“Trapped in their Shame”: A Qualitative Investigation of Moral Injury in Forensic Psychiatry Patients

Individuals who engage in criminal behavior for which they are found not criminally responsible (NCR) may be at increased vulnerability to experience moral pain and, in extreme circumstances, moral injury after regaining insight into the consequences of their behavior. Yet, almost no research exists characterizing the nature, severity, or impact of moral pain in this population. Semi-structured interviews were conducted with nine forensic psychiatric patients and 21 of their care providers. Narratives were explored using thematic analysis. Findings demonstrate that NCR patients endorse symptoms consistent with moral injury, including feelings of guilt toward victims, shame for one’s behavior, and a loss of trust in one’s morality. Moral pain is a strong driver of behavior and must be understood as part of a constellation of factors influencing criminality, risk, and recovery. Future research must develop adequate tools to measure and characterize offense-related moral injury to understand its impact on this population.

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Exploring the Criminal Behavior of Women with Psychopathy: Results from a Multicenter Study into Psychopathy and Violent Offending in Female Forensic Psychiatric Patients

International Journal of Forensic Mental Health ◽

10.1080/14999013.2014.951105 ◽

2014 ◽

Vol 13 (4) ◽

pp. 311-322 ◽

Cited By ~ 8

Author(s):

Stéphanie Klein Tuente ◽

Vivienne de Vogel ◽

Jeantine Stam

Keyword(s):

Multicenter Study ◽

Criminal Behavior ◽

Psychiatric Patients ◽

Violent Offending ◽

Forensic Psychiatric Patients ◽

Forensic Psychiatric

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A medico-judicial framework for the rehabilitation of forensic psychiatric patients in Zimbabwe

Journal of Forensic Practice ◽

10.1108/jfp-10-2014-0036 ◽

2015 ◽

Vol 17 (2) ◽

pp. 134-148 ◽

Cited By ~ 3

Author(s):

VIRGININIA DUBE-MAWEREWERE

Keyword(s):

Social Workers ◽

Psychiatric Patients ◽

Public Attitudes ◽

Psychiatric Rehabilitation ◽

Future Research ◽

Content Type ◽

The Public ◽

Forensic Psychiatric Patients ◽

Service Staff ◽

Forensic Psychiatric

Purpose – The purpose of this paper is to develop a medico-judicial framework for rehabilitation of forensic psychiatric patients in Zimbabwe. Design/methodology/approach – Grounded theory of the Charmaz (2006, 2014) persuasion was used. An exploratory qualitative design was utilised. The theoretical framework that was used as a point of departure was Pierre Bourdieu’s conceptual canon. Participants were purposefully and theoretically sampled. These included the judiciary, patients, patients’ family, psychiatrists, nurses, social workers, experts in forensic psychiatric practice. They were 32 in total. Findings – The findings reflected a need to realign the dislocation and dissonance between and within the fields of the prison system, medical system, and the judiciary. The realignment was done by co-constructing a therapeutic jurisprudent medico-judicial framework for rehabilitation of forensic psychiatric patients in Zimbabwe with participants who were stakeholders in forensic psychiatric rehabilitation. Research limitations/implications – The study was focused on male forensic psychiatric patients rehabilitation and not on female forensic psychiatric patients because there were important variables in the two groups that were not homogenous. However, it is possible that including females in the study could have added perspective to the study. This also limits the generalisation of findings beyond the male forensic psychiatric participants. Services beyond the experience of participants translate to the notion that findings cannot be generalised beyond the parameters of the study. Future research and service evaluation and audit need to be considered. The study findings focused on the “psychiatric” aspect and did not emphasise the “forensic” aspect of the service delivery service. Future research may need to feature physical provisions and progression pathways with reference to “forensic” risk reduction as a parallel goal. Practical implications – The study calls for the following: Transformation of the medico-judicial system, adjusting legislation and restructuring of the public service; changing of public attitudes to enable implementation of the medico-judicial framework; there is need for a step by step process in the implementation of the framework in which training needs of service staff, social workers, community leaders and key stakeholders will need to be addressed; the proposed changes presented by the model will require cultural, financial and infrastructural shifts. Social implications – There is need for policy makers to re-enfranchise or rebrand forensic psychiatric rehabilitation services in Zimbabwe. This could positively involve the marketing of forensic psychiatric rehabilitation to the stakeholders and to the public. This is projected to counter the stigma, disinterest and disillusionment that run through both professionals and public alike. This will foster a therapeutic jurisprudence that upholds the dignity and rights of forensic psychiatric patients. Originality/value – This work is an original contribution to forensic psychiatry in Zimbabwe. Research in that area is prohibitive because of the complexity of processes that are followed. This research is therefore ground breaking.

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Motivational Influences and Trajectories to Violence in the Context of Major Mental Illness

Journal of Interpersonal Violence ◽

10.1177/0886260519876719 ◽

2019 ◽

pp. 088626051987671

Author(s):

Stephanie R. Penney ◽

Andrew Morgan ◽

Alexander I. F. Simpson

Keyword(s):

Mental Illness ◽

Developmental Trajectories ◽

Psychiatric Patients ◽

Mentally Disordered Offenders ◽

Mentally Disordered ◽

New Information ◽

Forensic Psychiatric Patients ◽

Not Criminally Responsible ◽

Forensic Psychiatric ◽

Motivational Influences

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.

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Clinical Characteristics and Self-Harm in Forensic Psychiatric Patients

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.698372 ◽

2021 ◽

Vol 12 ◽

Author(s):

Natalie Laporte ◽

Andrejs Ozolins ◽

Sofie Westling ◽

Åsa Westrin ◽

Märta Wallinius

Keyword(s):

Affect Regulation ◽

Suicide Attempts ◽

Psychiatric Patients ◽

Conduct Disorders ◽

Structured Interviews ◽

Self Injury ◽

Forensic Psychiatric Patients ◽

Increased Risk ◽

Self Harm ◽

Forensic Psychiatric

Self-harm, comprising non-suicidal self-injury, and suicide attempts, is a serious and potentially life-threatening behavior that has been associated with poor life quality and an increased risk of suicide. In forensic populations, increased rates of self-harm have been reported, and suicide is one of the leading causes of death. Aside from associations between self-harm and mental disorders, knowledge on self-harm in forensic psychiatric populations is limited. The purpose of this study was to characterize the clinical needs of a cohort of forensic psychiatric patients, including self-harm and possible risk factors thereof. Participants (N = 98) were consecutively recruited from a cohort of forensic psychiatric patients in Sweden from 2016 to 2020. Data were collected through file information, self-reports, and complemented with semi-structured interviews. Results showed that self-harm was common among the participants, more than half (68.4%) of whom had at some point engaged in self-harm. The most common methods of non-suicidal self-injury were banging one's head or fist against a wall or other solid surface and cutting, and the most common method of suicide attempt was hanging. The most prominent functions of non-suicidal self-injury among the participants were intrapersonal functions such as affect regulation, self-punishment, and marking distress. Self-harm in general was associated to neurodevelopmental disorders (p = 0.014, CI = 1.23–8.02, OR = 3.14) and disruptive impulse-control and conduct disorders (p = 0.012, CI = 1.19–74.6, OR = 9.41), with reservation to very wide confidence intervals. Conclusions drawn from this study are that self-harm was highly prevalent in this sample and seems to have similar function in this group of individuals as in other studied clinical and non-clinical groups.

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Acceptance of the HPV Vaccine in a Multiethnic Sample of Latinx Mothers

Qualitative Health Research ◽

10.1177/1049732320980697 ◽

2021 ◽

Vol 31 (3) ◽

pp. 472-483

Author(s):

Ana Cristina Lindsay ◽

Madelyne J. Valdez ◽

Denisse Delgado ◽

Emily Restrepo ◽

Yessica M. Guzmán ◽

...

Keyword(s):

Health Care Providers ◽

Thematic Analysis ◽

Hpv Vaccine ◽

Female Adolescents ◽

Future Research ◽

Care Providers ◽

Foreign Born ◽

Structured Interviews ◽

Direct Benefits ◽

Multiethnic Sample

This descriptive qualitative study explored Latinx mothers’ acceptance of the human papillomavirus (HPV) vaccine for their adolescent children. Data were collected through individual, semi-structured interviews and analyzed using a hybrid method of thematic analysis that incorporated deductive and inductive approaches. Twenty-two ( n = 22), mostly foreign-born, Latinx mothers of male and female adolescents participated in the study. Three main themes and nine subthemes emerged from the analyses. Findings identified the need for increased efforts to raise awareness and knowledge among Latinx mothers of the direct benefits of the HPV vaccine for sons, including stressing prevention of HPV-associated cancers in males. Findings also underscore the need for improved health care providers’ communication and recommendation of the HPV vaccine for Latinx adolescent males. Future research should intervene upon the study’s findings to address barriers that remain and affect Latinx mothers’ acceptance and uptake of the HPV vaccine for their children, in particular their sons.

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The role of psychosocial treatment in decreasing of future violence behavior risk in forensicly treated psychiatric patients

European Psychiatry ◽

10.1016/s0924-9338(11)72488-9 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 783-783

Author(s):

S. Jonovska ◽

V.Š. Jengić ◽

L. Safner ◽

G. Bošković ◽

S. Zudenigo

Keyword(s):

Psychiatric Patients ◽

Violent Behavior ◽

Psychosocial Treatment ◽

Violence Risk ◽

Forensic Psychiatric Patients ◽

Forensic Treatment ◽

Aggression Questionnaire ◽

Schizophrenic Group ◽

Forensic Psychiatric ◽

In The Beginning

The main aim of this study was to establish to what extent psychosocial treatment as a part of complex, multicomponent forensic treatment has an influence on decreasing of the future violence behavior risk in population of forensic psychiatric patients. We examinated 13 patients treated on Department of Forensic Psychiatry of Psychiatric Hospital Rab in Rab, Croatia. 9 of them were males and 4 of them females, 25–60 years of age, all of them were compulsory hospitalized because of committed criminal act connected with violent behavior. All of them have diagnosis of schizophrenic group of diseases with different duration of forensic treatment (from few months to few years). During 2010. all of them participated in psychosocial programe workshops once a week, for 6 months.MethodsViolence Risk Screening-10 (V-RISK-10), subjective measure of the programme chairmen performed in the beginning and in the end of the programme. The Aggression Questionnaire and Daily Spiritual Experience Scale as self-assesment scales were performed in the end of the programme. Results point on decreasing of V-RISK-10 results in the end of the programe in all participants. Interested observation was that mentioned results and those on self-assesment scales were not always been correlated positively. We also proved negative correlation between aggressivity and spirituality. As a conclusion, we have indications to believe that is real to expect that comining psychosocial treatment with targeted psuchopharmacological interventions could leed to decreasing the risk of future violent bihevior in forensicly treated psuchiatric patients.

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