Self-harming behaviors and forensic system-related factors: an analysis of the Ontario review board database.

BACKGROUND: In Canada, ensuring public safety, and the safety and well-being of accused individuals under the jurisdiction of the provincial review board are very important. While previous studies have reported a significant risk of self-harming behaviors (non-suicidal self-injury and suicide attempt) in forensic psychiatric settings, no large population study has assessed any relationship between forensic system-related factors and self-harming behaviors. A better understanding of these factors can help clinicians implement protective measures to mitigate self-harming behaviors or actions. METHODS: Using the Ontario Review Board (ORB) database covering 2014-2015 period (n = 1211, mean age = 42.5 ± 13.37 years, males = 86.1%), we analyzed the prevalence and factors associated with self-harming behaviors, emphasizing the characterization of the forensic system-related factors (ORB status, legal status, type of offense, previous criminal history, and victim relationship). The relationships between the forensic system-related factors and self-harming behaviors were explored using five separate logistic regression models, controlling for clinical and sociodemographic characteristics. RESULTS: Approximately 4% of the individuals in the forensic system over the study period engaged in self-harming behaviors Among the studied patients, individuals determined to be unfit to stand trial and inpatients were significantly more likely to have self-harming behaviors. There was no significant relationship between the type of offence, victim relationship, and previous criminal history with self-harming behavior. CONCLUSION: Forensic psychiatry inpatients should have close observation, screening, monitoring, and individual tailored management strategies for self-harming behaviors. The findings of this study indicate that forensic system-related factors, especially those that pertain to the status of individuals in the forensic system (i.e., unfit to stand trial and being an inpatient) are more responsible for self-harming behaviors among forensic patients in Ontario.

Electroretinography and suicidal behaviors: a systematic review.

BACKGROUND: Electroretinogram (ERG) is one of the tools used to investigate the electrophysiological underpinnings of mental health illnesses and major clinical phenomena (e.g., suicide) to improve their diagnosis and care. While multiple studies have reported specific ERG changes among individuals with suicidal behaviors, we know of no review that has been done to characterize their findings to inform future research. METHODS: This review included available literature concerning ERG and suicidal behaviors. The paper's first section briefly overviews the theoretical basis of ERG and neurotransmitters involved in suicidal behaviors. The second section describes the findings of a review of studies reporting ERG findings among individuals with suicidal behaviors. RESULTS: Most reviewed studies reported normal amplitude and implicit time of the a-waves, but the latency in individuals with suicidal behaviors was lower than normal. Additionally, the b-waves amplitude was reduced, but the implicit time and latency were increased. The b-a amplitude ratio and oscillatory potential were decreased. CONCLUSION: Despite identifying certain ERG correlates with suicidal behaviors in the existing studies, there is a need for adequately powered and methodologically robust studies to advance clinical translation.

Forensic-Correctional Psychiatric Services in Abu Dhabi: Lessons From a Descriptive Analyis of the Attributes of a Sample of Service Users.

BACKGROUND: Forensic-correctional psychiatric services are an important component of the public mental health services that provide care to offenders with mental illness in the criminal justice system and conduct psycho-legal assessments. Although forensic-correctional psychiatric services have evolved in Abu Dhabi, more work is needed in providing adequate mental health care for offenders. METHODS: This study provides a situational analysis of forensic-correctional psychiatric services in Abu Dhabi. We included a descriptive analysis of the data collected on service users admitted for psycho-legal assessments and treatment in the forensic-correctional units and those reviewed in the medical board units for issuing court reports. The study spanned the period between January 2019 to October 2020. RESULTS: A total of 398 males were included in the study. The participants' mean age was 35.3 (SD 9.27) years and were predominantly single, unemployed and high school graduates. The most prevalent diagnosis was schizophrenia spectrum disorder, (n=129, 31.6%). The mean length of stay in the forensic-correctional unit was 11.07 days. As many as 82.4% of the participants were referred for evaluation. The most common type of crime was categorized as "abnormal behaviour" under the code of practice number 511 of the list of crimes as per the general prosecutor of the United Arab Emirates followed by violence. CONCLUSION: Considering the level of demand for services and the limited number of forensic-correctional health professionals, there is a need for more resources to develop expertise, clinical services and infrastructures to expand the practice of forensic-correctional psychiatry. The creation of a universal database for all forensic-correctional psychiatric services is needed to better understand the unmet mental health needs. An additional investment of resources for research to inform mental health policy, laws and practice is indicated. Optimally, the lessons highlighted in this study can guide action plans for improving forensic-correctional mental health services in comparable settings.

Public perceptions of psychiatric, justice-involved, and elderly populations during the COVID-19 pandemic.

The novel coronavirus disease (COVID-19) has had a significant global impact, with all countries facing the challenge of mitigating its spread. An unprecedented shortage of medical resources has raised concerns regarding allocation and prioritization of supplies, which may exacerbate social discrepancies for already vulnerable populations. As public opinion can impact healthcare policies, we aimed to characterize perceptions of psychiatric, forensic psychiatry, correctional, and elderly populations regarding COVID-19-related issues. This web-based study recruited participants (n = 583) from the general population in North America. The survey included perceptions of the pandemic, hypothetical scenarios on resource prioritization, and Likert scale questions. The majority of participants were cisgender female (72.7%), aged 31-74 years (80.0%), married (48.0%), retired (52.7%), resided in Canada (73.9%), had a college/university degree (50.9%) and had never worked in healthcare (66.21%). Most respondents reported not having a criminal history (95.88%), or a psychiatric disorder (78.73%). Perceptions of vulnerable populations were significantly different for resource allocation and prioritization (e.g., ventilator and vaccine resources, all p < 0.001). Healthcare workers and the elderly were commonly ranked the highest priority for resources, while forensic psychiatry and correctional populations were given the lowest priority. A high rate of disagreement was found for the more stigmatizing questions in the survey (all p < 0.0001). Our results suggest that perception from members of the general public in North America is aligned with current practices for resource allocation. However, individuals that already face social and health disparities may face additional opposition in decision-making for COVID-19 resources.

Stigmatization of psychiatric and justice-involved populations during the COVID-19 pandemic.

Psychiatric and justice-involved populations are known to be stigmatized and particularly vulnerable to adverse outcomes during COVID-19. The increased attention toward vulnerable populations from healthcare authorities, the media, and the general public has made it critical to uncover any developing stigmatization toward these groups and the possible consequences. The prioritization of public safety and shift in the prioritization of resource allocation and service delivery could lead to a rise in negative perceptions toward these already stigmatized groups. Thus, it is imperative to consider how the unique characteristics of vulnerable groups may impact their physical and mental health as well as their care during this pandemic. In this paper, we describe the challenges that psychiatric, correctional, and forensic psychiatry populations have faced during COVID-19 and how a rise in stigmatization could lead to adverse outcomes. Specifically, we outline the influence of the media on public perceptions and how stigmatization may be reflected in the allocation of resources, policies, and related decision-making during COVID-19.

Mental health services in Nigerian prisons: Lessons from a four-year review and the literature.

Forensic and correctional mental health services may constitute an important "safety net" for the mentally ill and can ensure a degree of public protection. The increasing prison populations and shift towards humane care of the mentally ill that encompasses promotion of human rights, community re-integration, utilitarian safety and operation of internationally comparable mental health legislations underscore the need to appraise correctional psychiatry services, especially in resource-restricted settings. We present findings from a review of the literature and from mental health services provided to 179 inmates in two Nigerian urban prisons. The mental health services spanned four years and allowed a focus on important issues deserving urgent attention. The mean age of participants was 33.10 years (SD = 9.91) and majority (86.6%) were males. The common clinical diagnoses among participants were schizophrenia (49.3%) and mood disorders (29.6%), while approximately half (46.5%) used psychoactive substances. About one-fifth was evaluated as having high risk for violence-dangerousness based solely on clinical evaluation. The majority (88.4%) presented with a first episode of mental illness, and 14% had a prior correctional history. Gender, marital status and hallucinatory experiences were associated with a high risk of dangerousness (p < 0.05), while gender, use of psychoactive substances, previous history of mental disorders and depot medication indexed participants more likely to have a previous forensic history (p < 0.05). Considering the current findings, we advocate for inclusion of validated tools in risk assessments, multipronged intervention strategy to address the unmet needs of prisoners and improved attention to forensic and correctional mental health in relevant policy-law, service-planning, research and training.