Introduction to special issue on social media for forensic mental evaluations.

This special issue of Behavioral Sciences & the Law presents six articles that focus on various issues related to social media in forensic mental health evaluations. These eclectic articles provide updated information about social media's use and navigating difficult ethical concerns. Ranging from violence risk assessment to disability evaluations, the up-to-date information in this special issue allows the forensic evaluator to be more prepared when they inevitably encounter information from social media. As social media continues to grow, both in terms of overall use and the number of available platforms, forensic clinicians will need to remain cognizant of the ways these data can be appropriately utilized as collateral data.

The Internet is a scary place: How does evidence source and examinee race or ethnicity influence determinations of threat?

Violent rhetoric online is becoming increasingly relevant to the practice of forensic mental health assessment as examinee's virtual lives may transform into real-world acts of violence. With the rise of a diverse subculture of violent online communities, the aim of the present study was to inform how concerns with online sources of collateral data and racial/ethnic biases may influence determinations of violence potential. Using an experimental design, jury-eligible participants (N = 278) and forensic mental health experts (N = 78) were presented with mock Twitter (now referred to as X) posts that varied by data source (i.e., how information was accessed) and the examinee's race/ethnicity. Results showed no differences in participants' ratings of data credibility, how much weight they would place on the posts in a threat assessment, or how likely the examinee was to act violently against his intended target. Implications regarding the interpretation of social media evidence, relevant limitations, and future research are discussed.

Conditional release and cannabis use: Concerns and challenges for community reintegration.

This article, which serves as a perspective review, delves into the complexities of cannabis use among individuals preparing for or already on conditional release (CR). These complexities include an association between cannabis use and mental illness and dealing with the fact that the use of illicit substances, such as cannabis, is against CR rules, leading to potential revocation. A focus of this article is the deleterious effects cannabis and synthetic derivatives of cannabis can have for individuals on CR. The article concludes with six-specific recommendations for managing cannabis use in this population with a focus on careful and detailed risk assessments that considers the relationship between substance use and dangerousness, the role of protective factors, the need for a detailed conditional release plan, inpatient and community-based interventions aimed at increasing individual autonomy, and education on the dangers of cannabis use for both the treatment team and the insanity acquittee.

MMPI-2-RF Differences Between Violent Offending and Institutional Violence Among Incarcerated Women.

The examination of violence perpetrated by female offenders remains an understudied topic, as research typically focuses on male offender samples. As such, it remains unclear what personality characteristics may be associated with the perpetration of violence among female offenders. This study sought to examine the relationship between personality characteristics, as assessed by the MMPI-2-RF, and engagement in violence, within a sample of 228 incarcerated women. Results indicated that women serving time for a violent offense obtained higher mean scores on MMPI-2-RF scales related to underreporting, atypical thoughts/experiences, and paranoia. Women who obtained disciplinary reports for violence within the institution obtained higher mean scores on MMPI-2-RF scales related to behavior/externalizing dysfunction, overactivation, and aggression. Taken together, violence was most strongly associated with the MMPI-2-RF scales related to paranoia and atypical thoughts/experiences (e.g., THD, PSYC-r). This study provides new data on the viability of the MMPI-2-RF to provide critical insights into violent and aggression behavior in female inmates, an understudied population and demonstrate the instrument's efficacy in assessing characteristics associated with violent behavior.

Limitations Using Neuroimaging to Reconstruct Mental State After a Crime.

Neuroimaging offers great potential to clinicians and researchers for a host of mental and physical conditions. The use of imaging has been trumpeted for forensic psychiatric and psychological evaluations to allow greater insight into the relationship between the brain and behavior. The results of imaging certainly can be used to inform clinical diagnoses; however, there continue to be limitations in using neuroimaging for insanity cases due to limited scientific backing for how neuroimaging can inform retrospective evaluations of mental state. In making this case, this paper reviews the history of the insanity defense and explains how the use of neuroimaging is not an effective way of improving the reliability of insanity defense evaluations.

Callous-unemotional traits and early life stress predict treatment effects on stress and sex hormone functioning in incarcerated male adolescents.

The stress response system is highly plastic, and hormone rhythms may "adaptively calibrate" in response to treatment. This investigation assessed whether stress and sex hormone diurnal rhythms changed over the course of behavioral treatment, and whether callous-unemotional (CU) traits and history of early adversity affected treatment results on diurnal hormone functioning in a sample of 28 incarcerated adolescent males. It was hypothesized that the treatment would have beneficial effects, such that healthier diurnal rhythms would emerge post-treatment. Diurnal cortisol, testosterone, and dehydroepiandrosterone (DHEA) were sampled two weeks after admission to the correctional/treatment facility, and again approximately four months later. Positive treatment effects were detected for the whole sample, such that testosterone dampened across treatment. CU traits predicted a non-optimal hormone response to treatment, potentially indicating biological preparedness to respond to acts of social dominance and aggression. The interaction between CU traits and adversity predicted a promising and sensitized response to treatment including increased cortisol and a steeper testosterone drop across treatment. Results suggest that stress and sex hormones are highly receptive to treatment during this window of development.

An update and expansion on the role of the Violence Risk Appraisal Guide and Historical Clinical Risk Management-20 in United States case law.

An individual's risk for future violent behavior may be considered in various legal contexts, including civil commitment, criminal sentencing, or suitability for parole. Among the assessment tools forensic evaluators use to assess violence risk are the Violence Risk Appraisal Guide (VRAG; Quinsey, Harris, Rice, & Cormier, ) and the Historical Clinical Risk Managment-20 (HCR-20)/Historical Clinical Risk Management-20, Version 3 (HCR-20V3 ) (Webster, Douglas, Eaves, & Hart, and Douglas, Hart, Webster, & Belfrage, , respectively). Previous surveys and case law research suggest that these measures are widely used and perceived to be useful in aiding forensic clinicians. This study provides an update to Vitacco, Erickson, Kurus, and Apple () and examines the use of the HCR-20 and VRAG in United States case law. A LexisNexis review revealed 134 cases decided between 1 January 2010 and 21 December 2016 that included the HCR-20, VRAG, or both. Results revealed that these measures are typically introduced by the prosecution to inform opinions regarding general violence risk. In addition, consistent with previous research, these data suggest the introduction of the HCR-20 and VRAG is rarely challenged and, when challenged, these challenges are rarely successful. However, data suggest that courts and parole boards may focus on specific risk factors (e.g., lack of insight) at the expense of other, more objective factors. Finally, we offer suggestions for clinicians who have transitioned to the newest version of the HCR-20.

Reconsidering risk assessment with insanity acquittees.

States continue to rely on conditional release (CR) as an effective and cost-effective way to manage individuals found not guilty by reason of insanity (NGRI). Research has demonstrated that insanity acquittees returning to the community have low recidivism rates and moderately low revocation rates. This study followed 238 individuals found NGRI in Oregon who were evaluated with the Historical, Clinical, Risk-20 (HCR-20; Webster, Douglas, Eaves, & Hart, 1997) and placed in the community on CR. The majority of individuals on CR (n = 157, 66%) maintained their release throughout the entire follow-up period (between 4 and 9 years), but 81 (33.6%) had their release revoked during the follow up. In considering the efficacy of violence risk assessment in predicting CR outcome with NGRI acquittees, the HCR-20 was mostly unrelated to CR outcome. Only two items from the HCR-20, both from the Risk Management scale (exposure to destabilizers and stress) predicted revocation, but not imminence to CR revocation. This paper reconsiders how risk assessments are utilized with insanity acquittees and provides a roadmap for improving risk assessments with this unique population by relying on risk assessment results to plan effective interventions to reduce the likelihood of revocation and violence. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Psychosis and Substance Use: Implications for Conditional Release Readiness Evaluations.

In Foucha v. Louisiana (1992), the United States Supreme Court ruled that individuals adjudicated not guilty by reason of insanity (NGRI) could not remain in a forensic hospital if they were no longer mentally ill and dangerous. Since this decision, a variety of important questions have arisen related to the insanity defense and what should happen to insanity acquittees post-adjudication. This article provides an analysis of clinical issues confronting forensic examiners when psychosis as a result of substance abuse is the underlying condition supporting an insanity defense. To accomplish this analysis, this article provides the reader with a review of literature showing the complex relationship between psychosis and substance abuse. Second, this article investigates how substance-induced psychosis may impact both insanity opinions and subsequent conditional release decisions. Third, the article aims to provide research-driven information to assist clinicians in conducting conditional release evaluations. Finally, this paper provides a model for evaluating dangerousness in the context of conditional release evaluations. Given the substantial comorbidity between substance abuse and psychosis, it is critical for researchers and clinicians to consider potential effects of substance abuse when evaluating insanity acquittees for conditional release, especially as substance use relates to future dangerousness. Copyright © 2016 John Wiley & Sons, Ltd.

Projecting Risk: The Importance of the HCR-20 Risk Management Scale in Predicting Outcomes with Forensic Patients.

The present study evaluates data from 116 forensic inpatients who underwent violent risk assessments, which included the Historical, Clinical, Risk-20 (HCR-20), from 2006 to 2013 as part of an opportunity to be conditionally discharged from state forensic facilities. Of the 116 inpatients, 58 were never released, 39 were released and returned to a hospital, and 19 were released and never returned. Results from analyses of variance and multinomial logistic regression found the risk management (R) scale of the HCR-20 successfully predicted group membership in that higher scores were associated with a greater likelihood of not being released from a forensic facility or returning to a forensic facility after release. The results of this study indicate that clinicians should consider community-based risk variables when evaluating forensic patients for potential return to the community. This research demonstrates that clinicians failing to fully consider dynamic risk factors associated with community integration jeopardize the quality and thoroughness of their violence risk assessment with regards to readiness for release. Copyright © 2016 John Wiley & Sons, Ltd.

Coupling of the HPA and HPG axes in the context of early life adversity in incarcerated male adolescents.

The effects of early life adversity can be observed across the lifespan, and the hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-gonadal (HPG) axes could be mechanistic intermediaries underlying this phenomenon. The current study examined 50 adolescent males aged 12-18 in a maximum-security correctional and treatment setting. Saliva samples were collected five times a day for 2 days and assayed for cortisol, testosterone, and DHEA. Youth completed semi-structured life stress interviews and self-reports of child maltreatment to index adversity. When youth had higher testosterone levels, they had higher cortisol and DHEA levels, indicating positive "coupling" of the HPA-HPG axes. In addition, children experiencing greater life adversity had tighter coupling of the HPA-HPG axes. Additional analyses hint that coupling may be driven largely by HPG axis functioning. Results indicate that positive coupling of the HPA-HPG axis is observed within incarcerated adolescents, especially for those with the greatest life stress.

Beyond physiological hypoarousal: the role of life stress and callous-unemotional traits in incarcerated adolescent males.

The development of antisocial behavior in youth has been examined with neurobiological theories that suggest that adolescents who are less responsive to their environments are less likely to develop empathy in the absence of extant physiological arousal. However, little attention is paid to these individuals' social context. Individuals with adverse early experiences can also exhibit attenuated physiological arousal. The current investigation examines whether psychopathic symptoms or life stress exposure is associated with cortisol and its diurnal rhythm within 50 incarcerated adolescent boys (14-18years old). Ten saliva cortisol samples were collected 1-2weeks after admission to a maximum-security juvenile facility. Hierarchical Linear Modeling distinguished waking cortisol levels, the awakening response (CAR) and the diurnal rhythm. Multiple interviews and self-report measures of CU traits and stressor exposure were collected. Boys with higher levels of CU traits or greater life stress exposure had flat diurnal rhythms and a steeper awakening response in analyses with lifetime stress exposure specifically. Nonetheless, boys who were elevated on both CU traits and prior stress exposure had steeper diurnal rhythms. These results extend neurobiological theories of cortisol and illustrate that boys with the combination of severe stress with CU traits have a unique physiological profile.

Psychopathy's influence on the coupling between hypothalamic-pituitary-adrenal and -gonadal axes among incarcerated adolescents.

Conduct disorder (CD) is a heterogeneous diagnosis, leading researchers to initiate studies focused on neurobiological mechanisms underlying this disorder. One specifier of CD currently considered for inclusion in the DSM-V is callous-unemotional (CU) traits, a key component of psychopathy. CU traits are thought to have neuroendocrine underpinnings, yet little is known about hypothalamic-pituitary-adrenal (HPA) and -gonadal (HPG) hormones in the context of psychopathic traits. The current study sought to identify daily coupling patterns between HPA and HPG hormones in order to clarify distinct neurobiological underpinning associated with psychopathic/CU traits. Fifty incarcerated adolescent males who met criteria for CD were recruited and provided 10 saliva samples across 2 days. Participants completed the Psychopathy Checklist Youth Version (PCL:YV) and Inventory of Callous Unemotional Traits (ICU) on a third day. Diurnal cortisol, testosterone, and DHEA functioning was modeled via hierarchical linear modeling. Psychopathy subscales from the measures administered were used as predictors of daily coupling patterns between these hormones. Results indicated all three hormones were tightly coupled. Further, higher PCL-YV interpersonal scores related to greater coupling between all three hormones, whereas higher ICU callousness scores related to greater uncoupling of testosterone with cortisol and DHEA. The current study is novel in its emphasis on testing the coupling of HPA and HPG hormones among incarcerated adolescent males. Results suggest that affective and interpersonal psychopathic traits are marked by unique HPA- and HPG coupling.

Decision-making in post-acquittal hospital release: how do forensic evaluators make their decisions?

A large number of individuals are acquitted of criminal charges after being found "not guilty by reason of insanity." Most of these individuals are hospitalized and later seek hospital discharge under a court-ordered provision called conditional release ("CR"). Courts rely on opinions from forensic evaluators to determine acquittees' readiness for CR. However, how evaluators make these decisions are unknown. Eighty-nine CR readiness evaluators from nine states were surveyed to understand which factors evaluators prioritize and to understand evaluators' assessment methodologies and their beliefs about the CR process itself. Little uniformity was found among evaluators on any aspect of the decision-making process. Evaluators utilized a wide variety of methodologies when making their decisions on readiness for CR. Moreover, evaluators' conceptualizations of the CR process itself varied widely. The results highlight the difficulty and confusion evaluators face when conducting CR readiness evaluations, and demonstrate the need for enhanced training, statutory guidance, and standardized evaluation protocols for these evaluations.

Predicting voluntary and involuntary readmissions to forensic hospitals by insanity acquittees in Maryland.

The current study investigated factors associated with voluntary and involuntary readmissions to forensic hospitals 356 insanity acquittees on conditional release in the state of Maryland from 2007, 2008, and 2009 and monitored their community progress for a 3-year follow-up period. The results indicated that voluntarily readmitted insanity acquittees had fewer reported arrests on conditional release and fewer reported instances of non-compliance with treatment compared with insanity acquittees who were returned involuntarily to hospital. As expected, arrests and treatment non-compliance predicted involuntary readmission. A third group of insanity acquittees who were not readmitted on conditional release presented with numerous differences compared with voluntarily and involuntarily readmitted acquittees. These included a longer duration in the community prior to any psychiatric readmission and fewer community psychiatric admissions than both the voluntary and involuntary groups. Data from this study provide useful information on where community monitoring resources for insanity acquittees may best be allocated.

Evaluating conditional release in not guilty by reason of insanity acquittees: a prospective follow-up study in Virginia.

Detailed research on treatment and risk management approaches with not guilty by reason of insanity acquittees (NGRI) during their conditional release is needed as states increasingly use community-based services for these individuals. Grounded in case law, and supported by follow-up studies demonstrating low recidivism rates, states have been encouraged in their efforts to conditionally release NGRI acquittees. The authors evaluated a state-wide sample of 127 NGRI acquittees released into the community after spending a mean of 61.63 months (SD = 76.54) in the hospital. One hundred individuals were committed to the hospital for lengthier treatment (M hospital time = 77.23 months, SD = 79.84), but 27 individuals were released to the community after a relatively short hospital stay (M hospital time = 5.60 months, SD = 3.01). Regarding release, 96 individuals (75.6%) maintained their conditional release. After evaluating a host of demographic and standardized risk data, the following variables predicted revocation on conditional release: previous failure on conditional release, nonadherence with hospital treatment, dangerousness to others, and previous violent charges. A multivariate survival analysis determined criminal behavior and previous failure on conditional release predicted time to revocation. The results of this study demonstrate the importance of considering standardized risk variables in the community-based management of forensic patients. In addition, the data are supportive of continued attempts at moving insanity acquittees from the hospital to the community via conditional release.

Psychopathy in Correctional Settings: Considerations for Developing and Implementing a Treatment Program.

Psychopathy is associated with higher levels of violence as well as general and violent recidivism after release from prison. A disorder with a long and rich clinical and research history, psychopathy has gained an undeserved reputation as a syndrome that is unresponsive to treatment. This article presents information that undermines long-standing problematic assumptions regarding the treatability of individuals with psychopathic traits and posits that implementing treatment programs in correctional settings is critical to decrease recidivism and violence. We discuss several treatment programs that have evidenced some success in the treatment of individuals with psychopathy and have the potential to be widely implemented in correctional settings, as well as general tenets of successful treatment programs and specific targets.

Jail-Based Competency Restoration: What's Out There and What's Missing.

Forensic systems have seen an increase in the number of defendants in need of competency restoration services. Traditionally, competency restoration services have occurred at state psychiatric hospitals. Unfortunately, the waitlists for hospital competency restoration are extensive and result in many defendants waiting in jail for more than 4 months for an inpatient bed. These waitlists have led to lawsuits forcing states to provide adequate treatment and evaluation services to mentally ill adults languishing in jails. To reduce waitlists for competency restoration and to combat the extensive delays in restoration, some states have implemented jail-based restoration to reduce hospital waitlists, restoration time, and costs to complete restoration. This review article discusses pros and cons of jail-based services and provides a framework for future services and research.

Paraphilias with co-morbid psychopathy: the clinical and legal significance to sex offender assessments.

This article briefly discusses the historical development of the constructs of paraphilia and psychopathy. An overview of recent developments in the assessment of these constructs for legal purposes is also provided. The historical, clinical, legal, and ethical obligations of clinicians who work with persons suffering from paraphilias and co-morbid psychopathy is then reviewed. An emphasis of the current article is integrating recent developments in the construct of psychopathy into a discussion of sex offender risk assessment and treatment. The co-morbidity of psychopathy and paraphilias as factors in predicting risk of recidivism is reviewed. The need for practitioners to remain cognizant of language requirements in both legal and clinical contexts is addressed. Finally, this article reviews the legal history of sex offender legislation and its evolution into current United States Supreme Court jurisprudence.