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Background: The relationship between schizophrenia spectrum disorders (SSD) and criminal behaviour is a central issue in forensic psychiatry. People with mental illness face some of the same types of criminogenic factors as people without mental illness, albeit more frequently. The research question of this study is the extent to which a framework of early and late offender typology can be empirically reconstructed in a forensic psychiatric population, and whether there are any practical implications., Method: For N = 733 patients in six different forensic hospitals in Germany, the age at first psychiatric admission and the age at first registered offence were documented, as well as a number of other patient-related characteristics. Two clustering procedures were used to investigate whether forensic psychiatric patients could be classified according to these characteristics., Results: A k-means cluster analysis using age at first psychiatric admission, age at first recorded offence, sociodemographic, clinical and criminological characteristics supported a 4-cluster solution. MANOVA analyses revealed further differences between the identified types., Conclusion: This study empirically confirms some of the sub-groups of the early and late starter typology described in the literature. In particular, the "early starters", "late starters" and "first presenters" were identified, but cluster four comprises individuals not previously described in the scientific literature. Each of these classes has group-specific characteristics that may have implications for forensic treatment, post-release aftercare, and the legal system., Competing Interests: Declaration of Competing Interest Authors have declared no conflicts of interests, (Copyright © 2024 Elsevier Ltd. All rights reserved.)

It has previously been demonstrated that decisions made by forensic experts can suffer from issues with both bias and poor reliability. The outcome of Swedish forensic psychiatric investigations can have a major impact on the courts' choice of sanction for a mentally disordered offender. These investigations are performed by multi-professional teams of experts, where each expert is obliged to state their opinion on whether the client has a severe mental disorder (SMD) or not. In the present study, a case vignette design was used to simulate the decision-making process of forensic psychiatric investigations. Of the 73 Swedish experts working with forensic psychiatric investigations, a total of 27 (37%) participated in the study. The results showed that the Swedish experts formulated multiple diagnostic hypotheses about cases throughout the process and revised these hypotheses when presented with new information. There was substantial variation between the experts in which hypotheses were seen as most relevant. While the experts grew more certain of their opinions on SMD during the simulated investigation, there was considerable variation in their opinions both throughout and at the end of the process. Although low statistical power and the sample not being randomized limit generalizations, the results indicate no idiosyncratic patterns in the decision-making processes of Swedish experts or signs of confirmation bias. If used properly, the variation in both process and outcome could be used to safeguard and possibly increase the reliability and validity of the final decision of Swedish forensic psychiatric investigations., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Forensic psychiatric investigations in Sweden can have a major impact on the choice of sentence in criminal cases. Previous research shows that the decisions in several forensic fields, including forensic psychiatry, can be affected in a negative way by factors not relevant to the case. In the present study, the decision-making process of forensic psychiatric investigations was explored by using semi-structured interviews with experts (n = 38) and analyzing these interviews thematically. The results showed that the decision-making process is both complex and iterative, where the experts use and shape a substantial amount of information to reach their decisions. The experts work in teams, which add both benefits and risks to the process, and feel that particularly time constraints may reduce the quality of their decisions. In summary, the decision-making process of Swedish forensic psychiatric investigations creates a potential for high validity, but also contains risks for bias effects that could warrant further mitigation., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Forensic psychiatric reports have a profound impact on the life of a defendant, on society and on the mental health system. Good-quality reports are essential but are often criticized for their lack of thorough substantiation. The use of multiple methods to obtain information, test instruments (psychological and/or risk) and third-party information are recommended., Study Purpose: To explore the use of test instruments and third-party information, as part of a multi-method approach, in forensic psychiatric evaluations. We examined 151 court-ordered expert reports in Flanders (Belgium)., Results: A psychological test instrument was used in 61% of the cases, and a risk taxation instrument in 19% of the cases. Third-party information was used in 43% of the cases., Conclusions: A multi-method approach is not common practice in forensic psychiatric evaluations. The use of validated test instruments and third-party information can be improved. The quality of forensic reports could be improved by the establishment of a forensic observation centre and the use of a standardized approach., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Despite the central role in criminal trials, there is little research on the decision-making processes of experts in forensic psychiatry. We aimed to investigate the role of sociodemographic, psychopathological, and criminological characteristics in forensic psychiatric decisions on criminal responsibility and social dangerousness in criminal trials. We analyzed 302 forensic psychiatric reports provided by 16 forensic psychiatrists from the North, Central and Southern Italy. Defendants' psychiatric symptom severity was evaluated through the 24-item Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impression (CGI) scale and the Global Assessment of Functioning (GAF). Defendants judged not criminally responsible (Not-CRDs) presented with more severe psychiatric symptoms (positive symptoms, negative symptoms, manic excitement / disorganization), were more likely to be female, to be affected by a schizophrenia spectrum disorder, or bipolar spectrum disorder and to have had a higher number of previous psychiatric treatments and previous involuntary hospitalizations compared to their criminally responsible counterparts. Not-CRDs affected by a schizophrenia spectrum disorder, personality disorder, with severe psychiatric symptoms and with histories of criminal convictions and more victims were more likely to have received a judgment of social dangerousness. The forensic psychiatric evaluations were carried out on average of 770 days after the time of the crime, which in light of the other results, suggests an effect of the perceptions of the expert on the judgment of responsibility, raising the possibility of time bias on forensic judgments concerning defendants' mental responsibility., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Forensic psychiatric practices and provisions vary considerably across jurisdictions. The diversity provides the possibility to compare forensic psychiatric practices, as we will do in this paper regarding Italy and the Netherlands., Aim: We aim to perform a theoretical analysis of legislations dealing with the forensic psychiatric evaluation of defendants, including legal insanity and the management of mentally ill offenders deemed insane. This research is carried out not only to identify similarities and differences regarding the assessment of mentally ill offenders in Italy and the Netherlands, but, in addition, to identify strengths and weaknesses of the legislation and procedures used for the evaluation of the mentally ill offenders in the two countries., Results: Italy and the Netherlands share some basic characteristics of their criminal law systems. Yet, forensic psychiatric practices differ significantly, even if we consider only evaluations of defendants. A strong point of Italy concerns its test for legal insanity which defines the legal norm and enables a straightforward communication between the experts and the judges on this crucial matter. A strong point of the Netherlands concerns more standardized practices including guidelines and the use of risk assessment tools, which enable better comparisons and scientific research in this area., Conclusions: We argue that there appears to be room for improvement on both sides with regards to the evaluation of mentally ill offenders. More generally, a transnational approach to these issues, as applied in this paper, could help to advance forensic psychiatric services in different legal systems., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Neuroscience has already changed how the law understands an individual's cognitive processes, how those processes shape behavior, and how bio-psychosocial history and neurodevelopmental approaches provide information, which is critical to understanding mental states underlying behavior, including criminal behavior. In this paper, we briefly review the state of forensic assessment of mental conditions in the relative culpability of criminal defendants, focused primarily on the weaknesses of current approaches. We then turn to focus on neuroscience approaches and how they have the potential to improve assessment, but with significant risks and limitations., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Various neuroscientific techniques are increasingly being used in criminal courts causing a vivid debate on the way that this kind of techniques will and should be used as scientific evidence. The role of experts in this context is important, since it is them that analyse, present, interpret and communicate the results of these techniques to the judges and the jury. In an attempt to contribute to the discussion about the role of the experts in criminal cases where neuroimaging evidence was introduced, we examined twenty seven cases from the US and Europe. Focusing on the role of experts and their presentation of neuroscientific evidence, we aimed to examine the extent to which neuroimaging data can contribute to the construction of a solid and more objective, "scientifically - based" case. We found that neurobiological information introduced through experts' testimony is generally used in order to demonstrate some physical, organic base of a psychiatric condition, or/and in order to make visible some brain lesion, (structural or functional), susceptible to have affected the capacity to reason and to control one's impulses. While neuroimaging evidence is often presented by the defence as a scientific method able to offer a precise diagnosis of the pathology in question, our case analysis shows that the very same neurobiological evidence can be interpreted in different - sometimes diametrically opposed - ways by defence and State experts. Conflicting testimony about the same empirical evidence goes against the hypothesis of neuroscientific techniques constituting "objective and hard evidence", able to reach solid, scientific and objective conclusions. Frequent conflicts between neuroimaging experts require the courts to deal with the resulting uncertainty. As the law changes with technology, it is necessary for legal professionals to train and be prepared for the new issues they may encounter in light of new developments in neuroscience, so that they become more vigilant as to the interpretation of neuroscientific data., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Even though the Bush Administration opened the Guantánamo Bay detention facility in 2002 in response to the September 11, 2001 attacks in the United States, little remains known about how forensic mental health evaluations relate to the process of detainees who are charged before military commissions. This article discusses the laws governing Guantánamo's military commissions system and mental health evaluations. Notably, the US government initially treated detainees as "unlawful enemy combatants" who were not protected under the US Constitution and the United Nations Convention Against Torture and Other Forms of Cruel, Inhuman or Degrading Treatment, allowing for the use of "enhanced interrogation techniques." In subsequent legal documents, however, the US government has excluded evidence obtained through torture, as defined by the US Constitution and the United Nations Convention Against Torture. Using open-source document analysis, this article describes the reasons and outcomes of all forensic mental health evaluations from Guantánamo's opening to 2018. Only thirty of 779 detainees (~3.85%) have ever had charges referred against them to the military commissions, and only nine detainees (~1.16%) have ever received forensic mental health evaluations pertaining to their case. Of these nine detainees, six have alleged mental torture while in US custody. This paper shows that leaders in the United States and Europe should consider whether counterterrorism policies that supersede traditional health and human rights complicate the ability of future governments to prosecute cases when successive leaders change laws, a pertinent consideration as North American and European states grapple with the return of foreign fighters., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Demand for legal capacity assessments is increasing, especially assessments of financial capacity for estate planning purposes such as wills and enduring powers of attorney. This article proposes that such assessments will be improved by taking greater account of the client experience, including individual and relational factors and processes, and considering the practice framework. A literature review was undertaken with a two-fold aim: firstly, to understand the fundamentally important perspective (inclusive of these experiences) of the evaluee; and, secondly, to identify potential improvements in the capacity assessment process with a view to informing best practice. No studies were identified that directly addressed the individual perspective in capacity assessments. Case studies and commentaries that indirectly discuss the individual perspective were therefore analysed to identify any potential issues and recommendations. This analysis showed that individual factors, such as the evaluee's functional and disease status, and relational factors, such as trust, should be considered by examiners. This review demonstrates that there is a significant gap in the literature examining the individual's perspective and experiences in capacity assessments, as well as, any impact this may have on the assessment process and outcomes. Further research into this vital perspective is needed so that the experiences of those undergoing assessments can help inform best practice and ensure that optimal processes are adopted when assessing the capacity necessary to make legally recognised decisions. This article examines the importance of the participant perspective and experiences in capacity assessments through the novel lens of therapeutic jurisprudence. It includes practice suggestions and provides the direction for this future research., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Both structured and unstructured clinical risk assessments within forensic care aim to prevent violence by informing risk management, but research about their preventive role is inconclusive. The aim of this study was to investigate risk management interventions that were planned and realized during forensic care by analysing patient records. Records from a forensic clinic in Sweden, covering 14 patients and 526 months, were reviewed. Eight main types of risk management interventions were evaluated by content analysis: monitoring, supervision, assessment, treatment, victim protection, acute coercion, security level and police interventions. Most planned risk management interventions were realized, both in structured and clinical risk assessments. However, most realized interventions were not planned, making them more open to subjective decisions. Analysing risk management interventions actually planned and realized in clinical settings can reveal the preventive role of structured risk assessments and how different interventions mediate violence risk., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

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.)

In Italy, following the closure of psychiatric hospitals in 1978 and the release of psychiatric patients into community care, there was a mismatch between common psychiatric patients and the convicted mentally ill who were sentenced to serve in state forensic psychiatric hospitals. The recent closure of such structures following the Prime Minister's Decree of April 1, 2008, fostered the need to create new structures. These are called "REMS," and they are based in the community and led by psychiatrists and healthcare staff who may rely on the collaboration of public security staff. This act completed a course of progressive deinstitutionalization of all psychiatric patients. However, some problems remain, and persons regarded as "partially mentally disabled" at the time of crime perpetration must serve part of their sentence in prison and the rest in the aforementioned structures or in psychiatric rehabilitation communities, depending on their claimed "social dangerousness." Psychiatric services now face the ambiguity of treating persons who are considered dangerous by court orders, while the civil law criteria for involuntary hospitalization is based only on the need of care. The complete closure of forensic hospitals may be considered a decisive step forward in the humanization of society, but there are still some issues to address to make it work better. The implementation of multidisciplinary teams and effective psychotherapy, psychoeducational, and rehabilitation interventions can help., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The likelihood of recidivism is considered to be the most important outcome measure in forensic psychiatry. Therefore, forensic psychiatric treatment focuses on the reduction of the risk of recidivism by treating dynamic risk and protective factors, aiming to reduce risk factors while enhancing protective factors during treatment. The goal of this study is to assess treatment progress with the Instrument for Forensic Treatment Evaluation (IFTE) in a Dutch forensic psychiatric centre (n=240). Latent Class Analysis was conducted to reconfirm previously found patient profiles. Patient profiles were based on risk factors, psychopathology, and offence type. Repeated measures ANOVAs were conducted to assess treatment progress for the whole patient group, for high and low risk patients, and for patients who had been in treatment for a period longer and shorter than one year. Latent Class Analysis has not reconfirmed the previously found profiles, therefore a repeated measures ANOVA was not conducted on profile level. On group-level, no significant progress was found. Though, patients with low protective behaviour, low resocialization scores, and high problem behaviour scores displayed significant treatment progress. Patients with low problematic behaviour showed a significant increase of problematic behaviour and patients with high protective behaviour a decrease of protective behaviour. Results indicated an interaction effect between time of admission and the factor resocialization skills, however this effect was not found for the other two factors. Results imply that higher risk patients can show more treatment progress than lower risk patients., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Mentally disordered offenders may be sent to secure psychiatric hospitals. These settings can resemble carceral spaces, employing high levels of security restricting resident autonomy, expression and social interaction. However, research exploring the restrictiveness of forensic settings is sparse. A systematic review was therefore undertaken to conceptualize this restrictiveness. Eight databases were searched for papers that address restrictive elements of secure forensic care in a non-cursory way. Fifty sources (empirical articles and policy documents) were included and subject to thematic analysis to identify 1) antecedent conditions to, 2) characteristic attributes, 3) consequences and 4) 'deviant' cases of the developing concept. The restrictiveness of forensic care was experienced across three levels: individual, institutional and systemic. Restrictiveness was subjective and included such disparate elements as limited leave and grounds access, ownership of personal belongings and staff attitudes. The manner and extent to which these are experienced as restrictive was influenced by two antecedent conditions; whether the purpose of forensic care was to be more caring or custodial and the extent to which residents were perceived to be risky. We argue that there must be a reflexivity from stakeholders between the level of restrictiveness needed to safely provide care in a therapeutic milieu and enable the maximum amount of resident autonomy., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Three studies describe development of the Psychopathic Processing and Personality Assessment (PAPA). Study one outlines a literature review and Expert Delphi (n=32) to develop the initial PAPA. Study two validates the PAPA with 431 participants (121 male prisoners and 310 university students: 154 men, 156 women), also using the Levenson Self Report Psychopathy scale and a measure of cognitive schema and affect. Study three refined the PAPA, employing it with 50 male students and 40 male forensic psychiatric patients using clinical (interview) assessments of psychopathy: the Psychopathy Checklist - Screening Version and the Affect, Cognitive and Lifestyle assessment. The PAPA comprised four factors; dissocial tendencies; emotional detachment; disregard for others; and lack of sensitivity to emotion. It positively correlated with existing psychopathy measures. Variations across PAPA subscales were noted across samples when associated with clinical measures of psychopathy. Support for the validity of the PAPA was indicated across samples. Directions for research and application are outlined., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The aim of the study is to explore the relationships between results of forensic psychiatric evaluation on "mental status at the time of the offense (MSO)" and the final decision of the courts after the amendment of the Criminal Code in 2005. All criminal cases referred to Taipei City Psychiatric Center for MSO evaluation from July 1, 2006, to December 31, 2015, were reviewed, and only the completed trials were included. Concordance rates in each category of MSO conclusion and the court decision were analyzed and compared. The sample consisted of 366 MSO evaluations. Overall concordance was 95.6% (350/366). The concordance rate in conclusions of "full responsibility", "diminished responsibility", and "insanity" were 98.3% (177/180), 97.7% (126/129) and 91.9% (34/37) separately, and these three groups showed no statistical significance after compared with the other. Conclusions of "intentionally or negligently induced insanity or diminished responsibility" reached the lowest concordance at 65.0% (13/20) and compared with the other three groups all showed statistical significance. We found, after the amendment of Criminal Code, the lowest concordance rate in those conclusions of "insanity" before change seemed diminished. But the conclusions of "intentionally or negligently induced insanity or diminished responsibility" became the major origin leading to discordance. Comparing to the previous finding in the same hospital which revealed separate conclusions resulted in statistically significant concordance rates, the effect of the amendment seems likely to improve the consensus among psychiatric experts and trial judges except substance and alcohol related mental condition., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Approaches to forensic report writing in psychiatry, psychology, and related mental health disciplines have moved from an organization, content, and stylistic framework to considering ethical and other codes, evidentiary standards, and practice considerations. The first part of the article surveys different approaches to forensic report writing, including that of forensic mental health assessment and psychiatric ethics. The second part deals especially with psychological ethical approaches. The American Psychological Association's Ethical Principles and Code of Conduct (2002) provide one set of principles on which to base forensic report writing. The U.S. Federal Rules of Evidence (2014) and related state rules provide another basis. The American Psychological Association's Specialty Guidelines for Forensic Psychology (2013) provide a third source. Some work has expanded the principles in ethics codes; and, in the third part of this article, these additions are applied to forensic report writing. Other work that could help with the question of forensic report writing concerns the 4 Ds in psychological injury assessments (e.g., conduct oneself with Dignity, avoid the adversary Divide, get the needed reliable Data, Determine interpretations and conclusions judiciously). One overarching ethical principle that is especially applicable in forensic report writing is to be comprehensive, scientific, and impartial. As applied to forensic report writing, the overall principle that applies is that the work process and product should reflect integrity in its ethics, law, and science. Four principles that derive from this meta-principle concern: Competency and Communication; Procedure and Protection; Dignity and Distance; and Data Collection and Determination. The standards or rules associated with each of these principles are reviewed., (Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.)

Medical malpractice litigation involving seven to nine figure settlements has been on the rise over the past decade. Given the life-altering scope of these incidents, forensic child psychiatrists may be asked to opine on the effects of a permanent perinatal injury on normal human development. Whether forensic child psychiatrists can assess risk of future psychiatric effects from such incidents is an important question. This paper is spurred by two separate cases, each involving a male infant having a portion of their genitals accidentally amputated by an obstetrician-gynecologist (OB/GYN) during a routine circumcision. In each case, the genitals were repaired, but permanent defects remained. The question arises how such injuries would affect these children as they matured. An analysis of the literature supported that there are risks of psychiatric effects of such birth-related injuries. Such predictions are made with reference to what is already known about human development, and by an exploration of the literature on the psychiatric effects of comparable injuries to children., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The legal concepts of emotional and volitional impairment in SVP evaluations are vague and ill-defined. This article reviews the legal terms of emotional and volitional impairment as they have been contemplated in extant SVP statutes, SVP case law, logical constructions, and limited empirical studies. To bridge the gap between psychiatry and the law, a broad, theory-based heuristic framework is furnished for understanding emotional and volitional impairment at a deep psychological (and intra-psychic) level. Specifically discussed are the concepts of transference, repetition compulsion, fixation, cathexis, regression, identification with the aggressor, and the object-relations and self-psychology concepts related to a loss of possession of the self., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

The standard of care is a legal and professional notion against which doctors and other medical personnel are held liable. The standard of care changes as new scientific findings and technological innovations within medicine, pharmacology, nursing and public health are developed and adopted. This study consists of four parts. Part 1 describes the problem and gives concrete examples of its occurrence. The second part discusses the application of the Model of Hierarchical Complexity on the field, giving examples of how standards of care are understood at different behavioral developmental stage. It presents the solution to the problem of standards of care at a Paradigmatic Stage 14. The solution at this stage is a deliberative, communicative process based around why certain norms should or should not apply in each specific case, by the use of "meta-norms". Part 3 proposes a Cross-Paradigmatic Stage 15 view of how the problem of changing standards of care can be solved. The proposed solution is to found the legal procedure in each case on well-established behavioral laws. We maintain that such a behavioristic, scientifically based justice would be much more proficient at effecting restorative legal interventions that create desired behaviors., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

There exists a valid concern among forensic psychology scholars that measures intended for sexual offenders have plateaued in their predictive accuracy. The current study examined this concern using the "coffee can" methodology of Kroner, Mills, and Reddon (2005). The Iowa Sex Offender Risk Assessment (ISORA8), Level of Service Inventory - Revised (LSI-R), and Static-99R were used to predict various methods of detected recidivism (general, sexual, and violent recidivism) as compared to three randomly generated measures and a weighted generated measure. Independent correlation and receiver operating characteristic comparisons found that in almost all cases, generated measures outperformed established measures. Analyses indicated that the current conceptualization of risk for sexual offenders has not been thoroughly integrated into established measures. Current measures appear incomplete, but have a clear and empirically-noted ability to improve., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

As more veterans return from Iraq and Afghanistan, Posttraumatic Stress Disorder (PTSD) often returns with them. As a result, PTSD has quickly become the most prevalent mental disorder diagnosis among active duty United States (U.S.) military. Although numerous studies have not only validated PTSD but have chronicled its negative behavioral impact, it remains a controversial diagnosis. It is widely diagnosed by all types of mental health professionals for even minimal trauma, and DSM-IV PTSD criteria have wide overlap with other mood and anxiety disorders. This, however, has not stopped PTSD from being used in civilian courts in the U.S. as a mental disorder to establish grounds for mental status defenses, such as insanity, diminished capacity, and self-defense, or as a basis for sentencing mitigation. Not surprisingly, PTSD has recently found its way into military courts, where some defense attorneys are eager to draw upon its understandable and linear etiology to craft some type of mental incapacity defense for their clients. As in the civilian sphere, this has met with mixed success due to relevance considerations. A recent court-martial, U.S. v. Lawrence Hutchins III, has effectively combined all the elemental nuances of PTSD in military court., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

The stakes of choosing the best theory as a basis for violence prevention and offender rehabilitation are high. However, no single theory of violence has ever been universally accepted by a majority of established researchers. Psychiatry, psychology and sociology are each subdivided into different schools relying upon different premises. All theories can produce empirical evidence for their validity, some of them stating the opposite of each other. Calculating different models with multivariate logistic regression on a dataset of N = 21,312 observations and ninety-two influences allowed a direct comparison of the performance of operationalizations of some of the most important schools. The psychopathology model ranked as the best model in terms of predicting violence right after the comprehensive interdisciplinary model. Next came the rational choice and lifestyle model and third the differential association and learning theory model. Other models namely the control theory model, the childhood-trauma model and the social conflict and reaction model turned out to have low sensitivities for predicting violence. Nevertheless, all models produced acceptable results in predictions of a non-violent outcome., (Copyright © 2015. Published by Elsevier Ltd.)

The quality of forensic mental health assessment has been a growing concern in various countries on both sides of the Atlantic, but the legal systems are not always comparable and some aspects of forensic assessment are specific to a given country. This paper describes the legal context of forensic psychological assessment in France (i.e. pre-trial investigation phase entrusted to a judge, with mental health assessment performed by preselected professionals called "experts" in French), its advantages and its pitfalls. Forensic psychiatric or psychological assessment is often an essential and decisive element in criminal cases, but since a judiciary scandal which was made public in 2005 (the Outreau case) there has been increasing criticism from the public and the legal profession regarding the reliability of clinical conclusions. Several academic studies and a parliamentary report have highlighted various faulty aspects in both the judiciary process and the mental health assessments. The heterogeneity of expert practices in France appears to be mainly related to a lack of consensus on several core notions such as mental health diagnosis or assessment methods, poor working conditions, lack of specialized training, and insufficient familiarity with the Code of Ethics. In this article we describe and analyze the French practice of forensic psychologists and psychiatrists in criminal cases and propose steps that could be taken to improve its quality, such as setting up specialized training courses, enforcing the Code of Ethics for psychologists, and calling for consensus on diagnostic and assessment methods., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Linking prisoners with mental illness with treatment following release is critical to preventing recidivism, but little research exists to inform efforts to engage them effectively. This presentation compares the engagement process in two model programs, each representing an evidence-based practice for mental health which has been adapted to the context of prison reentry. One model, Forensic Assertive Community Treatment (FACT), emphasizes a long-term wrap-around approach that seeks to maximize continuity of care by concentrating all services within one interdisciplinary team; the other, Critical Time Intervention (CTI), is a time-limited intervention that promotes linkages to outside services and bolsters natural support systems. To compare engagement practices, we analyze data from two qualitative studies, each conducted in a newly developed treatment program serving prisoners with mental illness being discharged from prisons to urban communities. Findings show that the working relationship in reentry services exhibits unique features and is furthered in both programs by the use of practitioner strategies of engagement, including tangible assistance, methods of interacting with consumers, and encouragement of service use via third parties such as families and parole officers. Nevertheless, each program exhibited distinct cultures and rituals of reentry that were associated with fundamental differences in philosophy and differences in resources available to each program., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

With the large and growing number of persons with mental illnesses under probation supervision, a form of specialized probation called specialized mental health caseload (SMHC) has been implemented. This study explores the effectiveness of a prototypic SMHC implemented statewide. A quasi-experimental design was used to compare criminal justice, mental health, and community engagement outcomes among three caseloads: a newly established SMHC supervising no more than 30 clients per officer (N=1367); an established SMHC supervising roughly 50 clients per officer (N=495); and a traditional caseload of clients receiving mental health treatment and supervised by officers with average caseloads of over 130 clients (N=5453). Using a mixed methods approach, we found that the SMHC was implemented with high adherence to fidelity, and comparisons based on different caseload samples generally support the effectiveness of the specialized mental health caseload, particularly on criminal justice outcomes. Future studies using random assignment are needed to examine the connection among mental health symptoms, compliance with treatment and probation supervision, and recidivism., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The first MHC was established in 1997 and now, over 15years later, there are over 300 mental health courts in the United States. In a relatively short time these courts have become an established criminal justice intervention for persons with a mental illness. However, few studies have looked at the long-term outcomes of MHCs on criminal recidivism. Of the studies evaluating the impact of MHCs on criminal recidivism, most follow defendants after entry into the court during their participation, and only a few have followed defendants after court exit for periods of one or two years. This study follows MHC defendants for a minimum of five years to examine recidivism post-exit with particular attention to MHC completion's effect. Findings show that 53.9% of all MHC defendants were rearrested in the follow-up and averaged 15months to rearrest. Defendants who completed MHC were significantly less likely to be rearrested (39.6% vs. 74.8%), and went longer before recidivating (17.15months vs. 12.27months) than those who did not complete. This study suggests that MHCs can reduce criminal recidivism among offenders with mental illness and that this effect is sustained for several years after defendants are no longer under the court's supervision., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Research has suggested questionable reliability of diagnosing mental abnormality during Sexually Violent Predator (SVP) evaluations, despite this being a necessary requirement for SVP commitment. Findings have been inconsistent across studies, and little is known about the extent of such trends across diagnoses and clinicians. The current study includes data from 375 sex offenders referred for evaluation for SVP commitment in New Jersey. Clinicians (n = 128) rendered a variety of diagnoses, most commonly Pedophilia. Results suggested questionable agreement across paraphilic and non-paraphilic diagnoses, although agreement was fair for diagnoses of Pedophilia. Further analyses of cases (n = 49) involving clinicians receiving a large number of referrals (n = 14) were generally consistent with these findings, with no outlier effect apparent. Findings suggest questionable diagnostic reliability to be a widespread issue in SVP evaluations, present across a variety of diagnoses and across the general body of clinicians involved in evaluations., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

As forensic psychiatry and forensic psychology have grown and matured, the range of specialized services provided by each has expanded. In addition to traditional services such as forensic mental health assessments in criminal, family, and civil contexts, forensic specialists are now involved in delivering services in the community that include (in the criminal justice context) assessment for diversion into specialized probation or problem-solving courts, rehabilitation needs upon reentry (including specialized parole), and risk assessment for particular populations such as sexual offenders. Specialized forensic treatment services include those provided to clients under the jurisdiction of problem-solving courts or parole/probation. Similar specialized assessment and treatment services may be provided for juveniles. The nature of such service needs underscores the importance of the university-based forensic clinic as one source of specialized forensic services in the community. Such clinics are based in universities, directed by supervising faculty, and offer services provided in part by forensic trainees (psychiatric residents and forensic fellows; psychology doctoral students, interns, and post-doctoral fellows). The structure and operations of such clinics are described, with different models provided. Implications for specialized training, forensic practice, and research are discussed., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Based on a sample of 682 male sex offenders, this study investigated variables of the offending behavior for predicting sexual recidivism in different age groups. The sex offenders were allocated into four age groups. For each group, those characteristics of offending behavior showing a significant bivariate correlation with sexual recidivism were extracted. Using logistic regression, we then analyzed their incremental validity above and beyond a previously developed Crime Scene Behavior Risk (CBR)-Score, which measures the risk of sexual recidivism without taking into account the offenders' age (Dahle, Biedermann, Gallasch-Nemitz, & Janka, 2010). Age-specific offending behavior variables with incremental validity were combined with the general CBR-Score into age-specific scores and examined for their predictive accuracy. We also analyzed the extent in which these age-specific scores showed incremental validity above and beyond the Static-99 (Hanson & Thornton, 1999). For three of the four age groups, age-specific Crime Scene Behavior Risk-Scores could be determined which were incrementally valid above and beyond the Static-99. Predictive accuracy varied between AUC=.74 and AUC=.90 (r=.28 to r=.49) depending on age group. The results are discussed within context of recent findings on the latent dimensions of actuarial risk assessment variables., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

In Germany, both the number of patients treated in forensic psychiatric hospitals and the average inpatient treatment period have been increasing for over thirty years. Biographical and clinical factors, e.g., the number of prior offences, type of offence, and psychiatric diagnosis, count among the factors that influence the treatment duration and the likelihood of discharge. The aims of the current study were threefold: (1) to provide an estimate of the German forensic psychiatric patient population with a low likelihood of discharge, (2) to replicate a set of personal variables that predict a relatively high, as opposed to a low, likelihood of discharge from forensic psychiatric hospitals, and (3) to describe a group of other factors that are likely to add to the existing body of knowledge. Based on a sample of 899 patients, we applied a battery of primarily biographical and other personal variables to two subgroups of patients. The first subgroup of patients had been treated in a forensic psychiatric hospital according to section 63 of the German legal code for at least ten years (long-stay patients, n=137), whereas the second subgroup had been released after a maximum treatment period of four years (short-stay patients, n=67). The resulting logistic regression model had a high goodness of fit, with more than 85% of the patients correctly classified into the groups. In accordance with earlier studies, we found a series of personal variables, including age at first admission and type of offence, to be predictive of a short or long-stay. Other findings, such as the high number of immigrants among the short-stay patients and the significance of a patient's work time before admission to a forensic psychiatric hospital, are more clearly represented than has been observed in previous research., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Post-Traumatic Stress Disorder (PTSD) is a complex psychiatric condition, the effects of which can be seriously debilitating. As it originates from a specific traumatic event, it often impacts soldiers and victims of violent crime. It is currently one of the most frequently litigated mental diseases. Neuroscience is slowly discovering the neural bases of PTSD and other psychiatric ailments and is building tests to distinguish actual patients from non-suffering individuals. We examine the current state of neuroscientific research on PTSD and its biomarkers, focusing on a recent experiment by Apostolos Georgopoulos and coworkers. Then we analyze the legal consequences of these scientific advances, both in civil and criminal law, from a comparative perspective. Neuro-technology is likely to provide courts with a new kind of evidence, which will not replace but add to older behavioral evidence. Furthermore, it will weaken the so far standing distinction between physical and emotional harm. However, even extremely sensitive tests (>95%) can have insufficient accuracy if the prevalence of a condition in the tested population is low. Therefore, the law ought to take into account the prevalence of PTSD and other psychiatric conditions when the decision whether to admit neuro-evidence in courts or not is made., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Non-invasive brain stimulation promises innovative experimental possibilities for psychology and neuroscience as well as new therapeutic and palliative measures in medicine. Because of its good risk-benefit ratio, non-invasiveness and reversibility as well as its low effort and cost it has good chances of becoming a widespread tool in science, medicine and even in lay use. While most issues in medical and research ethics such as informed consent, safety, and potential for misuse can be handled with manageable effort, the real promise of brain stimulation does raise one prominent moral worry: it may lay the foundation of reliable, precise and stable manipulations of the mind. This article addresses this worry and concludes that it is not the possibility of manipulation, but the shift in our understanding of our mind which stands in need of careful consideration., (Copyright © 2012. Published by Elsevier Ltd.)

This paper examined quality of forensic reports submitted to the Hawaii Judiciary. Hawaii utilizes a three panel system for assessing fitness to proceed, where two psychologists and one psychiatrist submit independent reports to the Court. Utilizing a survey instrument based on previous research and nationally-derived quality standards, 150 competency to stand trial (CST) reports were examined. Reports demonstrated pervasive mediocrity with respect to quality (Mean QC=68.95, SD=15.21). One quarter (N=38) of the reports scored at or above 80% of the maximum possible score. Levels of CST agreement between evaluators and evaluators and judges were high. Report quality did not differ as a function of evaluator professional identity. Full-time employed evaluators submitted a greater number of reports above the quality criterion. For those evaluators who attended the March training, reports demonstrated significantly improved quality. Suggestions for enhancing report quality are offered with a special attention to inclusion of report elements, focus on inclusion of historical elements, and clearly described rationales supporting forensic opinions. (7664 words. Competency to stand trial, inter-rater agreement).

Reducing recidivism is a central goal in the treatment of sex offenders. In Europe, there is an increased interest in using the polygraph ("lie detector") as a tool in the treatment and risk assessment of convicted sex offenders. This interest originated from optimistic reports by American clinicians who argued that polygraph testing in the treatment of sex offenders is akin to urine analysis in the treatment of drug addiction. In this article, we critically examine the validity and utility of post-conviction sex offender polygraph testing. Our review shows that the available evidence for the claims about the clinical potential of polygraph tests is weak, if not absent. We conclude that portraying post-conviction polygraph testing as analogous to urine analysis is inaccurate, misleading, and ultimately, risky.

The present study examined the effect of mode of target exposure (live versus video) on eyewitness identification accuracy. Adult participants (N=104) were exposed to a staged crime that they witnessed either live or on videotape. Participants were then asked to rate their stress and arousal levels prior to being presented with either a target-present or -absent simultaneous lineup. Across target-present and -absent lineups, mode of target exposure did not have a significant effect on identification accuracy. However, mode of target exposure was found to have a significant effect on stress and arousal levels. Participants who witnessed the crime live had higher levels of stress and arousal than those who were exposed to the videotaped crime. A higher level of arousal was significantly related to poorer identification accuracy for those in the video condition. For participants in the live condition however, stress and arousal had no effect on eyewitness identification accuracy. Implications of these findings in regards to the generalizability of laboratory-based research on eyewitness testimony to real-life crime are discussed.

This prospective study examines the predictive validity of the Dutch version of the Structured Assessment of Violence Risk in Youth (SAVRY) by examining relationships between SAVRY scores and various types of disruptive behavior during residential treatment. The SAVRY, a risk assessment instrument, was coded for 66 male adolescents on the basis of file information and interviews. The adolescents were referred to Rentray, a juvenile correctional and treatment facility, by the Dutch juvenile courts because of severe behavioral problems or serious offenses. Institutional infractions were retrieved from incident registration files, which included acts of physical violence, verbal threat, verbal abuse, and violation of institutional rules. The interrater reliability of the SAVRY scores was good. The predictive validity of the SAVRY for physical violence against persons was excellent (Risk Total: AUC=.80, r =.33; Summery Risk Rating: AUC =.86, r =.48). The SAVRY also had good predictive validity for violence against objects, verbal threats and violations of rules, but not for verbal abuse. Implications for assessment and management of violent behavior among adolescents in residential treatment are discussed.

Background: Assessment of violence risk in youth for juvenile court needs to be improved., Aim: To determine which items of the Structured Assessment of Violence Risk in Youth (SAVRY) are recorded in pre-trial mental health evaluations and which of these items are associated with the clinical judgment of the risk of violent recidivism., Method: A total of one hundred forensic diagnostic juvenile court files were rated with regard to the presence or absence of the thirty SAVRY risk items: ten historical, six contextual and eight individual items, and six protective items. Univariate and multivariate logistic regression analysis were used to examine the relationship between SAVRY risk items and the clinical judgment of violence risk., Results: Most SAVRY-items had been recorded in the files. However, five historical items and the contextual item 'rejection by peers' did not appear in 25-62% of the files. Especially SAVRY items like 'negative-attitudes' and 'psychopathic traits' were the most powerful predictors for clinical judgment of high violence risk. Unexpectedly, historical items played a minor role in clinical judgment., Conclusion: Prospective research is needed with the use of SAVRY-items to improve evidence based violence risk assessment in court ordered mental health evaluations of youngsters.

Several studies have shown that psychopathy is overrepresented among homicide offenders. There is a consensus that Hare's Psychopathy Checklist-Revised PCL-R is currently the most valid and useful tool for rating psychopathy (e.g., [Fulero, S. M. (1995). Review of the Hare Psychopathy Checklist-Revised. In J. C. Conoley & J. C. Impara (Eds.), Twelfth Mental Measurements Yearbook (pp. 453-454). Lincoln, NE: Buros Institute]). Usually, when making a rating of psychopathy, both an interview and an examination of the subject's files are used. However, it has been discussed what is really required to be able to rate psychopathy in a reliable manner. The aim of the present study was to retrospectively rate the degree of psychopathy in 35 homicide offenders being subjected to forensic psychiatric assessment. These ratings of psychopathy were carried out using forensic psychiatric files and courts'; verdicts only. Another aim was to examine the reliability of PCL-R in this specific Swedish sample of homicide offenders. There was a good agreement between the two raters with respect to the categorical diagnosis of psychopathy (Cohen's kappa=.81, p<.001), which indicates that retrospective ratings of psychopathy are well suited for research purposes. The prevalence of psychopathy among the homicide offenders was 31.4% (using a cut-off score of 30), which means that the construct of psychopathy may contribute to the understanding of the phenomenon of homicide. In the planning of treatment for homicide offenders, a consideration of possible psychopathy is necessary. As criminal psychopaths are known to relapse into violent criminality, it is very important that they are given efficient treatment, placement and management.