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Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The DUNDRUM Programme Completion (D3) and Recovery (D4) scales present a promising approach to a recovery-oriented and collaborative method of assessing risk, need, and rehabilitative tasks in forensic settings. We collected clinician- (n = 185) and patient- (n = 118) rated D3 and D4 scores across three security levels (medium, minimum, and outpatient) in a large Canadian forensic service over a 12-month period. Results supported the construct validity of the D3 and D4, showing that clinician (D3 and D4) and patient (D4 only) ratings differed across inpatient and outpatient settings, with lower outpatient scores signaling greater progress in treatment and recovery goals. Only clinician-rated scores differed across patients with moves from higher to lower levels of therapeutic security to those with no movement over the study period. Concordance analyses revealed poor to modest agreement between clinician- and patient-rated item scores, with patient self-ratings observed to be more optimistic than their clinician counterparts. However, concordance strengthened as patients progressed from higher to lower levels of security and restriction. Current findings add to the literature on the feasibility of shared approaches to care planning, and provide validation data for the DUNDRUM scales as part of available tools in collaborative, recovery-oriented forensic care. [ABSTRACT FROM AUTHOR]

The role of serious mental illness among those who sexually offend is not well understood. We investigated clinical and risk-related areas of difference between male forensic psychiatric patients with (n = 86) and without (n = 245) a sexual offense history, including the age at which indications of mental disorder and criminal offending first emerged, from a registry of Ontario patients adjudicated Not Criminally Responsible on account of Mental Disorder (NCRMD) from 1999–2012. We further explored motivations for offending among a subset of patients deemed NCRMD for a sexual offense specifically (n = 41). While no differences were found in the age onset of illness or offending across those with and without a sexual offending history, the former group was rated as having higher levels of historical/static risk for violence. Forensic patients with a sexual offense history were also more likely to offend against a stranger, and less likely to offend against a family member. Sexual index offenses were psychotically-motivated in the majority of cases, but with a meaningful proportion appearing to reflect criminogenic motivations, especially substance use and paraphilic interests. Results suggest greater similarity than difference among forensic patients with and without a sexual offense history, but also highlight an important divergence from the literature showing that victims of sexual offenses are frequently known to the individual committing them. [ABSTRACT FROM AUTHOR]

At present, there are few validated tools to assist clinicians in assessing absconding risk and formulating viable risk management plans. In this article, we review existing literature on instrument validity and reliability in relation to absconding among patients in forensic care. We examine the predictive validity of a new risk assessment scale for absconding, the Waypoint Elopement Risk Scale-Historical (WERS-H), and assess its incremental utility against a general violence risk assessment instrument (HCR-20V3). Results from all active inpatients in our service (N = 139) revealed 73 individuals who were responsible for 261 absconding events from 2014 to 2020, representing a similar event frequency from a previous census conducted in 2012, but also reflecting considerable annual fluctuations in rate. Confirming results of earlier studies, the presence of substance use and lengthy durations of forensic supervision emerged as key variables associated with absconding. The WERS-H was found to be a significant predictor of future absconding events (incident rate ratio = 1.21, 95% CI [1.07, 1.38], p =.002) and contributed incrementally over the HCR-20V3 Historical scale, suggesting that the use of an absconding-specific risk tool may yield better predictive accuracy compared to assessment instruments in the domain of general violence or offending. [ABSTRACT FROM AUTHOR]

Developmental trajectories regarding the age onset of violence and offending have not routinely considered the role of major mental illness (MMI). In parallel, despite several studies investigating the relationship between MMI, violence and offending, fewer have identified motivational processes that may link illness to these outcomes in a more direct and proximal manner. This study investigates whether subtypes of forensic psychiatric patients deemed Not Criminally Responsible on account of Mental Disorder (N = 91) can be identified based on the age onset of mental illness and offending behavior, and whether information on motivational influences for offending—elicited both from the patient directly and detailed collateral information—contributes to the clinical utility of this typology. Results indicated that most patients reported engaging in violence (51%) or antisocial behaviors (72%) prior to the onset of MMI, but that the index offense(s) resulting in forensic admission were predominantly psychotically motivated. In contrast to patients for whom the onset of MMI occurred prior to offending, patients exhibiting premorbid violence had higher levels of risk and criminogenic need; they were more likely to be diagnosed with personality and substance use disorders, and to have conventional (i.e., non-illness-related) motivations ascribed to their index offense. Findings are consistent with the existing literature regarding subgroups of mentally disordered offenders, but provide new information regarding proximal risk factors for violence through better identification of motivational processes. [ABSTRACT FROM AUTHOR]