Special considerations to the assessment of fitness to stand trial in Australia.

Australian criminal law presumes that defendants are fit to stand trial until proven otherwise on the balance of probabilities. Forensic mental health experts often provide opinions to the court about defendants' fitness, which requires them to understand the legal context within which the court decides the defendant's fitness status. This article outlines important case law considerations to the assessment of fitness in Australia, including the notions that fitness must be evaluated when there is a 'real and substantial question', assessments should be 'reasonable and common sense' and accommodations should be considered when impairments in capacity are evident. The essentially negligible impact of delusions, an unhelpful defence, unmanageable behaviour and poor defendant-lawyer relationship are also considered. Finally, precedent is reviewed for the use of the Presser standards in New Zealand and other pacific jurisdictions.

Psychiatric well-being among men leaving prison reporting a history of injecting drug use: A longitudinal analysis.

BACKGROUND: Community reintegration from prison is typically stressful, with several health and social outcomes impacting psychiatric well-being during this time, often exacerbated among individuals with histories of drug use. Longitudinal data was used to assess change in psychiatric well-being over 2 years following release from prison among men who reported a recent history of injecting drug use. METHODS: Data for this study come from the Prison and Transition Health cohort study of 400 men recruited in prison prior to release and followed up over three time points. Psychiatric well-being was assessed using the 12-item General Health Questionnaire. We calculated change in individual General Health Questionnaire scores between interviews and identified covariates associated with General Health Questionnaire score using linear mixed-effects regression. RESULTS: Data from 690 follow-up interviews among 326 participants were included in analyses. There was considerable variation in individuals' General Health Questionnaire scores. Moving accommodation frequently and frequent illicit drug injections were associated with an increase in General Health Questionnaire score (i.e. decline in psychiatric well-being). Two or more prior adult imprisonment episodes, social supports and past month primary healthcare attendance were associated with a decrease in General Health Questionnaire score. CONCLUSION: Our findings identify health, social and structural influences on psychiatric well-being after release from prison that can inform re-entry programmes to support community reintegration.

The cross-cultural fairness of the LS/RNR: An Australian analysis.

OBJECTIVE: Cross-cultural research into risk assessment instruments has often identified comparable levels of discrimination. However, cross-cultural fairness is rarely addressed. Therefore, this study explored the discrimination and fairness of the Level of Service/Risk, Need, Responsivity (LS/RNR) within a sample of Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander males. HYPOTHESES: We hypothesized that discrimination would not be significantly different for Aboriginal and Torres Strait Islander individuals and non-Aboriginal and Torres Strait Islander individuals. We further hypothesized that some fairness definitions would be unsatisfied. METHOD: The study included 380 males (Aboriginal and Torres Strait Islander, n = 180) from Australia. Discrimination was assessed with the area under the curve (AUC) and cross AUC (xAUC). To determine fairness, error rate balance, calibration, predictive parity, and statistical parity were used. RESULTS: The discrimination of the LS/RNR was not statistically different (p = .61) between groups. The xAUC identified disparities (p < .001), with the LS/RNR being unable to discriminate between Aboriginal and Torres Strait Islander nonreoffenders and non-Aboriginal and Torres Strait Islander reoffenders (xAUC = .46, 95% CI [.35, .57]). Disparities among certain fairness definitions were identified, with Aboriginal and Torres Strait Islander individuals scoring higher on the LS/RNR (d = 0.52) and nonreoffenders being classified as high risk more often. CONCLUSIONS: The findings suggest that the LS/RNR may not be a cross-culturally fair risk assessment instrument for Australian individuals, and standard discrimination indices with comparable levels do not imply that a risk assessment instrument is cross-culturally fair. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The effects of judicial supervision on recidivism of offenders in Australia and New Zealand: a systematic review and meta-analysis.

This meta-analysis compares recidivism reduction in problem-solving courts employing judicial supervision in Australia and New Zealand to traditional processes. Using a four-phased search strategy, 16 studies totalling a treatment sample of 6588 individuals and 32,147 comparison participants were identified from 7161 unique records. Meta-analyses indicate that the problem-solving courts significantly reduced both the odds and incidences of recidivism compared with standard justice processes but that the heterogeneity observed within the latter analysis plus reliance on weak methodologies limits the strength of these conclusions. Studies at risk of bias may have had an undue influence on the odds of recidivism analysis. Additionally, the benefits of treatment on the incidence of recidivism are closely linked to the overlap of measurement and treatment periods. The findings suggest a positive impact from judicial supervision but further rigorous research is needed that closely matches experimental samples, strictly measures participants post-intervention and meticulously reports pertinent information.

Strategies to maximise study retention and limit attrition bias in a prospective cohort study of men reporting a history of injecting drug use released from prison: the prison and transition health study.

BACKGROUND: There are significant challenges associated with studies of people released from custodial settings, including loss to follow-up in the community. Interpretation of findings with consideration of differences between those followed up and those not followed up is critical in the development of evidence-informed policies and practices. We describe attrition bias in the Prison and Transition Health (PATH) prospective cohort study, and strategies employed to minimise attrition. METHODS: PATH involves 400 men with a history of injecting drug use recruited from three prisons in Victoria, Australia. Four interviews were conducted: one pre-release ('baseline') and three interviews at approximately 3, 12, and 24 months post-release ('follow-up'). We assessed differences in baseline characteristics between those retained and not retained in the study, reporting mean differences and 95% confidence intervals (95% CIs).  RESULTS: Most participants (85%) completed at least one follow-up interview and 162 (42%) completed all three follow-up interviews. Retained participants were younger than those lost to follow-up (mean diff - 3.1 years, 95% CI -5.3, - 0.9). There were no other statistically significant differences observed in baseline characteristics. CONCLUSION: The high proportion of participants retained in the PATH cohort study via comprehensive follow-up procedures, coupled with extensive record linkage to a range of administrative datasets, is a considerable strength of the study. Our findings highlight how strategic and comprehensive follow-up procedures, frequent contact with participants and secondary contacts, and established working relationships with the relevant government departments can improve study retention and potentially minimise attrition bias.

Testing the Factor Structure of the Psychopathy Checklist: Screening Version (PCL:SV) in an Australian Violent Offender Population.

Although psychopathy is a correlate of recidivism, including violent offending, the inclusion of antisocial behavior items in the Psychopathy Checklist (PCL) assessment instruments has been debated. Further, the latent factor structure underpinning the PCL measures has not been comprehensively validated in Australia. This study examined the construct validity of the PCL:SV in a sample of 192 Australian male violent offenders using structural equation modeling. The incremental validity of including the antisocial behavior items for predicting recidivism was also assessed. Approximately one-third of the sample had high scores on the PCL:SV. Construct analyses indicated strongest support for two distinct three-factor models of PCL psychopathy, with the established two- and four-factor models demonstrating poorer fit. The Antisocial factor improved predictive accuracy incrementally relative to the other three factors (Interpersonal, Affective, and Lifestyle). Area under the curve analyses revealed predictive accuracy for recidivism only for factors containing the antisocial behavior items. Findings contribute to the construct and predictive validity of the PCL measures and are discussed relative to contemporary forensic risk assessment practice.

Predictive validity of the HCR-20V3 in a sample of Australian forensic psychiatric patients.

The Historical Clinical Risk Management-20 Version 3 is the latest iteration in the HCR-20 series, adopting novel changes such as the addition of Relevance ratings and non-requirement to include the Psychopathy Checklist-Revised. This study aimed to examine these changes and compare the predictive validity of the HCR-20V3 to the HCR-20V2. The sample comprised of 100 forensic psychiatric patients, retrospectively followed up for a maximum period of approximately 13 years post-discharge from the Thomas Embling Hospital. Recidivism data were sourced from official police records. Results indicated good to excellent inter-rater reliability. The HCR-20V3 significantly predicted violent recidivism (area under the curve = .70 to .77), levels of accuracy that were not significantly different from the HCR-20V2. HCR-20V3 Relevance ratings failed to add incremental validity above Presence ratings; however, the PCL-R improved upon the HCR-20V3's validity. The study represented one of the first evaluations of the HCR-20V3 in Australia.

Investigating the predictive validity of Static-99/99R scores in a sample of older sexual offenders.

There is limited information regarding the use of risk assessment tools with aging offender populations. It is known that the likelihood of offending behaviour decreases with age, a small group of men either continue or begin to offend sexually in the later decades of life. The current study investigated the predictive validity of the Static-99 and the Static-99R, in a sample of convicted Australian sex offenders aged 50 and older. A sample of 118 participants was identified, of which 17 (14.4%) re-offended within a follow-up period ranging from four months to 20 years (M = 9.07 years). There were seven recidivists (13.46%) above the age of 60 years (n = 52) and 10 aged 40 to 59.9 years (n = 66). Both the Static-99 and Static-99R demonstrated moderate predictive validity with both age groups. The limitations of this study are discussed as well as recommendations for future research.

Mental Health, Psychological Distress, and Coping in Australian Cross-Cultural Prison Populations.

The rates of mental illness are significantly higher in prison populations compared to the general community; however, little research has examined the rates of mental illness for cross-cultural groups of prisoners in Australia. This omission is concerning given the increasingly diverse nature of the Australian prison population. To address this gap in knowledge, the present study aimed to identify rates of key mental health factors and associated psychological processes in a cohort of 191 men from culturally and linguistically diverse, Indigenous Australian and English-speaking backgrounds who were incarcerated at a maximum-security prison in Victoria, Australia. We also explored differences in both psychological distress levels and predictors of psychological distress. Although no significant mental health differences were identified cross-culturally, the results revealed that several mental health factors predicted psychological distress for all prisoners, F(11, 147) = 33.23, p < .001, R2 = .71. The experiences of anxiety and sleep disturbance-related symptoms, ß = .34; depressive symptoms, ß = .19; posttraumatic stress disorder symptoms, ß = .25; and the use of psychological processes, such as avoidance coping, ß = .16; and engagement in cognitive fusion, ß = .15, all predicted psychological distress. The use of positive thinking as a coping strategy was found to predict a reduced level of psychological distress for prisoners, ß = -.13. The findings indicated that the mental health profiles of cross-cultural groups of prisoners are similar in nature, suggesting that justice involvement may be a more useful predictor than cultural differences concerning psychological health.

The mental health of culturally and linguistically diverse offenders - what do we know?

OBJECTIVE: A key challenge facing justice health service providers is addressing and treating the high rates of mental illness among offenders. It is well documented that rates of mental illness are substantially higher within prison populations compared to the general population. As such, the need to provide ongoing treatment to prisoners experiencing mental health issues is of fundamental importance. Prisoners experiencing mental health disorders are more likely to have poorer social outcomes on release, including a greater likelihood of recidivism and poorer health outcomes. The growing numbers of justice-involved individuals from culturally and linguistically diverse (CALD) backgrounds signal the need for justice systems to adapt to the changing demographic. CONCLUSIONS: In this commentary, we argue that greater efforts to explore the nature and prevalence of mental illness among CALD groups in custody, where such concerns are often intertwined with additional complex personal, environmental and historical criminogenic risk factors, are desperately needed to improve system responses and reduce recidivism.

Crime and victimization among people with intellectual disability with and without comorbid mental illness.

BACKGROUND: Accumulating evidence internationally points to an increased risk of crime perpetration and victimization among people with an intellectual disability (ID). This study aimed to examine the impact that comorbid mental illness had on the association between intellectual disability, crime perpetration and criminal victimization. METHOD: A case linkage methodology involving 2,220 individuals with an intellectual disability from an Australian State. RESULTS: One in four (27%) had contacts with public mental health services; 8.2% had a comorbid mental illness. This "dual disability" group was between 2.97 and 3.22 times more likely than those with intellectual disability alone to have a history of criminal charges, and between 2.76 and 2.97 times more likely to have been a victim of crime. CONCLUSIONS: The extent of criminality and victimization found among people with dual disability indicates a potentially multiply stigmatized group for whom the need for a coordinated cross-agency service response remains paramount.

Asking the Right Questions: Examining the Efficacy of Question Trails as a Method of Improving Lay Comprehension and Application of Legal Concepts.

The present study examines the 'fact based' approach to jury instructions, which embeds legal concepts in a series of logically ordered written factual questions that the jury must answer to reach a verdict. The study utilised a sample of 1007 adults called for jury service in Victoria, Australia. Four instructional types (standard, plain language, checklist, fact based) were compared on paraphrase and application measures across three time points. Results indicated that paraphrase performance was significantly lower for standard instructions compared to all other instructional types at the pre-deliberation stage. Findings around application of law were mixed. At the pre-deliberation stage, participants receiving fact based instructions had significantly higher scores on true/false application questions compared with participants in other conditions, whereas there were no significant differences between conditions for multiple-choice application. However, testing following deliberation revealed that participants in the fact-based condition had significantly higher scores on multiple-choice application items.

Psychological wellbeing, distress and coping in Australian Indigenous and multicultural prisoners: a mixed methods analysis.

The Australian prison population is growing and becoming increasingly diverse. Yet very little research has investigated mental health concerns for multi-cultural prisoners. This mixed methods study aimed to identify the prevalence of mental health factors (wellbeing, distress and coping) in a cohort of 530 prisoners from Indigenous, culturally and linguistically diverse (CALD) and English-speaking backgrounds (ESB) at a maximum-security prison in Victoria, Australia. Focus group interviews were also conducted with an additional 40 prisoners. It was found that Indigenous prisoners had significantly higher levels of distress and more symptoms of anxiety and depression than CALD and ESB prisoners. CALD prisoners had a greater sense of 'feeling in control' in prison than ESB prisoners. The focus group interviews also identified several factors that contributed to mental health differences between the groups. Findings reinforce the need for a more individualised approach in addressing mental health issues for prisoners cross-culturally.

Demographic, mental health, and offending characteristics of online child exploitation material offenders: A comparison with contact-only and dual sexual offenders.

Technological advances have dramatically increased the ability to access, distribute and produce child exploitation material (CEM) online, resulting in increased numbers of individuals being charged with CEM offences. This study examined the demographic, mental health, and offending characteristics of CEM offenders (n = 456) in comparison to child contact sexual offenders (n = 493) and offenders with a history of both CEM and contact offences (dual offenders, n = 256). A robust data linkage methodology was employed to link records from statewide corrections services with policing and mental health records in Victoria, Australia. The results indicated that CEM offenders differed from both contact and dual offenders, and that the groups were primarily differentiated based on two factors: antisocial orientation and sexual deviance. CEM offenders demonstrated high rates of sexual deviance but low rates of antisociality, contact offenders exhibited the opposite pattern, and dual offenders had both high sexual deviance and antisociality. The findings suggest that existing sexual offender assessment and treatment frameworks are unlikely to be suitable for exclusive CEM offenders. The implications for future research are discussed.

The Predictive Validity of the Static-99, Static-99R, and Static-2002/R: Which One to Use?

The use of Static tools (Static-99, Static-99R, Static-2002, and Static-2002R) in risk decision making involving sexual offenders is widespread internationally. This study compared the predictive accuracy and incremental validity of four Static risk measures in a sample of 621 Australian sexual offenders. Results indicated that approximately 45% of the sample recidivated (with 18.8% committing sexual offenses). All of the Static measures investigated yielded moderate predictive validity for sexual recidivism, which was comparable with other Australian and overseas studies. Area under the curve (AUC) values for the four measures across the 5-, 10-, and 15-year intervals ranged from .67 to .69. All of the Static measures discriminated quite well between low-risk and high-risk sexual offenders but less well for the moderate risk categories. When pitted together, none of the tools accounted for additional variance in sexual recidivism, above and beyond what the other measures accounted for. The overall results provide support for the use of Static measures as a component of risk assessment and decision making with Australian sexual offending populations. The limitations of this study and recommendations for further research are also discussed.

The Utility of the HCR-20 in an Australian Sample of Forensic Psychiatric Patients.

The Historical Clinical Risk Management-20 (HCR-20) is utilised internationally to assess an individual's risk for violence. Despite being widely administered in Australian correctional and forensic populations, the predictive validity of the HCR-20 instrument has never been explored in Australian settings. This retrospective study investigated the predictive validity of the HCR-20 for an Australian cohort of 136 forensic psychiatric patients. Findings support the relationship between the HCR-20 and violent offending post hospital discharge. The HCR-20 Total, Historical, and Risk Management scales shared moderate to large positive correlations with several reconviction categories.

Estimating the risk of crime and victimisation in people with intellectual disability: a data-linkage study.

PURPOSE: People with intellectual disability (PWID) appear more likely to be victims and perpetrators of crime. However, extant evidence pertaining to these risks is limited by methodological weaknesses and the absence of consistent operational definitions. This research aimed to estimate the prevalence of criminal histories and victimisation using a large, well-defined sample of PWID. METHODS: A case-linkage study was conducted comprising 2220 PWID registered with disability services in Victoria, Australia, whose personal details were linked with a state-wide police database. Criminal charges and reports of victimisation were compared to a non-disabled community comparison sample (n = 2085). RESULTS: PWID were at increased risk of having a history of criminal charges, particularly for violent and sexual offences. Although the non-disabled comparison group had a greater risk of criminal victimisation overall, PWID had a greatly increased risk of sexual and violent crime victimisation. CONCLUSIONS: PWID are at increased risk of victimisation and perpetration of violent and sexual crimes. Risk of sex offending and victimisation is particularly elevated, and signalling the need for specialised interventions to prevent offending and to ensure victims is assisted with access to justice, support, and treatment.

A comparison of psychopathology and reoffending in female and male convicted firesetters.

Little is known about the psychopathological or criminal history characteristics of female firesetters, or how often women reoffend by firesetting. The current study is one of the few large-scale longitudinal investigations to compare key psychiatric and offending variables in female and male firesetters who are not incarcerated or known to be mentally disordered. In addition, the study aimed to identify the base rate of recidivism for female firesetters compared with males. The study compared all 143 female and 909 male firesetters convicted of arson and fire-related offenses between 2000 and 2009 in Victoria, Australia. The study employed a data linkage approach to compare the psychiatric and criminal histories of participants and reoffending in the sample. Firesetters of both sexes reoffended by firesetting at similar rates (males 5.1%, females 7.0%), and reoffenders shared many characteristics. Compared with male firesetters, female firesetters were found to be less criminally versatile, to have offended less overall, and were less likely to have violent offenses. Females were more often diagnosed with depression, substance misuse, and personality disorder than men. The findings indicate that female firesetters might be suitable for assessment approaches and treatment programs offered to men, but tailored to take account of the personality and psychopathological characteristics seen more often in this group. (PsycINFO Database Record

Looking Beyond the Screen: A Critical Review of the Literature on the Online Child Pornography Offender.

This article reviews the current literature pertaining to those who engage in child pornography offending. The basic characteristics of online child pornography offenders (CPOs) and related typologies are briefly presented prior to reviewing the comparative literature pertaining to CPOs and child contact sexual offenders. In general, CPOs have been found to be relatively high functioning and generally pro-social individuals with less extensive and diverse offending histories than contact offenders. CPOs also display high levels of sexual pre-occupation, deviant sexual interests, and deficits in interpersonal and affective domains that surpass those of contact offenders. Although further research is required to replicate and clarify preliminary findings, the available evidence indicates that existing sexual offender risk assessment tools and treatment programs are not suitable for use with CPOs, and thus require revision and empirical evaluation prior to widespread use among this population. The article concludes with implications for clinical practice and directions for future research.

Crime and victimisation in people with intellectual disability: a case linkage study.

BACKGROUND: Studies have suggested that people with intellectual disability are disproportionately involved in crime both as perpetrators and victims. METHOD: A case linkage design used three Australian contact-level databases, from disability services, public mental health services and police records. Rates of contact, and official records of victimisation and criminal charges were compared to those in a community sample without intellectual disability. RESULTS: Although people with intellectual disability were significantly less likely to have an official record of victimisation and offending overall, their rates of violent and sexual victimisation and offending were significantly higher. The presence of comorbid mental illness considerably increased the likelihood of victimisation and offending; several sex differences were also noted. CONCLUSIONS: People with intellectual disability are at increased risk for both violent and sexual victimisation and offending. The presence of comorbid mental illness aggravates the risk of offending and victimisation. Future research should focus on a more nuanced exploration of the risks associated with intellectual disability and specific mental disorders and related indices of complexity.