Competing ethical paradigms in forensic psychiatry and forensic psychology: commentary for a special section of legal and criminological psychology

In her paper Gwen Adshead (2013) identifies the principle of respect for justice as the foundation for ethical practice in forensic psychiatry. This commentary discusses how forensic psychologists have approached a key aspect of the justice principle, the ethical imperative to promote the welfare of the individual client. The approaches of the psychiatric and psychological professions are compared and the role of psychologists as allied health professionals working in the forensic setting considered.

Occupational therapy in forensic psychiatry: Recent developments in our understandings (2007-2013)

Introduction: Occupational therapy in forensic settings has developed in recent decades, leading to an increasing amount of research being conducted in this field. There have been two previous attempts to provide overviews of this body of evidence and future directions for research; however, the rate of research has accelerated in recent years. This critical review addresses the following question: what evidence has been published about occupational therapy in forensic psychiatry over the past 7 years? Method: A mixed methods approach was adopted, with four databases and a search engine consulted (OTDBase, CINAHL, AMED, PSYCHInfo, Google Scholar). The inclusion criteria were: (a) articles published in peer reviewed journals since 2007 and (b) authored by at least one occupational therapist. Twenty-five studies were identified for review, and the four dimensions of occupation - doing, being, becoming and belonging - were used to provide a theoretical context for the subsequent discussion. Findings: The recent evidence base in forensic psychiatry focuses on doing and being, with fewer articles addressing becoming and belonging. Conclusion: This review has identified increasing numbers of studies about forensic occupational therapy, which may reflect growth in both interest and the worldwide workforce.

Changing violent behaviour : forensic mental health and criminological models compared

Evidence-based interventions designed to reduce the risk of re-offending, particularly violent re-offending, are commonly offered in correctional systems around the world. The interventions are often based upon the application of several principles of service delivery that have become widely known as the 'what works' approach to offender rehabilitation. The applicability of these principles to forensic psychiatric services has yet to be determined. The aims are to examine the possible application of the 'what works' approach and its implications for forensic mental health practice. The method used was a review of relevant research from both the general offender and forensic psychiatry literature. The principles underlying the 'what works' approach are likely to have utility in service delivery in forensic psychiatry, particularly when a treatment target is a reduction in risk of harm to others. The individualized models of patient care practiced in forensic psychiatry are also likely to have utility in improving treatment outcomes in correctional settings. The conclusion is that an increased interchange of ideas and interventions between the two areas of practice is likely to be of mutual benefit. This is an area that requires significant development.

Characteristics of Mentally Disordered Youth Referred to a Forensic Satellite Clinic for Violence Risk Assessment: A Case Control Study

There is a lack of appropriate services to manage youth with comorbid mental health problems and violence risks. To address this gap, we implemented a forensic satellite clinic in a youth mental health service. This paper characterises offending histories among 45 young patients referred to the clinic, and compares them with matched clinical controls (n = 45). Levels of prior risk taking and aggression were prominent among referred patients. Forensic cases and controls did not differ on demographic and clinical variables, with the exception of psychiatric inpatient admissions, which were higher among referred patients. Group differences were observed for prior offending variables (e.g., physical aggression), which were significantly higher among referred patients than controls. Findings suggest that referrals were made to the clinic based on challenging and aggressive behaviour rather than specific clinical characteristics. The role of specialist assessment, treatment and management of violence risks in youth mental health services are discussed.

Working with people who have killed: The experience and attitudes of forensic mental health clinicians working with forensic patients

Forensic mental health (FMH) clinicians sometimes feel unsupported and unprepared for their work. This article explores their experiences of working in a FMH setting in Australia. The research examined the clinical context of clinicians working with forensic patients (FP), particularly those individuals who have killed while experiencing a mental illness. A qualitative, exploratory design was selected. Data were collected through focus groups and individual interviews with hospital and community-based forensic clinicians from all professional groups: psychiatric medicine, social work, psychology, mental health nursing, occupational therapy, and psychiatric service officers. The main themes identified were orientation and adjustment to FMH, training in FMH, vicarious traumatization, clinical debriefing and clinical supervision, and therapeutic relationships. Participants described being frustrated and unsupported in making the transition to working with FP and felt conflicted by the emotional response that was generated when developing therapeutic relationships. Recommendations include the development of programmes that might assist clinicians and address gaps in service delivery, such as clinical governance, targeted orientation programmes, and clinical supervision.

The assessment of motivation for behaviour change among sex offenders against children: an investigation of the utility of the Stages of Change Questionnaire

A better understanding of motivation for behaviour change among sex offenders against children would improve treatment programmes designed to modify sexual offending behaviour. However, investigation of this issue is limited by lack of theoretically and empirically sound measures of motivation for behaviour change among sex offenders. This paper reports on two studies that were conducted to investigate the psychometric properties (validity, reliability, and social desirability) of the Stages of Change Questionnaire, adapted to measure motivation for behaviour change among sex offenders against children. In Study 1, the psychometric properties of the questionnaire were assessed for sex offenders against children (n=36) who were on a treatment waiting list. In Study 2, the psychometric properties of the questionnaire were assessed for sex offenders against children (n=47) at pre-treatment, mid-treatment, and post-treatment. Both studies supported the validity and reliability of the adapted Stages of Change Questionnaire, and the influence of social desirability upon responding was less than expected. The results of this investigation supported the potential utility of the Stages of Change Questionnaire as a measure of motivation for behaviour change for sex offenders against children.

Societal constructions of the psycho-legal notion of mental impairment in Victoria

This thesis explored the factors relevant to decision-making when the defence of mental impairment is raised in Victoria. Findings indicate that disorder type, crime outcome, and the relationship between victim and offender were significantly associated with verdict decisions, while offender gender did not play a significant role in responsibility decisions. The portfolio discusses the role of co-morbid psychopathology in the assessment and treatment of veterans with chronic PTSD by presenting four case histories.

Good lives model applied to a forensic population

According to the good lives model (GLM) all human beings seek primary goods (i.e., activities or experiences that benefit them) and offending reflects attempts to pursue these goods in ways that are unacceptable to society and damaging to the individual and others. The aim of this article was to explore how the GLM can be developed for use with a forensic population, a heterogeneous group of individuals whose common feature is the interface of the criminal justice and mental health systems. The conceptual, clinical and philosophical implications of using the good lives model of forensic mental health (GLM-FM) are explored. Three case studies are used to illustrate the ways in which the enriched model can provide a holistic approach to conceptualizing offending that occurs in the context of mental illness and in guiding treatment planning. It is suggested that the augmented model provides a clinically flexible and ethically sound framework for formulating treatment issues for forensic patients.

Enabling electronic medicine at Kiwicare : the case of video conferencing adoption for psychiatry in New Zealand

Telemedicine emerges as a viable solution to New Zealand health providers in reaching out to rural patients, in offering medical services and conducting administrative meetings and training. No research exists about adoption of telemedicine in New Zealand. The purpose of this case study was to explain factors influencing adoption of telemedicine utilizing video conferencing technology (TMVC) within a New Zealand hospital known as KiwiCare. Since TMVC is part of IT, tackling it from within technological innovation literature may assist in providing an insight into its adoption within KiwiCare and into the literature. Findings indicate weak presence of critical assessment into technological innovation factors prior to the adoption decision, thereby leading to its weak utilization. Factors like complexity, compatibility and trialability were not assessed extensively by KiwiCare and would have hindered TMVC adoption. TMVC was mainly assessed according to its relative advantage and to its cost effectiveness along with other facilitating and accelerating factors. This is essential but should be alongside technological and other influencing factors highlighted in the literature.

The treatment of multicultural issues in contemporary forensic psychology textbooks

This article examines whether practice issues relating to clients from different cultural or ethnic groups are adequately addressed in a wide selection of contemporary forensic psychology textbooks. Specifically, we examine the extent to which cross-cultural issues are engaged within these texts, and how well the information provided informs forensic practice. While most of the reviewed texts acknowledged the need to consider cultural issues, there was relatively little discussion of specific issues, and practical guidelines were rarely offered. It is argued that without more widespread acknowledgment of the direct implications of cultural issues for forensic practice, it is unlikely that a fair and reliable system for the investigation and treatment of complaints made by and against people from different cultural groups will be obtained.

Specialisation within specialisation? Thoughts on the content of contemporary forensic psychology programs

This paper provides details of, and the rationale for, a Doctorate of Forensic Psychology recently developed at Deakin University, Melbourne, Australia. The course prioritises training in psycho-legal issues with children and young people. In discussing this program, the presenters identify two issue  that guided the development of the program. The first concerns the need to delineate forensic content from that in clinical programs, while still maintaining appropriate focus on the skills needed to work effectively in forensic settings. The second addresses the need for courses to acknowledge the marked diversity among forensic clientele and to develop competencies that lead to effective work practices with these sub-groups. In constructing the Deakin forensic program, it was noted that forensic psychologists required an increasing degree of expertise in the procedural and substantive aspects of the legal system. The authors propose that as forensic psychology gains momentum as a discrete area of expertise, there is an increasing need for practitioners to have a sound understanding of the legal institutions and practices they work under, as well as being able to apply specialist knowledge to particular sub-groups. This paper discusses these issues, and outlines how the authors sought to address them in their course curriculum.

Scope of practice in forensic nursing

1. There is significant role variation, across the Western world, in relation to how forensic nurses practice. 2. The authors conducted a pilot survey of forensic nurses in Australia, New Zealand, the United States, and the United Kingdom to examine forensic nursing practice, role definition, and role boundaries. 3. Issues arising from the data include the visibility of forensic nurses, the client group, forensic-specific education, and role development.

Championing telemedicine in New Zealand : the case of utilizing video conferencing in psychiatry and dermatology

This research explores the factors that could influence telemedicine success in two hospitals involved in a rural setting in New Zealand. Findings from the cases revealed that telemedicine utilising the video conferencing technology (TMVC) was adopted based on its cost-benefit to the hospitals. This is necessary but considering the impact of other factors, specifically the compatibility factor could have made the adoption decision more effective earlier on. The administration manager was the primary instigator of TMVC in psychiatry in one of the hospitals, whereas in the other hospital it was the dermatologist. Therefore, this research emphasises the importance of the tight coupling between the roles of both the management and the clinical champions for TMVC to succeed in New Zealand. However, the research results suggest the limited use of the technology in the cases.