Female Forensic Psychiatric Patients Research Articles

Evaluation of whether commonly used risk assessment tools are applicable to women in forensic psychiatric institutions

ObjectiveBy providing a structured assessment of specific risk factors, risk assessment tools allow statements to be made about the likelihood of future recidivism in people who have committed a crime. These tools were originally developed for and primarily tested in men and are mainly based on the usual criminological background of men. Despite significant progress in the last decade, there is still a lack of empirical research on female offenders, especially female forensic psychiatric inpatients. To improve prognosis in female offenders, we performed a retrospective study to compare the predictive quality of the following risk assessment tools: PCL-R, LSI-R, HCR-20 v3, FAM, and VRAG-R. MethodData were collected from the information available in the medical files of 525 female patients who had been discharged between 2001 and 2017. We examined the ability of the tools to predict general and violent recidivism by comparing the predictions with information from the Federal Central Criminal Register. ResultsOverall, the prediction instruments had moderate to good predictive performance, and the study confirmed their general applicability to female forensic psychiatric patients. ConclusionThe LSI-R proved to be particularly valid for general recidivism, and both, LSI-R and HCR-20 v3, for violent recidivism.

The curse of experiencing and committing violence as a criminal recidivism predictor: A comparison between female forensic psychiatric patients with severe mental disorders and substance use disorder.

Violence occurs frequently in the life of forensic psychiatric patients, both as active aggression and in the form of victimization. Undoubtedly, these incidents shape personality, behavior, and affect the ability to interact adequately socially. Thus, such experiences may influence criminal recidivism and serve as forensic psychiatric/psychological predictors upon hospital discharge. Hence, this study aimed at characterizing two distinct female forensic psychiatric patient populations (nonsubstance use mental disorders [n=110] versus substance use disorder [n=415]) regarding their active and passive violent experiences as well as contextualizing these with their individual crime recidivism rates. The analysis followed a record-based, retrospective approach. While both groups experienced aggression throughout childhood and youth equally often, substance use disorder patients were significantly more often exposed to violence during adulthood. On the other hand, severely mentally ill patients tended to react more often with violence during their hospital confinement. However, regarding their violent recidivism rate, no intergroup effects were observed. Finally, within the addicted group, a violent index crime as well as physical aggression during hospital confinement increased the odds for violent reoffending by approximately 2.4-fold (95% confidence interval 1.3-4.5) and 2.5-fold (95% confidence interval 1.1-5.9), respectively. In summary, these findings underline the importance of active aggression rather than victimization as an influencing factor on resocialization especially in a substance use disorder patient population.

Predictive Validity of the HCR-20v3 Compared to the HCR-20v3 with the FAM in Women

Recent findings have highlighted unique risk factors for female-perpetrated violence as well as limitations in its risk assessment. To address these shortcomings, the Female Additional Manual (FAM) was designed as a complementary tool for the gender-neutral framework of the Historical, Clinical, Risk Management-20 (HCR-20). Little research has been undertaken exploring the predictive validity of the FAM, particularly when used with the most recent version of the HCR-20 (HCR-20v3), leaving equivocal evidence in regards of its use in clinical practice. The present study compared the predictive validity of the HCR-20v3 with and without the FAM for inpatient violence. The sample consisted of 42 female forensic psychiatric patients in a low to medium secure unit in the UK. Results revealed a significant difference in the predictive validity of the HCR-20v3 compared to the FAM when assessing for physical violence and no significant differences between the instruments’ validity in predicting nonphysical and any violence. In line with existing literature, the HCR-20v3 was an overall good predictor of violence. While the FAM was less accurate than the HCR-20v3 at predicting physical violence, it achieved moderate to large effect size in predicting each category of violence. The findings provide a degree of support for using the HCR-20v3 when assessing the risk of violence in women but do not demonstrate improved predictive power when adding the FAM.

Women admitted to forensic psychiatry in Flanders (Belgium): who are they?

PurposeDespite the rising number of females in forensic psychiatry, research about their characteristics remains limited and is currently lacking in Belgium. Optimizing knowledge about the characteristics of these women will lead to a better understanding of this specific group. Therefore, the aim of the study was to gain insight into the characteristics of female forensic psychiatric patients in Flanders, Belgium.Design/methodology/approachA case file study was carried out in the forensic psychiatric hospital Sint-Jan-Baptist in Zelzate, Belgium. The files of female patients admitted in the period 2006–2017 were analysed (N = 82) based on a checklist including sociodemographic, mental health care and offence-related characteristics as well as historical risk factors.FindingsThe study revealed that female patients have been confronted with a large number of adverse experiences during both childhood and adulthood, were frequently diagnosed with borderline personality disorder and usually had an extensive mental health treatment history with many drop-outs. The majority of the female patients had committed violent offences towards relatives.Practical implicationsThese findings are similar to those of other jurisdictions and highlight the importance of a gender-responsive treatment. This kind of treatment should include trauma-informed care, gender-sensitive risk-assessment and adapted versions of dialectical behavioural therapy and schema-focussed therapy. Additionally, treatment should focus on breaking the intergenerational transmission of violence and mental health problems by targeting parenting skills.Originality/valueTo the best of the authors’ knowledge, this is the first study that scientifically scrutinized the detailed characteristics of female forensic psychiatric patients in Flanders, Belgium. Recommendations for gender-responsive treatment and directions for future research are discussed.

Victimization history in female forensic psychiatric patients with intellectual disabilities: Results from a Dutch multicenter comparative study

BackgroundVictimization is highly prevalent in individuals with mild intellectual disability (MID) or borderline intellectual functioning (BIF) and is an important risk factor for mental health problems and violent behavior. Not much is known, however, about victimization history in women with MID-BIF admitted to forensic mental health care. AimsThe aim of this multicenter study is to gain insight into victimization histories and mental health problems of female forensic psychiatric patients with MID-BIF. MethodsFile data were analyzed of 126 women with MID-BIF who have been admitted to one of five Dutch forensic psychiatric hospitals between 1990 and 2014 and compared to data of 76 female patients with average or above intellectual functioning and to a matched sample of 31 male patients with MID-BIF. ResultsAll forensic patients had high rates of victimization, but women with MID-BIF showed an even higher prevalence of victimization during both childhood and adulthood and more complex psychopathology compared to female patients without MID-BIF. Compared to male forensic patients with MID-BIF, women with MID-BIF were more often victim of sexual abuse during childhood. During adulthood, the victimization rate in these women was more than three times higher than in men. ConclusionsVictimization is a salient factor in female forensic patients with MID-BIF and more gender-responsive trauma-focused treatment is needed.

Gender differences in a sample of Romanian forensic psychiatric inpatients

Objectives. To gain insight into the characteristics of female forensic psychiatric patients in Romania and to identify the potential differences between female and male forensic inpatients. Material and method. Data on all patients admitted according to art. 110 of the Romanian Penal code to Sapoca Psychiatry and Safety Measures Hospital between 2008 and 2018 were collected from hospital records (electronic records, clinical files, social assessment forms and legal files). The final sample comprised 650 individuals: 84% were men and 16% were women. Results and discussion. There were few socio-demographic differences. Both men and women had a psychiatric history, and schizophrenia spectrum disorders were the most frequent main diagnosis in both groups. Women were more likely to have committed arson, homicide and attempted homicide and to be hospitalized for a shorter period of time. Conclusions. Consistent with previous studies, we concluded that men and women admitted to forensic psychiatric hospitals differ in a number of ways. Our study highlights the need to continue and expand the research into the Romanian forensic psychiatric inpatient population.

Urine drug screening in women's forensic mental health services: is current practice meeting guidelines?

AimsTo investigate adherence to Trust guidelines for urine drug screening amongst female forensic psychiatric inpatients.BackgroundThe use of illicit substances is an important risk factor which needs to be considered in the management and treatment of forensic psychiatric patients. Research has demonstrated that a high proportion of women admitted within secure services in the UK have a history of substance use. Substance misuse amongst this population can lead to an increased risk of violence, re-offending and mental health relapse; which can pose a significant threat to the safety of other patients, staff and the public. It is therefore important that regular drug screening is carried out to minimise such risks. Ardenleigh is a blended female secure unit in Birmingham. The service has established specific substance use guidelines, outlining the need for each patient to have a personalised drug screen care plan in place. Here we present the findings of an audit completed in 2019.MethodA six month retrospective electronic case note audit for female inpatients admitted to Ardenleigh as of 1st September 2019 (n = 27). We compared drug screen care plans and frequency of urine drug screens over 6 months with the recommendations of the current service-specific Trust guidelines. Care plans should include: information regarding random drug screening; frequency of random drug screening; triggers for increased risk of substance misuse; and consequences for a positive test result to be contained within inpatient care plans.ResultPatient aged between 20 and 56 years old (median age 31). Fewer than half of inpatients (41%) had a documented random drug screen completed within the review period. In terms of care-planning, only 52% of patients had random drug screening mentioned in their care plan. 22% of patient care plans reported the actions/consequences for a positive test result. Not a single care plan mentioned how frequently patients should be being tested or potential triggers for increased risk of drug misuse amongst inpatients.ConclusionCurrent practice and recording of drug screening amongst female forensic psychiatric patients is poor compared to expected standards. The lack of consistency in drug screening raises concerns regarding whether potential substance misuse amongst inpatients may be going undetected, and therefore impacting the recovery of patients. Improvements to drug screening practice should be considered in order to ensure optimal recovery and safety to patients and others.

Service Provider Perspectives on Female Forensic Mental Health Services in Zimbabwe: An Interpretative Phenomenological Analysis.

Service providers' perspectives on female forensic mental health services have not been explored in Zimbabwe. This study examined how health service providers in forensic mental health in Zimbabwe understand and interpret rehabilitation of female forensic psychiatric patients. An interpretive phenomenological study was completed. Service provider participants were selected via purposive sampling from two main Special Institutions. Data were collected using audio-recorded semistructured interviews and subjected to interpretive phenomenological analysis. Two master themes evolved from interview data: (a) conflicting legal documents of care and management of female forensic psychiatric patients; and (b) the forensic mental health system's processes, procedures, and resources impacting female forensic psychiatric rehabilitation. Findings of the study call for the need to balance between public safety interests and fulfilling clinical rehabilitation objectives.

Assessing risk for inpatient physical violence in a female forensic psychiatric sample – comparing HCR-20v2 with the female additional manual to the HCR-20v2

Purpose and aim: Out from the sparse literature on risk assessment for violence committed by women the Female Additional Manual (FAM) was developed to be a complement to the HCR-20v2. The aim of this study was to investigate and compare the psychometrics of the HCR-20v2 with and without the FAM on risk for inpatient physical violence for female forensic psychiatric patients.Methods: The participants were 100 female patients admitted to forensic psychiatric care in a high-security clinic, assessed by clinicians with the HCR-20v2 during their admission. Researchers performed the FAM, both retrospectively and prospectively. The follow-up period was 12 months before being discharged.Results: Four main results were found; first, many risk factors were present although the summary risk ratings were mainly low to moderate. Secondly, the reliability was in general good, where the HCR-20v2 mainly showed higher reliability without than with the FAM, indicating that FAM risk factors did equal or did not contribute to a higher reliability. Third, the internal validity was higher for the HCR-20v2 than for the FAM. Risk factors correlated stronger with the summary risk ratings for the HCR-20v2 than for the FAM. Fourth, the validity for inpatient physical violence was high for the total score of both the HCR-20v2 and the FAM, but contradictory to previous finding the validity for summary risk ratings was not significant.Conclusions: The results support the use of HCR-20v2 when assessing risk for inpatient violence for female forensic psychiatric patients, but with only some support for adding or changing risk factors according to the FAM.

Gender-Sensitive Violence Risk Assessment: Predictive Validity of Six Tools in Female Forensic Psychiatric Patients

Most violence risk assessment tools have been validated predominantly in males. In this multicenter study, the Historical, Clinical, Risk Management–20 (HCR-20), Historical, Clinical, Risk Management–20 Version 3 (HCR-20V3), Female Additional Manual (FAM), Short-Term Assessment of Risk and Treatability (START), Structured Assessment of Protective Factors for violence risk (SAPROF), and Psychopathy Checklist–Revised (PCL-R) were coded on file information of 78 female forensic psychiatric patients discharged between 1993 and 2012 with a mean follow-up period of 11.8 years from one of four Dutch forensic psychiatric hospitals. Notable was the high rate of mortality (17.9%) and readmission to psychiatric settings (11.5%) after discharge. Official reconviction data could be retrieved from the Ministry of Justice and Security for 71 women. Twenty-four women (33.8%) were reconvicted after discharge, including 13 for violent offenses (18.3%). Overall, predictive validity was moderate for all types of recidivism, but low for violence. The START Vulnerability scores, HCR-20V3, and FAM showed the highest predictive accuracy for all recidivism. With respect to violent recidivism, only the START Vulnerability scores and the Clinical scale of the HCR-20V3demonstrated significant predictive accuracy.

Experiences of self-injury and aggression among women admitted to forensic psychiatric care

Background: Self-injury and institutional violence are well-known characteristics of female forensic psychiatric patients, but research on patients’ experiences of these behaviours is limited.Aim: The aim of the study was to investigate how female forensic psychiatric patients describe their self-injury and aggression.Methods: The authors performed qualitative in-depth interviews with 13 female forensic psychiatric inpatients. The interviews were analysed using thematic analysis.Results: The analysis resulted in three themes describing the process of handling negative thoughts and emotions by using self-injury or aggression towards others and thereby experiencing satisfaction. Both self-injury and aggression were experienced as strategies for emotional regulation. The forensic psychiatric care was perceived as important for the women in developing less harmful strategies for coping with negative thoughts and emotions instead of injuring themselves or others.Conclusions: Self-injury and aggression are often risk-assessed separately, but results from the present study suggest that these behaviours need a more holistic approach.

Risk and Protective Factors for Inpatient Aggression

Dynamic risk and protective factors serve to assess the violence risk level of (forensic) psychiatric patients and offer guidance to clinical interventions. Risk assessment scores on Historical Clinical Risk Management–20 (HCR-20) risk factors and Structured Assessment of Protective Factors for violence risk (SAPROF) protective factors at different treatment stages were compared with violent incidents during treatment for 399 multidisciplinary coded assessments on 185 male and female forensic psychiatric patients. At later stages of treatment, less risk factors and more protective factors were observed, and predictive validities were higher. The HCR-20 and SAPROF scores showed good overall predictive validity for inpatient violence. The combination of risk factors and protective factors was a good predictor of incidents of aggressive behavior for different groups of patients, such as patients with violent or sexual offending histories, patients with major mental illnesses or personality disorders, and patients with a high score on psychopathy. Implications of these findings and recommendations for future research are discussed.

Self-harm as a risk factor for inpatient aggression among women admitted to forensic psychiatric care

Background: Inpatient aggression among female forensic psychiatric patients has been shown to be associated with self-harm, that is considered to be a historical risk factor for violence. Research on associations between previous or current self-harm and different types of inpatient aggression is missing.Aim: The aim of this register study was to investigate the prevalence of self-harm and the type of inpatient aggression among female forensic psychiatric inpatients, and to study whether the patients’ self-harm before and/or during forensic psychiatric care is a risk factor for inpatient aggression.Methods: Female forensic psychiatric patients (n = 130) from a high security hospital were included.Results: The results showed that 88% of the female patients had self-harmed at least once during their life and 57% had been physically and/or verbally aggressive towards staff or other patients while in care at the hospital. Self-harm before admission to the current forensic psychiatric care or repeated self-harm were not significantly associated with inpatient aggression, whereas self-harm during care was significantly associated with physical and verbal aggression directed at staff.Conclusions: These results pointed towards self-harm being a dynamic risk factor rather than a historical risk factor for inpatient aggression among female forensic psychiatric patients. Whether self-harm is an individual risk factor or a part of the clinical risk factor ‘Symptom of major mental illness’ within the HCR-20V3 must be further explored among women. Thus, addressing self-harm committed by female patients during forensic psychiatric care seems to be important in risk assessments and the management of violence, especially in reducing violence against staff in high-security forensic psychiatric services.

Measuring Feelings of Staff Members Towards Their Most Complex Female and Male Forensic Psychiatric Patients: A Pilot Study into Gender Differences

ABSTRACTIt has been suggested that female forensic psychiatric patients evoke different or stronger feelings in their treatment staff compared to male forensic patients. More specifically, it has been stated that it can be more difficult and emotionally draining to work with women as they are seen as more manipulative and demanding than men (Lewis, 2006). However, there is not much empirical research to support this suggestion. In this pilot study, 146 staff members working in a gender-mixed forensic psychiatric hospital filled out the Feeling Word Checklist 30-item version for their most complex, demanding, female and male patient. Overall, it was found that staff members felt more helpful, accepting, strong, relaxed, affectionate, sympathetic, and receptive towards their most complex female forensic patient and more anxious, threatened and overwhelmed by their most complex male forensic patient. Differences were found between more experienced and less experienced staff members as well as between female and male staff members. Staff members working over 5 years in this hospital experienced much fewer differences in feelings towards female and male patients. Less experienced staff had significantly more positive feelings towards female patients and more negative feelings towards male patients. Female staff members usually felt more strong and in control with female patients and more overwhelmed by male patients. Male staff members felt more angry with male patients and more receptive towards female patients. Compared to female staff members, male staff members felt more cautious and embarrassed with female patients. It was concluded that there are substantial differences in feelings of staff members towards female and male forensic patients, with staff reporting predominantly more positive feelings towards women. More training, intervision, and support with respect to working in forensic gender-mixed settings would be valuable, especially for mental health professionals who are early in their career. Finally, suggestions are provided for future research into this topic.

Gender Comparisons in a Forensic Sample: Patient Profiles and HCR-20:V2 Reliability and Item Utility

ABSTRACTGiven documented gender differences in risk factors and manifestations of violence, researchers have advocated for gender-sensitive approaches to violence risk assessment. This study compares male (n = 292) and female (n = 68) forensic psychiatric patients on an array of demographic, clinical, behavioral, and legal variables to gain a clearer understanding of the prevalence of different risk factors and types of violence in this population. We investigate the interrater reliability and item utility of the Historical, Clinical, Risk Management-20 (HCR-20:V2), and examine whether individual HCR-20 items exhibit differential relationships to the tool's summary risk rating across gender. More women carried a diagnosis of borderline personality disorder, whereas antisocial personality disorder, substance use problems and extensive criminal histories were more often noted in men. These clinical differences were reflected in the distribution of HCR-20 item and subscale scores across gender. Interrater reliability was excellent, especially for women. A lack of personal support increased the odds of being deemed high risk in women to a greater extent than in men. We discuss the utility of structured professional judgment tools such as HCR-20 in women, and consider the importance of a gender-sensitive approach to risk assessment.

Characteristics and offences of women with borderline personality disorder in forensic psychiatry: a multicentre study

ABSTRACTAlthough female forensic patients diagnosed with borderline personality disorder (BPD) are generally considered taxing in clinical practice, little is known about their specific characteristics or offences. In this study, 156 female forensic psychiatric patients diagnosed with BPD were compared to 113 diagnosed otherwise. Information on demographic and psychiatric characteristics, victimization, index offences, and incidents during treatment was gathered from patient files. Risk factors for recidivism were assessed using the PCL-R and historical items of the HCR-20, including items from the new Female Additional Manual (FAM). Compared to non-BPD women, BPD women were more likely to have been abused as children and to have a history of outpatient treatment. While less likely to be convicted for (attempted) homicide, a higher percentage of BPD women was convicted for arson. Comorbid substance abuse was more frequent in the BPD group and incidents towards others and themselves were more violent in nature. The PCL-R and the H-scale of the HCR-20/FAM indicated several risk factors especially important for BPD women, such as poor behavioural control, impulsivity, and irresponsibility. The results support the clinical impression that women diagnosed with BPD are a subgroup within the female forensic psychiatric population, with specific focus points for treatment and management.

Infrahumanisation: the nurse versus the guard phenomenon in forensic psychiatric practice in Zimbabwe

Purpose– The purpose of this paper is to explicate the lived experiences of nurses involved in rehabilitation of forensic psychiatric patients in special institutions in Zimbabwe.Design/methodology/approach– The study used the grounded theory approach utilising a mixed sequential dominant status design (QUAL/Quant). Pierre Bourdieu’s conceptual canon of field, habitus and capital was used as a theoretical point of departure by the research study. Confirmatory retrospective document review of 119 patients’ files was also done to substantiate the nurses’ experiences. Theoretical sampling of relatives was also done.Findings– Findings and results revealed that nurses seemed to experience infrahumanisation, a subtler form of dehumanisation. The infrahumanisation was embodied in the unpleasant context in which nurses were expected to perform their mandate of championing rehabilitation of forensic psychiatric patients. The guards who represented the prison system seemed to possess all forms of capital in the prison system (where special institutions are housed): the prison cultural capital, social capital and economic capital. This capital seemed to represent symbolic power over the disillusioned and voiceless nurses. Guards attended to and discussed patients and relatives issues instead of nurses. This form of misrecognition of the nurses culminated in dominance and reproduction of the interests of the prison system which underlined the established order of realities in the rehabilitation of forensic psychiatric patients in special institutions at the time of the study. The nurses’ lived experience was confirmed by theoretically sampled by relatives of forensic psychiatric patients who also participated in the research study. Nurses’ powerlessness was also reflected in the patients’ files in which in which care was largely not documented.Research limitations/implications– The study focused on the nurses experiences related to rehabilitation of male forensic psychiatric patients and not on female forensic psychiatric patients because there were important variables in the two groups that were not homogenous. For the little documentation that was done, there was also a tendency nurses to document negative rather than positive events and trends. The documents/files of patients had therefore a negative bias which was a major limitation to this study.Practical implications– There is a need for major revision of the revision of the role of the nurse in the forensic psychiatric setting. Collaboration as academia, practice, professional organisations and regulatory bodies would foster a nurse led therapeutic jurisprudence in the future of rehabilitation of forensic psychiatric patients in Zimbabwe.Social implications– There is a need for major revision of the revision of the role of the nurse in the forensic psychiatric setting.Originality/value– This is the first description of the position of nurses’ seconded to special institutions in Zimbabwe and will go a long way in realigning conflictual policy documents guiding care of forensic psychiatric patients in special institutions.

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

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.

The national trajectory project of individuals found not criminally responsible on account of mental disorder. Part 5: how essential are gender-specific forensic psychiatric services?

To state the sociodemographic characteristics, mental health histories, index offence characteristics, and criminal histories of male and female forensic psychiatric patients. Clinicians and researchers advocate that mental health and criminal justice organizations implement gender-specific services; however, few studies have sampled forensic patients to evaluate the extent to which men's and women's treatment and management needs are different. Data were collected from Review Board files from May 2000 to April 2005 in the 3 largest Canadian provinces. Using official criminal records, participants were followed for 3 to 8 years, until December 2008. The final sample comprised 1800 individuals: 15.6% were women and 84.4% were men. There were few demographic differences, but women had higher psychosocial functioning than men. Both men and women had extensive mental health histories; women were more likely diagnosed with mood disorders and PDs and men were more likely diagnosed with schizophrenia spectrum disorders and SUDs. The nature of the index offence did not differ by gender, except women were more likely to have perpetrated murders and attempted murders. For offences against a person, women were more likely to offend against offspring and partners and less likely to offend against strangers, compared with men. Women had significantly less extensive criminal histories than men. Not criminally responsible on account of mental disorder-accused women have a distinct psychosocial, clinical, and criminological profile from their male counterparts, which may suggest gender-specific assessment, risk management, and treatment in forensic services could benefit patients. The findings are also consistent with traditional models (Risk-Need-Responsivity) and ultimately demonstrate the importance of individual assessment and client-centred services.

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

Research into the criminal behavior of women with psychopathy is scarce. The overall aim of the present study was to examine differences between the criminal behavior of women with and without psychopathy. The sample comprised 221 female forensic psychiatric patients who are or have been admitted to one of four participating forensic settings in the Netherlands between 1984 and 2012. An extensive questionnaire containing demographic, criminal, and psychiatric variables was coded, as well as the Psychopathy Checklist-Revised, several risk assessment tools, and a taxonomy of motivations (inspired by Coid, 1998). The lowered PCL-R cut-off score as applied in the Female Additional Manual was used to define women with psychopathy. It was found that women with psychopathy were younger at their first conviction and had more criminal versatility in their offense histories than women without psychopathy. With respect to the index offense it was found that women with psychopathy committed a fatal index offense less often, were more likely to have stranger victims, and committed offenses motivated by power, dominance, or personal gain (i.e., Bad motivation typology) more often than women without psychopathy. No differences were found between women with and without psychopathy with respect to type of weapon used at the index offense. Implications and suggestions for future research into psychopathy in women are discussed.