subsequent sessions. The MSFI guidelines presented demonstrate how an MSFI can fit with the SSFI model.

Introduction: Therapeutic relationship in forensic psychiatry is believed to be affected by the coercive setting and the role conflict of the therapists as both treaters and court-appointed experts. The aim of the study was to examine and compare the therapeutic relationship in forensic and general psychiatric settings., Material and Methods: 52 forensic patients and 66 general psychiatric patients filled in the Psychopathy Personality Inventory - Revised (PPI-R), the Inventory of Interpersonal Problems - German Version (IIP-D), the Questionnaire on Motivation for Psychotherapy (Fragebogen zur Erfassung der Psychotherapiemotivation (FPTM)) as well as the Working Alliance Inventory - Short Revised (WAI-SR). We applied descriptive analyses, calculated univariate t -tests as well as multivariate T -tests and performed general linear models., Results: The quality of the therapeutic alliance does not differ significantly between forensic and general psychiatric patients. Moreover, patients of forensic psychiatry consider therapeutic techniques applied by their therapists as more valuable for achieving their therapeutic aims than patients of the general psychiatry., Discussion: The therapeutic relationship in forensic psychiatry is as viable as in general psychiatry. This can be regarded as a result of the long-term therapy in the context of forensic psychiatry which allows more time to be spent on relationship building than in a general psychiatry setting where therapy is limited to a few weeks., Competing Interests: Die Autoren erklären, dass keine Interessenkonflikte bestehen., (© Georg Thieme Verlag KG Stuttgart · New York.)

Purpose and aim: Out from the sparse literature on risk assessment for violence committed by women the Female Additional Manual (FAM) was developed to be a complement to the HCR-20v2. The aim of this study was to investigate and compare the psychometrics of the HCR-20v2 with and without the FAM on risk for inpatient physical violence for female forensic psychiatric patients. Methods: The participants were 100 female patients admitted to forensic psychiatric care in a high-security clinic, assessed by clinicians with the HCR-20v2 during their admission. Researchers performed the FAM, both retrospectively and prospectively. The follow-up period was 12 months before being discharged. Results: Four main results were found; first, many risk factors were present although the summary risk ratings were mainly low to moderate. Secondly, the reliability was in general good, where the HCR-20v2 mainly showed higher reliability without than with the FAM, indicating that FAM risk factors did equal or did not contribute to a higher reliability. Third, the internal validity was higher for the HCR-20v2 than for the FAM. Risk factors correlated stronger with the summary risk ratings for the HCR-20v2 than for the FAM. Fourth, the validity for inpatient physical violence was high for the total score of both the HCR-20v2 and the FAM, but contradictory to previous finding the validity for summary risk ratings was not significant. Conclusions: The results support the use of HCR-20v2 when assessing risk for inpatient violence for female forensic psychiatric patients, but with only some support for adding or changing risk factors according to the FAM.

Aim: To evaluate how a 3-year patient safety intervention, more specifically, the implementation of a patient safety incident reporting system, influences patient safety culture., Background: Positive patient safety culture improves both the quality of health care and patient safety. Nevertheless, nursing managers need tools that can help them develop and evaluate patient safety culture., Methods: The Hospital Survey on Patient Safety Culture was used to evaluate patient safety culture at two Finnish forensic psychiatric hospitals (study and control) over two periods, baseline and follow-up. Data were analysed using Z-score and T test statistics., Results: The follow-up results from the study hospital showed that five patient safety culture dimensions exhibited a significantly (p < 0.05) positive change in positive response rates over the 3-year period. Furthermore, nine out of twelve patient safety culture dimensions at the study hospital showed a significant improvement in mean score. At the control hospital, only the dimension of frequency of reporting events showed a significantly positive change (p < 0.05) in mean score., Conclusion: This research shows that the studied patient safety intervention (implementation of the patient safety incident reporting system) significantly influences patient safety culture., Implications for Nursing Management: Nursing managers should utilize a variety of patient safety interventions to improve patient safety and focus on leveraging information from patient safety incidents to advance patient safety culture., (© 2019 John Wiley & Sons Ltd.)

Background: Since the 1990s, standardized competency to stand trial assessment measures have been developed to improve the reliability and validity of expert assessment and opinion in legal settings. This study aimed to meta-analyze the psychometric properties of the four 'second generation' assessment tools: the MacCAT-CA, MacCAT-FP, ECST-R and CAST*MR., Method: A systematic search of published and unpublished studies was undertaken on PsycNet, PubMed, Scopus, Web of Science and Science Direct up until February 2018. Test manuals were sourced and attempts at finding grey literature included contacting study authors and test developers., Results: Eleven studies were included in the final analysis. The MacCAT-CA, ECST-R and CAST*MR demonstrated acceptable subscale internal consistencies and interrater reliability. The MacCAT-CA and CAST*MR discriminated between competent and incompetent defendants with large effects. The MacCAT-FP had insufficient reliability data and poor discrimination. There was insufficient data to meta-analyze the factor structure, sensitivity, specificity, or effect sizes between types of clinical presentation on any tool., Conclusions: Very few studies have investigated the psychometric properties of the selected tools. Many studies were excluded for not providing original data or simply re-reporting the psychometric properties stated in test manuals. Whilst the MacCAT-CA and ECST-R have promising psychometric properties, ongoing construct validation is required., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Criteria to determine in which level of security forensic patients should receive treatment are currently non-existent in Belgium. Courts largely rely on the evaluations of the prison psychiatrists and psychologists to form their decision. None of the few available instruments - e.g., the DUNDRUM-1 - is currently used to provide structured clinical judgment when determining security level., Method: DUNDRUM-1 scores were collected for 150 forensic patients. Security levels according to DUNDRUM-1 assessment were compared to security levels as decided by the court., Results: There was little agreement between DUNDRUM-1 scores and proposals for secure care made by the court. The DUNDRUM-1 predicted eventual admission to a high security setting, but not a medium security setting., Conclusion: The DUNDRUM-1 is an instrument that can help clinicians and judges to make more reliable and transparent decisions regarding secure care. However, further research with regard to practical applicability is needed., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: The UHSA (UHSA) are French psychiatric units for inmates which admit detainees suffering from a psychiatric disorder requiring full-time hospital care. Non-psychiatric pathologies are overrepresented in patients with psychiatric disorders but also in detainees. As a result, patients hospitalized in UHSA are largely exposed to non-psychiatric conditions, and exploring the organization of general medical care for these patients appears very relevant. The aim of this study is to review the general medical care in all French UHSA., Methods: A descriptive study was carried out through a survey of the nine facilities., Results: All UHSA benefit from the intervention of a general practitioner. The physical clinical examination, the biological assessment and the electrocardiogram are systematically performed at the patient's admission in 7, 5 and 9 establishments, respectively. However, the offer of general medical care in UHSA seems disparate and sometimes insufficient. Specialized consultations are regularly requested during hospitalizations, but no establishment benefits from a telemedicine system or specialized consultations on site. The extraction of the patient to the general hospital is therefore systematic when such a consultation is needed. But the number of penitentiary escorts per day is limited. In 6 UHSA, medical extractions are thus regularly canceled by the penitentiary administration, sometimes without a medical opinion. Finally, the patient's regular physician is only contacted in 3 UHSA during hospitalizations., Conclusion: Based on these results, ways of improving the organization of general medical care in UHSA are proposed through four main axes: the structure and general organization; the general medical care; the link with the healthcare partners and the articulation with the penitentiary administration., (Copyright © 2018 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Post-conviction polygraph testing of sex offenders (typically referred to as PCSOT) is common in the US, increasingly applied in England and Wales, but hardly if ever used elsewhere in the world. This article provides an account of the nature and aims of PCSOT, research into its efficacy, and controversies associated with it.

Background:: In forensic psychiatric care, a hermeneutic caring conversation between caregivers and patients can improve health outcomes. The hermeneutic approach entails starting from the whole and involves openness for what is shown as well as paying attention to the different parts. One way to deepen these conversations is to take advantage of both the caregivers' and the patients' life experiences., Research Questions:: The purpose of the study is to discuss and reflect on what hermeneutic caring conversations can mean for a deepened understanding of the movement in the health processes of patients in forensic care, patients who are in deep suffering., Research Design:: This study uses a hermeneutic methodology. Conversations with patients receiving care in forensic psychiatry are deepened using texts from philosophy, caring science, and poetry. The outcome emerges through a phase of creating patterns., Participants:: Three patients in forensic care., Ethical Considerations:: This study builds on a doctoral thesis approved by The Ethical Review Board at the Faculty of Medical and Health Sciences, Linköping, Sweden., Findings:: Hermeneutic caring conversations provide a possibility for rich caring conversations with patients who are often not given a voice. These conversations are seen as ethical expressions of hermeneutic caring communion that affect patients' health processes in a positive way., Discussion:: It takes courage and responsibility to initiate and conduct these conversations as the patients volunteer to share their suffering. In hermeneutic caring conversations, the caregiver's attitude is crucial for the transference of knowledge., Conclusion:: This study provides a preliminary outline for hermeneutic caring conversations. A caring culture that provides time and space to prepare hermeneutic caring conversations is a prerequisite for the implementation of hermeneutic caring conversations.

Guidelines for pharmacological treatment of patients with paraphilic disorders have been developed by a working group of the World Federation of Societies of Biological Psychiatry (Thibaut et al., 2010 ). With an increasing duration of experience and number of treated patients as well as aging patients, change of or withdrawal from testosterone-lowering medications (TLM) has become an important issue. The current study aimed to assess the quality of a structured professional judgment procedure that helps switching or discontinuing TLM in patients with paraphilic disorders. We used the Delphi method to estimate the quality of 10 factors originally proposed by the authors. A total of 30 experts participated in the first stage; 18 experts participated in the second stage. The experts' assessment resulted in an instrument of 15 factors that can be used to structure the process of changing or discontinuing TLM. These factors can be grouped into five broader categories: age and duration of treatment; therapeutic alliance; psychopathology and risk factors; motivation; and compliance and level of control. The developed COSTLow-R Scale provides an instrument that can be used to structure the process of changing or discontinuing TLM in patients with severe paraphilic disorders.

Following the risk-need-responsivity (RNR) model, cognitive-behavioral therapy is considered most effective in reducing recidivism when based on dynamic risk factors. As studies have found differences of these factors across age, exploring this seems beneficial. The current study investigates the Central Eight (C8) risk factors across six age groups of outpatient sex offenders ( N = 650). Results showed that recidivism rates and age were inversely related from 19 years and up. Half of the C8 did not predict general recidivism at all, substance abuse, antisocial cognition, antisocial associates, and history of antisocial behavior in only one or several age groups. However, factors differed between age groups, with the youngest group demonstrating the most dysfunction in several areas and the oldest group the least. It is concluded that the C8 risk factors seem to lose significance in the older age groups. Results may benefit targeting treatment goals.

Objectives: This paper describes the main areas of civil forensic psychiatry (FP) and the skills required by psychiatric experts. Some specific areas of civil FP are discussed, including tort law reform, reliability of psychiatric evidence, contentious psychiatric disorders, and the many domains of civil FP., Conclusions: Civil FP is an important sub-specialty component of forensic psychiatry that requires greater emphasis in the training and continuing education of psychiatrists. A process of accrediting psychiatrists as having competency in advanced civil FP may be of value.

Objectives: This is the third in a series of papers on Civil Forensic Psychiatry and provides practical advice for forensic psychiatrists, general psychiatrists and trainees who are expanding or contemplating a medico-legal aspect to their practice., Conclusions: Attention to the practice setting, office layout, recording of information, management of documentation, screening of briefs and proper timetabling can improve safety, quality, reliability and workload manageability.

With the increase in the number of risk assessment tools and clinical algorithms in many areas of science and medicine, this Perspective article provides an overview of research findings that can assist in informing the choice of an instrument for practical use. We take the example of violence risk assessment tools in criminal justice and forensic psychiatry, where there are more than 200 such instruments and their use is typically mandated. We outline 10 key questions that researchers, clinicians and other professionals should ask when deciding what tool to use, which are also relevant for public policy and commissioners of services. These questions are based on two elements: research underpinning the external validation, and derivation or development of a particular instrument. We also recommend some guidelines for reporting drawn from consensus guidelines for research in prognostic models., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

A large national sample of 4,775 reports of child physical and sexual abuse made in Israel in 2014 was analyzed in order to examine whether assessments of credibility would vary according to abuse type, physical or sexual, and whether child and event characteristics contributing to the probability that reports of abuse would be determined as credible would be similar or different in child physical abuse (CPA) and child sexual abuse (CSA) cases. Results revealed that CPA reports were less likely to be viewed as credible (41.9%) compared to CSA reports (56.7%). Multigroup path analysis, however, indicated equivalence in predicting factors. In a unified model for both types of abuse, salient predictors of a credible judgment were older age, lack of a cognitive delay, and the alleged abusive event being a onetime less severe act. Over and beyond the effects of these factors, abuse type significantly contributed to the prediction of credibility judgments.

The notion of truth and its determination in legal proceedings is contingent on the cultural setting in which a claim is argued or disputed. Recent years have demonstrated a dramatic shift in the public dialogue concerning sexual harassment. This shift reflects changing cultural mores and standards in the workplace and society as a whole, particularly with respect to the validity of women's voices. The subjective reality experienced by victims of sexual harassment is inherently tied to the legal system's treatment of women throughout history. In determinations of truth, our understanding of which information and perspectives are relevant, and our expectations regarding the credibility of complainants and the accused, are undergoing a period of rapid change. The discourse surrounding the #MeToo movement suggests that the "reasonable-person" standard so often applied by courts is poorly suited to sexual-harassment litigation. As our understanding of what constitutes "severe," "pervasive," and "unwelcome" conduct continues to evolve, forensic psychiatrists must strive to uphold the values of respect for persons in the search for the truth., (© 2018 American Academy of Psychiatry and the Law.)

Forensic psychiatry has often been neglected in nonwestern countries, including the African continent. Our aim was to assess the practices and needs for improvement in the field of forensic psychiatry in Rwanda. During a one-week visit conducted in October 2017, we interviewed key-informants working at decisional levels in the domains of health, justice and security. Two clinical workshops involving psychiatrists, psychologists and nurses were held in psychiatric facilities, including at Ndera, the main psychiatric hospital of the country. Three axes of development and improvement were identified: First there is a need for a clearer, more coherent and updated legislative framework. Second, the absence of a forensic secured unit, which compromises both quality of care for forensic patients and security of the other patients and staff, should be remediated. Third, the supervision and training in this specialized domain should be provided through international collaborations. Hopefully, Rwanda could become in the next few years a driving force for other African countries in the field of forensic psychiatry.

Objectives: The aim of this paper is to describe the development and technical specifications of a framework and national key performance indicators (KPIs) for Australian mental health Court Liaison Services (CLSs) by the National Mental Health Court Liaison Performance Working Group (Working Group)., Methods: Representatives from each Australian State and Territory were invited to form a Working Group. Through a series of national workshops and meetings, a framework and set of performance indicators were developed using a review of literature and expert opinion., Results: A total of six KPIs for CLSs have been identified and a set of technical specifications have been formed., Conclusions: This paper describes the process and outcomes of a national collaboration to develop a framework and KPIs. The measures have been developed to support future benchmarking activities and to assist services to identify best practice in this area of mental health service delivery.

This article focuses on the development of a Forensic Mental Health Services Census (FMHSC), proposed to differentiate between five different patient populations institutionalized in state facilities. The FMHSC would comprise patients who are civilly committed for mental illness or sexual dangerousness, those found incompetent to stand trial, those committed after a verdict of not guilty by reason of insanity, and those voluntarily committed. The census would be performed by state mental health authorities for each of these populations within the particular jurisdiction and then would be reported to a national coordinating organization. These data are important because of the large number of persons involved and the significant resources devoted to the management and treatment of each involuntary group. The census is necessary for clinical, research, and policy purposes, to provide more rational management of these populations, both within and across jurisdictions., (© 2017 American Academy of Psychiatry and the Law.)

Competing Interests: Competing interests: None declared.

Background: In France, special full-time inpatient hospital units (UHSA) have been created for inmates with psychiatric disorders. Since they were established in 2010, the quality of care in such units has not been studied. Particularly, no patient satisfaction survey has been conducted yet. The main objective of this study was to assess the patients' satisfaction about their hospitalization in UHSA., Methods: A descriptive study has been performed in two hospitals (UHSA of Villejuif and UHSA of Lille-Seclin). From February to May 2015, 125 adult patients were included, at the end of their hospitalization (voluntary or involuntary psychiatric care) in UHSA. The patient's satisfaction was assessed by a psychiatrist who did not participate in patient care with a 16-item scale exploring three areas (quality of care, quality of information provided and UHSA functioning and organization). The items were evaluated with a visual numeric scale (1 to 10)., Results: The average score of overall satisfaction was 7.3±1.9 (average±standard deviation) for this sample. For the care area, the average score was 7.6±2; for the quality of information provided, it was 7.5±2.5 and for UHSA functioning and organization, 7.0±2. Furthermore, 84.8 % of patients reported their wish to continue psychiatric care in prison and 77.6 % after release., Conclusion: This study demonstrates that patients hospitalized in UHSA are satisfied. Given the relationship between patient satisfaction and compliance, these structures could therefore have an important medical interest for inmates with psychiatric disorders. However, these results need to be replicated in a study involving all the UHSA of France., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)