Comparaison franco-canadienne du développement des Cercles de soutien et de responsabilité (CSR) pour la prévention du risque de récidive des délinquants sexuels

Les Cercles de Soutien et de Responsabilité (CSR), nés il y a 24 ans à Hamilton au Canada pour répondre à l'inquiétude du public provoquée par le retour des délinquants sexuels dans la société après leur libération, se développent partout dans le monde. Ils proposent l’accompagnement de l’agresseur dans sa réinsertion sociale. Efficaces dans les pays étrangers, ces dispositifs se développent lentement en France. L’objectif de cet article est de tenter d’expliquer les freins à l’implantation des CSR en France au regard des difficultés rencontrées lors des expériences françaises passées et actuelles, mais aussi des différences interculturelles entre la France et le Canada.

Offering group mental health programs in a maximum security correctional facility

In the following article, I discuss psychoeducational groups offered in a men’s maximum security prison by the Centre for Addiction and Mental Health’s (CAMH) Forensic Early Intervention Service (FEIS) in partnership with correctional services staff. I share observations and experiences facilitating mental health programs with clients in custody and explore related challenges, risks and opportunities. Outcomes and feedback from group participants are reviewed and recommendations for others interested in offering similar programs are presented.

International Journal of Risk and Recovery, beginning of an exciting journey

Sébastien Prat is an Assistant Professor at McMaster University and a Staff Psychiatrist at St. Joseph’s Healthcare Hamilton. His medical training and residency in Psychiatry took place at the University François Rabelais of Tours in France. He underwent a subspecialty training in Forensic Psychiatry at McMaster University. He is the Executive Editor of the International Journal of Risk and Recovery.

Kratom-induced Psychosis: case report and literature investigation

Substance Use Disorder is a major concern for public health. Legal substances are often misused to get “high”. Beside the risk of developing subsequent mental health and physical conditions, one of major risk is related to behavioural changes leading to criminal behaviour. There is need for regulation on some of these substances to ensure public as well as individual safety. This article is a case report describing Mitragyna speciosa (Kratom) induced psychosis in a patient suffering from Schizophrenia. We hope this article can bring attention to regulating bodies about the risks associated with readily available “legal” drugs like Kratom.

Expertise psychiatrique pénale: comparaison des modèles français et canadien

L’expertise psychiatrique est une des disciplines de la psychiatrie légale. Sa pratique est spécifique aux juridictions où elle s’exerce et aux ressources qui lui sont attribuées. L’évolution des connaissances en psychiatrie et psychopathologie, ainsi que les décisions politiques ont un impact majeur sur la nature et le déroulement des missions d’expertise. Il existe des différences significatives entre les pays, ce qui surprend fréquemment, puisque la pratique de la psychiatrie générale est quant à elle la même. Nous proposons dans cet article une comparaison entre la pratique de l’expertise psychiatrique pénale en France et au Canada.

Clinicians’ Perceptions of the Implementation of the Structured Assessment of Protective Factors for Violence Risk (SAPROF) on an Inpatient Forensic Unit

The Structured Assessment of PROtective Factors for Violence Risk (SAPROF) is an assessment tool that examines protective factors when assessing for violence risk. There is limited research on clinicians’ perceptions of the use and implementation of risk assessment tools, and this study aimed to examine the experiences of clinicians using the SAPROF in a low secure forensic rehabilitation inpatient unit in Canada. An exploratory research design was used, and five clinicians participated in semi-structured interviews. Data was analyzed using a thematic approach and three central themes were identified: understanding of the patient from a strengths-based point of view, providing clinicians with a focus on how to help the patient, and bringing in opportunities to collaborate as a team. The findings highlight the additional value of the SAPROF as tool in helping forensic teams to adopt strengths based approaches to risk assessment, enhancing treatment planning and inter-professional collaboration. Keywords: strengths, risk assessment, SAPROF, consensus scoring, recovery

Battered woman syndrome: updating the expert checklist

The aim of this article is to examine the current state of the battered woman syndrome (BWS) defence in Canada and propose an update to the list of factors considered by experts evaluating the applicability of the defence to individual cases. The history and current legal definition of the defence are presented, and theories relating to BWS are summarized. Factors required of expert testimony in BWS cases are presented; cases relevant to the development of the defence that highlight these assessment factors are discussed. In a subsequent section, limitations of the defence and the role of the expert are explored. The PTSD Checklist (used in clinician diagnosis) is summarized before an updated, BWS-specific expert checklist is proposed. The updated checklist proposes six elements to be considered by an expert assessing a BWS case: 1. environmental factors, 2. attempts to leave or alter the situation, 3. risk factors of the abuser, 4. risk factors of the victim, 5. triggers for violence, and 6. contrary evidence. It is hoped that using this checklist will help experts to cover all the essential elements they must consider in order to conclude that a woman satisfies the criteria for BWS. In particular, this updated checklist will help experts to prepare comprehensive testimony that addresses the five issues defined by Justice Wilson as the expert’s duty to assess. In addition, this checklist will help experts present a firm foundation for a defence regarding the critical question of why the night of the offence was different from all other nights.

Absconsion from forensic psychiatric institutions: a review of the literature

Background: Absconding from mental health units is referred to as a patient leaving without permission and can have significant consequences for the patient, family, community, and institution. The varying definitions of absconsion involve breaching security of an inpatient unit, accessing grounds or community without permission, gaining liberty during escorted leave or being absent for longer than permitted from authorized or trial leave. While considerable literature exists on absconsion from acute psychiatric units, there is a paucity of literature specific to forensic absconsions, despite inherent differences between patients and systems. Forensic patients are offenders who are found unfit to stand trial, or not criminally responsible on account of mental disorder. The literature indicates the absconding rate within the forensic population is expected to be low, based on the fact that the level of security in forensic units is higher than general psychiatric units. Despite the rates being considered low, the outcomes of absconding in this population can potentially be serious, thus the exploration of factors surrounding these incidents is essential. Purpose: To review the literature regarding absconsion from forensic psychiatric institutions. This review will identify potential risk factors and motivations of forensic patients that have absconded. Methods: Electronic database and hand searches were conducted to locate articles pertaining to absconding specific to forensic psychiatric institutions published from 1969-present. Search terms included “abscond”, “escape”, “AWOL”, “runaway”, “psychiatric inpatient”, “forensic institution”, & variants. All full-text articles meeting inclusion & exclusion criteria were appraised for qualitative themes, limitations, and assessed for risk of bias using appropriate CASP Checklists. The review is structured following the PRISMA checklist and framework. Results: A total of 19 articles meeting literature review criteria were identified. The majority of the articles were of retrospective case-control design (n=12). Three systematic reviews were found on absconsion that included analyses from both forensic and general psychiatric populations. Definitions for absconding were omitted or varied making comparisons between studies difficult. Much research compared demographic, static and dynamic factors. History of previous absconsion, scores on validated risk-of-violence assessment tools, substance-use disorder, acute mental state, and socio-environmental factors were consistently noted as risk-factors. Four distinct motivations for absconding emerged: goal-directed, frustration/boredom, symptomatic, and accidental. Overall, the literature suggested forensic absconsion was a rare event of short duration with low risk to the public and few re-offending incidents. Conclusions: There is a paucity of literature on forensic absconsions. A consistent definition of absconsion and use of standardized reporting protocols across forensic programs would be beneficial in order to be able to compare data on absconding events. Also, prospective studies should be undertaken to better understand the motivations and dynamic risk factors of forensic patients who have absconded and would help inform a forensic absconsion risk assessment protocol.

The Implementation of Cognitive Behavioural Therapy for Psychosis (CBTp) in a Forensic Setting

In this Letter to the Editor, the authors comment on the implementation of a cognitive behavioural therapy for psychosis program for individuals admitted to a forensic psychiatry program. They highlight their experience and how they adapted the sessions to fit the needs of the patient in this context.

Forensic Psychiatry in the largest security ward in Portugal

Forensic Psychiatry is defined as the Psychiatry subspecialty in which the clinical and scientific knowledge is applied to legal aspects, both with regard to Civil and Criminal Law. Nowadays, the largest security ward is in Coimbra, at the University Hospital. It covers 110 patients, 90 males and 20 females. The aim of the security measure, in accordance with the penal code, is the protection of legal assets and the psychosocial rehabilitation. In our sample, the main most frequent diagnosis was schizophrenia (37.8%). Moderate intellectual disability (23.4%) and mild intellectual disability (14.4%) were the second and third most frequent diagnosis. The unlawful acts that generated the prevalent security measure were in first place domestic violence (19,8%) followed by attempted murder (16,2%) and theft (14,5%). The elaboration of a therapeutic and rehabilitation plan is essential and its aim is to diminish the person’s dangerousness. It is fundamental to think of the safety ward as a health production space and not as a place of mere disease management or “dangerous states”, thus trying to solve the patient’s problems.