Forensic Outpatients Research Articles

Negative emotionality and coping in forensic outpatients with sexually transgressive behaviour

ABSTRACT Negative emotionality has been consistently linked to an increased risk of sexual offending. Ninety-one Dutch males treated in outpatient forensic psychiatry for sexually transgressive behaviour were studied on self-reported negative emotionality, coping and sexual coping, and therapist assessed corresponding dynamic risk factors. Outpatients reported more prevalence of high negative emotionality than therapists. Correlation analyses showed, amongst others, a significant positive association between emotional coping and all subscales of negative emotionality: stress (strong), aggression (weak) and alienation (weak). Furthermore, regression analyses revealed that self-reported stress was a significant predictor of several types of self-reported coping (task, emotional, avoidant, and sexual consent and molest) and assessed sexual coping. Additionally, self-reported aggression predicted consent and rape-themed sexual coping. These results indicate a nuanced relationship between different aspects of negative emotionality and coping mechanisms, underscoring the relevance of careful consideration tailored to characteristics of the patient involved when addressed in forensic treatment. PRACTICE IMPACT STATEMENT The observed associations between (aspects of) negative emotionality and coping, promote the use of patient-tailored emotion regulation interventions in the forensic treatment of outpatients with sexually transgressive behaviour. Moreover, self-report appears to provide useful additional information for further tailoring therapy.

Neurofeedback and meditation technology in outpatient offender treatment: a feasibility and usability pilot study.

Although Cognitive Behavioral Therapy (CBT) is the most often used intervention in forensic treatment, its effectivity is not consistently supported. Interventions incorporating knowledge from neuroscience could provide for more successful intervention methods. The current pilot study set out to assess the feasibility and usability of the study protocol of a 4-week neuromeditation training in adult forensic outpatients with impulse control problems. The neuromeditation training, which prompts awareness and control over brain states of restlessness with EEG neurofeedback, was offered in addition to treatment as usual (predominantly CBT). Eight patients completed the neuromeditation training under guidance of their therapists. Despite some emerging obstacles, overall, the training was rated sufficiently usable and feasible by patients and their therapists. The provided suggestions for improvement can be used to implement the intervention in treatment and set up future trials to study the effectiveness of neuromeditation in offender treatment.

Treatment of aggression regulation problems with virtual reality: study protocol for a randomized controlled trial.

Aggressive conduct among delinquents presents a pervasive issue, bearing substantial implications for not only society at large but also for the victims and the individuals displaying the aggression. Traditional approaches to treating aggression regulation deficiencies generally employ Cognitive Behavioral Therapy (CBT) in conjunction with analog role-playing exercises. A body of research supports the efficacy of various therapeutic models for aggression regulation, including Responsive Aggression Regulation Therapy (Re-ART). Role-playing within a therapeutic context has been shown to contribute significantly to reductions in violent reoffending. However, the practical application of these skills in real-world settings remains challenging due to the inherent risk of aggressive outbreaks. Additionally, the conventional role-playing scenarios, often conducted in a therapy room, lack contextual realism and may induce role confusion between the patient and the therapist. Virtual Reality (VR) technology could offer a viable solution to these limitations by allowing for skill training in both behavioral and cognitive domains within a realistic yet safe and controlled setting. The technology also facilitates real-time awareness of emotional states and tension levels in the patient. This paper describes the study protocol of a randomized controlled trial in which Re-ART offered in a virtual environment (Re-ART VR) is compared to Re-ART offered as treatment as usual. Adult forensic outpatients with aggression regulation problems are randomly assigned to either Re-ART VR or Re-ART. The Controlling Skills, Influence of Thinking and Handling Conflicts modules will be offered to both groups during 3-6 months. Pre- and post-intervention measurements are performed. The primary outcome measurement is the degree of aggression regulation, while secondary outcome measurements include impulsivity and cognitive biases. Additionally, patient motivation and therapist motivation are expected to act as moderating factors. To date, scarcely previous research has been done on the effectiveness of VR in treatment of aggression regulation problems in forensic outpatients. Forensic outpatients who do not benefit sufficiently from mainly CBT-based interventions may benefit more from experiential learning. The unique capabilities of VR in this regard have the potential to enhance the treatment effect.Clinical trial registration: [https://clinicaltrials.gov/], identifier [NL78265.018.21].

The value of HoNOS in assessing mental health symptom severity and social functioning in forensic outpatients

ABSTRACT The Health of the Nation Outcome Scales (HoNOS) is used for routine outcome measurement in forensic outpatient mental health care. Until now, no research has been done on its psychometric properties and clinical value in this population. Statistical analyses on 3,951 forensic outpatients (general violence, domestic violence, property offense, and sexual offense) showed that at domain level internal consistency coefficients varied between .30 and .58. The item scores were heavily skewed with scores in the subclinical range. Non-parametric analyses revealed that, at item level, aggressive offenders scored significantly higher (but still subclinical) than other offender subgroups. Compared to general mental health samples, forensic outpatients scored significantly lower (mainly large effects) on the total rating. Based on these results, it is concluded that the HoNOS does not provide good psychometric properties nor clinical value for ROM purposes in forensic outpatients.

Patients’ and volunteer coaches’ experiences with an informal social network intervention in forensic psychiatric care: a qualitative analysis

Background:Improving supportive social networks in forensic psychiatric patients is deemed important due to the protective effects of such networks on both mental health problems and criminal recidivism. Informal interventions targeted at social network enhancement by community volunteers showed positive effects in various patient and offender populations. However, these interventions have not specifically been studied in forensic psychiatric populations. Therefore, forensic psychiatric outpatients’ and volunteer coaches’ experiences with an informal social network intervention were explored in this study.Methods:This qualitative study was based on semi-structured interviews conducted alongside an RCT. Forensic outpatients allocated to the additive informal social network intervention, and volunteer coaches, were interviewed 12 months after baseline assessment. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis was used to identify and report patterns in the data.Results:We included 22 patients and 14 coaches in the study. The analysis of interviews revealed five main themes reflecting patients’ and coaches’ experiences: (1) dealing with patient receptivity, (2) developing social bonds, (3) receiving social support, (4) achieving meaningful change, and (5) using a personalized approach. Patient receptivity, including willingness, attitudes, and timing, was a common reported barrier affecting patients’ engagement in the intervention. Both patients’ and coaches’ experiences confirmed that the intervention can be meaningful in developing new social bonds between them, in which patients received social support. Despite, experiences of meaningful and sustainable changes in patients’ social situations were not clearly demonstrated. Coaches’ experiences revealed broadened worldviews and an enhanced sense of fulfillment and purpose. Finally, a personalized, relationship-oriented rather than goal-oriented approach was feasible and preferable.Conclusion:This qualitative study showed positive experiences of both forensic psychiatric outpatients and volunteer coaches with an informal social network intervention in addition to forensic psychiatric care. Notwithstanding the limitations, the study suggests that these additive interventions provide an opportunity for forensic outpatients to experience new positive social interactions with individuals in the community, which can initiate personal development. Barriers and facilitators to engagement are discussed to improve further development and implementation of the intervention.Trial registration:This study is registered at the Netherlands Trial Register (NTR7163, registration date: 16/04/2018).

Narcissism and relational capacity: the contribution of identity integration and social concordance

Narcissism is often seen as a unidimensional construct, however, more recently, a plethora of studies have pointed to its multidimensional nature. Despite this, the role of narcissism as a multifaceted construct in the quality of interpersonal relationships has rarely been tested. In addition, less is known about what mechanisms may underly this association. In this study, we investigated how grandiose, vulnerable, and isolated narcissism, are associated with relational capacity and whether identity integration and social concordance may underly these associations. The sample included 222 male participants with a mean age of 37.71 (SD = 13.25). Of these, 157 were participants from the community, and 65 were in outpatient treatment at four Dutch forensic centers. The Dutch Narcissism Scale was used to measure three forms of narcissism, while The Severity Indices of Personality Problems – Short Form was used to measure identity integration, social concordance, and relational capacity. The mediation model was tested in R and adjusted for age and criminal behavior. Despite significant bivariate correlations between three narcissistic types and relational capacity only isolated narcissism was directly and negatively associated with relational capacity in the mediation model. Likewise, both identity integration and social concordance were positively associated with relational capacity. Grandiose narcissism was positively, while vulnerable narcissism was negatively associated with relational capacity, but only through identity integration. Identity integration was also a significant mediator in the association between isolated narcissism and relational capacity along with social concordance. Finally, criminal behavior appeared to be the only significant covariate indicating that forensic outpatients (versus community participants) were more likely to have impaired relational capacity. The findings of this study could be useful in clinical practice to improve the treatment of narcissistic individuals and make them less harmful to others in social and intimate relationships.

Exploring the effects of a wearable biocueing app (Sense-IT) as an addition to aggression regulation therapy in forensic psychiatric outpatients.

Preventing and reducing violence is of high importance for both individuals and society. However, the overall efficacy of current treatment interventions aimed at reducing aggressive behavior is limited. New technological-based interventions may enhance treatment outcomes, for instance by facilitating out-of-session practice and providing just-in-time support. Therefore, the aim of this study was to assess the effects of the Sense-IT biocueing app as an addition to aggression regulation therapy (ART) on interoceptive awareness, emotion regulation, and aggressive behavior among forensic outpatients. A combination of methods was used. Quantitatively, a pretest-posttest design was applied to explore group changes in aggression, emotion regulation, and anger bodily sensations associated with the combination of biocueing intervention and ART. Measures were assessed at pretest, after 4 weeks posttest, and after one-month follow-up. During the 4 weeks, a single-case experimental ABA design was applied for each participant. Biocueing was added in the intervention phase. During all phases anger, aggressive thoughts, aggressive behavior, behavioral control, and physical tension were assessed twice a day, and heart rate was measured continuously. Qualitative information regarding interoceptive awareness, coping, and aggression was collected at posttest. 25 forensic outpatients participated. A significant decrease in self-reported aggression was found between pre- and posttest. Furthermore, three-quarters of participants reported increased interoceptive awareness associated with the biocueing intervention. However, the repeated ambulatory measurements of the single-case experimental designs (SCEDs) did not indicate a clear effect favoring the addition of biocueing. On group level, no significant effects were found. On the individual level, effects favoring the intervention were only found for two participants. Overall, effect sizes were small. Biocueing seems a helpful addition to increase interoceptive awareness among forensic outpatients. However, not all patients benefit from the current intervention and, more specifically, from its behavioral support component aimed at enhancing emotion regulation. Future studies should therefore focus on increasing usability, tailoring the intervention to individual needs, and on integration into therapy. Individual characteristics associated with effective support by a biocueing intervention should be further investigated, as the use of personalized and technological-based treatment interventions is expected to increase in the coming years.

Are clinical severity and real-world functioning associated to committing crimes in people with severe mental illness? Results from a cross-sectional study on three cohorts of forensic and non-forensic patients

IntroductionIn Italy, subjects with severe mental illness (SMI) considered “in danger of posing a threat to others” are hospitalized into structures known as “REMS–Residenze per l’Esecuzione delle Misure di Sicurezza”, designed to provide rehabilitating programs. There are also specialized forensic teams to support Community Mental Health Centers (CMHC) in helping patients who committed crimes. A better characterization of clinical and real-world functioning of forensic patients represents a topic of clinical interest (Caruso R et al. Curr Psychiatry Rep 2021; 7 29; Barlati et al. Eur Arch Psychiatry Clin Neurosci 2022, in press; Fazel et al. Br J Psychiatry. 213 609-614).ObjectivesAims were to compare clinical and psychosocial functioning characteristics in three cohorts of SMI patients.MethodsA total of 29 patients hospitalized in REMS facilities were included into this study; starting from this first group an equal number of individuals matched for sex, age, and diagnosis were included in other two groups of outpatients cared for by the forensic team and of non-forensic outpatients treated by CMHC. Clinical severity was measured through the Clinical Global Impression scale – Severity (CGI-S) and real-world functioning was measured through the Personal and Social Performance scale (PSP). Analyses included Chi-Square test for categorical variables and Kruskall-Wallis test for continuous variables with Mann-Withney U test for post/hoc comparisons. P values < 0.05 were considered significant.ResultsSignificant between-groups differences emerged regarding psychosocial functioning (p=0.013): that was more compromised in the REMS group (mean:34.0) when compared to the forensic team subjects (mean:41.3) and to the subjects in the CMHC group (mean:47.7).Results concerning clinical severity point in the opposite direction: more severe symptoms were observed in the CMHC group (mean:4.7) compared to the REMS group (mean: 4.3) and the forensic outpatients (mean:3.5). The difference in the CGI-S mean scores is significant for the forensic outpatients when compared to the REMS group (p=0.011) and to the CMHC group (p<0.001).ConclusionsSpecialized teams are central in the managing of forensic patients: of particular interest are the data regarding clinical symptoms severity, which could also be read with a de-stigmatizing focus, highlighting that a worse clinical severity is not associated with being more dangerous to other people and to the society in general.Disclosure of InterestNone Declared

Forensic Psychiatric Outpatients' and Therapists' Perspectives on a Wearable Biocueing App (Sense-IT) as an Addition to Aggression Regulation Therapy: Qualitative Focus Group and Interview Study.

Given the increased use of smart devices and the advantages of individual behavioral monitoring and assessment over time, wearable sensor-based mobile health apps are expected to become an important part of future (forensic) mental health care. For successful implementation in clinical practice, consideration of barriers and facilitators is of utmost importance. The aim of this study was to provide insight into the perspectives of both psychiatric outpatients and therapists in a forensic setting on the use and implementation of the Sense-IT biocueing app in aggression regulation therapy. A combination of qualitative methods was used. First, we assessed the perspectives of forensic outpatients on the use of the Sense-IT biocueing app using semistructured interviews. Next, 2 focus groups with forensic therapists were conducted to gain a more in-depth understanding of their perspectives on facilitators of and barriers to implementation. Forensic outpatients (n=21) and therapists (n=15) showed a primarily positive attitude toward the addition of the biocueing intervention to therapy, with increased interoceptive and emotional awareness as the most frequently mentioned advantage in both groups. In the semistructured interviews, patients mainly reported barriers related to technical or innovation problems (ie, connection and notification issues, perceived inaccuracy of the feedback, and limitations in the ability to personalize settings). In the focus groups with therapists, 92 facilitator and barrier codes were identified and categorized into technical or innovation level (n=13, 14%), individual therapist level (n=28, 30%), individual patient level (n=33, 36%), and environmental and organizational level (n=18, 20%). The predominant barriers were limitations in usability of the app, patients' motivation, and both therapists' and patients' knowledge and skills. Integration into treatment, expertise within the therapists' team, and provision of time and materials were identified as facilitators. The chances of successful implementation and continued use of sensor-based mobile health interventions such as the Sense-IT biocueing app can be increased by considering the barriers and facilitators from patients' and therapists' perspectives. Technical or innovation-related barriers such as usability issues should be addressed first. At the therapist level, increasing integration into daily routines and enhancing affinity with the intervention are highly recommended for successful implementation. Future research is expected to be focused on further development and personalization of biocueing interventions considering what works for whom at what time in line with the trend toward personalizing treatment interventions in mental health care.

"Released but still locked-in": Impact of the SARS-CoV-2 Pandemic on Forensic Outpatients

The coronavirus pandemic (SARS-CoV-2) affects some people's psychological well-being and has become a challenge for our society. People in forensic settings are at specific risk, especially those who have been released from prison or forensic clinics just before or during the pandemic. Although there are theoretical assumptions about these peoples' experience of the pandemic and recommendations for treatment and risk management, supporting empirical findings are yet missing. The present study investigated forensic outpatients' experience of restrictions in various fields of their everyday life due to SARS-CoV-2-related measures and changes in their attitudes toward treatment and offending, psychological well-being, and resource awareness over the course of the current pandemic. Most patients were satisfied with treatment despite SARS-CoV-2-related limitations. There was a certain stability in psychological well-being, although increased SARS-CoV-2-related stress was associated with increased general psychological burden. Over the course of the pandemic, resource awareness declined, which is of specific importance regarding offense-oriented risk assessment and treatment. Implications are discussed for treatment that offers optimum support based on personal and situational factors and contributes to a lower risk of future delinquency and, thus, the protection of our society.

Impact of ADHD as a Risk and a Treatment Factor in Intimate Partner Violence

Intimate partner violence (IPV) has a very high prevalence (25%) in society and has serious consequences for its victims. As former studies showed minimal effectiveness of therapeutic interventions addressing IPV, the Dutch guideline for Familial/Domestic Violence (NVVP, 2008) recommends to focus more on systemic factors and on individual risk factors of IPV. ADHD is one of these individual risk factors. This presentation focuses on the association between ADHD and IPV, presenting data and clinical examples. ADHD was missed in 56% of a sample of forensic outpatients. Reasons for this issue of underdiagnosis of ADHD in case of aggression and IPV are discussed. Also, data of the ITAP (impact of treatment of ADHD on IPV) study are presented, showing that ADHD in offenders of IPV with ADHD scored higher on minor physical aggression, minor and severe psychological aggression and clinician-rated IPV than offenders without ADHD. Further, after a one year treatment of ADHD and IPV, decrease in IPV was mainly associated with decrease in ADHD symptoms. The importance of screening and treatment of ADHD symptoms in all IPV offenders is discussed to make treatment of IPV more effective.DisclosureNo significant relationships.

The impact of COVID-19 restrictions on social relationships of forensic psychiatric outpatients with preexisting social network-related problems: A mixed methods study

ABSTRACT This study aimed to explore the impact of the COVID-19 restrictions on social relationships of forensic psychiatric outpatients with preexisting social network-related problems. Data from 70 participants of an ongoing randomized controlled trial, investigating the effectiveness of a social network intervention among forensic psychiatric outpatients, were examined. Demographic characteristics, quality of social relationships, loneliness, and social support were assessed at baseline. During the COVID-19 pandemic, an additional questionnaire that contained quantitative and qualitative questions regarding the impact of COVID-19 restrictions on social relationships was administered. Participants showed high levels of loneliness and dissatisfaction with social relationships before COVID-19. The majority of forensic outpatients perceived no changes on social relationships due to the COVID-19 restrictions. Qualitative results revealed some participants already lived socially isolated. Negative changes on social relationships were related to deterioration of social contacts, interruption of daytime activities, changed mental health care, and well-being. Emotional loneliness predicted deteriorated general and romantic relationships. These findings suggest that social relationships of forensic patients with preexisting social network-related problems remain of concern throughout the COVID-19 pandemic.

Gender Differences Between Domestic Violent Men and Women: Criminogenic Risk Factors and Their Association With Treatment Dropout.

Although many studies have concluded that men and women engage in domestic violence at equal levels, existing studies have hardly focused on gender specific risk factors for domestic violence perpetration. Therefore, this study aimed to examine gender differences in criminogenic risk factors between Dutch male and female forensic outpatients who were referred to forensic treatment for domestic violence. Clinical structured assessments of criminogenic risk factors were retrieved for 366 male and 87 female outpatients. Gender differences were not only found in the prevalence and interrelatedness of criminogenic risk factors, but also in associations between criminogenic risk factors and treatment dropout. In men, risk factors related to the criminal history, substance abuse, and criminal attitudes were more prevalent than in women, whereas risk factors related to education/work, finances, and the living environment were more prevalent in women. Further, having criminal friends, having a criminal history, and drug abuse were associated with treatment dropout in men, whereas a problematic relationship with family members, housing instability, a lack of personal support, and unemployment were associated with treatment dropout in women. Finally, network analyses revealed gender differences in risk factor interrelatedness. The results provide important insights into gender specific differences in criminogenic risk factors for domestic violence, which support clinical professionals in tailoring treatment to the specific needs of male and female perpetrators of domestic violence.

Protective factors as uni- or bipolar factors and their incremental validity and accuracy in predicting general recidivism

This study examined whether protective factors are unique or the opposite of risk factors and whether they have incremental validity in the prediction of general recidivism. Using a sample of 3306 Dutch forensic outpatients, this study was the first large-sample study ever performed on this topic. Results from exploratory factor analyses demonstrated a relatively stable factor structure of 14 factors, consisting of 32 of the initially included 68 risk factors and 11 of the initially included 17 protective items. The protective factors were found to be either bipolar (i.e., mirror images of risk factors) or responsivity characteristics (i.e., motivation for treatment, cognitive disability). Incremental validity for the recidivism prediction was found in one factor with internal protective items (e.g., empathy, financial management, life goals). This factor decreased the recidivism risk by 6%. However, weak predictive accuracy was found for this factor. Implications for clinical forensic practice are discussed with special focus on the risk-need-responsivity model.

Development of a Wearable Biocueing App (Sense-IT) Among Forensic Psychiatric Outpatients With Aggressive Behavior: Design and Evaluation Study.

BackgroundThe ability to regulate anger is often impaired in forensic psychiatric patients, frequently resulting in aggressive behavior. Although some treatment programs are partially successful in enhancing aggression regulation and reducing recidivism among specific subgroups, generalizable conclusions on the effectiveness of these interventions cannot be drawn to date. In forensic outpatient care, low treatment adherence and a predominant focus on cognitive control in most treatment programs may entail some of the factors impeding treatment. Technology-based interventions may address some of these treatment challenges.ObjectiveThe aim of this study is to explore whether a new technology-based biocueing intervention, the Sense-IT app, can be a valuable addition to aggression regulation treatment programs in forensic outpatient care. The Sense-IT app, which provides the user with real-time physiological feedback and behavioral support, is developed to strengthen emotional awareness and facilitate real-life practice. In this study, we aim to develop and evaluate an updated version of the Sense-IT app that is suitable for forensic outpatients with aggressive behavior.MethodsFirst, we conducted a design study to assess the attitudes of forensic professionals and patients toward biocueing and to collect requirements for a biocueing app for this specific population. On the basis of this information, we developed an updated version of the Sense-IT app. In an evaluation study, 10 forensic outpatients used the app for 2 weeks. The app’s acceptability, usability, and clinical outcomes (aggression, anger, and recognition of bodily signals related to anger) were measured before and after the intervention using both quantitative and qualitative measures.ResultsThe design study revealed a cautiously positive attitude toward the use of biocueing as an addition to aggression regulation therapy. The evaluation study among forensic outpatients demonstrated moderate acceptability and adequate usability for the new version of the Sense-IT app. Exploratory analysis revealed a significant decrease in trait aggression postintervention; no significant changes were found in other anger-related clinical outcomes. To further increase acceptability and usability, a stable functioning app with self-adjustable settings, the use of smartwatches with a longer battery life, and the use of the patient’s own smartphone devices were recommended.ConclusionsThis study, which is one of the first attempts to enroll and evaluate the real-life use of a biocueing intervention among forensic outpatients, emphasized the importance of involving both patients and therapists throughout the development and implementation process. In the future, experimental studies, including single-case experimental designs using ecological momentary assessment, should be performed to evaluate the effectiveness of the Sense-IT intervention on clinical outcomes. An open attitude toward new technology, allowing exploration of the potential benefits of the Sense-IT app case-by-case, and training of therapists in using the app are expected to facilitate its integration in therapy.

Dutch Forensic Flexible Assertive Community Treatment: Operating on the Interface Between General Mental Health Care and Forensic Psychiatric Care.

In the Netherlands, Forensic Flexible Assertive Community Treatment (ForFACT) is used as a specialized form of outpatient intensive treatment. This outreaching type of treatment is aimed at patients with severe and long lasting psychiatric problems that are at risk of engaging in criminal behavior. In addition, these patients often suffer from addiction and experience problems in different areas of their life (e.g., financial debt, unemployment, or lack of daytime activities). The aim of this exploratory study was to gain more insight into the characteristics of the ForFACT patient population. More knowledge about these patients may enhance the effectiveness of ForFACT and therefore (further) reduce the risk of recidivism. Data on 132 ForFACT patients were gathered by studying electronic patient records, criminal records, and by conducting semi-structured interviews with practitioners and patients. Additionally, as part of a cognitive screening, two screening instruments were conducted to gain insight into intelligence and possible mild cognitive impairments. This article gives a broad description of the ForFACT patient population, including demographic data and context variables, diagnostics, recidivism risk and offense history, and aspects related to care. Furthermore, several recommendations are given to further improve ForFACT. Based on the results it can be concluded that the ForFACT patient population shows a high degree of diversity in complex care needs and responsivity issues. Therefore, this article highlights the necessity for ForFACT to collaborate with other mental health institutions, as well as probation officers, and forensic or criminal justice institutions. Moreover, it is important to continually check the inclusion and exclusion criteria when admitting patients to ForFACT, and to examine whether ForFACT is still the most adequate care for patients or if they need to be referred. In addition, the results emphasize the importance of cognitive screening for forensic outpatients. Finally, this study zooms in on the interface between forensic psychiatric care and general mental health care.

Effectiveness of forensic outpatients' psychiatric treatment and recidivism rates: A comparison study

It was previously shown that forensic outpatient psychiatric treatment lowers recidivism and improves mental health. However, there is no data specifically from Switzerland, a fact that has been repeatedly criticized by local policymakers in the course of healthcare planning. The present study aimed to describe two groups of mentally ill offenders referred to a Swiss forensic outpatient clinic, namely those accepted for treatment and those who were left untreated because their treatment was rejected. The recidivism rates of the two groups were then compared, to determine whether differences in recidivism rates between the two groups might be related to socio-demographic characteristics and mental health. Finally, improvements regarding general functional level and severity of psychopathology were evaluated over the course of time. A total of n = 131 mentally ill offenders were studied. After an average time at risk of 42.6 months, our preliminary results show that 18% of those accepted for treatment relapsed into delinquent activities, while 38% of the rejected offenders did so. We found no sociodemographic variable that differentiated between reoffenders in the two samples. Likewise, the prevalence of personality disorders was similar in the two groups. Regarding comorbidity, the combination of any substance abuse disorder and any personality disorder was more prevalent in the treated sample. Over the course of therapy, the treated group showed improvements regarding their general functional level and the severity of their psychopathology. This is the first study to explore the effects of therapeutic outpatient treatment of mentally ill offenders on Swiss recidivism rates.

Improving mental wellbeing of forensic psychiatric outpatients through the addition of an informal social network intervention to treatment as usual: a randomized controlled trial

BackgroundForensic psychiatric patients often suffer from a multitude of severe psychiatric and social problems. Meanwhile multimodal evidence-based interventions are scarce and treatment effectiveness is in need of improvement. The main goal of forensic psychiatric treatment is to address psychiatric and social factors and thereby mitigate criminal behaviour. Notably, a supportive social network is an important protective factor for criminal behaviour. As such, improving a poor social network may decrease the risk of criminal recidivism. This study aims to examine the effectiveness of the addition of an informal social network intervention (FNC) to treatment as usual (TAU) among forensic psychiatric outpatients.MethodsIn a mono-center randomized controlled clinical trial with two parallel groups, forensic psychiatric outpatients with social network-related problems (N = 105) will be allocated to either TAU + FNC or TAU alone. The informal social network intervention consists of a 12-month coaching intervention, performed by the forensic network coach (a volunteer trained by an informal care institute). Assessments will be conducted at baseline and 3 months, 6 months, 9 months, 12 months, and 18 months after baseline. The primary outcome variable is mental wellbeing. Psychiatric functioning, criminal recidivism, substance abuse, quality of life, social network, social support, loneliness and self-sufficiency are included as secondary outcomes. A variety of potential mediators and moderators of effectiveness will be explored. Additionally, a qualitative evaluation of effectiveness will be performed.DiscussionThis study will contribute to the existing literature of forensic treatment effectiveness as it is the first RCT examining the effectiveness of adding a social network intervention in a forensic outpatient population. If effectiveness is shown, forensic mental health care could be optimized by collaborating with informal care or community initiatives aimed at improving a positive social network. In addition, results will provide insight regarding mediators and moderators of treatment effectiveness.Trial registrationThis study is registered at the Netherlands Trial Register (NTR7163). Date of registration: 16 april 2018.

Cognitive-motivational, interpersonal, and behavioral functioning in relationship to treatment and research engagement in forensic patients with ADHD.

ObjectivesTo provide more insight into treatment and research responsivity in offenders with attention‐deficit hyperactivity disorder (ADHD).MethodVia self‐reports and patients' scores on cognitive computer tasks, it was examined whether poorer cognitive‐motivational, interpersonal, and behavioral functioning were related to treatment no‐shows, longer treatment time duration intervals, and no‐show at the research appointment in 52 forensic outpatients with ADHD (M age = 35.3, SD = 9.38). Treatment adherence was tracked for 10 appointments after research participation.ResultsRegression analyses showed that higher self‐reported impulsivity was associated with research no‐show, and more alcohol use with longer treatment time intervals. Yet, self‐reported delay aversion was associated with fewer treatment no‐shows, and, uncontrolled for alcohol use, impulsivity was associated with shorter treatment time intervals in a subsample of patients.ConclusionsThese preliminary results indicate that externalizing behaviors increase the risk for nonadherence in forensic ADHD patients, but that cognitive‐motivational problems also motivate patients to be more engaged.

A Cumulative Substance Use Score as a Novel Measure to Predict Risk of Criminal Recidivism in Forensic Juvenile Male Outpatients.

This longitudinal study aimed to evaluate a newly developed cumulative measure for substance use problems as predictor of criminal recidivism in youth. Questionnaires-based substance-related behaviors (tobacco, alcohol, cannabis and further drugs), and interview-based psychiatric disorders were assessed in a sample of 142 male adolescent forensic outpatients in Zurich, Switzerland (mean age 16.8years, SD = 1.4years). Cox regressions were used to test whether substance use behaviors/disorders were predictors of officially recorded criminal offenses 365days after the initial assessment. The cumulative substance problem score (SPS) was a valid measure for assessing the risk of criminal recidivism for youth having 2-3 (OR 2.24-2.56) and 4+ problems (OR 3.40-4.37) in comparison to youth with 0-1 problems. Forensic experts and clinicians should comprehensively assess substance use patterns in juvenile offenders and may use the SPS as an indicator for further criminal risks. Additional analysis of the SPS in other forensic samples and cultures would be worthwhile.