Factors associated with referrals to high security forensic services among people with severe mental illness and receiving inpatient care in prison

Capuzzi, Enrico; Pini, Elena; Malerba, Maria Rosaria; Cova, F.; Lax, Annamaria; Mauri, Sara; Ornaghi, Annalisa; Provenzi, Milena; Rubelli, Paola; Sergio, Maria Ripalta; Truisi, Emanuele; Clerici, Massimo

doi:10.1016/j.ijlp.2018.11.003

Cited by 11 publications

(8 citation statements)

References 38 publications

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“…In particular, the presence of adjustment disorders at the early phases of imprisonment is a well-known phenomenon with a high incidence mainly in solitary confinement [ 37 ]. Schizophrenia is one of the main determinants of COT in most Western countries [ 6 , 15 , 17 , 40 – 42 ]. At first glance, the frequency of personality disorders was not significantly different between patients with COT and regular inmates.…”

Section: Discussionmentioning

confidence: 99%

Prison inmates with court-ordered treatments: are they really different?

2022

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Background Both the frequency of court-ordered treatments (COT) for offenders and prevalence of mental disorders among regular prison inmates steadily increased in most western countries. Whether there are major sociodemographic and clinical differences between these two populations is still matter of debate. Methods We compared the sociodemographic and clinical characteristics in a representative sample of 139 regular prison inmates versus 61 offenders with COT admitted during a 5-year period in an acute psychiatric care unit located in the central prison of the Geneva county. Fisher exact, unpaired Student’s t and Mann–Whitney U tests were used to compare demographic and clinical variables between COT patients and regular inmates. In addition, univariate and multivariable ordered logistic regression models were built to identify the sociodemographic and clinical determinants of COT. Results COT patients were significantly older, less frequently married, with better education attainment, predominantly French-speaking, of the Christian religious group and with regular religious practice. History of psychiatric outpatient care was significantly more frequent in this group. Unlike the significantly higher occurrence of adjustment disorders in regular prisoners, psychosis was the main diagnosis in COT patients. When all diagnostic categories were taken into account in multivariable models, the presence of personality and psychotic disorders were the stronger predictors of COT status. Conclusions Our data reveal that offenders with COT represent a clinically distinct group with an overrepresentation of personality and psychotic disorders. Moreover, they show that, at least in the Swiss penitentiary system, COT patients are less exposed to acculturation issues compared to regular inmates.

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Section: Discussionmentioning

confidence: 99%

Prison inmates with court-ordered treatments: are they really different?

2022

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“…High security institutions are commonplace among international mental health systems and provide specialist care for patients with enduring psychiatric problems in combination with a high risk of further violence. Research indicate that patients in high security settings in western countries were predominantly Caucasian male, between 28 and 38 years old on average (1)(2)(3)(4)(5)(6)(7)(8). Judicially, index offenses are presented in a diverse manner across studies, making comparisons difficult.…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, the majority appeared to be admitted for violent offenses and in one in five cases even life crimes (4,5). In most studies the prevalence rate of sex offenses was <10% (3,4,9), while some studies reported up to 25% of sex offenses (7). Clinically the most common psychiatric diagnoses involved psychotic disorders (3,4,6).…”

Section: Introductionmentioning

confidence: 99%

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High Security Settings in Flanders: An Analysis of Discharged and Long-Term Forensic Psychiatric Patients

Jeandarme

Goktas²,

Boucké³

et al. 2022

Front. Psychiatry

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BackgroundTwo Forensic Psychiatric Centres (FPC) were implemented the last decade in Flanders in Ghent (2014) and Antwerp (2017). FPCs are forensic institutions for forensic psychiatric patients with a high recidivism risk and a high security need. The objective of FPCs is to create a care process with sufficient flow (from high to lower forms of security), and transitions (from specialized forensic care to regular psychiatric care).AimsTo examine the characteristics of the high security population in FPCs, treatment length, number of discharges, and discharge locations and to determine the profile of long-term patients within an FPC.MethodsA retrospective file study of an admission cohort of 654 patients admitted to FPC Ghent or FPC Antwerp was conducted. Sociodemographic, clinical, judicial and risk characteristics were analyzed. Bivariate analyses were used to test the difference between two groups: the group that was discharged to a lower security level vs. the group of long-term patients.ResultsMost patients had psychosis and personality disorders, while comorbidity was also high. Judicial histories were extensive, with many sexual index offenses. During a 6-year follow-up period, the number of referrals back to prison was low. Nearly a third of the population was discharged to a setting with a lower security level. Long-term patients typically presented with more personality disorders, higher psychopathy traits and higher risk scores and were more frequently subjected to coercive measures during treatment.ConclusionsThe Flemish FPC population is characterized by a high proportion of sex offenders as well as a high proportion of personality-disordered patients. It is this last group, and the group with elevated psychopathy traits, who remain for longer than expected and is difficult to resocialize. This study further highlights the need for clear criteria to assess the conditions of these long-term patients in Flanders.

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“…Even though treatment programs for offenders with ADHD are very limited, targeted psychosocial and pharmacological interventions were reported to reduce recidivism and ideally improve offenders’ quality of life [ 23 ]. The reduction of delayed recognition and treatment of prisoners affected by ADHD results are even more significant considering the younger age of prisoners with ADHD than those without this condition and the related societal costs [ 71 , 72 ]. In this regard, even though our findings cannot identify a causal association between childhood trauma and ADHD, the present study recommends exploring the eventual presence of childhood trauma in prisoners to assess vulnerability to ADHD.…”

Section: Discussionmentioning

confidence: 99%

Screening for ADHD Symptoms among Criminal Offenders: Exploring the Association with Clinical Features

et al. 2022

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Background: Attention-deficit/hyperactivity disorder (ADHD) is a disabling disorder. High rates of ADHD have been consistently reported among prisoners. The main objectives were (1) to estimate the prevalence of ADHD symptoms in a sample of male inmates and (2) to investigate the relationship between ADHD symptoms and socio-demographic/clinical features. According to the high prevalence of childhood trauma among inmates, we assessed whether exposition to childhood trauma can be related to the presence of ADHD symptoms. Methods: A total of 159 male prisoners admitted to Monza prison between January 2020 and June 2021 were included. Both Wender Utah ADHD rating scale and adult ADHD self-report scale were administered to assess ADHD symptoms. Moreover, inmates completed the childhood trauma questionnaire. Results: Data were available for 108 inmates. Thirty-five prisoners (32.4%) were found on screening to meet the criteria for symptoms of ADHD. Cocaine use disorder, prescription of mood stabilizers and a history of emotional abuse significantly increased the likelihood of having clinically significant ADHD symptoms. Furthermore, patients who experienced physical neglect resulted in meeting the criteria for ADHD symptoms. Conclusions: ADHD symptoms are widespread among inmates and are associated with specific risk factors. Screening for ADHD should be done to provide appropriate intervention strategies.

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Factors associated with referrals to high security forensic services among people with severe mental illness and receiving inpatient care in prison

Cited by 11 publications

References 38 publications

Prison inmates with court-ordered treatments: are they really different?

Prison inmates with court-ordered treatments: are they really different?

High Security Settings in Flanders: An Analysis of Discharged and Long-Term Forensic Psychiatric Patients

Screening for ADHD Symptoms among Criminal Offenders: Exploring the Association with Clinical Features

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