Psychiatric Placement Research Articles

Attitudes and Knowledge of Electroconvulsive Therapy: An Exploration of Medical Students' Perspectives.

To explore knowledge and attitudes of medical students before and after exposure to a technology-enhanced learning and teaching (TELT) session about electroconvulsive therapy (ECT). Adequate knowledge of and attitudes toward ECT is essential for medical students. However, the impact of teaching on knowledge and attitudes is infrequently studied. Fourth- and fifth year medical students at the University of Glasgow were provided with an online questionnaire before and after engaging in a remote TELT session, led by a consultant psychiatrist with expertise in ECT. The online teaching session used resources developed by a multidisciplinary team who specialize in ECT. The teaching session lasted around 1 hour. The questionnaire contained 3 sections: baseline demographics, knowledge of ECT, and attitudes toward ECT. Changes in scores were analyzed. Sixty-seven students completed the teaching session. Response rate to the precourse questionnaire was 68.7% (n = 46), and the postcourse questionnaire was 44.8% (n = 30). Prior to engaging with the learning materials, 9 students reported no knowledge of ECT and a third believed that ECT did not cause a seizure. In general, students who had personal experience of mental illness (friend, relative, or self) had more positive attitudes toward ECT and higher knowledge scores. In general, an increase in knowledge and attitude scores was found in the postcourse questionnaire. Exposing medical students to a TELT session focused on ECT during their psychiatric placement appeared to improve knowledge and attitudes surrounding ECT.

Quantifying Time from Medical Clearance to Psychiatric Placement in Hospitalized Patients

Introduction: Patients presenting to the hospital with active psychiatric illness often have concurrent general medical conditions requiring medical clearance before transfer to a psychiatric facility. There may be a time lag from medical clearance to psychiatric placement which could have implications for patient care and hospital capacity constraints. Materials and Methods: We performed a chart review for 106 patients at an academic medical center from June through December of 2020 to determine this time from medical clearance to psychiatric placement (TMCPP). Results: The average TMCPP was 2.1 days with a range of 0 to 13 days, with aggregate time spent awaiting discharge during the 7- month study of 220 days. Conclusion: These delays may contribute to emergency department overcrowding and ultimately result in delays in care across the health care system.

The new Foundation Programme Mental Health Curriculum: foundation doctors' perceptions of its importance and their competency: pre-post psychiatric placement evaluation study.

The new 2021 UK Foundation Programme Curriculum mandates foundation doctors to acquire mental health competencies. This study aimed to evaluate the effectiveness of psychiatry placements in facilitating competency attainment, foundation doctors' perceived importance of acquiring these and their preferred teaching methods. Utilising Kirkpatrick's evaluation framework, the study employed a pre-post intervention design assessing the impact of psychiatry placements on 135 foundation doctors across three cohorts from August 2021 to March 2022. Initially, foundation doctors assigned high importance to mental health competencies. Post-placements, this perceived importance improved slightly, whereas that of clinical skills scenarios slightly decreased. Significant confidence increases were observed in recognising and assessing specific psychiatric disorders. Foundation doctors favoured small seminar groups and on-the-job ad hoc teaching. Qualitative insights underscored the need for context-specific teaching. Psychiatry placements enhance foundation doctors' confidence and perceived importance of mental health competencies as specified by the curriculum. Addressing clinical scenario gaps through context-specific teaching and transferable skills development is essential. Customised teaching approaches, especially small seminars and ad hoc teaching, hold promise for effective mental health training.

De-escalation of the Agitated Pediatric Patient: A Standardized Patient Case for Pediatric Residents.

Over the past 5 years, pediatric mental health emergencies requiring emergency safety evaluations and inpatient boarding of pediatric patients requiring psychiatric admission have increased. Pediatric trainees must learn to effectively and safely de-escalate a patient with agitated or aggressive behavior, as mental health patients take up a larger proportion of their patient population. This standardized patient case addresses gaps in knowledge and skills to ameliorate the care of children and adolescents with behavioral crises in the hospital. Resident learners were presented with a teenage patient admitted to the hospital and awaiting inpatient psychiatric placement for suicidal ideation who became acutely agitated with aggressive behaviors. Learners were expected to attempt to verbally de-escalate the patient and select an appropriate pharmacologic agent for decreasing agitation in the patient. A standardized debrief was conducted with the assistance of child and adolescent mental health experts. Twenty-two learners participated in this activity. Residents' confidence in their management skills of the acutely agitated pediatric patient significantly increased after completion of the activity. Seventy-three percent of learners felt confident or very confident in their de-escalation skills at the end of the case, and 86% agreed that the case improved their confidence in managing acute agitation scenarios on the inpatient wards. This case led to overall increased self-efficacy in caring for the acutely agitated pediatric patient. Future iterations may include multidisciplinary learners of various skill levels and evaluating changes in patient-centered outcomes, such as restraint use, after implementation of the case.

Exploring the experience of undergraduate nursing students following placement at psychiatric units in China: A phenomenological study

AimTo explore undergraduate nursing students' experiences of psychiatric placements. BackgroundPlacement is an important learning phase for undergraduate nursing students and the placement experiences may affect their career choices. However, nursing students' experiences of psychiatric placements have not been fully explored in China. DesignThis study adopted a descriptive, phenomenological design. MethodsAfter psychiatric placement, a semi-structured interview was conducted in June 2022 among 22 final-year undergraduate nursing students using purposive sampling. The data were analysed using Colaizzi’s seven-step analysis method. ResultsFive themes were identified: i) destigmatising mental illness; ⅱ) beneficial communication; ⅲ) gaining confidence; iv) disappointment and sadness; and v) fear and discomfort. ConclusionNursing students experienced various positive experiences and negative emotions during their psychiatric placement. Further research should explore and validate appropriate educational strategies to optimise students’ placement experiences to increase their career interest in psychiatric nursing.

The perils of boarding: A call to achieve parity in the delivery of acute psychiatric services for children with COVID-19.

Boarding across pediatric healthcare systems is on the rise during the pandemic. Children with positive COVID-19 test results awaiting psychiatric placements in the emergency department or medical unit settings are at increased risk for decompensation with unmet psychiatric needs during a time of crisis marked by vulnerability. There is scant literature unveiling best practices on delivery of care for these patients to achieve acute crisis stabilization. Recent studies have uncovered substantial increases in mental health disorders among children during the pandemic compared to previous incidence and prevalence rates prior to the pandemic. From the published literature, two healthcare systems have initiated long-term planning, development, and implementation of biodome psychiatric units for patients with COVID-19 in need of acute crisis stabilization services. We sampled 100 acute inpatient child and adolescent psychiatric programs to discern their post-COVID positive clearance policies for admission. Findings were mixed among days of quarantine required, symptomology, covid-designated spaces vs. self-isolated rooms for psychiatric treatment, number of COVID negative retests, and additional considerations. We also review a range of considerations and recommendations for clinical practice and the health system in achieving parity in mental health care for these patients which in turn could contribute towards mitigating the rising global mental health crisis. Furthermore, increasing access to acute psychiatric services for these patients will also contribute towards the larger goal of the World Health Organization, Sustainable Developmental Goals of the United Nations, and Healthy People 2030 in increasing accessibility, quality and equity of mental health care for individuals on both global and national frontiers.

Homeless in the hospital: A call to strengthen multidisciplinary care for children awaiting out-of-home and psychiatric placements.

Increasingly more school-age and adolescent children continue to await psychiatric or out-of-home placements across pediatric healthcare systems. These children comprise the growing overstay pediatric population. The medical, developmental, socioemotional, behavioral and academic needs of these patients are complex and diverse. The uncertainty of waiting times for placement further continues. This growing pediatric issue emphasizes the importance of mobilizing a myriad of resources across healthcare and community contexts to support these patients during this precarious time. The reality is that there is a significant scarcity of placement resources which contributes to extended waiting times for placement. This contemporary issue brings child development, ethical and moral considerations, and healthcare operations to the forefront. We discuss a myriad of dimensions surrounding this growing issue from our clinical practice. We present a wealth of recommendations in working through each of these dimensions through a multi-systems approach that include development of individualized care plan, access to consistent psychiatric services, and implementing short-term and long-term goals pertaining to treatment and placement. We also review our clinical practices that have supported these patients on a continuum at our healthcare institution which integrate our recommendations and also involve an open line of communication with established community partners involved in the care of these children. Furthermore, we propose suggestions from an operational perspective on developing a comprehensive, multidisciplinary care model for this fragile and oftentimes neglected patient population across the healthcare system as the basis to achieve equity and translational impact in the quality and delivery of healthcare care services across pediatric healthcare systems.

Pharmacologic restraint use for children experiencing mental health crises in pediatric hospitals.

Children in mental health crises are increasingly admitted to children's hospitals awaiting inpatient psychiatric placement. During hospitalization, patients may exhibit acute agitation prompting pharmacologic restraint use. To determine hospital-level incidence and variation of pharmacologic restraint use among children admitted for mental health conditions in children's hospitals. We examined data for children (5 to ≤18 years) admitted to children's hospitals with a primary mental health condition from 2018 to 2020 using the Pediatric Health Information System database. Hospital rates of parenteral pharmacologic restraint use per 1000 mental health bed days were determined and compared after adjusting for patient-level and demographic factors. Cluster analysis (k-means) was used to group hospitals based on overall restraint use (rate quartiles) and drug class. Hospital-level factors for pharmacologic restraint use were compared. Of 29,834 included encounters, 3747 (12.6%) had pharmacologic restraint use. Adjusted hospital rates ranged from 35 to 389 pharmacologic restraint use days per 1000 mental health bed days with a mean of 175 (standard deviation: 72). Cluster analysis revealed three hospitals were high utilizers of all drug classes. No significant differences in pharmacologic restraint use were found in the hospital-level analysis. Children's hospitals demonstrate wide variation in pharmacologic restraint rates for mental health hospitalizations, with a 10-fold difference in adjusted rates between highest and lowest utilizers, and high overall utilizers order medications across all drug classes.

35.1 The Boarding Crisis: A Background and Overview of Pediatric Patients Awaiting Psychiatric Placement on Medical Units

The number of children and adolescents presenting to emergency departments (ED) in need of inpatient psychiatric care has risen dramatically in the last 2 years, in part related to the mental health impact of the COVID-19 pandemic. Due to the shortage of inpatient psychiatric beds, these patients often are cared for in the ED or on pediatric medical units for prolonged periods of time while they are awaiting appropriate inpatient placement, a practice that is commonly referred to as “boarding.”

Insider, Outsider, Observer: Reflections of a Young Black Female Trainee on a Psychiatric Placement

This paper explores the experience of a short-term psychiatric placement completed by a first-year Child and Adolescent Psychotherapist in training. Thought is given as to how three specific attributes of the trainee: being black, being female, and being a participant observer shaped the author's experience and the lessons learned. The theory of Internal Racism (Davids, 2011) is used to highlight how a racist structure in the mind acted to navigate and resolve anxiety before the placement began and during its course. Fanon's (1952/2008) notion of ‘the Black Problem’ is also used to show how historical colonial patterns of relationship have been internalized into a social unconscious and so shaped the trainee's interactions with all individuals on the ward. Two examples are described to illustrate how exchanges with others can be influenced by race. These include ‘the nod’, a subtle form of recognition used amongst black people and ‘racial codeswitching’, adjusting one's self-presentation with the purpose of assimilation. Further thought is given to the practicalities of therapeutic treatment in contrast to medication.

Moral Distress Amid the Pediatric Behavioral Health Crisis: A Call to Action

Moral Distress Amid the Pediatric Behavioral Health Crisis: A Call to Action

Improving Clinical Skills in Psychiatry Using Online Simulation

AimsThe COVID-19 pandemic impacted medical education with teaching moving online. The aim of this study was to evaluate whether online simulation is an effective tool for the delivery of student psychiatric clinical skills teaching. This has important implications for the future planning of psychiatric clinical skills teaching.Methods162 students were divided across nine online psychiatric simulation sessions held over a four month period. The sessions lasted 3.5 hours and consisted of three simulated scenarios with a professional actor and experienced facilitator. Students were asked to rate: confidence in taking a psychiatric history, conducting a mental state exam, formulating treatment plans, conducting risk assessment, assessing capacity and communicating with patients in psychiatry. Confidence ratings were completed pre and post session on Likert scale (1 = least confident, 10 = most confident). Students were also given the opportunity to provide qualitative feedback after the sessions. The study was conducted with permission from Associate Dean for Undergraduate Teaching and QMUL Centre Lead for Psychiatry.Results137 (92.7%) of students attending the workshop completed pre-session questionnaire and 122 (82.4%) completed post-session questionnaire. 95.1% students rated workshops as good/very good. Pre and post confidence comparisons showed significant increases in average confidence for all questions from pre (M = 5.1, SE = 0.2) to post (M = 7.1, SE = 0.2), t = 10.7 p < 0.001. Paired t-tests were used to compare average pre and post-session results for individual questions from the same session. All questions showed significant increases in scores. Qualitative feedback indicated that students valued the opportunity to practice, obtain feedback and requested more sessions.ConclusionResults show significant increases in confidence in psychiatric clinical skills using online psychiatric simulation. This supports our hypothesis that online simulation is an effective tool for delivery of student psychiatric clinical skills teaching. Students may benefit from online simulation increasing their confidence prior to attending psychiatric placements. This teaching method will also provide an additional method for practising clinical skills with increasing student numbers and demands on psychiatric placements. It therefore has important implications in the future of psychiatric education and could be adapted for use across clinical years and medical schools.

Music Therapy Program Development for Pediatric Patients in a Medical Facility Awaiting Behavioral/Mental Health Placement

Abstract There is a growing need for support and treatment of individuals experiencing a mental health crisis, especially among the pediatric population. Pediatric patients in need of psychiatric stabilization have little access to supportive services during interim hospitalizations prior to psychiatric admission. The purpose of the evidence-based practice project was to assess if music therapy was an effective intervention to support pediatric behavioral/mental health (BMH) patients awaiting medical stabilization and psychiatric placement. Music therapy services were offered, consisting of interventions to promote positive coping and normalization and to decrease anxiety and behavioral outbursts in pediatric BMH patients. Pre- and post-behavioral states and characteristics of engagement demonstrated a beneficial change after the music therapy session(s) as evidenced by 88.5% of recorded patients reaching a positive behavioral state and 86.9% demonstrating a higher level of engagement. Music therapy was an effective intervention to support pediatric BMH patients awaiting medical stabilization and placement. The availability of music therapy services for BMH patients can produce positive effects for patients, families, and medical staff.

Communiquer l’évaluation psychométrique dans les rapports d’expertise : quels challenges selon les experts psychiatres et psychologues ?

ObjectivesFor more than a century, psychiatrists and psychologists have seen their field of activity expand and their role become more important in the courts, particularly in criminal matters. Indeed, their solicitation by magistrates increases to realize forensic reports. In Belgium, the new law on psychiatric placements of criminals (May 5, 2014) has increased the value of expertise in criminal justice. This law stipulates that when an individual has committed a criminal offence and there is reason to consider that he was suffering from a mental disorder at the moment of the offense, it is possible to resort to his placement within a secure psychiatric hospital, provided that a psychiatric expertise is performed. Through a Royal Decree (2018) of this law, psychiatric expert must now write his findings according to an established standard model: a psychiatric expertise framework. A body of research has highlighted the significant influence of the mere presence of the expert report, according to its form and content. Moreover, the expert's speech can have a significant influence on the perception of the magistrates and their decisions. However, few empirical studies have investigated what experts said or should say in their reports in Belgium. As a result of these findings, this research studies the communication of psychometric assessments in expert reports. MethodsThrough semi-structured interviews, we gathered the opinions of seven psychiatrics’ or psychologists’ expert about the writing of their expert reports. These professionals all had significant professional experience in the field of expertise. Their discourses were analyzed through a thematic content analysis with a mixed approach (deductive and inductive). ResultsThe experts highlighted a lack of use of the compulsory psychiatric expertise framework, explaining not to be aware of the existence of the framework and its obligation to apply. However, they emphasize the advantage to use it in order to obtain a better homogeneity. Majority of them use structured diagnostic's assessment instruments to bring more objectivity to their findings. They also emphasize their efforts to make their reports as easy to understand as possible. In this respect, they prefer as much as possible a clinical type of communication, free of statistical data. Regarding the recidivism risk's assessment, it seems to be more systematized and generally carried out by means of structured instruments. Finally, most of the experts in the sample preferred to communicate the risk of recidivism in the form of verbal labels (low, moderate, high), as this seemed to them to be more understandable. Moreover, results show an overestimation of the risk when it is communicated in the form of probability (e.g. 80%) or frequency (e.g. 8/10). ConclusionsThis research explored, in the Belgian criminal field, the perception of psychiatric experts and psychologists concerning the writing of psychiatric expertise. This study is an applied research with an innovative character and the objective of confronting the reality in the field. Despite the observation of a systematization of the use of structured evaluation instruments, it remains essential to make the judicial actors aware of the obligation to respect the current psychiatric expertise framework. In addition, the popularization and use of a clinical type of writing is to be recommended.

GP Trainees' perceptions and experiences of the training placement in Psychiatry - A qualitative study

AimsThis qualitative study aims to explore the leaning needs of the GP trainees for their psychiatry placements.MethodIn this qualitative study, semi-structured interviews of eight former GP trainees were conducted. Data were transcribed and analysed using thematic analysis. Triangulation through multiple analysts” was used to improve the validity of the studyResultThis study identified six key areas of learning needs for GP trainees during their psychiatry placement. i) the on-call experience which enabled the participants to learn how to manage acutely unwell patients in psychiatry, ii) learning the self-harm and suicidal risk assessment which is an important skill for a GP practising in primary care, iii) training in relation to psychiatric medication which enabled GPs to prescribe more confidently in the community, iv) exposure to the community psychiatry which was helpful in getting exposure to community-based clinical practice, v) learning from formal teaching activities which can be tailored to cover the relevant primary care related clinical topics and finally, vi) getting the opportunity to improve the communications skills during the psychiatry placement which is useful for all doctor in training.ConclusionWe recommend that detailed induction of the service setup is required before GP trainees start on-calls and a well-defined support network should be provided and explained to the training doctors. Risk assessment teaching should be delivered by formal training, regular supervision and discussions. Training on psychiatric medication especially in the context of GP prescribing should be considered as part of formal teaching experience. Opportunities to work with community mental health teams and outpatient clinics should be generated and offered to the trainees. Formal teaching sessions should be set up with an understanding of the GP training curriculum and their learning needs. Improvement of communications skills with exposure to difficult communication scenarios under supervision during psychiatric placement should be identified as an important area of learning for the GP trainees.

Stigma towards psychiatry: correlating personal experience with existing literature

AimsStigma towards psychiatry feels rife within medical school and this extends from university life into clinical placements. Mental health remains an unattractive area of medicine and is frequently regarded as subpar by other specialists. Against existing literature, this study compares the authors first hand experiences over the last five years within medical school to evaluate how representative their experiences of stigma in psychiatry are for the wider community and published literature. The study aims to inform the wider discussion on this topic and offer areas where intervention may yield a better perception and hence uptake of this specialism.MethodLiterature review relating to the topic was completed. Studies pertaining to medical students and/or educators views and experiences of psychiatric medical education and clinical placement were included for discussion. A reflection on the first author's specific experiences to date of psychiatry and his intent to pursue psychiatric career was conducted, with careful reference to existing literature. This allowed validating personal experiences in light of shared experience within the medical community in various national and international settings.ResultArguably, some non-psychiatric clinicians do inadvertently set the scene early in medical school for the stigma that is to be thrust upon students. This builds upon prospective students ranking psychiatry low for satisfaction, prestige and stating it to be a ‘pseudoscience’ or words to that effect. The lack of understanding from junior medical students of the role of the psychiatrist sees them associating psychosocial education as equivalent to psychiatry. This reinforces the idea of psychiatry being grounded in sciences other than anatomy, biochemistry, physiology and pharmacology. On clinical placement, there is little cross-speciality support for those students who want to be psychiatrists and sometimes even lost opportunities for those publically aspiring towards psychiatry. Placements in psychiatry give students a better understanding of psychiatry but this does not seem to significantly change their career aspirations and this is rather defined from the admission stages.ConclusionAfter comparing experience with literature, stigma towards psychiatry appears to be universal. It may be important to consider the types of students who are being attracted to medical school as currently students seem to have an intrinsic disinterest in psychiatry despite later becoming better informed through psychiatric placement. Culture is notoriously hard to change, particularly within medicine. This stigma exists both in the lay and medical communities with early potentially inaccurate lay views of psychiatry being validated and reinforced throughout medical school.

Edu-couch-ing the masses: an online, multi-disciplinary psychiatry teaching programme

AimsIn response to medical students expressing concer at limited access to psychiatric placements, particularly on-the-ground teaching or witnessed patient cases, we established “Psych From The Couch” – an open-access, free, Zoom-based, interactive teaching programme. We sought to:Explore new means of psychiatric education, assess needs of multiple “categories” of student – medical, nursing, or PA students, junior doctors, wider MDT – and meet those needs in a creative, yet virtually-limited format.Assess disparities between students' self-declared learning deficits and objective knowledge gaps.To explore the use and value of virtual programmes as a structured means for inclusive multi-disciplinary education of psychiatric practice.MethodWe gathered information on students' self-declared learning needs and deficits, location, role, training level, and confidence at the outset of the programme, with data from ~180 “students”.We experiemtned with learning styles and methods of online interaction, running a series of 10 sessions - recorded for those unable to attend - incorporating the bredth of psychiatric curricula:Diagnostic Principles“Organic” PsychiatrySubstance MisusePsychotic DisordersAffective DisordersOld Age PsychiatryCAMHSEmergencies & LegalitiesExaminations in PsychiatryReal World PsychiatryWe utilised initial sign-up forms and repeated feedback requests to assess wider student needs, establish overarching structure to our programme, and ensure learning objectives were appropriate and met.We collated final feedback and scores at the close, assessing via examination questions and self-defined Likert scale, and incentivising feedback with a final portfolio certificate.ResultDemographics of open-access teaching varied broadly, from senior medical staff to access to medicine students; 92.9% were medical students. Students were diversely sourced from all years', with ~50% collectively in their penultimate or final years' of study.Most common self-defined decficits reported were understandably anxiety regarding practical examinations or assessment given recent placement restrictions, however many reflected on anxieties regarding psychiatric emergencies, substance misuse, legal frameworks, personality disorders as a diagnostic category, and pharmacological management.Our cohort responded warmly to our teaching style and techniques, with feedback and consequent improvements to teaching technique weekly. We were able to evidence improvements to global confidence, and confidence in key areas of prior learning anxiety.ConclusionCategorising self-defined deficits yielded fasctinating information on students' perception of their learning needs and deficits; these data may offer insight into potential deficits in the scope of nationwide psychiatric teaching.We were able to separately identify international students' or professionals' self-defined needs as distinct from UK students and graduates, with further rich data on the potential needs of those entering the NHS workforce.We also evidenced – with data regarding increased confidence, fewer self-defined learning deficits, significant Twitter social interaction, and in practical application of a virtual teaching methodology – proof of the concept of “Psych From The Couch”.

Normativity, Marginality, and Deviance in a Psychiatric Placement: A Parallel Process

This article explores links between normativity, marginality, and deviance via the experiences of the author, a trainee psychotherapist on a psychiatric placement in an American mental health emergency services unit. Drawing on her own experience as a woman of Sri Lankan heritage living in postcolonial Great Britain, she weaves together themes of identity, power, and marginalization, asking questions about the lived experience of those who are positioned as deviant by normative society. She uses the work of social and political theorists to illustrate how such themes are integrated at a wider group level. Two distinct forms of writing are used as a self-reflexive mechanism offering both personal revelation and critical analysis: the autoethnographical and the theoretical as a method of intersubjective textual speculation on that which lies in and outside of awareness. The author holds the view that there are gains to be made when we place psychotherapeutic concerns back into the world in which we live.

Balint Groups for Foundation and GP Trainees

Balint groups are increasingly offered to doctors in training, both to give support to the doctors and to develop a deeper empathic understanding of their patients, the family and the clinical team. We describe Balint groups; the history of such groups and current applications. Using material from groups we ran over a three‐year period, we consider practical and theoretical aspects of setting up short‐term, contemporary Balint groups for doctors working in four‐month psychiatric placements as part of their foundation or GP training in medicine. Current medical and psychiatric practice is gradually moving away from the dyadic doctor–patient relationship, with the use of wider team members and family as an integral part of patient care. In addition to the doctor–patient dyad traditionally explored in a Balint group we consider ways in which group analytic ideas have an important role to play. We consider that group analytic concepts enhance the Balint groups and add to the experience of those leading the groups. We describe how these can be used to illuminate unconscious factors within Balint and supervision groups. We use clinical vignettes to demonstrate some of our experiences, using both group analytic and Balint ideas.

The Predictive Properties of Psychiatric Diagnoses, Dynamic Risk and Dynamic Risk Change Assessed by the VRS-SO in Forensically Admitted and Released Sexual Offenders.

Psychiatric diagnoses, static risk factors, and criminogenic needs at time of admission and release were examined in a mentally ill sample of psychiatrically detained sexual offenders. Although clinically found to be at low or even very low risk at discharge, 12% reoffended sexually over an average follow-up of 7 years. Psychotic disorders were present in only 5% of offenders, whereas 93% had a personality disorder diagnosis and 76% a paraphilic disorder diagnosis. Only exhibitionism and alcohol misuse were associated with relapse. Static risk factors captured by the Static-99 also did not significantly predict recidivism; however, the VRS-SO—a structured risk assessment tool that assesses criminogenic needs and changes in risk from treatment or other change agents, rated retrospectively on the present sample—predicted sexual recidivism as well as any new imprisonment or psychiatric placement. In particular, the sexual deviance factor of the VRS-SO had large in magnitude predictive associations with sexual reoffending, while treatment related changes assessed on this factor were significantly related to non-reoffending. Findings corroborate the advantages of structured risk assessment and structured change monitoring, particularly for complex clientele such as mentally ill sexual offenders.