"Purpose – Despite the rising number of females in forensic psychiatry, research about their characteristics remains limited and is currently lacking in Belgium. Optimizing knowledge about the characteristics of these women will lead to a better understanding of this specific group. Therefore, the aim of the study was to gain insight into the characteristics of female forensic psychiatric patients in Flanders, Belgium. Design/methodology/approach – A case file study was carried out in the forensic psychiatric hospital Sint-Jan-Baptist in Zelzate, Belgium. The files of female patients admitted in the period 2006–2017 were analysed (N = 82) based on a checklist including sociodemographic, mental health care and offencerelated characteristics as well as historical risk factors. Findings – The study revealed that female patients have been confronted with a large number of adverse experiences during both childhood and adulthood, were frequently diagnosed with borderline personality disorder and usually had an extensive mental health treatment history with many drop-outs. The majority of the female patients had committed violent offences towards relatives. Practical implications – These findings are similar to those of other jurisdictions and highlight the importance of a gender-responsive treatment. This kind of treatment should include trauma-informed care, gender-sensitive risk-assessment and adapted versions of dialectical behavioural therapy and schema-focussed therapy. Additionally, treatment should focus on breaking the intergenerational transmission of violence andmental health problems by targeting parenting skills. Originality/value – To the best of the authors’ knowledge, this is the first study that scientifically scrutinized the detailed characteristics of female forensic psychiatric patients in Flanders, Belgium. Recommendations for gender-responsive treatment and directions for future research are discussed."
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Aims and objectives. The Forensic Early Warning Signs of Aggression Inventory (FESAI) was developed to assist nurses and patients in identifying early warning signs and constructing individual early detection plans (EDP) for the prevention of aggressive incidents. The aims of this research were as follows: First, to study the prevalence of early warning signs of aggression, measured with the FESAI, in a sample of forensic patients, and second, to explore whether there are any types of warning signs typical of diagnostic subgroups or offender subgroups. Background. Reconstructing patients’ changes in behaviour prior to aggressive incidents may contribute to identify early warning signs specific to the individual patient. The EDP comprises an early intervention strategy suggested by the patient and approved by the nurses. Implementation of EDP may enhance efficient risk assessment and management. Design. An explorative design was used to review existing records and to monitor frequencies of early warning signs. Methods. Early detection plans of 171 patients from two forensic hospital wards were examined. Frequency distributions were estimated by recording the early warning signs on the FESAI. Rank order correlation analyses were conducted to compare diagnostic subgroups and offender subgroups concerning types and frequencies of warning signs. Results. The FESAI categories with the highest frequency rank were the following: (1) anger, (2) social withdrawal, (3) superficial contact and (4) non-aggressive antisocial behaviour. There were no significant differences between subgroups of patients concerning the ranks of the four categories of early warning signs. Conclusion. The results suggest that the FESAI covers very well the wide variety of occurred warning signs reported in the EDPs. No group profiles of warning signs were found to be specific to diagnosis or offence type. Relevance to clinical practice. Applying the FESAI to develop individual EDPs appears to be a promising approach to enhance risk assessment and management.
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Substance abuse is an important risk factor for offending, but is mostly studied in males. The aim of this multicentre study is to gain insight into possible gender differences in substance abuse history and offending behavior in forensic psychiatric patients. Files were analyzed of 275 women and 275 matched men who have been admitted between 1984 and 2014 to one of four Dutch gender-mixed forensic hospitals. Risk assessment ratings were related to registered violent incidents during treatment for both women and men and to official recidivism data after discharge for a subgroup of 78 women. Substance abuse history was coded as a risk factor for more than half of the women (56.7%), but significantly more often for men (68.4%). Men were more often diagnosed with substance dependence and more frequently committed the index-offense whilst intoxicated. Prediction of violent incidents during treatment was more accurate for men. A history of substance abuse was not a significant predictor for recidivism after discharge in the subgroup women. It is concluded that there are gender differences in substance abuse history and that the relationship with offending behavior seems stronger for men. These differences have implications for substance use treatment in forensic mental health services.
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"Background: Victimization is highly prevalent in individuals with mild intellectual disability (MID) or borderline intellectual functioning (BIF) and is an important risk factor for mental health problems and violent behavior. Not much is known, however, about victimization history in women with MID-BIF admitted to forensic mental health care. Aims: The aim of this multicenter study is to gain insight into victimization histories and mental health problems of female forensic psychiatric patients with MID-BIF. Methods: File data were analyzed of 126 women with MID-BIF who have been admitted to one of five Dutch forensic psychiatric hospitals between 1990 and 2014 and compared to data of 76 female patients with average or above intellectual functioning and to a matched sample of 31 male patients with MID-BIF. Results: All forensic paients had high rates of victimization, but women with MID-BIF showed an even higher prevalence of victimization during both childhood and adulthood and more complex psychopathology compared to female patients without MID-BIF. Compared to male forensic patients with MID-BIF, women with MID-BIF were more often victim of sexual abuse during childhood. During adulthood, the victimization rate in these women was more than three times higher than in men. Conclusions: Victimization is a salient factor in female forensic patients with MID-BIF and more gender-responsive trauma-focused treatment is needed."
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The past two decades, a disproportionate growth of females entering the criminal justice system and forensic mental health services has been observed worldwide. However, there is a lack of knowledge on the background of women who are convicted for violent offenses. What is their criminal history, what are their motives for offending and in which way do they differ from men convicted for violent offenses? In this study, criminal histories and the offenses for which they were admitted to forensic care were analyzed of 218 women and 218 men who have been treated between 1984 and 2014 with a mandatory treatment order in one of four Dutch forensic psychiatric settings admitting both men and women. It is concluded that there are important differences in violent offending between male and female patients. Most importantly, female violence was more often directed towards their close environment, like their children, and driven by relational frustration. Furthermore, female patients received lower punishments compared to male patients and were more often considered to be diminished accountable for their offenses due to a mental illness.
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The study of human factors in forensic science informs our understanding of the interaction between humans and the systems they use. The Expert Working Group (EWG) on Human Factors in Forensic DNA Interpretation used a systems approach to conduct a scientific assessment of the effects of human factors on forensic DNA interpretation with the goal of recommending approaches to improve practice and reduce the likelihood and consequence of errors. This effort resulted in 44 recommendations. The EWG designed many of these recommendations to improve the production, interpretation, evaluation, documentation, and communication of DNA comparison results.
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Insomnia has a negative impact on mental health and is a potential risk factor for impulsive and problematic behavior. This multicenter, cross-sectional study investigated the prevalence of insomnia and underlying and maintaining factors in a group of forensic psychiatric inpatients (N = 281). Insomnia severity, subjective sleep quality, sleep hygiene and erroneous cognitions about sleep were measured with the Insomnia Severity Index, Pittsburgh Sleep Quality Index, Sleep Hygiene questionnaire and Dysfunctional Beliefs and Attitudes about Sleep, respectively. Impulsivity was derived from risk assessment instruments routinely completed by trained professionals. Almost half of the patients (48.7%) appeared to suffer from insomnia. Particularly moderate-severe insomnia (26.7%) was significantly associated with worse sleep quality, poorer sleep hygiene, stronger endorsement of dysfunctional sleep cognitions and higher impulsivity scores. It can be concluded that insomnia is rather common in forensic psychiatric patients. Insomnia appears related to various sleep hygiene behaviors and sleep-related cognitions, and probably also to diverse situational and environmental factors as well as a lack of autonomy. Cognitive behavioral therapy for insomnia, with some adjustments specific for this population, may be an effective intervention, ameliorating sleep problems and possibly also emotional and behavioral dysregulation.
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In this study, growth trajectories (from admission until unconditional release) of crime-related dynamic risk factors were investigated in a sample of Dutch forensic patients (N = 317), using latent growth curve modeling. After testing the unconditional model, three predictors were added: first-time offender versus recidivist, age, and treatment duration. Postanalyses were chi-square difference tests, t tests, and analyses of variance (ANOVAs) to assess differences in trajectories. Overall, on scale level, a decrease of risk factors over time was found. The predictors showed no significant slope differences although age and treatment duration differed significantly at some time points. The oldest age group performed worse, especially at later time points. Treatment duration effects were found at the second time point. Our results that forensic patients show a decrease in crime-related risk factors may indicate that treatment is effective. This study also found differences in growth rates, indicating the effect of individual differences
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Purpose Incidents of self-injury by forensic psychiatric patients often have a deleterious impact on all those involved. Moreover, self-injurious behaviour is an important predictor for violence towards others during treatment. The aim of this study is to analyse methods and severity of incidents of self-injury of patients admitted to forensic psychiatry, as well as the diagnoses of self-injuring patients. Design/methodology/approach All incidents of self-injury during treatment in a forensic psychiatric centre recorded between 2008 and 2019 were analysed and the severity was coded with the modified observed aggression scale+ (MOAS+). Findings In this period, 299 incidents of self-injury were recorded, displayed by 106 patients. Most of these incidents (87.6%) were classified as non-suicidal. Methods most often used were skin cutting with glass, broken plates, a razor or knife and swallowing dangerous objects or liquids. Ten patients died by suicide, almost all by suffocation with a rope or belt. The majority of the incidents was coded as severe or extreme with the MOAS+. Female patients were overrepresented and they caused on average three times more incidents than male patients. Practical implications More attention is warranted for self-injurious behaviour during forensic treatment considering the distressing consequences for both patients themselves, supervisors and witnesses. Adequate screening for risk of self-injurious behaviour could help to prevent this behaviour. Further research is needed in different forensic settings into predictors of self-injurious behaviour, more specifically, if there are distinct predictors for aggression to others versus to the self. Originality/value Incidents of self-injury occur with some regularity in forensic mental health care and are usually classified as severe. The impact of suicide (attempts) and incidents of self-injurious behaviour on all those involved can be enormous. More research is needed into the impact on all those involved, motivations, precipitants and functions of self-injurious behaviour and effective treatment of it.
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The specific risks and mental health needs of women in forensic services and the relevance of gender-responsive treatment include gender differences in criminological and psychiatric characteristics; gender-sensitive risk assessment; and gender-sensitive management. Some recommendations are provided for practitioners working with women in forensic services.
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