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Although research on e-mental health in criminal justice settings continues to accumulate, the evidence base on this topic remains limited. In recent years, technological innovations have increasingly entered forensic and correctional mental health care, and the COVID-19 pandemic has accelerated their diffusion. The present special issue aims to promote evidence-based best practices and inform clinical decision-making in criminal justice settings by presenting recent developments and findings relevant to the use of e-mental health. In this introduction, we summarize the eight articles in the special issue and discuss directions for future research.

Although the validity of forensic risk assessment has been in the focus of academic research in forensic mental health for the last 40 to 50 years, the quality of such assessments is still only moderately satisfactory on average. On one hand, there have been numerous attempts to improve the quality of assessments by developing new instruments or revising the content criteria of existing instruments. On the other hand, significant findings from decision psychology regarding the effect of cognitive biases on processes of judging have hardly found their way into the scientific debate so far. Consequently, there is also a lack of in-depth consideration of measures that counteract cognitive biases by applying debiasing strategies. However, erroneous judgements in the field of forensic mental health can cause severe consequences for individuals as well as for society. Therefore, sound empirical examination of debiasing strategies and their relevance to improve the validity of risk assessment is strongly recommended.

The field of risk assessment was long dominated by the view that the scientific focus should be on the analysis of accuracy. The methods under investigation were considered valid if they succeeded in distinguishing recidivists from non-recidivists with a sufficient degree of accuracy. The forensic risk assessment process is part of a more complex event that has implications for different parties. The result of the risk assessment must be communicated to different audiences. Forensic risk assessment is thus the basis of forensic risk communication, which in turn is the basis of forensic intervention or risk management. We recommend that forensic risk communication be guided by Fischhoff's (1995) model. This is a seven-stage model to which we add reference literature from forensic research. Key questions are provided to facilitate the application of the model to practical work.

Background The suitability of driving simulators for the prediction of driving behaviour in road traffic has been able to be confirmed in respect of individual assessment parameters. However, there is a need for overarching approaches that take into account the interaction between various influencing factors in order to establish proof of validity. The aim of this study was to explore the validity of our driving simulator in respect of its ability to predict driving behaviour based on participants‘ observed driving errors and driver’s individual characteristics. Method 41 healthy participants were assessed both in a Smart-Realo-Simulator and on the road. By means of linear modelling, the correlation between observed driving errors was investigated. In addition, the influence of self-reported and externally assessed driving behaviour as well as individual parameters (education and training; driving history) were analysed. Results By including these factors, 58% of the variance could be explained. For observed driving errors, a relative validity was established. For self-reported and externally assessed driving behaviour, an absolute to relative validity emerged. The amount of time spent in education and training proved to have a significant influence on driving performance in the simulator, but not on the road. Discussion In general, our results confirmed the validity of our driving simulator with regard to observed and self-reported driving behaviour. It emerged that education and training as potential indicators of cognitive resources played a differential role regarding the study conditions. Since real road driving is considerably automated in experienced drivers, this result suggests that simulation-related behavioural regulation is challenged by additional cognitive demands as opposed to behavioural regulation extending to real road driving. However, the source of these additional cognitive demands remains currently elusive and may form the subject of future research.

Although the global diffusion of e-mental health has increased in recent years, research on the use of technologies in criminal justice settings is limited. To bridge this knowledge gap, we conducted an international online survey ( N = 555) of forensic and correctional mental health professionals from Germany, Switzerland, the United Kingdom, the United States, and 20 additional countries. Telecommunication technologies and mental health platforms had the highest numbers of users, the broadest scope, and the largest increase in use due to the coronavirus disease 2019 (COVID-19) pandemic. In contrast, the use of social media and advanced technologies was lower, narrower in scope, and remained the same or decreased during the COVID-19 pandemic. Respondents’ age, professional discipline, country, and clinical setting significantly predicted total technology use in clinical practice. The study findings provide an overview of the current patterns of technology use and point to opportunities for research and development.

ZusammenfassungEine Verschwörungstheorie kennzeichnet u. a., dass eine Gruppe einer anderen Gruppe wahrheitswidrig ein destruktives Vorhaben unterstellt.Die Autoren dieses Artikels formulieren einen Vorschlag für eine typologische Einordnung von Verschwörungstheorien und skizzieren exemplarisch anhand der Protokolle der Weisen von Zion sowie QAnon die Entstehung sowie Auswirkungen von Verschwörungstheorien. Zudem wird auf die Persönlichkeit der Urheber und der Anhänger von Verschwörungstheorien Bezug genommen.Etwa 10–30 von 100 Deutschen glauben an eine Verschwörungstheorie. Wer sich für eine Verschwörungstheorie begeistert, interessiert sich i.d.R. auch für weitere. Die Persönlichkeiten von Verschwörungstheoretikern sind zwar nicht psychopathologisch auffällig, weisen aber ein salientes Persönlichkeitsprofil auf: Sie sind weniger verträglich, offen für neue Erfahrungen, schätzen sich als weniger intelligent ein, sie sind ansprechbar für Paranormales und weisen eine hohe externale Fatalität bzw. soziale Abhängigkeit auf.In einem dritten Teil werden Verschwörungstheorien unter dem Blickwinkel der Forensischen Humanwissenschaften beleuchtet. Im Zentrum steht dabei die Frage nach dem Zusammenhang von Verschwörungstheorien und Gewalthandlungen. Die überwiegende Mehrheit der Personen, die sich intensiv mit Verschwörungstheorien beschäftigen, überschreitet nicht die Handlungsschwelle zur Gewalt. Allerdings haben sich nahezu alle Extremisten, die massive Gewalt angewendet haben, mit Verschwörungstheorien beschäftigt. Verschwörungstheorien sind somit forensisch gesehen relevant, etwa so wie extremistische Weltanschauung, Drohungen und querulatorisches Verhalten, weshalb eine Risikoeinschätzung anhand der üblichen Beurteilungsschritte des Bedrohungsmanagements erfolgen kann.

Background: The purpose of this study was to evaluate the self-reported stability of psychopathic traits in adolescents in residential care (both child welfare and juvenile justice placed juveniles) and potential influencing factors. Method: We applied the Youth Psychopathic traits Inventory (YPI) in a sample of 162 adolescents (M=15.0 years, SD=1.3) over a mean time interval of 11 months (min. 6, max. 21 months, SD=3.14). Results: There was no significant difference in YPI total score nor in the three underlying dimensions Grandiose-Manipulative (GM), Callous-Unemotional (CU), and Impulsive-Irresponsible (II) between t1 and t2. Furthermore, 70% of the adolescents showed no clinically significant reliable change on the YPI total score (as measured with the reliable change index), 15% improved, 15% deteriorated. The strongest predictor for psychopathic traits at t2 were psychopathic traits at t1. Additional predictors for higher levels of general psychopathic traits was male gender, for CU-traits male gender and lower levels of internalizing mental health problems, and for II-traits higher levels of externalizing mental health problems. Generally, the three reliable change groups (increase, no change, decrease) did not seemed to differ on relevant factors. Conclusions: Our results add to the findings that psychopathic traits are relatively stable in this high-risk group over approximately a one-year time interval. Research with a longer follow-up time and more time points is warranted to better interpret these results.

Background Motivation to change is a central component of successful psychotherapeutic treatment. It is however unclear how external pressures in court-mandated treatments interfere with a patient's internal motivation. This study sought to investigate service providers' and users' experiences with court-mandated psychotherapeutic treatment and its effects on a patient's motivation. Methods We conducted a qualitative interview study with 41 older incarcerated persons receiving involuntary treatment and 63 mental health professionals (MHP) from Canada and Switzerland. Interviews were analyzed using thematic analysis. Results MHP participants referred to the difficulties of using internal motivation as selection criterion for treatment participation but emphasized the advantage of the legal referral as a chance to connect with a person who would otherwise not seek treatment. This coerced participation in psychotherapy allowed the MHPs to build internal motivation throughout the intervention. Further, we delineate certain external and internal factors that influence treatment motivation. For instance, a patient's strategic motivation to engage in treatment to regain freedom; the influence of authorities' decision-making processes on treatment motivation; conveying and understanding of psychotherapy to promote active participation. Conclusions Our study provides important empirical findings on the effects of the legal referral on a patient's motivation. Findings suggest that the legal referral in itself does not stand in contradiction to internal motivation. In fact, it facilitates the engagement with a person needing treatment. However, a patient's internal motivation is challenged if goals set by external decision-makers are unclear, unpredictable, and vague. To increase the effectiveness of court-mandated treatment, institutions should therefore establish clear goals that are communicated clearly and transparently to the patients. With this clarity, a patient's internal motivation can be enhanced, which ultimately affects outcomes of court-mandated treatment orders.

Recovery orientation (RO) is a modality of supporting patients to improve self-determination, leading a meaningful life and well-being in general. This approach is widely studied in general psychiatry, but evidence is lacking for forensic inpatient settings in Switzerland. While secure forensic clinics tend to be regarded as total institutions, which are an anathema to RO, a project to implement RO interventions in this setting was financed by the Swiss Federal Office of Justice. This explorative study investigates baseline expectations and views of patients in forensic wards in German-speaking Switzerland in the context of a recovery-oriented intervention. As such wards are non-existent in Latin-speaking Switzerland, the investigation could only be carried out in this language region. Six focus groups with 37 forensic inpatients were conducted. Thematic analysis revealed two major and several subthemes. The major theme “heteronomy” includes the subthemes “stigmatization and shame,” “coercion,” “lack of support,” “mistrust,” “waiting,” and “structural impediments.” The subthemes “learning to live with the disorder and working on oneself,” “participation,” “connectedness,” “confidence,” and “joie de vivre” belong to the major theme “regaining self-determination.” In this way, results of prior research are extended to forensic peculiarities. Furthermore, the personal views of patients are discussed in detail regarding their possible influence on therapeutic outcomes and personal recovery. These findings should be of help to therapeutic staff in the respective setting to be better informed about, and to counter the effects of, heteronomy and long-term hospitalization. Important in this regard is the concept of procedural justice and the subjective client's perception thereof.

Die Qualitat der therapeutischen Beziehung ist pradiktiv fur den Therapieerfolg und der groste Einflussfaktor, der diesbezuglich isoliert untersucht wurde. In der Allgemeinpsychiatrie existieren verschiedene Beziehungsmodelle, deren Operationalisierungen als Messinstrumente Verwendung finden. Aufgrund der Vorhersagekraft dieser Fragebogen fur den Therapieerfolg in der allgemeinen Psychotherapie ist es sinnvoll, die therapeutische Beziehung auch in der forensischen Psychiatrie zu operationalisieren. Die vorliegende systematische Ubersichtsarbeit untersuchte die Besonderheiten und Unterschiede validierter Messinstrumente zur Erfassung der therapeutischen Beziehung bei unfreiwillig behandelten psychiatrischen Patienten. Dabei zeigte sich, dass die ublichen Beziehungskonzepte im forensischen Kontext stark adaptiert werden mussen. Die wenigen vorliegenden Messinstrumente sind in der Lage, forensische von allgemeinpsychiatrischen Patienten zu unterscheiden, wenn sie die „Strenge“ des Therapeuten als zusatzliche eigene Beziehungsdimension berucksichtigen. Zudem sind diese, anders als Fragebogen der allgemeinen Psychotherapie, pradiktiv fur die strafrechtliche Ruckfalligkeit der Patienten. Die gemeinsame Einigung auf Therapieziele und therapeutische Aufgaben ist in der Forensik weniger relevant fur eine gute Beziehungsqualitat. Diese profitiert am ehesten von einem bestimmten und direktiven Stil, mit klar definierten Rollen und einem „Hart-aber-fair-Prinzip“.

The present study aimed to differentiate pedophilic child sex offenders (CSOs) from nonoffending controls (CTLs), as well as contact from noncontact CSOs. For this purpose, we investigated 21 contact CSOs, 20 noncontact CSOs (child pornography offenders), as well as 21 CTLs on neuropsychological test measures and indirect test measures of sexual interest. Multiple logistic regression models showed that three parameters of indirect tests and two neuropsychological test parameters allowed the differentiation of CSOs from CTLs with a maximum accuracy of 87%. The profile of contact and noncontact CSOs was remarkably similar and the optimal model for this group differentiation had a maximum accuracy of 66%, with slightly increased levels of risk-taking behavior and greater susceptibility for perceptual interference in contact CSOs than in noncontact CSOs. The findings suggest that standardized, objective methods can support the assessment of sexual offenders against children in forensic psychiatry and legal psychology.

Damit eine stationäre therapeutische Massnahme angeordnet werden kann, muss u.a. eine vorsätzliche und rechtswidrige Anlasstat gegeben sein. Der vorliegende Beitrag zeigt auf, dass der krankheitsbedingte Irrtum eines Schizophrenen die Rechtswidrigkeit der Anlasstat aufheben kann, wenn der Täter bei Abwehrhandlungen im Verfolgungswahn die Voraussetzungen der Putativnotwehr erfüllt. Um eine Gefährdung der öffentlichen Sicherheit und des therapiebedürftigen Schizophrenen zu verhindern, bieten die Autoren verschiedene Lösungsansätze und sprechen sich letztlich klar für eine Gesetzesänderung aus.

Der Basler Kriterienkatalog ist ein klinisch bewahrtes idiografisches Prognoseinstrument zur Beurteilung der Legalprognose und wurde durch eine interdisziplinare Arbeitsgruppe in einem mehrjahrigen Peer-Review-Prozess aktualisiert und in einer abschliesenden Vernehmlassung der Konkordatlichen Fachkommission der Nordwest- und Innerschweiz gutgeheisen. Vielfaltige Erganzungen und Anwenderhinweise aus der forensischen Praxis wurden integriert und spiegeln dabei u. a. Risikoaspekte der „central eight“ wider, einer auf soziales Lernen fokussierten Erklarungsperspektive kriminellen Verhaltens, die sowohl fur psychisch Kranke wie fur nichtgestorte Straftater ohne psychiatrische Diagnose Ruckfallrelevanz besitzen. Neu wurden spezifische Anwendungshinweise zur Kriterienliste (Manualisierung) erstellt. Dabei werden zum jeweiligen Kriterium die enthaltenen statischen und dynamischen Risikofaktoren und deren Bedeutung und Interpretation im Rahmen des vorliegenden Instruments erlautert, um die Interrater-Reliabilitat zu erhohen. Die Anwendungshinweise zur Gesamtbeurteilung enthalten weitere Uberlegungen zur integrativen legalprognostischen Gesamteinschatzung, Risikoszenarien und Risikomanagementstrategien. Die bisherige implizite Vorgehensweise der Vorgangerversion wurde im Hinblick auf die Nachvollziehbarkeit verschriftlicht. Durch seine Struktur und die beispielhaften Variablen ermoglicht der Kriterienkatalog eine breite Anwendung im Sinne des „structured professional judgement“ und einer Fallkonzeption, welche einerseits in alle modernen, integrativen Prognosemethoden integriert ist und andererseits der Forderung vonseiten der Gerichte nach einer Individualprognose entspricht. Neben risikoerhohenden werden auch legalprognostisch protektive Faktoren berucksichtigt. Die anschliesende Gesamtbeurteilung bildet fur den normativen Entscheidungstrager legalprognostische Kriterienschwerpunkte transparent und nachvollziehbar ab und beschreibt Wahrscheinlichkeit und Art von Risikoszenarien. Mithilfe der gewonnenen Fallubersicht lassen sich Vorschlage zu Fallmanagement und Einflussmoglichkeiten auf erhobene Risikoprofile bzw. ungunstige Verlaufe ableiten.

Studies in child sex offenders (CSO) often report deviant personality characteristics. In our study, we investigated neuroticism in CSO and tested the hypothesis that CSO with high neuroticism show more serious abuse behavior and are more likely to exhibit sexual dysfunction and cognitive distortions, as compared to CSO with low neuroticism. A sample of 40 CSO (both child sexual abusers and child sexual material users) was split into two subsamples based on their neuroticism scores, obtained by the NEO-Personality Inventory-Revised (NEO-PI-R) questionnaire. Subsequently, we compared their scores in the Multiphasic Sex Inventory (MSI) questionnaire and Symptom Checklist-90-Revised (SCL-90-R). Our results show that CSO exhibited higher levels of neuroticism than controls, but were still in the normal range. In CSO, neuroticism was associated with sexual dysfunction and cognitive distortions, rather than with more severe abuse behavior. Moreover, neuroticism in this group was linked to a broad range of psychological problems and psychopathological symptoms, such as somatization or anxiety. Our findings suggest that neuroticism even below the level of personality disorder is associated with a broader range of psychological problems in CSO, which should be addressed in therapy.

Personality traits are considered as an important aspect in the assessment of child sex offenders (CSOs). The current study sought to elucidate the association between neuroticism, psychopathy, and abusive behavior in low risk CSOs. 43 pedophilic CSOs and 21 controls (CTLs) completed the NEO-Personality Inventory-Revised (NEO-PI-R), Psychopathy Checklist: Screening Version (PCL:SV), and Multiphasic Sex Inventory (MSI). Our results revealed small differences in PCL scores between CSOs and CTLs, with comparatively low levels of psychopathy in both groups. Higher levels of neuroticism were associated with higher PCL scores, in both CSOs and CTLs. However, higher PCL scores in CSOs did not correlate with higher MSI total scores on the subscale child molest. These findings suggest an ambiguous role of psychopathy in CSOs: higher levels of psychopathy co-occur with higher levels of neuroticism, but psychopathy does apparently not modulate abusive behavior, at least not in low risk offenders, as currently investigated.

Objectives: Brain-derived neurotrophic factor (BDNF) is involved in numerous cognitive processes. Since cognitive deficits are a core feature of psychotic disorders, the investigation of BDNF levels in psychosis and their correlation with cognition has received increased attention. However, there are no studies investigating BDNF levels in individuals with an at-risk mental state (ARMS) for psychosis. Hence, the aims of the present study were: (1) assessing peripheral BDNF levels across different (potential) stages of psychosis; (2) investigating their association with cognition. Methods: Plasma and serum BDNF levels and neuropsychological performance were assessed in 16 ARMS, six first-episode psychosis (FEP), and 11 chronic schizophrenia (CS) patients. Neuropsychological assessment covered intelligence, verbal memory, working memory, attention and executive functioning. Results: Both plasma and serum BDNF levels were highest in CS, intermediate in FEP and lowest in ARMS. Multiple regression analysis revealed a significant positive association of plasma BDNF levels with planning ability across all groups. Conclusions: The lower peripheral BDNF levels in ARMS compared to FEP and CS might point towards an important drop of this neurotrophin prior to the onset of frank psychosis. The associations of peripheral BDNF with planning-abilities match previous findings.

Die Schweizerische Strafprozessordnung sieht die Moglichkeit der Anordnung von psychiatrischer und psychotherapeutischer Behandlung als Auflage zur Entlassung aus der Untersuchungshaft vor („Ersatzmasnahmen“). Im Gegensatz zu den gesetzlichen Regelungen fur die gerichtliche Anordnung von ambulanten und stationaren Masnahmenbehandlungen im Schweizerischen Strafrecht (entsprechend dem deutschen Masregelvollzug) gibt es fur die Anordnung von psychiatrisch-psychotherapeutischer Behandlung als Ersatzmasnahme keine verbindliche Regelung. Eine sachverstandige Begutachtung ist nicht zwingend. Durch die besondere Situation einer Therapieverpflichtung vor Bestehen eines rechtskraftigen Urteils konnen sich diverse psychotherapeutische, ethische und juristische Problemstellungen ergeben. Dazu gehoren Aspekte der Diagnose- und Indikationsstellung, die mogliche prajudizielle Wirkung einer solchen Anordnung, die Nutzen-Risiko-Abwagung einer daraus resultierenden Behandlung und die Frage der Kostenubernahme. Eine Auswertung uber den Zeitraum von 2 Jahren von 9 durchgefuhrten Ersatzmasnahmen in der Forensischen Ambulanz fur Erwachsene in Basel zeigte, dass nicht alle Falle vorher begutachtet werden, dass nach der Anordnung einer solchen Masnahme bis zur Gerichtsverhandlung durchschnittlich fast ein Jahr (338 Tage) vergeht und im Urteil nicht immer eine gerichtliche Weisung zur Fortsetzung der Behandlung angeordnet wird. Ersatzmasnahmen konnen in bestimmten Fallen sinnvolle Alternativen darstellen, die Anordnung sollte sich aus Sicht der Autoren immer auf eine sachverstandige Begutachtung stutzen.

Objectives Impairment in working memory (WM) is a core symptom in schizophrenia. However, little is known about how clinical features influence functional brain activity specific to WM processing during the development of first-episode psychosis (FEP) to schizophrenia (SZ). We compared functional WM-specific brain activity in FEP and SZ patients, including the effects of the duration of illness, psychopathological factors and antipsychotic medication. Methods Cross-sectional study of male FEP (n = 22) and SZ (n = 20) patients performing an n-back task when undergoing functional magnetic resonance imaging (fMRI). Clinical features were collected by semi-structured interviews and medical records. Results The SZ group performed significantly worse than the FEP group in the 2-back condition. The SZ group also showed significantly higher activation in the left superior frontal gyrus in the 2-back versus 0-back condition (2-back > 0-back). This frontal activation correlated positively with negative symptoms and with cumulative antipsychotic medication during the year before the fMRI examination. There were no significant correlations between activation and duration of illness. Conclusion There was greater frontal neural activation in SZ than in FEP. This indicated differences in WM processing, and was significantly related to cumulative antipsychotic exposure and negative symptoms, but not to the duration of illness.

Objective Impaired response inhibition might play a role in child sexual offences. Recording of event-related potentials (ERPs) can help to clarify whether child sexual offenders (CSOs) show an altered processing of stop signals and commission errors. Methods In the current ERP study, we investigated these processes in a Go/Nogo task on two groups of CSOs, pedophilic contact CSOs and non-contact CSOs (child pornography offenders), as well as on non-offenders as controls. Results Behaviorally, CSOs showed a slight, but non-significant increase of the false alarm rate to Nogo cues, as compared to controls. The amplitudes of the ERP components N2 and P3 to Nogo cues followed by correctly withhold responses did not vary between CSOs and controls. The analysis of the ERPs to committed errors showed that the Ne amplitudes (reflecting error detection) did not differ between the groups either, whereas the Pe amplitudes (reflecting error evaluation and error awareness) were strongly diminished in CSOs. This diminishment was primarily found in contact CSOs. Conclusions The findings suggest that response inhibition, processing of stop signals, and error detection are not necessarily impaired in CSOs. However, CSOs appear to dedicate less cognitive resources to the evaluation of committed errors. Significance This selective alteration could reflect a reduced sense of responsibility for misconduct in this offender group, which might contribute to their delinquent behavior.

Ziel der Studie: In der vorliegenden Studie wurden eine Ubersetzung und eine deutschsprachige Validierung des Stress Appraisal Measure (SAM) von Peacock und Wong an einer studentischen Stichprobe vorgenommen. Der SAM ist ein vergleichsweise kurzer Fragebogen (28 Items) zur Bewertung eines aktuellen, stressauslosenden Ereignisses. Den theoretischen Hintergrund lieferte das Stressmodel von Lazarus und Folkman. Methodik: Bei 85 Studenten (Durchschnittsalter: 23; 59 Frauen, 26 Manner; Rucklaufquote: 42 %) wurde anhand von kurzen Imaginationsgeschichten Stress induziert, und anschliesend sollte der SAM ausgefullt werden. Zunachst wurde die stressauslosende Wirkung der Imaginationsgeschichten gepruft. Als weiterer statistischer Analyseschritt wurden eine Faktorenanalyse sowie die Bestimmung der internen Konsistenzen der sieben SAM-Skalen durchgefuhrt. Auserdem wurde die konvergente Validitat des SAM zum State and Trait Anxiety Inventory (STAI), zum Coping Inventory for Stressful Situations (CISS) und zu spezifischen Emotionsskalen mittels Pearson-Produkt-Moment-Korrelation ermittelt. Ergebnisse: Eine stressinduziernde Wirkung der Imaginationsgeschichten konnte nachgewiesen werden. Die Faktorenstruktur, die internen Konsistenzen der einzelnen Skalen sowie die konvergente Validitat des SAM aus der ursprunglichen Studie konnten in der vorliegenden deutschen Version in grosen Teilen repliziert werden. Einzelne Items (besonders des funften Faktors) luden allerdings auf anderen Faktoren als bei der Studie von Peacock und Wong. Schlussfolgerung: Der SAM konnte nun auch in deutscher Sprache eingesetzt werden.