Derek Eaves

A Comparison of General Adult and Forensic Patients with Schizophrenia Living in the Community

Schizophrenia is associated with an elevated risk for violence. The response has been to incarcerate people with schizophrenia and to increase the number of forensic beds. Most of these beds are filled by men with schizophrenic disorders with long histories of offending and of treatment in general psychiatry. Outcome from forensic, as compared to general psychiatric services, is unknown. The present study compared outcome defined as levels of positive and negative symptoms, readmission, and aggressive behavior for 248 men with schizophrenic disorders (150 discharged from forensic hospitals and 98 from general adult wards) during a two-year period after discharge from forensic and general psychiatric services. Patients were intensively assessed at discharge and four times during the subsequent two years. Illicit drug use was assessed both objectively and by self-report. More of the forensic than the general patients had failed to complete high school, had displayed a stable pattern of antisocial behavior since at least mid-adolescence, and had convictions for non-violent and violent offences. At discharge and throughout the follow-up period, general patients displayed higher levels of positive and negative symptoms than forensic patients, and more of them engaged in aggressive behavior towards others. Aggressive behavior was associated with positive symptoms and Antisocial Personality Disorder. Rates of readmission were similar for the two groups. The forensic approach that includes assessing and managing the risk of violence as well as treating symptoms of schizophrenia led to better outcome than that of general psychiatry.

The assessment, treatment and community outcome of insanity acquittees: forensic history and response to treatment

The rather startling similarities in the controversies surrounding the insanity defense over several centuries (Golding & Roesch, 1987; Hans, 1986; Hermann, 1983a; Shah, 1986) underscore the transhistorical and deeply rooted problems involved in the development of a rational and coherent policy for adjudicating criminal non-responsibility on grounds of mental disorder. The importance of developing a clear and coherent set of social, legislative and clinical policies with respect to insanity acquittees, regardless of the statistical infrequency of the insanity verdict (Pasewark & McGinley, 1985), is made patently clear by the continuing legal, public, and scholarly controversy which surrounds the defense. Modern sentiments following John Hinckley’s acquittal by reason of insanity differ little from those of Queen Victoria, “We have seen the trials of Oxford and MacNaughten conducted by the ablest lawyers of the dayand they allow and advise the Jury to pronounce the verdict of not guilty on account of insanity, whilst everybody is morally convinced that both malefactors were perfectly conscious and aware of what they did” (cited in Walker, 1968, p. 168). It is quite clear that the bundle of problems surrounding the insanity defense and the disposition of insanity acquittees will remain a focal problem, whether or not one abolishes or modifies the plea.’ Until both social science researchers and political decision-makers, as well as the lay public, have available a longitu-

A model for the provision of jail mental health services: An integrative, community-based approach

Although a considerable amount of attention has been paid to the development and implementation of mental health services in prisons, relatively little work has focused on the provision of such services to jails. Jails generally serve two purposes: (1) they hold inmates awaiting arraignment or trial and (2) they serve as short-term correctional facilities for individuals who have been assigned relatively short sentences (no longer than one or two years). Because inmnates in the first category usually remain in jail for a short period of time, it is particularly challenging to provide them mental health services. This article describes an innovative program that has recently been developed for assessing the mental health needs of inmates awaiting arraignment or trial, and providing them with mental health services.

A Multisite Study of Community Treatment Programs for Mentally Ill Offenders With Major Mental Disorders Design, Measures, and the Forensic Sample

This article presents reasons for undertaking “The Comparative Study of the Prevention of Crime and Violence by Mentally Ill Persons” and reasons for decisions regarding the study design and choice of measures. A brief portrait of the forensic patients that have been recruited is also presented. Community treatment programs could offer long-term cost-effective care for offenders with major mental disorders (MMDs). The study aims to identify the necessary ingredients of an effective program. Sites are selected in four countries where identification of most, if not all, persons with MMD who commit crimes within the catchment area was possible. Within each site, two samples of patients with MMD are recruited, one from a forensic hospital and one from a general psychiatric hospital. Assessments are completed prior to discharge. Participants are followed during a 5-year period. Comparisons of the forensic patients recruited in the four sites indicate many more similarities than differences.

The fitness to stand trial interview test: How four professions rate videotaped fitness interviews

The results of this study provide some preliminary support for the use of the FIT as a method for providing structure to interviewers. The FIT may be particularly useful as a guide for making initial decisions about fitness. It was suggested that a screening evaluation based on the FIT could be completed by any properly trained individual with some professional background. The more difficult cases can be referred for lengthier evaluations. Of course, further research on the use of the FIT with actual defendants in real assessments will need to occur before such a procedure can be used as a matter of routine. Finally, the FIT promises to be an effective research tool for isolating professional group differences in definitions of fitness and the importance of different aspects of it, from both a legal and a mental health perspective.

The International Association of Forensic Mental Health Services: Working Toward Interdisciplinary and International Collaboration

©2002 International Association of Forensic Mental Health Services It is a privilege to be asked to write a brief introduction to a new association and a new journal. Psychiatry, psychology, nursing, and social work all have recognized a forensic specialization, and in the past decade or so there have been notable advances in, for example, the understanding of the relationship between mental disorders and violence, and in the assessment of the risk of future violence in mentally disordered persons. Though many organizations exist which deal with forensic mental health, most are national in scope or profession-based, so it was felt that an important gap existed—a need to have an international interdisciplinary organization devoted to forensic mental health services. In an article in this issue, Hodgins defines forensic mental health as “the study, treatment and management of persons with mental disorders who engage in illegal and/or violent behaviors. It is a larger and more encompassing field than either forensic psychiatry or psychology.” The International Association of Forensic Mental Health Services was founded in 2001, at a conference held in Vancouver, British Columbia. Its presently defined purposes are: