Most violence risk assessment tools have been validated predominantly in males. In this multicenter study, the Historical, Clinical, Risk Management–20 (HCR-20), Historical, Clinical, Risk Management–20 Version 3 (HCR-20V3), Female Additional Manual (FAM), Short-Term Assessment of Risk and Treatability (START), Structured Assessment of Protective Factors for violence risk (SAPROF), and Psychopathy Checklist–Revised (PCL-R) were coded on file information of 78 female forensic psychiatric patients discharged between 1993 and 2012 with a mean follow-up period of 11.8 years from one of four Dutch forensic psychiatric hospitals. Notable was the high rate of mortality (17.9%) and readmission to psychiatric settings (11.5%) after discharge. Official reconviction data could be retrieved from the Ministry of Justice and Security for 71 women. Twenty-four women (33.8%) were reconvicted after discharge, including 13 for violent offenses (18.3%). Overall, predictive validity was moderate for all types of recidivism, but low for violence. The START Vulnerability scores, HCR-20V3, and FAM showed the highest predictive accuracy for all recidivism. With respect to violent recidivism, only the START Vulnerability scores and the Clinical scale of the HCR-20V3 demonstrated significant predictive accuracy.
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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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Research shows that victimization rates in forensic mental health care are high for both female and male patients. However, gender differences have been found in types and patterns of victimization (more sexual abuse and more complex trauma for women), cognitive appraisal, and response to traumatic events. Gender-responsive treatments focusing on trauma have been designed to adhere to these gender differences; however, despite promising research results, these interventions are yet to be introduced in many settings. This study examined how trauma is addressed in current clinical practice in Dutch forensic mental health care, whether professionals are knowledgeable of gender differences in trauma, and how gender-responsive factors such as self-esteem, self-efficacy, social relations, and coping skills are considered in treatment for female patients. We used a mixed-method design consisting of an online survey and 33 semi-structured interviews with professionals and patients. The results suggested that Dutch forensic mental health care could address trauma more structurally, and professionals could be more aware of gender differences and gender-responsive factors. Early start of trauma treatment was deemed important but was not current practice according to patients. Based on this study, guidelines were developed for gender-responsive, trauma-informed work in forensic mental health care.
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Aggressive incidents occur frequently in health care facilities, such as psychiatric care and forensic psychiatric hospitals. Previous research suggests that civil psychiatric inpatients may display more aggression than forensic inpatients. However, there is a lack of research comparing these groups on the incident severity, even though both frequency and severity of aggression influence the impact on staff members. The purpose of this study is to compare the frequency and severity of inpatient aggression caused by forensic and civil psychiatric inpatients in the same Dutch forensic psychiatric hospital. Data on aggressive incidents occurring between January 1, 2014, and December 31, 2017, were gathered from hospital files and analyzed using the Modified Overt Aggression Scale, including sexual aggression (MOAS+). Multilevel random intercept models were used to analyze differences between forensic and civil psychiatric patients in severity of aggressive incidents. In all, 3,603 aggressive incidents were recorded, caused by 344 different patients. Civil psychiatric patients caused more aggressive incidents than forensic patients and female patients caused more inpatient aggression compared with male patients. Female forensic patients were found to cause the most severe incidents, followed by female civil psychiatric patients. Male forensic patients caused the least severe incidents. The findings have important clinical implications, such as corroborating the need for an intensive treatment program for aggressive and disruptive civil psychiatric patients, as well as emphasizing the importance of gender-responsive treatment
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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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Women and girls represent only a minority in the penitentiary system and in forensic mental health care. About 6%–10% of both prison and forensic psychiatric populations in Western countries comprise women (see for the most recent offi cial statistics in the UK w ww.gov. uk/government, in Canada w ww.statcan.gc.ca, and in the US w ww.bjs.gov) . However, there seems to be widespread agreement that in the past 20 years female offending has been on the rise, especially violent offending and particularly among young women ( Miller, Malone, and Dodge, 2010; M oretti, Catchpole, and Odgers, 2005) . Overall, a disproportionate growth of females entering the criminal justice system and forensic mental health care has been observed in many countries (for reviews, see Nicholls, Cruise, Greig, and Hinz, 2015; Odgers, Moretti, and Reppucci, 2005 ; Walmsley, 2015) . In addition, it should be noted that the ‘dark number’ for women is suggested to be bigger than for men. Offi cial prevalence rates of female offending might constitute an underestimation as women usually commit less reported offences, for example, domestic violence (N icholls, Greaves, Greig, and Moretti, 2015) . Furthermore, it has been found that – if apprehended – girls and women are treated more leniently by professionals and the criminal justice system. Generally, they receive lower prison sentences and are more often admitted to civil psychiatric institutions instead of receiving a prison sentence or mandatory forensic treatment after committing violence ( Javdani, Sadeh, and Verona, 2011 ; Jeffries, Fletcher, and Newbold, 2003 ). Hence, although female offenders compared to male offenders are a minority, female violence is a substantial problem that deserves more attention. Our understanding of female offenders is hindered by the general paucity of theoretical and empirical investigations of this population. In order to improve current treatment and assessment practices, our knowledge and understanding of female offenders should be enlarged and optimised (d e Vogel and Nicholls, 2016 ).
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"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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Important gender differences, relating to trauma history, offending and mental health needs are not sufficiently considered in most (risk) assessment and treatment procedures in forensic practice. We developed guidelines for gender-responsive work in Dutch forensic mental health care. The experiences of practitioners and forensic psychiatric patients were collected and analyzed by means of an online survey (n = 295), interviews with professionals (n = 22), female (n = 8) and male (n = 3) patients. Guidelines regarding gender-sensitive (risk) assessment and trauma-informed care were rated as most relevant in the survey. In the interviews we focused on experiences and wishes for trauma treatment and gender-mixed treatment. Practical guidelines were written based on the results of the survey, interviews and literature, and presented in expert meetings with patients and practitioners, and further refined based on their comments. Applying these guidelines may contribute to improved treatment for female patients thereby preventing relapse.
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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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Inpatient violence can have a major impact in terms of traumatic experiences for victims and witnesses, an unsafe treatment climate, and high-financial costs. Therefore, the purpose of this paper is to gain more insight into patterns of violent behavior, so that adequate preventive measures can be taken.
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