The Reconvictions of Mentally Disordered Offenders - How, When, and Where?

Background Little is known about the recidivism of mentally disordered offenders after discharge from forensic psychiatric services. This is problematic because such knowledge could (i) help professionals who come into contact with this group to better plan interventions to prevent recidivism and (ii) clarify the effectiveness of forensic psychiatric care. The aim of this study was to investigate the new crimes of mentally disordered offenders who had been reconvicted after discharge from forensic psychiatric care. Methods Included in this study were all individuals who had been discharged from forensic psychiatric care in Sweden during 2009-2018, were included in the Swedish National Forensic Psychiatric Register, and had been reconvicted in a criminal court within the follow-up period of 2009-2018 (n=157). Retrospective registry data along with coded data from criminal judgments (n=210) were used to create a database. Descriptive statistical analysis was performed. Results 75% of included individuals were reconvicted for at least one violent crime, but only 9 individuals were reconvicted for a serious violent crime, which can be compared to the 44 individuals with serious violent index crimes. The most common crime was “Other violent”. The most common sentence was probation. The offender’s most common relationship to the victim was having no known relationship, followed by the victim being a person of authority. The most common circumstance of the crime leading to the reconviction was that it occurred without apparent provocation; other common circumstances were related to the exercise of public authority. The most common crime scene was a public place. Conclusions Even though the reconvictions of this group included many violent crimes, there were very few serious violent crimes. The finding that the victims of the crimes of mentally disordered offenders are most commonly either unknown to the perpetrator or persons of authority, and that the crimes are often perpetrated without apparent provocation or reason, is important information for all professionals who come into contact with this group and should be taken into consideration in order to assess risk more accurately.

Long Term Metabolic and Inflammatory Effects of Second-Generation Antipsychotics: A Study in Mentally Disordered Offenders

Mentally disordered offenders provided with forensic psychiatric care are often treated with second generation antipsychotic (SGA) medication and experience metabolic and inflammatory side effects. Aim: In this paper, we monitored the three-year fluctuation of selected anthropometric, biochemical, and inflammatory indices in forensic psychiatric patients receiving antipsychotic (AP) medication for more than five years, according to the type of AP. Methods: Thirty-five patients with psychotic disorders were classified into two groups based on the type of AP. Specifically: AP1, related to a lower risk, and AP2, related to an increased risk of weight gain (WG) and metabolic complications. Biochemical, hematological, anthropometric, blood pressure (BP), and medication data were retrieved from the individual medical files. Statistical analysis was performed with SPSS 23. Results: No significant differences in weight and glucose and cholesterol levels were observed, but patients taking AP2 more often needed drugs to control diabetes mellitus (DM), lipidemia, and cardiovascular disease (CVD). In those taking AP1, the mean HDL level decreased significantly over time (p < 0.05) and a higher proportion developed higher BP (52.9% of AP1 vs. 16.7% AP2). In the AP2 group the median level of C-reactive protein (CRP) (p < 0.001) and the white blood cell count (WBC) increased over the three years (p < 0.001). Conclusions: The proposed sub-classification of SGAs into AP1 and AP2, depending on their potential for metabolic and inflammatory effects, might facilitate study of their long-term side-effects but also help in personalized prevention or treatment measures to counteract these side-effects.

The Totalising Nature of Secure and Forensic Mental Health Services in England and Wales

This evidence-based opinion piece explores the totalising risk averse nature of secure and forensic mental health services and associated iatrogenic harms in England and Wales. Drawing on the research literature I consider the various influences, both external and internal which impact on the provision of such services and how both the therapeutic alliance and recovery potential for patients may be improved. Especial attention is paid to the deployment of restrictive practise, practitioner attitudes, the potential for non-thinking, and how these may impact on decision-making and the care and treatment of mentally disordered offenders.

Police Officers' Perception of Mentally Disordered People: A National Survey in Japan

BackgroundsThe treatment of mentally disordered offenders is an issue in forensic mental health. In most countries, police officers working in the community are the first to deal with patients at risk of harming themselves or others. However, their perceptions and opinions regarding forensic mental health have not been adequately investigated in Japan.MethodsWe conducted a national survey to gather police officers' views regarding legislation on mentally disordered people and inter-organizational collaboration.ResultsA total of 241 police officers participated in this study. Many participants were aware of the mental health care scheme in their daily work. Contrastingly, many participants complained about the public health center and psychiatrists. They seem to have emerged partially from the differences in each organization's structure, lack of resources, and communication gaps. Many participants felt a lack of opportunity to learn about psychiatry.ConclusionBetter collaborative care for mentally disordered people requires mutual relationships among the police, public health centers, and psychiatrists with a deeper understanding of community mental health.

Patterns of Lifetime Criminality in Mentally Disordered Offenders – Findings From a Nationally Representative Cohort

Background: Treatment of mentally disordered offenders (MDOs) is challenging as their behavior and clinical conditions can be traced to a complex constellation of major mental disorders, substance use and antisocial lifestyle. Finding subgroups of these offenders, which could guide treatment and risk assessment, is desirable. There are few long-term, prospective studies of risk factors for persistent criminal behavior among MDOs.Aims: The aims are (1) to provide a map of lifetime criminality in MDOs, (2) to identify subgroups of offenders, and (3), if such clusters exist, to test whether they differ in lifetime criminality and patterns of negative events during in-patient treatment.Methods: Background data on all offenders from the Malmö University Hospital catchment area sentenced to forensic psychiatric in-patient treatment 1999–2005 (n = 125) was collected. Data on negative events during treatment (violence, threats, absconding and substance use) from date of admittance until discharge or until June 30, 2008 was gathered. Court decisions for 118 of the cohort-individuals were collected from the 1st of January 1973 until December 31, 2013. We used hierarchical cluster analysis to identify subgroups and MANOVA-analysis to examine differences between these clusters on lifetime criminality variables and negative events. A MANCOVA was used to control for time in treatment.Results: The cohort was sentenced to a total of 3,380 crimes (944 violent) during the study period. Median age at first crime was 20 years (range 15–72), and at first violent crime 27 years (range 15–72). A subgroup (n = 26) was characterized by childhood adversities, neurodevelopmental disorders and later substance use disorders and was more often associated with substance-related crimes, financial crimes and lower age at first crime. During treatment, this cluster showed higher rates of substance use and threats. When controlling for treatment time, no differences in negative events were found.Conclusions: This study replicated findings from prison populations of the existence of a more criminally persistent phenotype characterized by early-onset neurodevelopmental and behavior disorders, childhood adversities and later substance use disorders. We did not find this cluster of variables to be related to negative events during inpatient treatment when controlling for length of stay.

Offender Recovery. Forensic Patient Perspectives on Long-Term Personal Recovery Processes

Knowledge on user experiences from mentally disordered offenders (MDOs) is still limited in a Danish context, especially regarding recovery from offences, severe mental illness, long-term admissions and often involuntarily contact with hospital psychiatry. The study is based on 34 semi-structured interviews with nine forensic patients exploring their experiences with personal recovery processes. The MDOs point out a significant number of elements and factors enhancing, supporting and limiting personal recovery processes. Long-term recovery processes for MDOs involve coming to terms with mental disorders as well as offences. Working with offender recovery implies addressing and understanding the index offence leading to psychiatric measurement as well as addressing risk and prevention of future crime. This coming to terms is an individual and deeply personal process and it often involves several and changing narratives. According to the informants, professionals play a crucial role in supporting recovery processes and maintaining hope and optimism over time. MDOs experience structural barriers limiting recovery potential, especially stigma or limited areas of participation. It is important not to focus solely on personal recovery as a one-dimensional individual process or responsibility, but as a process also marked by structural and organisational challenges.

Postcharge mental health diversion: characteristics of clients and predictors of success

How to best serve criminal offenders who have mental health issues is of ongoing concern within the justice system in Canada. Mental health diversion has become a popular option that allows mentally disordered offenders to be diverted from custodial sentences to community treatment and supports. However, research on this type of intervention, particularly in Canada, is scant. In order to address this gap, the current set of studies examined mental health diversion in a multisite sample obtained from court support programs in the Greater Toronto Area. In Study 1, it was found that individuals who successfully completed their diversion programming were less likely to have a criminal history and had fewer clinical and psychosocial issues. These results were borne out in the multivariate analyses in Studies 2 and 3 as well, with individuals who had a criminal history, more clinical needs, and who committed more severe nonviolent index offences having lower odds of successfully completing their diversions. In Study 4, when these predictors were developed into a screening tool to determine the likelihood of diversion success, they still predicted diversion outcome at better than chance levels, but the overall predictive accuracy was lower than that found in the multivariate models from Study 3.