Risk assessment and treatment in Dutch forensic psychiatry

The predictive value of the dynamic risk outcome scales (DROS) for recidivism in (forensic) clients with mild intellectual disabilities or borderline intellectual functioning

BACKGROUND

The dynamic risk outcome scales (DROS) was developed to assess treatment progress of clients with mild intellectual disability or borderline intellectual functioning using dynamic risk factors. We studied the predictive value of the DROS on various classifications and severity levels of recidivism.

METHOD

Data of 250 forensic clients with intellectual disabilities were linked to recidivism data from the Judicial Information Service in the Netherlands. Receiver operating characteristics (ROC) analyses were used to determine the predictive values.

RESULTS

The DROS total score could not significantly predict recidivism. A DROS recidivism subscale predicted general, violent and other recidivism. These predictive values were comparable to those of a Dutch tool validated for risk assessment in the general forensic population.

CONCLUSIONS

The DROS recidivism subscale predicted various classifications of recidivism better than chance. At present, the DROS appears to have no added value beyond the HKT-30 for the purpose of risk assessment.

Assessment of ICD-11 Personality Disorder Severity in Forensic Patients Using the Semi-structured Interview for Personality Functioning DSM-5 (STiP-5.1): Preliminary Findings

In forensic settings, several challenges may affect reliability of assessment of personality pathology, specifically when based upon self-report. This study investigates the Semi-Structured Interview for DSM-5 Personality Functioning (STiP-5.1) to assess level of severity of personality functioning in incarcerated patients. Thirty inpatients of three forensic psychiatric facilities completed the STiP 5.1 and additionally completed self-report questionnaires assessing symptom severity, personality functioning and traits. Staff members completed informant versions of personality functioning questionnaires. Previously assessed community (N = 18) and clinical samples (N = 80) were used as a reference. Interrater reliability and internal consistency of the STiP 5.1 were good. As expected, no associations were found between self-report and expert-ratings (STiP 5.1) of personality functioning. Remarkably, no associations were found between informant rated personality functioning and the STiP 5.1. This study confirms the discrepancies between self-report and expert-ratings in forensic settings and identifies the need to design and test assessment instruments within this context instead of generalizing findings obtained in regular mental health care samples. The STiP-5.1 may be a candidate for use in forensic samples, particularly to guide treatment planning and individual patient policy, although it remains unclear what specific information it offers above and beyond self-report and informant-report.

A Comparison of English and Dutch Long-Stay Patients in Forensic Psychiatric Care

Background: A significant proportion of forensic patients in England are long-stayers. This can be problematic as individuals are kept in restrictive environments at potentially inappropriate levels of security for many years, sometimes decades. Improvements to the current English forensic mental health system to meet the needs of long-stay forensic patients more effectively might be informed by the Dutch service for long-stay forensic patients. Aims: To compare the characteristics of representative samples of long-stay patients in England and in the Netherlands in an attempt to draw conclusions on the degree to which the Dutch service model might be relevant to England. Method: This cross-sectional study explores the relevance of the Dutch service model by comparing the characteristics of representative samples of long-stay patients in England (n = 401) and the Netherlands (n = 102). Descriptive statistics and analyses of differences between groups are presented. The Risk-Need-Responsivity model was used to guide the selection of the study variables and structure the interpretation of the findings. Results: Compared to their English counterparts, the long-stay Dutch patients were less likely to be diagnosed with schizophrenia, but more likely to have personality disorder and have committed sex offences. The English group were younger at first conviction and at first custodial sentence. The total number of offences and the proportion of violent offenders were similar, but the Dutch HCR-20 scores indicated a significantly higher risk of violence. Conclusions: Whilst there may be barriers to adopting the Dutch service model in England, the differences in the characteristics of the two groups studied here do not necessarily preclude this approach.

Forensic psychiatric evaluations of defendants: Italy and the Netherlands compared

BACKGROUND

Forensic psychiatric practices and provisions vary considerably across jurisdictions. The diversity provides the possibility to compare forensic psychiatric practices, as we will do in this paper regarding Italy and the Netherlands.

AIM

We aim to perform a theoretical analysis of legislations dealing with the forensic psychiatric evaluation of defendants, including legal insanity and the management of mentally ill offenders deemed insane. This research is carried out not only to identify similarities and differences regarding the assessment of mentally ill offenders in Italy and the Netherlands, but, in addition, to identify strengths and weaknesses of the legislation and procedures used for the evaluation of the mentally ill offenders in the two countries.

RESULTS

Italy and the Netherlands share some basic characteristics of their criminal law systems. Yet, forensic psychiatric practices differ significantly, even if we consider only evaluations of defendants. A strong point of Italy concerns its test for legal insanity which defines the legal norm and enables a straightforward communication between the experts and the judges on this crucial matter. A strong point of the Netherlands concerns more standardized practices including guidelines and the use of risk assessment tools, which enable better comparisons and scientific research in this area.

CONCLUSIONS

We argue that there appears to be room for improvement on both sides with regards to the evaluation of mentally ill offenders. More generally, a transnational approach to these issues, as applied in this paper, could help to advance forensic psychiatric services in different legal systems.

Problematic alcohol use and mild intellectual disability: standardization of pictorial stimuli for an alcohol cue reactivity task

The present study focused on the first step in developing a cue reactivity task for studying cognitive biases in individuals with mild to borderline intellectual disability (ID) and alcohol use-related problems: the standardization of pictorial stimuli. Participants (N=40), both with and without a history of alcohol use-related problems and varying in IQ, were admitted to a forensic setting and were all abstinent. They were asked to rate familiarity, complexity, valence and attractiveness of pictures portraying both alcoholic and non-alcoholic beverages. There was a tendency to rate non-alcoholic beverages as more pleasant and attractive than alcoholic beverages. In participants with mild to borderline ID, this difference reached statistical significance, even when controlling for alcohol use-related problems in the past. The overall result of the study is a large database of 255 pictures portraying both alcoholic and non-alcoholic beverages that will be used to validate an implicit measure of cognitive biases for alcohol in individuals with mild to borderline ID.