No abstract

In 2014, the Canadian government amended the Criminal Code, allowing courts to designate some individuals found not criminally responsible on account of mental disorder (NCRMD) as high-risk accused (HRA). As a result, individuals found HRA face significant new restrictions for transitioning through the forensic system. This study examined the relevance of the HRA designation by simulating the retrospective application of the legislative criteria to the National Trajectory Project (NTP) sample of 1,800 persons found NCRMD between 2000 and 2005 in Quebec, Ontario, and British Columbia, followed until 2008. Focusing on all individuals who had committed a serious contact offense (part of the first HRA criterion) in the NTP sample, we selected variables from the NTP database based on the remaining legislative criteria. We found that an HRA designation could apply to up to 1 in 4 individuals found NCRMD. The HRA group had been under the supervision of the Review Board for a longer period of time than had the non-HRA group. The HRA group reoffended at rates similar to those for the non-HRA group. Our results suggest that the HRA criteria do not identify a subgroup of persons found NCRMD who present an elevated risk of harm to others. Moreover, the findings suggest that NCRMD-accused with serious personal index offenses were already conservatively managed by the Review Boards. As such, a HRA designation based largely on offense severity is likely to miss its mark in terms of improving public safety.

The funders had no role in the study design, data collection, data analysis, or manuscript composition. We thank Shanna Li and Julia Schillaci-Ventura for data entry and editing and Dr. Matthew Sigal for statistical assistance with the ggplot2 package in R. Jodi L. Viljoen designed the study, wrote the protocol, conducted analyses, and wrote the manuscript. Lee M. Vargen, Dana M. Cochrane, Melissa R. Jonnson, Ilvy Goossens, and Sanam Monjazeb extracted data from the studies, conducted analyses, and contributed to the final manuscript. Also, Lee M. Vargen and Dana M. Cochrane conducted the systematic searches.

This study examined the perceived costs, benefits, and motivations for participating in individual trauma-focused interviews among forensic psychiatric patients ( N = 74). The majority of our participants were male, and 100% endorsed adverse childhood experiences (e.g., abuse, neglect) or exposure to potentially traumatic events (e.g., assault). Levels of posttraumatic avoidance (41.9%), reexperiencing (59.5%), and increased arousal (51.3%) were high. In line with previous studies, our findings suggest an overall positive research experience in this sample. In spite of extensive histories of lifetime victimization we did not find an association between victimization, posttraumatic symptomatology, and a negative research experience. Our findings suggest that participation in trauma-focused research is not only possible with, but also potentially beneficial for forensic patients.

The knowledge–practice gap remains a challenge in many fields. Health research has shown that professional networks influence various aspects of patient care, including diffusion of innovative practices. In the current study, we examined the potential utility of professional networks to spread the use of violence-risk-assessment tools in forensic psychiatric settings. A total of 6,664 reports, written by 708 clinicians, were used to examine the effect of clinicians’ use of risk-assessment tools on subsequent reports by other clinicians with whom they share patients. Results show that professional networks serve as an important channel for the spread of assessment practices. Simulation of a continuing education program showed that targeting more influential clinicians in the network could be 3 times more efficient at disseminating best practices than randomly training clinicians. Decision-makers may consider using professional networks to identify and train influential clinicians to maximize diffusion of the use of risk-assessment instruments.