Search

Background: Accumulating evidence internationally points to an increased risk of crime perpetration and victimization among people with an intellectual disability (ID). This study aimed to examine the impact that comorbid mental illness had on the association between intellectual disability, crime perpetration and criminal victimization. Method: A case linkage methodology involving 2,220 individuals with an intellectual disability from an Australian State. Results: One in four (27%) had contacts with public mental health services; 8.2% had a comorbid mental illness. This "dual disability" group was between 2.97 and 3.22 times more likely than those with intellectual disability alone to have a history of criminal charges, and between 2.76 and 2.97 times more likely to have been a victim of crime. Conclusions: The extent of criminality and victimization found among people with dual disability indicates a potentially multiply stigmatized group for whom the need for a coordinated cross-agency service response remains paramount.

Accessible Summary: What is known on the subject: Research suggests that the Dynamic Appraisal of Situational Aggression (DASA) is a useful risk assessment instrument to identify individuals who might be at risk of aggression in mental health inpatient units.Although, risk assessment research has typically focused on an individual's risk of aggression, recent research has begun exploring whether the DASA could be used to assess the likelihood that a group of patients would be aggressive. What the paper adds to existing knowledge: While the DASA was useful for assessing whether an individual was likely to be aggressive, the group average score was not a useful indicator for the likelihood of aggression once the individual DASA score was taken into consideration.Unexpectedly, patients who were assessed as high risk on the DASA were more likely to be aggressive on settled units compared to unsettled units, which included other individuals whose risk was elevated. What are the implications for practice: There is not enough evidence to suggest that the group DASA average improves the identification of aggression above the individual DASA score. Introduction: The Dynamic Appraisal of Situational Aggression (DASA) is an inpatient aggression risk assessment instrument. Recently, research explored whether the unit atmosphere, as indicated by a unit's average DASA score, was related to inpatient aggression risk, but failed to control for individual risk. Aim: Investigate whether the DASA unit average score or an interaction between the unit average and an individual patient's DASA score was related to the likelihood that an individual would act aggressively. Method: Cox regression with repeated assessments and recurrent events was used to analyse 11,243 DASA risk assessments of 113 inpatients collected via retrospective file review. Results: The unit DASA average score was not related to aggression towards staff. There was a negative interaction between the individual and the unit DASA average scores when identifying patient‐to‐patient aggression; high‐risk patients engaged in less aggression when the unit average was heightened relative to units with lower DASA average scores. Discussion: It is possible that there were more nursing interventions and/or patients engaged in greater self‐regulation on unsettled units, thus reducing aggression. Implications for Practice: Currently, there is insufficient evidence to suggest that the unit average score should be used to supplement individual DASA scores to identify aggression risk. [ABSTRACT FROM AUTHOR]

Objective: Mental disorder is common among people who stalk. However, the nature of this association is unclear and it is not known whether the commencement of stalking is associated with symptoms of disorder. This study used a longitudinal design to examine the association between the onset and cessation of stalking behavior and indicators of mental disorder in the form of mental health service use. Method: Data linkage was used to explore public mental health service use among 157 people who engaged in stalking in Melbourne, Australia. Mental health service use across the lifetime, 5 months prior to stalking onset, between the onset and cessation of stalking (during stalking) and 5 months post-stalking was identified. Mixed regression models tested temporal associations between types of mental health service use (acute vs continuing care) and onset and cessation of stalking in a subsample of 130 participants where dates of the stalking episode were available. Results: A total of 105 (67%) participants had lifetime use of public mental health services, while 15% accessed mental health services in the 5 months prior to (N = 19) or during the stalking (N = 20) and 22% (N = 29) used services in the 5 months after the stalking ceased. Odds of using acute mental health services and average monthly rate of use were highest during the stalking. Odds and average monthly rate of using continuing care were highest after the episode ceased. Conclusions: Most people who stalk have used public mental health services, but a minority access services immediately prior to or during the stalking episode. Acute service use was more common during the stalking, while use of continuing care services was more common after the stalking ceased. These findings provide preliminary support for a temporal relationship between acute mental disorder and stalking behavior. [ABSTRACT FROM AUTHOR]

This study explored the frequency, recency, content, severity, and targets of aggressive scripts reported by 94 incarcerated Australian males. The scripts of participants who reported a history of repeated and severe aggression were compared with the scripts of participants who reported a history of less severe and less frequent aggression. As hypothesized, participants with a history of more frequent and severe aggressive behavior reported more severe aggressive script content and more frequent script rehearsal. Furthermore, participants with a history of more frequent and severe aggressive behavior reported feelings of anticipation and excitement when they rehearsed aggressive scripts as well as an increase in the severity of aggressive scripts rehearsed over time. These results have important implications for risk assessment and treatment of violent offenders. [ABSTRACT FROM AUTHOR]

This study examined the associations between schema modes and aggression in 59 male forensic psychiatric inpatients. Two instruments were used to assess schema modes: One measured modes through self-report, the Schema Mode Inventory (SMI), and one measured modes via observer (nurse) judgments, the Mode Observation Scale (MOS). Aggression was measured in two ways: Self-reported aggression during participants' lifetimes was assessed using the Life History of Aggression-Self-Report-Aggression Scale (LHA-S-A), and incidents of aggression during hospitalization in the month following schema mode assessment, were identified through review of medical records. Self-reported (SMI) and observer-reported (MOS) measures of schema modes were poorly related and produced disparate associations with aggression. As hypothesized, the observer-reported MOS Angry-Child and MOS Impulsive-Undisciplined-Child modes were significantly associated with aggression during the follow-up. A number of other schema modes (MOS-Healthy-Adult, SMI-Angry-Child, MOS-Complaining-Protector, SMI-Undisciplined-Child, and MOS-Angry-Protector) were unexpectedly associated with aggression. [ABSTRACT FROM AUTHOR]

The Historical Clinical Risk Management-20 Version 3 is the latest iteration in the HCR-20 series, adopting novel changes such as the addition of Relevance ratings and non-requirement to include the Psychopathy Checklist–Revised. This study aimed to examine these changes and compare the predictive validity of the HCR-20V3 to the HCR-20V2. The sample comprised of 100 forensic psychiatric patients, retrospectively followed up for a maximum period of approximately 13 years post-discharge from the Thomas Embling Hospital. Recidivism data were sourced from official police records. Results indicated good to excellent inter-rater reliability. The HCR-20V3 significantly predicted violent recidivism (area under the curve =.70 to.77), levels of accuracy that were not significantly different from the HCR-20V2. HCR-20V3 Relevance ratings failed to add incremental validity above Presence ratings; however, the PCL–R improved upon the HCR-20V3's validity. The study represented one of the first evaluations of the HCR-20V3 in Australia. [ABSTRACT FROM AUTHOR]

This study evaluated the internal consistency and factor structure of the Personality Inventory for DSM-5 –Brief Form (PID-5-BF), and its relationship to aggression in 438 incarcerated Australian male offenders. Results provide support for the internal consistency and five-factor and bifactor structure of the PID-5-BF. The PID-5-BF total score, as well as the domains of Antagonism, Disinhibition, and Negative Affect (low), demonstrated significant relationships with aggression. These results provide preliminary support for the psychometric properties of the PID-5-BF within prison settings, and suggest that a PID-5-BF assessment may be useful within forensic settings to screen for broad maladaptive personality characteristics that are indicative of a greater propensity for aggressive behavior. [ABSTRACT FROM AUTHOR]

Risk assessment is a pre‐requisite for violence prevention in mental health settings. Extant research concerning risk assessment and nursing intervention is limited and has focused on the predictive validity of various risk assessment approaches and instruments, with few attempts to elucidate and test interventions that might prevent aggression, and reduce reliance on coercive interventions. The integration of risk assessment and violence prevention strategies has been neglected. The aim of this feasibility study was to test a novel Aggression Prevention Protocol designed to prioritize the instigation of less restrictive interventions on an acute forensic mental health unit for female patients. A prospective quasi‐experimental study was designed to test an Aggression Prevention Protocol, linked to an electronic application of the Dynamic Appraisal of Situational Aggression (DASA). Following introduction of the DASA and Aggression Prevention Protocol, there were reductions in verbal aggression, administration of Pro Re Nata medication, the rate of seclusion, and physical and mechanical restraint. There was also an increase in documented nursing interventions. Overall, these results support further testing of the electronic application of the DASA and the Aggression Prevention Protocol. [ABSTRACT FROM AUTHOR]

Background: Accumulating evidence internationally points to an increased risk of crime perpetration and victimization among people with an intellectual disability (ID). This study aimed to examine the impact that comorbid mental illness had on the association between intellectual disability, crime perpetration and criminal victimization. Method: A case linkage methodology involving 2,220 individuals with an intellectual disability from an Australian State. Results: One in four (27%) had contacts with public mental health services; 8.2% had a comorbid mental illness. This "dual disability" group was between 2.97 and 3.22 times more likely than those with intellectual disability alone to have a history of criminal charges, and between 2.76 and 2.97 times more likely to have been a victim of crime. Conclusions: The extent of criminality and victimization found among people with dual disability indicates a potentially multiply stigmatized group for whom the need for a coordinated cross‐agency service response remains paramount. [ABSTRACT FROM AUTHOR]

Purpose: People with intellectual disability (PWID) appear more likely to be victims and perpetrators of crime. However, extant evidence pertaining to these risks is limited by methodological weaknesses and the absence of consistent operational definitions. This research aimed to estimate the prevalence of criminal histories and victimisation using a large, well-defined sample of PWID.Methods: A case-linkage study was conducted comprising 2220 PWID registered with disability services in Victoria, Australia, whose personal details were linked with a state-wide police database. Criminal charges and reports of victimisation were compared to a non-disabled community comparison sample (n = 2085).Results: PWID were at increased risk of having a history of criminal charges, particularly for violent and sexual offences. Although the non-disabled comparison group had a greater risk of criminal victimisation overall, PWID had a greatly increased risk of sexual and violent crime victimisation.Conclusions: PWID are at increased risk of victimisation and perpetration of violent and sexual crimes. Risk of sex offending and victimisation is particularly elevated, and signalling the need for specialised interventions to prevent offending and to ensure victims is assisted with access to justice, support, and treatment. [ABSTRACT FROM AUTHOR]

Background: Widespread public concern about youth violence persists, particularly the so-called acts of appetitive violence characterised by positive affect and exemplified in modern trends such as 'happy slapping'. Empirical research into this phenomenon is scant.Aim: The aim of this study was to determine whether perpetration of appetitive violence signals a specific offending trajectory.Method: We reviewed reports and related material from 105 violent young offenders referred to court mental health services in the state of Victoria, Australia. Index violent offences were categorised as appetitive or not. Official police records were used to determine rearrest during the 12 months following mental health assessment.Results: The nine young people whose offence was classified as appetitive were male and did not reoffend, generally or violently, at different rates than the other youths.Conclusion: The offending trajectories of young people with appetitively violent index offences were indistinguishable from other violent youths. There is thus insufficient information here to recommend distinctive intervention for this subgroup, but their high reoffending rate (7/9) suggests that they are worthy of more research attention. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This study tests whether specific dimensions of emotion dysregulation predict maladaptive anger expression among offenders from Italy and Australia. In particular, it examines the unique associations among emotion dysregulation dimensions and different aspects of anger expression and control, in both inmates and offenders on parole. Multiple regression analyses reveal that difficulties controlling impulsive behaviour when distressed are related to state anger, trait anger, and chronic anger expression. On the other hand, alexithymia predicts the maladaptive expression of anger inwardly directed. Finally, lack of emotional awareness and limited access to emotion regulation (ER) strategies are negatively related to anger control, suggesting that they may represent useful treatment targets. Interestingly, incarcerated offenders reported significantly higher levels of state anger and lower levels of anger control out (i.e. seeking support from others) than offenders living on parole in the community, highlighting the importance of contextual influences in the emotional life of offenders. [ABSTRACT FROM PUBLISHER]

Research has consistently demonstrated a link between certain personality disorders (PDs) and increased rates of aggression and violence. At present, understanding of the mechanisms that underlie this relationship is limited. This study was designed to examine the contention (Gilbert & Daffern, 2011) that the application of a contemporary psychological aggression theory, the General Aggression Model (GAM; Anderson & Bushman, 2002), may assist in elucidating the PD-aggression relationship. Eighty-seven offenders undergoing presentence evaluation were assessed for Axis II PDs and psychopathy, aggression, and three constructs delineated by the GAM: scripts, normative beliefs, and anger. Regression analyses were undertaken to examine the relative contributions of these variables to aggression. The results upheld a relationship between several PDs and aggression, and suggested that for these PDs, the consideration of scripts, beliefs supportive of aggression, and anger facilitated an improved understanding of aggressiveness. Overall, the findings indicate that the GAM offers valuable insight into the psychological features that characterize individuals with PD who are prone to aggression. [ABSTRACT FROM AUTHOR]

To explore and evaluate extant and potential methods used in risk assessment and aggression prevention training. This study was also designed to consider the most appropriate method for educating nurses in use of a novel risk assessment instrument linked to a structured nursing intervention protocol (the electronic application of the Dynamic Appraisal of Situational Aggression and Aggression Prevention Protocol). Organisational and personal concerns have led to the development of training programs designed to prevent and manage aggression in mental health units. This descriptive qualitative study explored experts' opinions about effective training approaches. Data were collected via focus groups (a total of four discrete groups), with each of the four focus groups repeated after four weeks. A semi-structured guide was used to guide the focus group discussions. Seventeen experts with experience coordinating and facilitating training in prevention and management of aggression in mental health units in New Zealand and Australia participated in this study. Three themes emerged from the data 1) existing training can be "like pulling teeth without anaesthetic" 2) the need to "breathe life" into the training and 3) a vision of the "gold standard" for practice and training. Training is optimal when it is place-based, responsive to local needs and inclusive of relevant clinical, cultural, consumer/carer and contextual factors. Training may benefit from a focus on the application of the knowledge, skills and attitudes learnt and there is a need for ongoing reinforcement of training in the clinical setting, beyond initial introduction and provision of information and orientation to relevant skills. [ABSTRACT FROM AUTHOR]

Youth offending is an important issue; it has significant social, psychological, interpersonal, and financial impacts on the society. International research has shown that young offenders generally have multiple and complex needs across a wide range of domains; however, research examining the depth and breadth of difficulties faced by young offenders in Australia is lacking. Arguably, such information is critical to help guide the development of valid preventative and treatment initiatives. This article describes a study examining the prevalence of mental illness, low intelligence, psychopathy, risk for reoffending, and criminogenic needs in 75 youth and young adult offenders in Victoria, Australia. Results suggest that the prevalence of mental illness and low intelligence is high in this population. Most (86%) of the sample had likely Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision Axis I disorders (including mood, anxiety, substance use, eating, and psychotic disorders); 15% had a Full Scale Intellectual Quotient ( FSIQ) below 70; and an additional 25.7% had an FSIQ in the borderline range. The majority (80%) of the sample was considered to be at a high or very high risk of reoffending. The high prevalence of mental health issues found in this population highlights the need for comprehensive and multifaceted assessment, and for psychosocial treatment and management to be comprehensive, addressing clinical, criminogenic, and social domains. [ABSTRACT FROM AUTHOR]

ABSTRACT Aggression during psychiatric hospitalization is frequent, problematic, and a major challenge for nurses and mental health services more generally. The strength of the therapeutic alliance between nursing staff and patients has been posited as an important protective factor that can limit the likelihood of aggression. This study examined the relationship between interpersonal style, perceived coercion, and psychiatric symptoms on the therapeutic alliance between patients and staff, and how each, in turn, is related to aggression. Participants in this study were 79 patients admitted to an acute psychiatric hospital. Each participant was interviewed to determine perceived coercion, symptoms of psychiatric illness, interpersonal style, and therapeutic alliance. Incidents of aggression were recorded at discharge through a review of incident forms, file review, and interviews with unit nursing staff. The results showed that a hostile-dominant interpersonal style and symptoms of paranoia predicted poor therapeutic alliance, contributing 14% of the variance in therapeutic alliance scores. A dominant interpersonal style predicted aggression towards staff. Therapeutic alliance, perceived coercion, and symptoms of psychiatric illness did not predict aggression. Implications for engagement in treatment and the prevention of aggression are discussed. [ABSTRACT FROM AUTHOR]

An international movement promoting the reduced use of physical restraint and other coercive practices has brought into focus the ways in which those who are responsible for the care of children and young people respond to problematic behaviour. The topic generates emotive discussion, with proponents advancing the argument that the use of coercive measures enhances the quality of care and protects young people from harm, and civil libertarians who argue that restraint is never an appropriate way of managing behaviour. Despite such debates there is an absence of good research and scholarly activity on restraint practices, leading to uncertainty about the immediate and long-term effects of particular practices on both staff and young people. Consequently, it has been difficult for agencies to develop clear, consistent, and definitive policies. Drawing on international perspectives, the aim of this article is to discuss issues relevant to the practice of restraint in residential care facilities for children and young people in Australia, highlighting a number of issues that require resolution prior to the development of practice guidelines. [ABSTRACT FROM AUTHOR]

There is a considerable body of research on the assessment and prediction of aggression in psychiatric hospitals. A range of clinical and demographic characteristics associated with aggressive inpatients, such as young age and active symptoms of psychosis, have repeatedly been shown to contribute to aggression. Environmental factors have also been shown to be important. The study examined aggressive behaviours in an Australian forensic psychiatric hospital, using aggression-specific recording instrumentation developed for the study. The purpose of the study was to compare results using aggression specific-recording instrumentation with a previous study using retrospective methods relying on standard hospital incident forms, and to examine the relationship between type, direction and severity of aggression with the use of seclusion. In contrast with the results obtained in a previous study, staff rather than patients were more often the victims of both verbal and physical aggression, although patients were more frequently the victims of more severe forms of aggression. Patients were verbally and physically aggressive towards other patients at similar rates, although they were more frequently verbally, rather than physically, aggressive to staff. Acute wards recorded more aggression than rehabilitation wards. Males and females were aggressive at similar rates. A reduction in reported incidents of verbal and physical aggression, particularly against staff, occurred over the course of the study. Patients were secluded and incident forms were completed following approximately 30% of aggressive behaviours. Whether or not a patient was secluded and whether or not an incident form was completed depended on a range of factors, including the nature of the victim and the type and severity of the aggression. [ABSTRACT FROM AUTHOR]

Investigates patterns of aggression in a forensic psychiatric hospital in Australia. Prevalence and determinants of aggression; Clinical and demographic characteristics of aggressive patients; Aggression management and minimization strategies; Frequency and type of aggression.

An introduction is presented in which the editor discusses various reports within the issue on topics including ethical issues that arise when working in forensic settings, the norms guiding legal-ethical decision making, and an examination of psychological practices with indigenous Australians.