The Use of Crime Scene and Demographic Information in the Identification of Non-Serial Sexual Homicide.

As with other sexual offenders, sexual homicide perpetrators can be reluctant to talk about their criminal behavior. Therefore, in homicide cases, forensic practitioners frequently rely on crime scene information to identify any sexual behavior associated with the offense. This study aims to identify objective and readily available crime scene information, alongside information about victims and perpetrators, based on 65 cases from England and Wales in the United Kingdom of men convicted of homicide who had committed a non-serial sexual homicide and 64 cases of men convicted of homicide where the available evidence indicated that it was a non-serial non-sexual homicide. Chi-square tests and logistic regression were used to analyze the data. There were few differences in terms of demographic information and criminal histories between the two perpetrator groups. There were crime scene indicators supporting the use of Ressler et al.'s definition of sexual homicide. The victims of sexual homicide were generally found in their home with the lower half of the body exposed and with evidence of vaginal sex. Furthermore, extreme injuries and strangulation were more frequent in sexual homicides. Use of weapon was associated with a non-sexual homicide. Victims of sexual homicide were as likely to know the perpetrator as not. Potential benefits of the characteristics reported to investigators and forensic practitioners tasked with identifying sexual homicides are discussed and areas for further research suggested.

Treatment progress in medium security hospital settings for women: changes in symptoms, personality and service need from admission to discharge.

BACKGROUND: Service evaluations of medium secure hospital facilities for women are underrepresented in the extant literature. HYPOTHESIS: That positive changes in symptoms, personality traits and service need would be evident between admission and discharge among women in a medium security hospital service. METHODS: A pre-test/post-test design was used, with comparisons made between admission and pre-discharge points on a variety of measures of psychiatric symptoms and personality traits. RESULTS: There were significant improvements in mood according to Beck Depression Inventory scores, mood and other symptoms of mental disorder and distress as measured by the Brief Psychiatric Rating Scale and the Modified Post Traumatic Stress Disorder Symptom Scale, personality traits recorded using the Millon Clinical Multiaxial Inventory III and service need as measured by the Camberwell Assessment of Need, Forensic Version. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Significant positive change during treatment, in all clinical areas, is encouraging given poor outcomes for women reported in other research. Findings cannot, however, be unequivocally attributed to the treatments given. Further work is needed to improve early engagement and tailor treatment more specifically to the needs of a heterogeneous population.

Developing an assessment of fire-setting to guide treatment in secure settings: the St Andrew's Fire and Arson Risk Instrument (SAFARI).

BACKGROUND: Arson and fire-setting are highly prevalent among patients in secure psychiatric settings but there is an absence of valid and reliable assessment instruments and no evidence of a significant approach to intervention. AIMS: To develop a semi-structured interview assessment specifically for fire-setting to augment structured assessments of risk and need. METHOD: The extant literature was used to frame interview questions relating to the antecedents, behaviour and consequences necessary to formulate a functional analysis. Questions also covered readiness to change, fire-setting self-efficacy, the probability of future fire-setting, barriers to change, and understanding of fire-setting behaviour. The assessment concludes with indications for assessment and a treatment action plan. The inventory was piloted with a sample of women in secure care and was assessed for comprehensibility, reliability and validity. RESULTS: Staff rated the St Andrews Fire and Risk Instrument (SAFARI) as acceptable to patients and easy to administer. SAFARI was found to be comprehensible by over 95% of the general population, to have good acceptance, high internal reliability, substantial test-retest reliability and validity. CONCLUSIONS: SAFARI helps to provide a clear explanation of fire-setting in terms of the complex interplay of antecedents and consequences and facilitates the design of an individually tailored treatment programme in sympathy with a cognitive-behavioural approach. Further studies are needed to verify the reliability and validity of SAFARI with male populations and across settings.

The influence of admission characteristics on outcome: evidence from a medium secure forensic cohort.

OBJECTIVE: Outcomes for any mental health service will vary with the characteristics of those admitted as well as with the clinical provision of the service itself. This study aims to explore, for a medium secure forensic service in England, temporal changes in (1) characteristics of those admitted and (2) outcome after discharge and (3) to examine whether such changes are related. METHOD: Baseline characteristics and reconviction outcomes were derived from multiple data sources for 550 first admissions to a medium secure forensic unit for a 20-year period. Time to reconviction was examined using Kaplan-Meier analysis and Cox regression. RESULTS: Over time, severity of admissions increased, as did discharges to prison; discharges to non-secure hospitals reduced. Risk of reconviction increased by 3.9%-4.2% for each year of admission from 1983, which was explained by the increased admission of higher-risk patients. CONCLUSION: This medium secure service admitted patients with increasing levels of risk; reoffending rates reflect admission characteristics. Service funding decisions should take account of the characteristics of those admitted. SIGNIFICANT OUTCOMES: This study indicates that the profile of patients admitted over a 20-year period increased in severity. Over time, reconviction after discharge occurred earlier after release. This increase in reconviction was explained by the type of patient admitted. LIMITATIONS: Examination of a cohort from a single medium secure unit limits the generalizability of the findings. The study focuses on a criminological outcome measure (i.e. reconviction); other domains may be equally relevant (e.g. the relief of psychological distress). Examining an entire series of admissions introduces heterogeneity by, for example, considering the outcome of men and women together.

Patients with a history of arson admitted to medium security: characteristics on admission and follow-up postdischarge.

Patients who set fires are a perennial cause of concern with psychiatric services although perhaps rather neglected in the clinical research literature. The current study considered the characteristics on admission of 129 patients, 93 men and 36 women, with a known history of arson who had been admitted to a medium secure psychiatric hospital. The distinguishing characteristics of the sample were high numbers of patients with extensive criminal histories, most probably due to high levels of prison transfer and a higher occurrence of mental illness than psychopathic disorder. Aside from return to prison, most patients were discharged either to another psychiatric hospital or directly to the community. There was a high rate of re-conviction after discharge, mainly for minor offences, with about one in 10 of discharged patients committing arson. It was established, however, that not all incidents of arson led to a prosecution. It is concluded that there are weaknesses in the areas of both risk assessment and evidence-based treatment for arsonists.

Treatment of chronic anorexia nervosa: a 4-year follow-up of adult patients treated in an acute inpatient setting.

Despite evidence from a number of long-term follow-up studies of anorexia nervosa that nearly 50% of patients eventually make a full recovery, controlled trials of psychotherapy for anorexia nervosa are lacking. Those with severe and enduring problems represent a considerable therapeutic challenge. Thirty-four consecutive adult referrals to the inpatient treatment unit who fulfilled Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria for anorexia nervosa were examined pre-admission, post-discharge and 4 years after admission. Characteristics of remitted and non-remitted patients were examined. Secondary analyses considered the differences between patients with anorexia nervosa, restricting type and anorexia nervosa binging/purging type. The findings highlight a number of differences between patients with anorexia nervosa (restricting type) versus anorexia nervosa (binging/purging type) as well as remitted versus non-remitted patients. The use of a comprehensive battery of assessments found that resolution of eating disorder symptomatology was paralleled by improvements in emotional and psychological distress and improvement in body image perception and coping skills. Better results were obtained for those who had continuity of care on an outpatient basis. This pattern is particularly significant given the more 'chronic' nature of the sample that were older, with a higher incidence of binge-eating and purging than previous samples. Results provide some encouragement for the treatment of those adults with anorexia nervosa who typically have less favourable outcomes.

The effect on reconviction of an intervention for drink-driving offenders in the community.

This study reports an evaluation of the Drink-Impaired Drivers program in the English and Welsh probation service. Participants were adult male offenders who had been convicted of a drink-driving offence and were serving community sentences. The 1-year drink-drive reconviction rates were compared for offenders who completed the program, offenders who started but did not complete the program, and a comparison group who were not allocated to the program. At 1-year follow-up, there was no reconviction among offenders who had completed the program. Multivariate analysis showed that the noncompleters had a significantly higher rate of reconviction than the completers and comparison group.

Methodological considerations in the evaluation of offender interventions: the problem of attrition.

Attrition from offender interventions presents methodological problems when the effectiveness of the intervention is under evaluation. This article proposes a treatment-received (TR) design, which incorporates one-to-one matching on criminogenic variables. This design permits the comparison of completer, noncompleter, and nonstarter groups with their paired comparisons and, hence, allows a more accurate evaluation of program completion and noncompletion effects. A sample of 173 offenders, referred to one of two general offending behavior cognitive skills programs within community settings, was matched one-to-one by criminogenic variables to offenders from an appropriate comparison group. Reconviction analyses were undertaken using intention to treat (ITT) analysis, TR analysis using the full comparison group, and TR analysis using matched comparison groups. The ITT design found no impact of group membership on reconviction. The TR designs, however, provided evidence of moderate effects of completion: For every three completers, five of the matched comparison group members were reconvicted. The analysis also suggested a noncompletion effect: Noncompleters were twice as likely as their matched comparison group to be reconvicted.

Dealing with Feelings: the effectiveness of cognitive behavioural group treatment for women in secure settings.

BACKGROUND: Women in secure psychiatric settings have gender specific treatment needs. The current study examined the feasibility of a Dealing with Feelings Skills Group training for dual diagnosis women admitted to a medium secure setting. METHOD: A pre-test--post-test design was used to evaluate a group programme adapted from dialectical behaviour therapy skills training. RESULTS: Most patients had a primary diagnosis of personality disorder. Treatment completers (n = 29) were compared with non-completers (n = 15). Clinically significant changes in treatment completers were apparent on coping response measures of positive reappraisal, problem solving and alternative rewards; on measures of anxiety and suicidality; on self-reported ability to engage in activities to reduce negative mood and to recognize mood changes. Self-harming and aggressive behaviours also reduced in the 3 months following group treatment. CONCLUSION: An adapted coping skills component of DBT benefit many dual diagnosis patients: issues related to treatment drop-out and failure to benefit are discussed.

Assessing comorbid substance use in detained psychiatric patients: issues and instruments for evaluating treatment outcome.

This review assesses the issues involved in the selection and treatment of patients comorbid for mental illness and substance misuse being treated in secure psychiatric facilities. It includes those individuals who have a history of offending and whose placement is the result of severe behavioral disturbance. The relevant issues in the assessment and treatment of these patients are reviewed and a battery of tests is suggested on the basis of their usefulness with this population in terms of their brevity, ease of administration, and for their value in planning treatment, providing motivational feedback, and monitoring change. The paucity of assessment tools developed specifically for this patient population is highlighted.

The development of a 'best practice' service for women in a medium-secure psychiatric setting: treatment components and evaluation.

The inadequacy of inpatient facilities for women with severe psychiatric and co-morbid difficulties has been repeatedly documented. The establishment of effective therapeutic programmes for women in medium psychiatric facilities is also in their infancy, and little research has been undertaken. This article describes the development of a 'best practice' psychological treatment programme for women with a dual diagnosis. Emphasis is placed on the need to develop further intensive gender-specific services using an established model for effective therapeutic service development. In addition to a detailed description of the group therapy programme, staff training initiatives, methods for ensuring treatment integrity and a methodology for service evaluation is given.

Usefulness of the CANFOR-S for measuring needs among mentally disordered offenders resident in medium or low secure hospital services in the UK: a pilot evaluation.

BACKGROUND: The short form of the forensic version of the Camberwell Assessment of Needs (CANFOR-S) (Thomas et al., 2003) is of potential value in all clinical forensic settings, but so far reported mainly with high security hospital patients. AIMS: To conduct a pilot study of the feasibility of using the CANFOR-S in medium and low security hospital units and to report preliminary findings there. METHODS: Thirty-six of 38 patients on one medium secure ward for women, one low secure ward for women and one low secure ward for men, all in the same hospital, agreed to participate in the study. Staff and patients completed the CANFOR-S as part of a larger formal assessment package. RESULTS: All the women and 18 of the 20 men completed the CANFOR-S. It was found to be easy and quick (25 minutes) to use, and acceptable. Staff and patient ratings were similar on all but one item: needs with regard to safety to others, with staff consistently rating more. Men and women were similar in number of needs, but had different needs profiles. Those in medium security were generally more needy than those in low security. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The CANFOR-S is feasible for clinical practice, with results perceived as useful in treatment planning by patients and staff. More widespread use could improve service planning.

Aggression control therapy for violent forensic psychiatric patients: method and clinical practice.

Aggression control therapy is based on Goldstein, Gibbs, and Glick's aggression replacement training and was developed for violent forensic psychiatric in- and outpatients (adolescents and adults) with a (oppositional-defiant) conduct disorder or an antisocial personality disorder. First, the conditions for promoting "treatment integrity" are examined. Then, target groups, framework, and procedure are described in detail, followed by the most important clinical findings during the period 2002 to 2006. Finally, new programme developments are mentioned, with aggression control therapy as a starting point.

The importance of appropriate allocation to offending behavior programs.

This study examined the impact on reconviction of appropriate allocation to three general offending behavior programs involving adult male offenders in the English and Welsh Probation Service. Appropriate allocation was defined by level of risk for reconviction. There were three allocation groups: too low, appropriate, and too high. Using a quasi-experimental design, the reconviction rates of offenders who were allocated to and completed a program, offenders allocated to a program who failed to start, and a comparison group were compared. It was found that the appropriateness of allocation affected reconviction independently of treatment group. Furthermore, in line with the risk principle, there was an interaction between treatment group and the appropriateness of allocation.

Development of the Observation Scale for Aggressive Behavior (OSAB) for Dutch forensic psychiatric inpatients with an antisocial personality disorder.

The Observation Scale for Aggressive Behavior (OSAB) has been developed to evaluate inpatient treatment programs designed to reduce aggressive behavior in Dutch forensic psychiatric patients with an antisocial personality disorder, who are "placed at the disposal of the government". The scale should have the sensitivity to measure changes in the possible determinants of aggressive behavior, such as limited control of displayed negative emotions (irritation, anger or rage) and a general deficiency of social skills. In developing the OSAB 40 items were selected from a pool of 82 and distributed among the following a priori scales: Irritation/anger, Anxiety/gloominess, Aggressive behavior, Antecedent (to aggressive behavior), Sanction (for aggressive behavior) and Social behavior. The internal consistency of these subscales was good, the inter-rater reliability was moderate to good, and the test-retest reliability over a two to three week period was moderate to good. The correlation between the subscales Irritation/anger, Anxiety/gloominess, Aggressive behavior, Antecedent, Sanction was substantial and significant, but the anticipated negative correlation between these subscales and the Social behavior subscale could not be shown. Relationships between the corresponding subscales of the OSAB and the FIOS, used to calculate concurrent validity, yielded relatively high correlations. The validity of the various OSAB subscales could be further supported by significant correlations with the PCL-R and by significant but weak correlations with corresponding subscales of the self-report questionnaires. The Observation Scale for Aggressive Behavior (OSAB) seems to measure aggressive behavior in Dutch forensic psychiatric inpatients with an antisocial personality disorder reliably and validly. Contrary to expectations, a negative relationship was not found between aggressive and social behavior in either the OSAB or FIOS, which were used for calculating concurrent validity.

An adapted version of the Rosenzweig Picture-Frustration Study (PFS-AV) for the measurement of hostility in violent forensic psychiatric patients.

BACKGROUND: The original Rosenzweig Picture-Frustration Study (PFS), designed to measure reactive aggressive behaviour in adults, contains 24 pictures of ambiguous situations in which someone is making a remark that can be interpreted as provocative. AIM: An adapted version of Rosenzweig's PFS (PFS-AV) was developed to assess the hostile thoughts elicited by interpersonal frustrating situations in forensic psychiatric patients with a conduct disorder or an antisocial personality disorder. METHODS: Patients were asked to give their responses in a few words on paper, which were then evaluated for hostility using a seven-point Likert scale. The patients also completed questionnaires on personality and on aggressive and socially competent behaviour. RESULTS: Twelve of the 24 pictures that had a good internal consistency, inter-rater reliability, and test-retest reliability were selected. In support of the instrument's concurrent validity, scores on the PFS-AV were positively correlated with those on the aggressive behaviour questionnaires but less strongly than the correlations between the aggressive behaviour questionnaires mutually. The validity of the PFS-AV was demonstrated by the positive correlation between PFS-AV hostility and neuroticism, and by the negative correlation with extraversion, openness, agreeableness and conscientiousness. A relatively low but positive correlation was found with social anxiety and a negative correlation was found with social skills in situations where approaching behaviour may be exhibited. CONCLUSION: The adapted version of the PFS-AV appears reliably and validly to measure hostility in violent forensic psychiatric patients.

Level of Service Inventory-Revised profiles of violent and nonviolent prisoners.

Level of Service Inventory-Revised (LSI-R) assessments were conducted on 251 male prisoners beginning prison sentences in six English prisons. The prisoners who were classified as violent, on the basis of either current or previous convictions, scored significantly higher than the nonviolent prisoners on the four LSI-R subscales of Criminal History, Companions, Education and Employment, and Alcohol and Drugs. In addition, those prisoners with a record of violent offenses gave higher total LSI-R scores, indicating an overall higher risk of recidivism. Multivariate analysis using the LSI-R subscales to classify the higher risk violent prisoners and minimum-risk nonviolent prisoners basically confirmed the findings of the univariate analysis. The implications of the findings for informing practice with violent offenders are discussed in terms of screening for intensity of service delivery and identification of targets for change. It is suggested that screening for drug and alcohol problems should be a prerequisite to working with violent offenders.