Forensic Population Research Articles

Is there adequate evidence to support the use of compassion focused therapy group interventions with forensic mental health service users? A rapid evidence assessment

Compassion focused therapy (CFT) is a model of psychotherapy based on cultivating the capacity for compassion to others and self. The evidence base has grown considerably in the last decade regarding CFT’s effectiveness for a range of mental health problems. However, the literature supporting CFT as a treatment provision for forensic service users with mental health needs is lacking despite the observed overlap in needs between this population and their non-offending clinical counterparts. This rapid evidence assessment (REA) sought to evaluate the current evidence of CFT’s effectiveness as a group therapeutic intervention with clinical populations to allow consideration of the use of CFT with individuals with both mental health and criminogenic needs. A search of electronic databases was undertaken and after a process of review and extraction 10 papers were included. These studies showed promising effects of group-level CFT for those with complex mental health needs. Some evidence emerged of CFT generating significant improvements compared to no treatment and treatment as usual (TAU), but insufficient evidence has been produced in respect of whether CFT can supersede traditional ‘gold-standard’ approaches such as Cognitive Behavioural Therapy (CBT). Tentative conclusions are made regarding the applicability of CFT interventions but the observed reductions in shame and self-criticism and a move towards more guilt-based motivational drives suggest that this approach shows some promise in being able to assist forensic service users in taking more responsibility for their harmful actions and foster social and affiliative processes with others. Further high quality RCTs are needed in order to make firm conclusions about the clinical utility of this therapy for forensic populations with mental health needs.

In the blink of an eye: Quantitative blink dynamics predict deceptive personality traits in forensic interviews

It is commonly believed that eye movements and blinks can be indicative of deception, however, there are few laboratory studies of such effects in general and no studies in real-world forensic populations in particular. Here we test the hypothesis that automated eye blink detection and blink frequency dynamics would predict trait levels of deception in a forensic sample. Participants were incarcerated male offenders (n = 125) undergoing life history interviews which were used in part to assess psychopathic personality traits using the Hare Psychopathy Checklist-Revised. Psychopathy is a personality disorder characterized in part by trait dishonesty, manipulation, and pathological lying. We developed a novel automated image analyses approach using hidden Markov machines, where the assumption is that an underlying hidden process influences the observable, measurable process (i.e., deception). Consistent with hypotheses, blink dynamics were predictive of interpersonal psychopathic traits (i.e., pathological lying and conning/manipulative behavior). This study provides the first evidence that blink dynamics from a naturalistic forensic interview, may help understand individual differences in trait deception.

Testing the cross-applicability of juvenile sex estimation from diaphyseal dimensions

Sex estimation is a crucial component of the biological profile. Stull et al. (2017) have proposed a promising juvenile sex estimation method using long bone measurements taken from a South African sample, providing relatively high classification accuracies and made easy to use via the KidStats web-based app. In this study, we test the models developed by Stull et al. (2017) on an external historic population from Lisbon, Portugal, in order to determine whether the models can be reliably applied to archeological and forensic populations outside of the original population sample. The study sample consisted of 102 individuals (45 females and 57 males) aged under 13 years at death from the Lisbon identified skeletal collection. Measurements from these individuals were used to test the flexible discriminant analysis (FDA) models given by Stull et al. (2017). Allocation accuracies were calculated for boys and girls and children over and under 2 years separately and combined. Our findings show that the models developed by Stull et al. (2017) yield poor accuracy when applied to our external population and thus can potentially be misapplied on archeological skeletal remains or forensic remains of unknown origin. A number of statistical issues may explain why models fail to be transportable or even generalizable, namely multicollinearity, model overfitting and overly optimist bootstrapped cross-validation rates. It is also likely that population differences in size and sexual size dimorphism also affected the applicability of the models. We emphasize the importance of externally validating prediction models, particularly if they are intended to be applied across populations. Our study addresses Stull and co-worker’s request for further validation of the method on populations outside of South Africa, as the models cannot be confidently applied in the field until it has been externally validated.

Factors influencing adjudicative competence and length of time to restoration.

Few studies on adjudicative competence explore the relationship between diagnosis, treatment, and restorability. Most focus on demographics and major psychiatric diagnosis with very few exploring the diagnoses common to the forensic population (i.e., personality disorders and substance abuse). Our study of 365 defendants who were incompetent to stand trial at a state psychiatric facility indicates that non-restored defendants have a greater likelihood of cognitive disorders, misdemeanor charges, and histories of prior hospitalization, and less likelihood of personality disorders. In addition, the odds of having a substance use disorder and being medication non-adherent was greater among restored defendants. The mean length of time to restoration (LOR) of 56days was significantly different from the mean length of time to adjudication (LOA) for those not restored (88days). This study supports prior literature on restorability while distinguishing those treated for psychosis from those treated for substance use and personality disorder. In its novel focus on medication adherence, the study expands the remediable factors available to clinical and forensic professionals and supports interventions that improve treatment and shorten the time to restoration.

The Safe pilot study: A prospective naturalistic study with repeated measures design to test the psychosis - violence link in and after discharge from forensic facilities

The research evidence is very strong for high recidivism rates of violence after discharge from forensic facilities. Big data research has found that a substantial proportion of the forensic population with relapse into violence has a psychosis diagnosis and a criminal record. However, more research on the association between psychotic symptoms and violence may inform and enhance risk assessment, prevention, and treatment. We conducted a prospective naturalistic study with a repeated measures design in a sample of 22 psychotic patients during follow-up after discharge from forensic mental health facilities. We had three aims: to test the predictive validity of three psychotic symptom scales for violence, to analyze main and interaction effects between psychotic symptoms and previous criminal conviction, and to explore the feasibility and potential benefit of the repeated measures design for prospective follow-up research. Interpreted within the limitation of the small sample size, the results were promising for all scales, particularly for adjusted effects without interaction. Two scales remained significant when their interaction with criminal conviction was adjusted. This indicates that risk judgment of psychotic patients with criminal conviction can be improved by adding measurement of fluctuations in psychotic symptoms. The repeated measures design was instrumental in this research.

Social climate and hope amongst staff and prisoners in a high security male prison

PurposeThere is an increased focus on making prison cultures more rehabilitative, with clear evidence that certain environmental characteristics contribute towards rehabilitation. To date, limited research has explored the rehabilitative culture in a high security prison. This study aims to measure staff and prisoner ratings of social climate and their levels of hope in such an establishment.Design/methodology/approachThe research adopted a quantitative approach, using the EssenCES and State Hope Scale. Data was analysed using parametric and non-parametric tests to explore correlations/relationships between variables.FindingsFindings indicated that higher ratings of social climate were associated with higher levels of hope. Staff rated the social climate more favourably than prisoners, and Category B prisoners had higher levels of hope than Category A prisoners. No significant correlation was found between length of time in service or custody and ratings of social climate or hope.Practical implicationsThis paper highlights the importance of developing a positive social climate and hope, supporting the rehabilitative culture initiatives.Originality/valueThis paper contributes to the limited literature on social climate and hope within UK forensic settings. Furthermore, reliability testing indicates the State Hope Scale is appropriate for use with a UK forensic population, extending its application.

Psychopathic traits predict moral judgements in five moral domains: The mediating effect of unpleasantness

PurposeThe relationship between psychopathic traits and moral judgements has evoked passionate debates among researchers. Psychopathic traits have been characterized as risk factors for immoral behaviours in both non‐forensic and forensic populations; however, whether individuals with elevated psychopathic traits display atypical moral judgements has been controversial. Here, we aim to examine how psychopathic traits are related to moral judgements in five moral foundations (Care, Fairness, Loyalty, Authority, and Sanctity) and further explore how unpleasantness mediates the relationship in non‐forensic and forensic samples.MethodsTwo hundred and twenty five college students and 219 detainees were recruited in two separate surveys. All the participants were asked to complete the moral judgement task in everyday moral scenarios, the unpleasantness ratings for the immoral behaviours and the Levenson Self‐Report Psychopathy Scale (LSRP).ResultsPsychopathic traits predicted the binary moral distinction (moral vs. immoral category) in the Care foundation in the non‐forensic sample. Moreover, psychopathic traits predicted moral acceptability ratings (continuous category) in all of the moral foundations in the non‐forensic sample but only for the Care and Loyalty foundations in the forensic sample. Finally, unpleasantness fully mediated the relationship between psychopathic traits and moral judgements in both samples.ConclusionsOur findings provide further evidence that individuals with elevated psychopathic traits have atypical moral judgements – emphasizing the role of unpleasantness in contributing to this phenomenon. Our study has implications for understanding and treating various deviant behaviours in psychopathic individuals.

Forensic features and genetic structure of 20 autosomal STR loci in the Han population of Ningde City, Southeastern China

Background Short tandem repeat (STR) loci are widely used in forensic medicine and population genetics. Aim To profile 20 autosomal STR loci using the SureID® 21 G Human STR Identification Kit. Subjects and methods Samples were obtained from 1412 unrelated Chinese Han individuals from Ningde City, Southeastern China and 20 autosomal STR loci were profiled using the SureID® 21 G Human STR Identification Kit. Results A total of 261 alleles were observed among 1412 unrelated individuals and the corresponding allelic frequencies ranged from 0.5464 to 0.0004. The combined power of discrimination and exclusion of the 20 autosomal STR loci were 0.99999999999999999922 and 0.999999340285752, respectively. There was no significant deviation from Hardy–Weinberg equilibrium (HWE) and minimal departure from linkage equilibrium (LE) for two pairwise combinations of loci after sequential Bonferroni correction. In the population comparison, phylogenetic analysis was performed between the Han population and other relevant populations on the basis of the shared autosomal STR genotyping. Moreover, the neighbor-joining tree and principal component analysis were analysed based on the Nei’s standard genetic distance. Conclusion The population comparison revealed that the structure of the Ningde Han population was similar to the structure of southern Han populations in China and was significantly different to the other Chinese ethnic groups, such as Kyrgyz, Uzbek, Kazakh, Uyghur, Manchu from Xinjiang and Mongols.

The Application of the Repertory Grid in Forensic Practice

The purpose of this paper is to demonstrate the utility of the repertory grid method with forensic populations. Three case studies are presented, each using an adapted variation of the repertory grid method with a different forensic clients: an individual maintaining their innocence, an individual convicted of sexual offenses, and an individual convicted of stalking. An analysis of the repertory grid findings is presented for each case study, including a Principal Component Analysis and a Self-Identity Plot. This analysis of subjective meaning and idiosyncratic belief systems proves invaluable ordinarily, but particularly when working with populations who present as suspicious and guarded in research or clinical settings. Relationship and offending-related psychological vulnerabilities are explored, with small psychological changes documented and the use of the repertory grid approach as a clinical tool is highlighted. The findings provide a significant contribution to the field of forensic practice, by demonstrating the utility of the repertory grid method when working with forensic populations. This may, in turn, contribute to researchers’ and practitioners’ consideration of its use within future forensic practice.

Examining the relationship between neuropsychological functioning assessed during admission to a high secure psychiatric care hospital and vulnerability to long-term segregation

PurposeThis paper aims to examine the relationship between neuropsychological functioning as assessed following admission to a high secure psychiatric care (HSPC) hospital and subsequent time spent in long-term segregation (LTS). Evidence from forensic populations suggests neuropsychological functioning difficulties can increase vulnerability to interpersonal violence. However, the impact of this relationship on restrictive interventions used in these settings is poorly understood.Design/methodology/approachThis study quantitatively examined the neuropsychological profiles of 80 male HSPC patients as assessed during routine admission assessments, comparing data against any subsequent LTS duration during a one-year period, and a non-LTS control (n = 27).FindingsAnalysis found individuals who were willing and able to complete a routine neuropsychological admissions assessment spent significantly less time in LTS than those unable to complete the assessment. Performance within a test of novel problem solving (Key Search Test) was significantly worse in the LTS group than controls. Performance within a visual memory task (Immediate Recall section of the Rey Complex Figure Test) significantly correlated with LTS duration. Additional findings suggest the absence of self-reported planning difficulties as measured by a Dysexecutive Questionnaire (DEX) negatively correlated with LTS duration, while self-reported restlessness was positively correlated with LTS.Practical implicationsThis has implications for early assessment of LTS risk and potential use of cognitive interventions to reduce the use of restrictive practices.Originality/valueThe results suggest some aspects of neuropsychological performance as assessed during admission to a HSPC hospital appear to be related to subsequent time spent in LTS.

Functional remission in Belgian forensic psychotic patients – story of a virtuous cycle?

ABSTRACT In this article, we examine the associations between functional remission, psychotic symptoms and protective risk factors, and we study the reliability and validity of the Functional Remission Of General Schizophrenia scale (FROGS) in a sample for forensic psychotic patients. Functional remission was measured using the FROGS, psychotic symptoms were assessed using the Positive and Negative Syndrome Scale scale (PANSS), and protective risk factors were collected using the Structured Assessment of Protective Factors (SAProF). A sample of 127 patients from a forensic medium-secure unit for psychosis were included in this retrospective correlational study. The FROGS factor scales, Daily Life and Relationship subscales and total scale had acceptable psychometric properties. Functional remission is strongly associated with the absence of psychotic symptoms (especially negative symptoms), and protective risk factors. The FROGS factor scales and subscales were able to predict the care setting at discharge (residential, semi-residential, or independent living). Functional remission appears to be a cornerstone in the forensic rehabilitative process as the Good Lives Model for Mental Health and the Remission in Schizophrenia Working Group suggested. The FROGS can be used reliably and validly in a forensic population.

Emotionality during and after the Commissions of an Offence: A Look at Offence-Related Shame and Intrusive Memories in Justice-Involved Adult Males

The limited research concerning trauma secondary to committing crime in justice-involved persons has been restricted to male forensic psychiatric and violent offender populations. We aimed to extend this by examining justice-involved persons’ memories about their crimes, and exploring factors involved in intrusive memories across offence types. One hundred justice-involved adult males completed a questionnaire package examining offence-related shame, guilt, instrumentality-reactivity, and memory characteristics. Forty-three percent reported intrusive memories of a crime they committed. These were experienced across all crime types, especially those with reactive elements. Shame was found to be the most significant correlate of intrusive memories over and above all other factors. While further research is needed (e.g., with justice-involved women), results are in line with theoretical foundations of posttraumatic stress disorder and shed light on psychological consequences of offending. The findings have implications for clinicians and researchers alike, in that intrusive memories and shame may be precipitating factors for related risk factors and would relatedly be worth considering when evaluating patterns of violence and creating relapse prevention plans.

Urine drug screening in a forensic mental health population: frequency and clinical utility in risk management

ABSTRACT There is a high frequency of urine drug screens performed within forensic patient populations, at significant use of resources and without firm evidence of utility in identifying prohibited substance use, assisting in risk management, or reducing other adversities. This study describes the clinical practice of urine drug testing in a large forensic psychiatric service in Ontario, Canada, and aims to determine the period prevalence of substance use in this setting. Over a three-month period, there were 1493 tests performed in 132 patients, representing 50.4% of patients surveyed and 31.1% of all active patients. Ten percent of urine samples retuned positive for a prohibited substance (most commonly cannabis or alcohol) while a similar proportion were dilute. Although inpatients received double the number of tests as compared to outpatients, they were less likely to return positive. Patients with positive test results were more likely to receive frequent testing, suggesting that clinical teams often employ urine drug screening to monitor those at highest risk for ongoing use, rather than as a method of deterrence or therapeutic intervention. Implications for the continued use of urine drug screening in this patient population, as well as recommendations to better tailor their use, are discussed.

Forensic Evaluation and Population Genetic Study of KIR2DS4 Insertion/Deletion Polymorphisms in a Spanish Population

Forensic Evaluation and Population Genetic Study of KIR2DS4 Insertion/Deletion Polymorphisms in a Spanish Population

Supporting youth workers: A reflective group consultation approach

Forensic child and adolescent mental health services (FCAMHS) became a service within the Tavistock and Portman NHS Foundation Trust in 2018, and since then has become a multidisciplinary expansion of the Portman Clinic’s consultation and assessment work. FCAMHS provides specialised consultation, assessment and brief interventions to professionals, families, and young people across 13 boroughs in Central, North, and East London. As a service provider we aim to support third sector service users who are working directly with some of the most vulnerable, at risk, and risky young people in our area. Through an existing contact in a local youth organisation we began to discuss the idea of creating a space where professionals could come together as a group to reflect on experiences and identify areas of difficulty in their work. Reflective practice groups offered by the Portman Clinic are often psychoanalytically-informed consultation groups which offer a way of working with professionals and young people by reflecting on the meaning, communication and experience of the young person’s behaviour, and our own responses to this. Therefore, we decided to offer a reflective practice group to third sector professionals known to FCAMHS from local youth services and other local agencies, who work with some of the most vulnerable, challenging and high risk young people in this location of London. This reflective practice group has now been running for almost two years and provides a valuable space for youth workers to process and make sense of their work with this challenging forensic population.

Allele frequencies and forensic parameters of 22 autosomal STR loci in a population of 983 individuals from Serbia and comparison with 24 other populations

Background Analysis of allele frequencies of short tandem repeat (STR) loci in ethnically diverse populations is essential for forensic reference database construction and studies on population genetics. Aim To analyse genetic polymorphisms of 22 autosomal STR loci in the Serbian population and to compare them with previously published data from some European and Turkish populations. Subjects and methods The study was conducted among 983 unrelated individuals from Serbia. Genotyping was performed using the PowerPlex® Fusion amplification kit. Allele frequencies and forensic parameters were calculated using FORSTAT software. Interpopulation comparisons and genetic distance calculations were performed in Arlequin and POPTREEW software. Results A total of 280 alleles were detected with corresponding allelic frequencies ranging from 0.0005 to 0.5255. Based on heterozygosity and the polymorphism information content, D1S1656 and Penta E may be considered as the most informative markers. Both the combined power of discrimination (CPD) and the combined power of exclusion (CPE) for the 22 analysed loci were higher than 0.999999. The combined match probability (CPM) for all 22 loci was 6.773688e−29. Conclusion With respect to the results, the 22 STR loci are highly polymorphic and discriminating in the Serbian population and could be used for forensic practice and population genetics studies.

Reading skills deficits in people with mental illness: A systematic review and meta-analysis.

Good reading skills are important for appropriate functioning in everyday life, scholastic performance, and acquiring a higher socioeconomic status. We conducted the first systematic review and meta-analysis to quantify possible deficits in specific reading skills in people with a variety of mental illnesses, including personality disorders (PDs). We performed a systematic search of multiple databases from inception until February 2020 and conducted random-effects meta-analyses. The search yielded 34 studies with standardized assessments of reading skills in people with one or more mental illnesses. Of these, 19 studies provided data for the meta-analysis. Most studies (k=27; meta-analysis, k=17) were in people with schizophrenia and revealed large deficits in phonological processing (Hedge's g=-0.88, p<0.00001), comprehension (Hedge's g=-0.96, p <0.00001) and reading rate (Hedge's g=-1.22, p=0.002), relative to healthy controls; the single-word reading was less affected (Hedge's g=-0.70, p <0.00001). A few studies in affective disorders and nonforensic PDs suggested weaker deficits (for all, Hedge's g <-0.60). In forensic populations with PDs, there was evidence of marked phonological processing (Hedge's g=-0.85, p<0.0001) and comprehension deficits (Hedge's g=-0.95, p=0.0003). People with schizophrenia, and possibly forensic PD populations, demonstrate a range of reading skills deficits. Future studies are needed to establish how these deficits directly compare to those seen in developmental or acquired dyslexia and to explore the potential of dyslexia interventions to improve reading skills in these populations.

Examining the connection between nature connectedness and dark personality

The psychological construct of nature connectedness - the depth of an individual's relationship with the natural world - has not only been associated with benefits for mental well-being but has also shown relationships with personality traits relevant to the dark personality literature. These include agreeableness, cognitive and affective empathy, and callous and uncaring traits. Across two independently-sampled studies we delineate relationships between explicit and implicit indices of nature connectedness and dark personality. In Study 1 (N = 304), psychopathy (and Machiavellianism) was associated with self-reported, but not implicitly-measured, nature connectedness. Moreover, individuals scoring high on dark personality exhibited a preference for inner-city, relative to suburban or rural living. In Study 2 (N = 209), we replicated the findings of Study 1 in relation to explicit measures of nature connectedness but did not find further relationships between dark personality and the population densities of where participants had previously lived. Limitations of implicit and pseudo indices of nature connectedness are outlined, and the results are discussed in relation to future research and the potential role of nature connectedness interventions in forensic populations. Data, syntax, and the manuscript pre-print are available here: [https://osf.io/3mg5d/?view_only=b5c7749d4a7945c5a161f0915a2d0259].

The forgotten families; a systematic literature review of family interventions within forensic mental health services

ABSTRACT The Department of Health, England, recommends that all relatives in close contact with a person experiencing schizophrenia should be offered Family Intervention (FI). Given that up to 70% of the forensic population meet the criteria for such a diagnosis there is a strong rationale for providing FIs within forensic settings. This review aimed to explore the prevalence and attitudes towards such work. A systematic search of nine databases was conducted; of 1206 citations, 6 met criteria for inclusion. Findings suggest despite a high degree of contact between forensic patients and their relatives, the provision of FIs within forensic settings remains sparse. Numerous barriers to the execution of this work were identified, along with service recommendations on how to overcome these.

Predictors of civil and forensic inpatient psychiatric readmissions at a Public Mental Health Hospital

Inpatient psychiatric readmissions are increasingly prevalent and associated with worse prognostic outcomes and high economic costs, regardless of the medicolegal ramifications that necessitate them. Unlike most general medical readmissions, psychiatric readmissions are commonly warranted for both medical and legal purposes. However, studies focusing on analyzing the predictors of inpatient psychiatric readmission and their relationship to civil versus forensic readmission are limited. The purpose of this study was to examine the predictors of psychiatric readmission among civil and forensic patients admitted to a psychiatric hospital. In this retrospective chart review, we extrapolated data from medical records of 741 patients admitted from 2012 to 2017 with follow up until 2019. Analyses involved chi-square tests for comparing the distribution of demographic and clinical variables between forensic and civil readmission, and Cox regression to determine predictors of time to first readmission. Our results show that race, diagnosis, restraint/seclusion, type of admission, and disposition are significantly associated with an increased risk of psychiatric readmission. This study has important implications for healthcare providers and policy makers in revising mental health policies and improving systems-based practices for the mental health system. Future efforts in improving community psychiatric services and enhancing inpatient therapeutic environment may reduce psychiatric readmissions.