Anne G. Crocker

Antisocial Personality, Psychopathy, and Violence in Persons with Dual Disorders A Longitudinal Analysis

Few studies have explored correlates of antisocial personality disorder (ASPD) and psychopathy among individuals with severe mental illness and co-occurring substance use disorder. This study examined the reliability and validity of measures of ASPD and psychopathy among 203 clients with dual disorders and their prospective relationship to criminality and violence over 3 years. Except for the interpersonal/affective factor, the total Self-Report Psychopathy Scale (SRP-II) and antisocial lifestyle factor displayed good reliability and convergent validity with other measures of antisociality. SRP-II scores had limited associations with criminality and violence, whereas ASPD, thought disturbance, negative affect, and earlier age at psychiatric hospitalization were predictive of aggressive behavior. Further research on community violence should examine other measures of psychopathy as well as ASPD and symptoms.

The predictive validity of clinical ratings of the Short-Term assessment of risk and treatability (START)

With the increased need to assess and manage risk in inpatient settings, the Short-Term Assessment of Risk and Treatability (START) was implemented on a civil psychiatric unit. The goal of the present study was to examine the tools predictive validity when completed by clinical teams as part of routine practice. Data were collected for 34 patients hospitalized for a minimum of 30 days prior to and after a START evaluation. Several challenging behaviors, such as aggression towards others, self-harm, and substance abuse were assessed using the START Outcomes Scale (Nicholls et al., 2007). Results from multilevel logistic regression and Receiver Operating Characteristics analyses lend partial support for the predictive validity of the START. A limited set of START items combined was significantly better at predicting the challenging behaviors than the original total Strength and Vulnerability scales. Results are discussed in terms of the clinical use of risk assessment.

Public attitudes towards intellectual disability: a multidimensional perspective

BACKGROUND Public attitudes towards persons with intellectual disabilities (IDs) have a significant effect on potential community integration. A better understanding of these can help target service provision and public awareness programmes. OBJECTIVE The objective of the present study is threefold: (1) describe public attitudes towards persons with ID along affective, cognitive and behavioural dimensions; (2) compare and contrast attitudes according to sex, age, education and income, as well as frequency and quality of contacts with persons with ID; and (3) ascertain whether the level of functioning has an effect on attitudes. METHODS The Attitudes Toward Intellectual Disability Questionnaire (ATTID) was administered by phone to 1605 randomly selected adult men and women, stratified by region in the province of Québec, Canada. The ATTID uses a multidimensional perspective of attitudes that reflect affective, cognitive and behavioural dimensions. RESULTS The results showed that public attitudes were generally positive regarding all three attitudinal dimensions. Public attitudes towards persons with ID are presented in terms of the five factors measured through the ATTID: (1) discomfort; (2) sensibility or tenderness; (3) knowledge of causes; (4) knowledge of capacity and rights; and (5) interaction. Attitude factor scores vary as a function of participant characteristics (sex, age, education and income) and the degree of knowledge about ID, the number of persons with ID known to the participants, as well as the frequency and quality of their contacts with these persons. Men had greater negative attitudes than women as regards the discomfort factor, while women had more negative attitudes regarding the knowledge of capacity and rights factor. More positive attitudes were revealed among younger and more educated participants. Attitudes were generally not associated with income. Public attitudes tended to be more negative towards people with lower functioning ID. CONCLUSION These results yield useful information to target public awareness and education.

Criminal Behavior and Victimization Among Homeless Individuals With Severe Mental Illness: A Systematic Review

OBJECTIVES The objectives of the systematic review were to estimate the prevalence and correlates of criminal behavior, contacts with the criminal justice system, and victimization among homeless adults with severe mental illness. METHODS MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Web of Science were searched for published empirical investigations of prevalence and correlates of criminal behavior, contacts with the justice system, and episodes of victimization in the target population. RESULTS The search yielded 21 studies. Fifteen examined prevalence of contacts with the criminal justice system; lifetime arrest rates ranged between 62.9% and 90.0%, lifetime conviction rates ranged between 28.1% and 80.0%, and lifetime incarceration rates ranged between 48.0% and 67.0%. Four studies examined self-reported criminal behavior, with 12-month rates ranging from 17.0% to 32.0%. Six studies examined the prevalence of victimization, with lifetime rates ranging between 73.7% and 87.0%. Significant correlates of criminal behavior and contacts with the justice system included criminal history, high perceived need for medical services, high intensity of mental health service use, young age, male gender, substance use, protracted homelessness, type of homelessness (street or shelter), and history of conduct disorder. Significant correlates of victimization included female gender, history of child abuse, and depression. CONCLUSIONS Rates of criminal behavior, contacts with the criminal justice system, and victimization among homeless adults with severe mental illness are higher than among housed adults with severe mental illness.

Prevalence of psychological distress and mental disorders, and use of mental health services in the epidemiological catchment area of Montreal South-West

BackgroundThis report presents the initial results of the first Epidemiological Catchment Area Study in mental health in Canada. Five neighbourhoods in the South-West sector of Montreal, with a population of 258,000, were under study. The objectives of the research program were: 1) to assess the prevalence and incidence of psychological distress, mental disorders, substance abuse, parasuicide, risky behaviour and quality of life; 2) to examine the links and interactions between individual determinants, neighbourhood ecology and mental health in each neighbourhood; 3) to identify the conditions facilitating the integration of individuals with mental health problems; 4) to analyse the impact of the social, economic and physical aspects of the neighbourhoods using a geographic information system. 5) to verify the adequacy of mental health services.MethodA longitudinal study in the form of a community survey was used, complemented by focused qualitative sub-studies. The longitudinal study included a randomly selected sample of 2,433 individuals between the ages of 15 and 65 in the first wave of data collection, and three other waves are projected. An overview of the methods is presented.ResultsThe prevalence of psychological distress, mental disorders and use of mental health services and their correlates are described for the first wave of data collection.ConclusionSeveral vulnerable groups and risk factors related to socio-demographic variables have been identified such as: gender, age, marital status, income, immigration and language. These results can be used to improve treatment services, prevention of mental disorders, and mental health promotion.

Rate and characteristics of men with an intellectual disability in pre‐trial detention

Abstract Background Various lines of research point to the overrepresentation of individuals with intellectual disability1 (ID) in the criminal justice system. Studies have also shown that individuals with ID are vulnerable to mental health problems. To date there have been no Canadian studies of individuals with an ID in the criminal justice system. Method The present study reports on the sociodemographic, mental health and criminological characteristics of 281 individuals with an ID from a Canadian study of men in a pre‐trial holding centre. Results Almost 19% of the men had a probable ID, and nearly one‐third (29.9%) were in the borderline IQ range. As was the case for their non‐ID counterparts, the mean age of the probable ID group was in the early 30s, few were employed, and most had low incomes. Individuals in the probable and borderline ID groups had lower rates of high school completion than those in the average intellectual ability range. Over 60% of individuals with an ID had a substance use disorder, and 1 in 5 was intoxicated at the time of assessment. These rates were similar across groups, and to those found in the literature. A large majority of individuals with ID had a previous conviction, and most had previously committed a violent offence. Conclusions Among other limitations, the sample may not have been entirely representative of the total population of men in the pre‐trial detention centre, given the relatively high refusal rate (39.5%). Results are discussed in terms of orienting criminological and mental health services as a function of the level of intellectual and adaptive functioning of individuals with ID.

The National Trajectory Project of Individuals Found Not Criminally Responsible on Account of Mental Disorder in Canada. Part 2: The People Behind the Label

Objective: To examine the psychosocio-criminological characteristics of not criminally responsible on account of mental disorder (NCRMD)–accused people and compare them across the 3 most populous provinces. In Canada, the number of people found NCRMD has risen during the past 20 years. The Criminal Code is federally legislated but provincially administered, and mental health services are provincially governed. Our study offers a rare opportunity to observe the characteristics and trajectories of NCRMD–accused people. Method: The National Trajectory Project examined 1800 men and women found NCRMD in British Columbia (n = 222), Quebec (n = 1094), and Ontario (n = 484) between May 2000 to April 2005, followed until December 2008. Results: The most common primary diagnosis was a psychotic spectrum disorder. One-third of NCRMD–accused people had a severe mental illness and a concomitant substance use disorder, with British Columbia having the highest rate of dually diagnosed NCRMD–accused people. Most accused people (72.4%) had at least 1 prior psychiatric hospitalization. Two-thirds of index NCRMD offences were against the person, with a wide range of severity. Family members, followed by professionals, such as police and mental health care workers, were the most frequent victims. Quebec had the highest proportion of people with a mood disorder and the lowest median offence severity. There were both interprovincial differences and similarities in the characteristics of NCRMD-accused people. Conclusions: Contrary to public perception, severe violent offenses such as murder, attempted murder or sexual offences represent a small proportion of all NCRMD verdict offences. The results reveal a heterogeneous population regarding mental health and criminological characteristics in need of hierarchically organized forensic mental health services and levels of security. NCRMD—accused people were well known to civil psychiatric services prior to being found NCRMD. Risk assessment training and interventions to reduce violence and criminality should be a priority in civil mental health services.

The Criminality of Noninstitutionalized Mentally Retarded Persons Evidence from a Birth Cohort Followed to Age 30

This study examines the criminality of noninstitutionalized mentally retarded (NIMR) men and women in a Swedish birth cohort composed of 15,117 participants followed from before birth to age 30. NIMR participants were compared with participants who had never been placed in a special class or in an institution for the mentally retarded or admitted to a psychiatric ward (NMR). NIMR participants were more likely than NMR participants to have been convicted for a criminal offense before age 30 and for a violent offense. NIMR offenders had been convicted, on average, for the same number of offenses as NMR offenders. Among the NIMR offenders, 71% of men and only 43% were first convicted before the age of 18. For both NIMR men and women, childhood conduct problems were found to be associated with adult criminality.

The National Trajectory Project of Individuals Found Not Criminally Responsible on Account of Mental Disorder in Canada. Part 4: Criminal Recidivism

Objective: To examine criminal recidivism rates of a large sample of people found not criminally responsible on account of mental disorder (NCRMD) in Canadas 3 most populous provinces, British Columbia, Ontario, and Quebec. Public concern about the dangerousness of people found NCRMD has been fed by media attention on high-profile cases. However, little research is available on the rate of reoffending among people found NCRMD across Canadian provinces. Method: Using data from the National Trajectory Project, this study examined 1800 men and women in British Columbia (n = 222), Ontario (n = 484), and Quebec (n = 1094) who were found NCRMD between May 2000 and April 2005 and followed until December 2008. Results: Recidivism was relatively low after 3 years (17%). There were interprovincial differences after controlling for number of prior criminal offences, diagnosis, seriousness of the index offence, and supervision by the review boards. British Columbia (10%) and Ontario (9%) were similar, whereas Quebec had almost twice the recidivism (22%). People who had committed severe violent index offences were less likely to reoffend than those who had committed less severe offences. People from the sample were less likely to reoffend when under the purview of review boards, across all 3 provinces. Conclusion: The results of this study, along with other research on processing differences, suggest systemic differences in the trajectories and outcomes of persons found NCRMD need to be better understood to guide national policies and practices.

Validation of the attitudes toward intellectual disability – ATTID questionnaire

BACKGROUND Individuals with an intellectual disability (ID) continue to experience major obstacles towards social, educational and vocational integration. Negative attitudes toward persons with ID has remained relevant over time and has led to discrimination and stigma. OBJECTIVE The present study describes the development of a new questionnaire for tapping into the general populations attitudes toward individuals with ID and addresses its psychometric properties. METHODS Adopting a multidimensional perspective, the Attitudes Toward Intellectual Disability Questionnaire (ATTID) was developed from a series of previously validated instruments and principles from the Montreal Declaration on Intellectual Disability (2004). The ATTID was administered by phone to 1605 randomly selected adult men and women, stratified by region in the Province of Quebec, Canada. RESULTS The ATTID yielded a five-factor structure overlapping the tri-partite model of attitudes. The cognitive component was represented by two factors: knowledge of capacity and rights and knowledge of causes of ID. The affective component tapped into two factors: discomfort and sensitivity/compassion. Finally, the behavioural component emerged as a single factor. The ATTID had good internal consistency with Cronbachs alpha coefficients ranging from 0.59 to 0.89 for the five factors and of 0.92 for the overall questionnaire. Test-retest reliability yielded correlations from 0.62 to 0.83 for the five factors. CONCLUSION The ATTID can be used to measure attitudes among different populations and allows comparisons over time within the same population as a function of various intervention strategies for de-stigmatising ID.