Factor structure and reliability of the Greek version of Attitudes Towards Mentally Ill Offenders (ΑΤΜΙΟ) Scale in a general population sample

Mentally ill offenders constitute a group with a unique set of characteristics since they are doubly stigmatized by both their mental illness and the offence they have committed. The coexistence of these two circumstances significantly heightens negative public attitudes towards these people. The group of mentally ill offenders has been shown to elicit more stigmatic attitudes than offenders without a mental health condition. Nevertheless, research on stigma towards mentally ill offenders is rather limited, while the number of psychometric tools used to measure this stigma is even smaller compared to the number of relevant tools assessing mental illness stigma. The purpose of this study was to explore the attitudes towards mentally ill offenders in a Greek sample in terms of demographic characteristics, and at the same time to assess the psychometric properties of a specialized tool on stigma towards this patient group, namely the Attitudes Towards Mentally Ill Offenders (ΑΤΜΙΟ) scale in Greek. The study included 1031 participants from the general population who completed an online questionnaire on sociodemographic data as well as the ATMIO scale. The scale's structural validity was tested on the basis of the exploratory factor analysis after Quartimax rotation, and the internal relevance of its factors recorded a Cronbach's alpha value of more than 0.7, both for the whole scale and its individual factors. It was shown that more negative stereotypes towards mentally ill offenders were correlated with less compassion and less desire for their rehabilitation, with stronger belief and conviction that they represent a danger to the community, with less diminished responsibility, and a lot fewer positive attitudes in general. Women, older people, individuals with a lower education level and participants with children were found to hold more negative attitudes. The ATMIO scale translated in Greek is the first tool to measure attitudes towards mentally ill offenders in the country and shows satisfactory internal consistency and interpretation of its four-factor structure. It is a comprehensible and easy-to-complete scale, which can become a reliable tool to record attitudes towards mentally ill offenders also in our country.

When the security measure meets bordered penality: Release procedures for persons who are not criminally responsible without residence rights in Belgium

Offenders considered to be persons not criminally responsible (hereafter Persons NCR) in Belgium, are subjected to a security measure. This is executed by means of a forensic care trajectory, often beginning in high-security prison units or forensic psychiatric facilities, and moving through medium and lower security psychiatric facilities, with the intention to ultimately integrate them back into society. Within this group there are 145 persons without residence rights. This article is attentive to how the forensic care trajectories for people without residence rights are currently navigated. Six qualitative interviews were conducted with key decision-makers in the forensic care trajectories of Persons NCR. Moreover, we analyse the legislative framework regarding the security measure and illustrate how features of 'bordered penality' are clearly present. Our results indicate that when working towards a return to the country of origin fails, Persons NCR without residence rights become neglected, either in high-security prison units or forensic facilities. We explore avenues to improve this precarious situation, and consider possibilities to guarantee mental healthcare according to a persons' security needs rather than their residence rights.

Socio-demographic, clinical and offense-related characteristics of forensic psychiatric inpatients in Hunan, China: a cross-sectional survey

BACKGROUND

There is still a lack of comprehensive research on the profile of patients in forensic mental health hospitals in China. This study aims to investigate the socio-demographic, clinical, and offense-related characteristics of mentally ill offenders in the Hunan Provincial Forensic Psychiatric Hospital in China.

METHODS

This study was conducted from November 1, 2018, to January 30, 2019. The data of socio-demographic, clinical, and offense-related characteristics of the patients were collected. The Brief Psychiatric Rating Scale (BPRS), the Modified Overt Aggression Scale (MOAS), and the Clinical Global Impression-Severity (CGI-S) scale were used to measure their psychiatric conditions.

RESULTS

A total of 461 participants were enrolled in this study. Among them, 86.3% were males and 56.8% were unmarried; the average age of them was 44.7 ± 10.1 years, and the mean years of education were 7.51 ± 3.3 years. Before their current offense, a total of 345 patients (74.8%) had sought medical help for their mental illnesses. While 303 (87.8%) of these patients were prescribed antipsychotics, 254 (73.6%) failed to take them regularly. Of all the inpatients, 90.5% were diagnosed with schizophrenia; 385 (83.5%) engaged in homicidal offenses, with 54.0% of the victims being their family members. In homicide cases, the relatives were more likely to be victims of female patients. The mean length of stay in the forensic hospital was 8.02 ± 4.74 years, and over 80.0% of the patients had been hospitalized for over 5 years.

CONCLUSIONS

To our knowledge, this is the first study investigating the profile of forensic patients receiving compulsory treatments in a forensic psychiatric hospital in China. These results add to the world literature on the characteristics of forensic patients and can help identify common treatment and risk-related needs of this population.

Public's Attitudes Toward Mentally Ill Offenders in Greece

Mentally ill offenders constitute a vulnerable population group with unique characteristics, and have endured multiple public stigmatizations, which has not been sufficiently studied. The purpose of this study was to capture attitudes of the public toward mentally ill offenders in relation to their perceptions of mental illness in general, as well as their degree of familiarity with it. Our sample of 2059 people can be overall described as a men preponderance, married, with mean value age of 26 years, higher educational level, and medium or higher socio-economic status. Participants completed the ATMIO, CAMI, and Familiarity scales online. The total familiarity index value with mental illness was found to be 4.88, which counts as moderate to low. It was also concluded that women and those with a high educational level sustained more positive attitudes toward mentally ill offenders. However, negative stereotypes (with a mean value of 26.20), stigmatizing attitudes related to risk in the community (mean 16.10), and reduced responsibility for actions (mean 9.45) were recorded, while some (mean 16.50) showed compassion and emphasized on the mentally ill need of rehabilitation. The youngest people were the ones who recorded the most absolute and harsh attitudes. These findings validate the need of raising awareness and informing, especially, the young public about issues of mental health, including the need to oppose prejudices with everyday measures, which can be accessible to the new generation. Besides, we should extend research to various professional groups that come in contact with mentally ill offenders in order to collect data, which could contribute for intervening policies and formulating different sets of strategies for those people.

"It's Not Like Therapy": Patient-Inmate Perspectives on Jail Psychiatric Services

Jails may serve an important public health function by treating individuals with psychiatric problems. However, scholars debate the service qualities that can best achieve this aim. Some suggest the possibility of comprehensive psychiatric services in jails, while others recommend a narrower focus on basic elements of care (assessments, medication management, and crisis intervention). To date, this debate remains uninformed by service recipients. This qualitative study addresses this gap by illuminating patient-inmate perspectives on jail psychiatric services. Patient-inmate experiences indicate that the jail environment is incongruent with the provision of comprehensive psychiatric services. Thus, program administrators would best serve patient-inmates by strengthening basic services and connections to community-based providers who can provide comprehensive and effective care.

How family members of mentally ill offenders experience the internment measure and (forensic) psychiatric treatment in Belgium: A qualitative study

Mentally ill offenders in Belgium can be subjected to mandated care under an "internment measure" if they are viewed as a danger to society. This study investigated how family members of mentally ill offenders experience this internment measure and view the (forensic) psychiatric treatment of their relative. Semi-structured interviews were conducted with 24 relatives and analysed using Nvivo 11. Six different themes emerged: (1) the criminal offence and the internment measure as an additional stigma, (2) ambivalent feelings towards the judicial system, (3) prison is not the right place to be, (4) mental health support as an answer to problems, (5) fight a losing battle, and (6) while there is life there is hope. The experiences of family members indicate the need for improved treatment guidelines that allow earlier compulsory interventions to prevent crime and preferential admission to (forensic) psychiatric facilities rather than prisons. In addition, family members expressed the need for better communication from mental health professionals and the judicial system during the process and greater availability of peer support.

Firearms regulation, violence and the mentally ill: a contemporary Antipodean appraisal

As recent cases of mass murder at Utoya Island in Norway, and in the United States (US) at Virginia Tech, Virginia; Tucson, Arizona; Aurora, Colorado; and Newtown, Connecticut all illustrate, acts of extreme violence involving high powered weapons and committed by persons with a presumed or confirmed mental illness tend to arouse intense public and political debates about the efficacy of firearm regulation and control. Following these tragedies, in the US at least, various law reform measures have been proposed and in some cases implemented designed principally to make it more difficult for mentally ill persons to gain access to firearms. In this article it is contended that measures like these are at best tinkering with the margins of gun control and also have the tendency to reinforce the stigma and discrimination experienced by persons with a mental illness, while perpetuating stereotypes of them as dangerous to themselves and others. Despite these limitations, and while firearm regulation policies and practices vary widely across the globe, most nations still seek in some way to limit access to guns by persons with a mental illness. This article explores in more detail how such policies and practices have been applied in the Australian State of New South Wales and the lessons to be learned elsewhere from this experience.