international association of forensic mental health …

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DearmembersoftheIAFMHScommunity,Welcome to the first edi=on of the 2021 IAFMHSnewsleBer!What a strange start to the year it hasbeen, as we find ourselves withmoments of hopemixedwithon-goinguncertainty. In lightofouron-going COVID-19 pandemic, wewould like to solicitcontribu=ons pertaining to the impact that thepandemic has on the prac=ce of forensic mentalhealth. To this end, we are featuring a recentlypublished ar=cle by Dr. Lemieux and colleaguesprovides a review regarding best prac=ces,challenges, and recommenda=ons of managingCOVID-19insecureseQngs.In this issue of the newsleBer, I would also tohighlight the research update provided by the EU-VIORMEDInterna=onalCollabora=on,whichaimstoimprove the quality of forensic psychiatric careacrossEurope.As always, we would like to encourage graduatestudents, early career professionals, and othermembers of IAFMHS to submit content to thenewsleBerortojoinourteam.

SarahCoupland,Editor

INTERNATIONALASSOCIATIONOFFORENSICMENTALHEALTHSERVICES

VOLUME6|ISSUE1Winter2021

Le5erfromtheEditorRiskyBusinessVideoconferencingTechnologiesinAssessment:GetonBoardorGetLe8Behind 2Dr.AshleyBatas.ni

SpotlightonMentalHealthDiversion 4RandomizingDispatchCallsforServiceforaPoliceMentalHealthCo-ResponseTeaminIndianapolis,IN,USA.EmilySightes

ForensicMentalHealthNursing 5TheCaseforNormalizingPhysicalHealthCareinForensicMentalHealthServices.Dr.BrianMcKenna

HighlightonCOVID-19inForensicMentalHealth 7Dr.AshleyLemieuxetal.

TheEU-VIORMEDInternaRonalCollaboraRonViolenceRiskAssessmentandTreatmentforForensicPaLentswithSchizophreniaSpectrumDisordersDr.GiovannideGirolamoetal. 8

IJFMHFeatureArRcle 10

StudentSecRon 11

WinterEdiRonFeatures

Connect with us at http://www.iafmhs.org/ or

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RISKYBUSINESS

VideoconferencingTechnologiesinAssessment:GetonBoardorGetLe[BehindWith massive shortages in mental healthcare providers,especially in rural communi=es, remote deliverymechanisms have been hailed as a sort of savior in thiscrisis(seee.g.,Frueh,2015;MaBhews,2017).Amongthem o s t c ommon o f t h e s e m e c h a n i sm s a r evideoconferencing technologies (e.g., Polycom, CiscoWebEx, Zoom, etc.), which use audiovisual monitors orscreens to connect agencies (e.g., hospitals, jails) orindividual clients to service providers who are locatedelsewhere.Whilemuchof the research todate is basedon U.S. prac=ces and clientele, the fast-growing use ofvideoconferencing technologies can be observedinterna=onally.Across theglobe,healthcare systemsaremakingroomfor this trend (e.g.,AmericanPsychologicalAssocia=on, 2013; American Telemedicine Associa=on,2013; Digital Health & Care Scotland, 2018; UnitedKingdom Na=onal Health Service, 2019; Australia’sNa=onalDigitalHealthStrategy,2018).Inthewakeofanunprecedented, worldwide pandemic, there has been anear overnight shi[ in prac==oners turning to virtualservices,needingtoquicklyacquiretrainingandestablishinfrastructuretoconnectwithclients.

Inforensicmentalhealthassessment(FMHA),theuseofvideoconferencing technologies had been gainingaBen=on,evenbeforethepandemichit.Ina2019survey,about 34% of forensic examiners reported having usedthembefore(Batas=nietal.2019).Notably,however,theempirical literature is limited in this area. One of theearlier(andonly)knownexperimentalstudiestoexaminethe reliability of competency to stand trial evalua=onsfound liBle differences in examiners’ clinical forensicopinions using the Georgia Court Competency Toolbetween in-person and videoconference administra=on(i.e.,viaalocalareanetwork[LAN]andaPolycomsystem;Manguno-Mire et al., 2007). Given this rise invideoconferencing technologies, my team and Iconducted a smal ler -sca le meta-ana lys i s ontelepsychological serviceswith both jus=ce-involved andsubstanceabuseclients (Batas=nietal.,2016).AlthoughthefocuswasbroaderthanFMHA,includingmeasuresofmentalhealthsymptoms,therapeu=cprocesses,programengagement, program performance, and servicesa=sfac=on,wesimilarlyfoundliBlecompellingevidence

thatvideo-basedserviceswereunderperforming

that video-based services were underperformingcompared to in-personmethods.As such,we concludedthat being physically present in a room with a client islikely not as important as wemight believe it to be. Ofcourse, our findings were based on only a small set ofstudies.Further,violenceriskandthreatassessmentsarenotably absent from this literature. Given its prevalenceandtheproblemofsignificantwait=mesforevalua=ons,much of the discussion about videoconferencingtechnologies has centered on adjudica=ve competency(Luxton&Lexcen,2018;Luxtonetal.,2019).In addi=on to establishing the extent to whichvideoconferencing technologies may lead to differentforensicclinical judgmentsandunderwhatcondi=ons, itisalso relevant toexamine theopinionsofpsychologicaland legal experts, as percep=ons are directly linked touse. Especially now, remote op=ons for FMHA mayincrease the rateatwhich individuals canmove throughthe judicial system without viola=ons to their rights orcrea=ng poten=al threats to public safety. In our 2019survey,evaluatorsexpressedmoderateconcernovertheethics and legality of using videoconferencingtechnologies in FMHA. Importantly, the use ofvideoconferencing technologies in FMHAs has, thus far,notbeenchallengedincourt.Asagroup,theseexaminersmost frequently cited reduced costs for courts as abenefit of these technologies, while challenges inadministering psychological tes=ng and poten=altechnologicalproblemswereseenasthemostsignificantproblems. Interes=ngly, however, early careerprac==oners and those with prior experience endorsedmore posi=ve aQtudes about videoconferencingtechnologies than their counterparts. In light of theincreased exposure to these technologies during theCOVID-19 pandemic, it is quite possible that examiners’opinionshavesinceshi[ed.(Con.nued...)

AshleyB.BatasRni,Ph.D.AssistantProfessorUniversityofMemphis

SarahCoupland,Editor ForensicPsychiatricServicesCommission(CAN)

KrystleMarRn,AssociateEditor–RiskyBusiness,OntarioShoresCentreforMentalHealthSciences(CAN)

HelenWalker,AssociateEditor–ForensicMentalHealthNursing,NHSStateHospitals(Scotland)

EvanLowder,AssociateEditor–MentalHealthDiversion,GeorgeMasonUniversity(USA)

MarichelleLeclair,EditorialAssistant,UniversitédeMontréal(CAN)

EditorialTeam

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VideoconferencingTechnologiesinAssessment:GetonBoardorGetLe[BehindWhile liBle researchandbestprac=cecommentaryhaveaddressed remote violence risk and threat assessmentspecifically,manyof thesamegeneral recommenda=onsandcau=onsapply.Theseinclude,butarenotlimitedto:

1.  Ensuring data transmission systems are secure (e.g.,using encrypted email, HIPAA compliant virtualplaoorms);

2.  Working with agencies and clients to minimize therisk of disrup=ons and distrac=ons and maintaindocumenta=onwhenincidentsoccur;

3.  Tes=ngnetworkconnec=vityandop=cs(e.g.,ligh=ng,physicalposi=oning,appearanceofaQre)inadvance;

4.  Iden=fyingareliableon-siteorlocalcontactpersonincase of an emergency (clinical or medical) or someother issue requiring immediate response (e.g., anexamineedamagingcomputerequipment);

5.  Assessing examinees’ ability to engage in a videointerview (e.g., hearing or visual impairments,paranoididea=on);

6.  Determining whether assessment tools can bemodified in a clinically jus=fiable and legallydefensiblemanner (i.e., does themodifica=onmakesenseandisits=lllikelytoyieldvalidresults?);and,

7.  Clearly explaining the ra=onale for using technologyand the implica=ons of any associated limita=ons inreports and tes=mony. As Luxton and Lexcen (2018)argue, in cases that are likely to be subjected tointenselegalscru=ny(e.g.,conten=ousorhigh-profilecases), examiners may want to exercise greatercau=onwhenchoosingVCT.

VCTisunlikelytoreplacein-personassessments,butitisalmost certainly here to stay. Prac==oners who fail toadaptriskgeQngle[behind.

If you are a prac==oner or researcher engaged in riskassessment/management and would like to share yourresearch, perspec=ve, or ideas with readers, pleasecontact the Risky Business editor, Krystle Mar=n [email protected].

ReferencesAmerican Psychological Associa=on. (2013). Guidelines for the prac=ce ofte lepsycho logy . The Amer i can Psycho log i s t , 68 (9 ) , 791-800 .hBps://doi.org/10.1037/a0035001

AmericanTelemedicineAssocia=on.(2013).Prac=ceGuidelinesforVideo-BasedOnline Mental Health Services. Washington, DC: American TelemedicineAssocia=on.hBps://doi.org/10.1089/tmj.2013.9989

Australia’sNa=onalDigitalHealthStrategy. (2018).Safe, seamlessandsecure:A u s t r a l i a ’ s n a . o n a l d i g i t a l h e a l t h s t r a t e g y .hBps://conversa=on.digitalhealth.gov.au/sites/default/files/adha-strategy-doc-2ndaug_0_1.pdf

Batas=ni, A. B., King, C. M., Morgan, R. D. & McDaniel, B. (2016).Telepsychologicalserviceswithcriminaljus=ceandsubstanceabusingclients:Asystema=c review and meta-analysis. Psychological Services, 13(1), 20-30.hBps://doi.org/10.1037/ser0000042

Batas=ni,A.B.,Pike,M.,Thoen,M.A.,Jones,A.C.T.,Davis,R.M.,&Escalera,E.(2019). Percep=ons and use of videoconferencing in forensic mental healthassessments:Asurveyofevaluatorsand legalpersonnel.Psychology,Crime&Law,26(6),593-613.hBps://doi.org/10.1080/1068316X.2019.1708355

Digital Health & Care Scotland. Scotland's digital health and care strategy:e n a b l i n g , c o n n e c . n g a n d empowe r i n g . ( 2 0 1 8 , A p r i l 2 5 ) .hBps://www.gov.scot/publica=ons/scotlands-digital-health-care-strategy-enabling-connec=ng-empowering/

Frueh,B.C. (2015).Solvingmentalhealthcareaccessproblems in the twenty-fi r s t c e n t u r y . A u s t r a l i a n P s y c h o l o g i s t , 5 0 ( 4 ) , 3 0 4 – 3 0 6 .hBps://doi.org/10.1111/ap.12140

Luxton, D. D. & Lexcen, F. (2018). Forensic competency evalua=ons viavideoconferencing: A feasibility review and best prac=ce recommenda=ons.Professional Psychology: Research and Prac.ce. 49(2), 124-131.hBps://doi.org/10.1037/pro0000179

Luxton, D. D., Lexcen, F. J., & McIntyre, K. A. (2019). Forensic competencyassessment with digital technologies. Current Psychiatry Reports, 21(60).hBps://doi.org/10.1007/s11920-019-1037-9

Manguno-Mire,G.M.,Thompson,J.W.,Jr.,Shore,J.H.,Croy,C.D.,Artecona,J.F.,&Pickering,J.W.(2007).Theuseoftelemedicinetoevaluatecompetencytostandtrial:Apreliminaryrandomizedcontrolledstudy.JournaloftheAmericanAcademyofPsychiatryandtheLaw,35(4),481-489.

MaBhews, K. (2017, August). Telepsychiatry: The modern solu=on to ourm e n t a l h e a l t h . T e c h T r e e . R e t r i e v e d a thBps://www.techtree.com/content/features/13159/telepsychiatry-modern-solu=on-mental-health.html

UnitedKingdomNa=onalHealthService.TheNHS longtermplan. (August21,2019).hBps://www.longtermplan.nhs.uk

RISKYBUSINESS

AnnualIAFMHSConference

Forupdatesaboutthe2021IAFMHSConference,pleasecheckourconferencewebsitehere.

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SPOTLIGHTONMENTALHEALTHDIVERSION

RandomizingDispatchCallsforServiceforaPoliceMentalHealthCo-ResponseTeaminIndianapolis,IN,USA.Co-responseteamshavegainedpopularity inrecentyearsfortheirfocusindiver=ngindividualswithamentalhealthillnessawayfromthecriminaljus=cesystem(Baileyetal.,2018). Co-response teams partner a police officerwith atleast one social ormedical services provider (e.g.,mentalhealth clinician, social worker, paramedic, psychiatrist) torespondtoemergencycallsforserviceinvolvingbehavioralhealth concenrs. By way of background, the IndianapolismodelconsistsofaMobileCrisisAssistanceTeam(MCAT)that responds to mental health, substance-use, and co-occurring emergencies in addi=on to a Behavioral HealthUnit (BHU) that provides follow-up services. Both theMCATandBHU includea IndianapolisMetropolitanPoliceDepartment (IMPD) crisis interven=on-trained officer andan Eskenazi mental health clinician. The MCAT teamresponds to immediate mental health dispatch calls forservicewhiletheBHUteamprovidesfollow-upcaretotheMCAT clients within 48 hours a[er the ini=al call forservice.

Researchers from the Center of Health and Jus=ceResearch at the Indiana University Public Policy Ins=tuteandtheCenterforBehavioralHealthandJus=ceatWayneState University have partnered with IMPD and EskenaziHealth to conduct one of the first randomized controlledtrials of a co-response team. The study was designed toexamine the effec=veness of the MCAT-BHU model inreducing criminal jus=ce involvement among persons inmentalhealthandsubstanceuse-relatedcrises rela=ve topolice response as usual. This research effort hasnecessitated crea=ve strategies to conduct randomassignmentofpar=cipantstocondi=on.

To achieve the goals of this study, our research teamdecided to implement randomiza=on at the level of anemergency 9-1-1 call for service. As a member of theresearch team, I am one of two Indianapolis-basedresearchers who is responsible for determining calleligibilityandthenrandomlyassigning9-1-1calls tostudycondi=on. This process involves listening to an IMPDdispatch radio five days perweek from10:00 am to 5:30pm.When anMCAT-eligible call for service comes in viathe radio, we randomize the call for service usingTrueRandom.org’s coin flip applica=on; a HEADS resultsindicatesMCATcanrespondtothecall,andaTAILSresultindicates MCAT cannot respond to the call. We thencommunicate this result to the MCAT officer via Zello, amobileapplica=onthatactsasawalkie talkie. In thecaseof a HEADS result, once the MCAT team is finishedresponding to the call for service, the team willcommunicatetheiravailabilitytorespondtofurthercalls.

Although our research team has established acomprehensive list of MCAT-eligible dispatch call types,thereareinstancesinwhichitisunclearifacallforservicemeetstheMCATcriteria.Inthesecases,IwillreachouttotheMCATofficeronZelloandaskhisopinion,andwewilldecidetogetherifacallcons=tutesanMCATcall.Sincethestart of the study, I have established great trust andrapport with the MCAT team which facilitates such acollabora=on. Indeed, throughout the en=re crea=on andimplementa=onofthestudy,wehavereliedheavilyonthefeedbackandexper=se frommembersof theMCATteamas they have valuable experience responding to varioustypes of dispatch calls. Fortunately, IMPD has beenmorethan willing to collaborate with researchers to facilitatestudyimplementa=on.

Overall,workingclosingwiththeMCAT-BHUteaminordertoestablishthisrandomiza=onprotocolhasallowedmetogain insight into the poten=al impact that co-responseteamscanhaveonthecommunity.MembersoftheIMPDco-responseteamhaveapassionfortheirwork,andwe’vefoundthistobeakeyfactorimpac=ngthesuccessoftheseteams.

References

Bailey,K.,Paquet,S.R.,Ray,B.R.,Grommon,E.,Lowder,E.M., & Sightes, E. (2018). Barriers and facilitators toimplemen=nganurbanco-respondingpolice-mentalhealthteam. Health Jus.ce, 6(21) hBps://doi.org/10.1186/s40352-018-0079-0

If you are a prac..oner or researcher engaged in newornovelmental healthdiversion ini.a.vesandwould like tosee this work highlighted, contact Evan Lowder [email protected].

EmilySightes,MPHDataAssistantCenterforBehavioralHealthandJusRceWayneStateUniversity


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When I trainedasanurse in theearly1980’s (yes,a long=meago),welearnedaboutCartesianDualism,Descartes’17th century theory of the mind-body split. Broadly, hetheorized that the mind and body were dis=nct andseparableen==es.CartesianDualismhasbeenreplacedinfavourofholism,whichsuggeststhatanindividual’sparts(e.g., physical, psychological, social, cultural and spiritual)canonlybeunderstoodinrela=ontotheirwhole.Andyet,wewereconfrontedwiththeprac=cerealityofhowbusyins=tu=ons focus exclusively on the part and not thewhole,andstruggledtoholdtruetotheholis=cvision.

Our“modernworld”hasseveralphysicalhealthepidemics,some of which have been exacerbated by poor lifestylechoices. Weareea=ngtoomuchofthewrongfoods,wearephysicallyinac=ve,andweover-indulgeinthelifestylechoicesperceivedasquickfixestothestressesofmodernliving (e.g., alcohol and other substance use). The healthimplica=onsare immense:obesity,cardiovasculardisease,diabetes,cancer,andthelistgoeson.

Our severely mentally ill popula=ons have even poorerhealth outcomes when compared with the generalpopula=on, that results in staggering implica=ons andreduced life expectancy. Specifically, studies havesuggested that mortality is more than doubled forindividuals with any mental illness, and that mostcommonly deaths result from condi=ons like diabetes,cardiovascular disease, metabolic syndrome andrespiratory illness (Walker, McGee, & Druss, 2015). Theunderlying reasons are complex and mul=faceted. Thesereasons includepoorhealthy lifestyle choices (likeusall),the experience of ins=tu=ons (which limit choice andmo=va=on),thesymptomsofmentalillness(which cloudeffec=veresponse),medica=onstorelievesuchsymptoms,(which further compromise physical health), and reduced

accesstoandqualityofhealthcaredeliveryduetofinancialand structural barriers, s=gma and discrimina=on (see TePouoteWhakaaroNuiresource).

Thesolu=on?Normalisingphysicalhealthalongsidementalhealth. Systemically, interna=onal ini=a=ves such as“EquallyWell” embrace the challenge through suppor=ngthe combined efforts of the health, social care services,communi=es, and educa=on providers. Yet my personalpercep=onisthatnormalisingphysicalhealthcareremainsa challenge in secure forensic mental health services.Contrac=ng out physical health care to external generalprac==oners, or having it addressed through short termnew graduate doctor internships does not providecon=nuity of care. It is only a par=al solu=on to theeverydayexperienceofserviceusers.

Person-centred physical health care support requires aseven-day-a-week service, embedded into our secureservices. In my own profession, it is exci=ng to see thepossibility offered by the evolving roles of nurseprac==oners. Nurseprac==onerscombinetheiradvancednursing knowledge and skills with diagnos=c reasoning,therapeu=c knowledge, and skills, including prescribingrights. Nurse prac==oners work autonomously and inmul=-disciplinary teams to promote health, preventdisease, and improve access and popula=on healthoutcomes fora specific serviceusergroupor community.Specifically,theirfocusisonthisunmetneed.

If we acknowledge that physical health care need withinourforensicmentallyillpopula=onsisanunmetneed,theopportunity to embed nurse prac==oner skills withinforensicmentalhealthservicesisanexci=ngpossibility. Itnow requires bold leadership to ar=culate such unmetmeetandconsiderplannedinnova=onasawayforward.

ResourcesandReferences

TePouoteWhakaaroNui.

NewZealandMinistryofHealth

Walker,E.R.,McGee,R.E.,Druss,B.G.(2015).Mortalityinmentaldisordersandglobaldiseaseburdenimplica=ons:Asystema=c review and meta-analysis. JAMA Psychiatry,72(4), 334-341. hBps://doi.org10.1001/jamapsychiatry.2014.2502.If you are a nurse working in a forensic mental healthseQngandwouldliketocontributetothissec=on,[email protected].

FORENSICMENTALHEALTHNURSING


BrianMcKenna,RN,Ph.D.,ProfessorofForensicMentalHealth,AucklandUniversityofTechnologyandtheAucklandRegionalForensicPsychiatryServices

TheCaseforNormalizingPhysicalHealthCareinForensicMentalHealthServices.

6 Connect with us at http://www.iafmhs.org/ or

POSTDOCTORAL RESEARCH FELLOWSHIP OPPORTUNITY

A full time postdoctoral position in the area of Forensic mental health (mental health, justice and safety). The fellowship is for 12 months with a possible second year appointment and provides a research and academic training.

Description

The postdoctoral fellow will lead and participate in the development of a series of scientific papers on trajectories of individuals receiving forensic mental health services as well as coordinate research activities and supervise research assistants and students.

The goal is to expand and enrich the candidate’s knowledge of forensic mental health and the scientific method, and to extend the candidate’s skills in conceptualizing and executing statistical analyses and writing manuscripts for publication in high impact scientific journals.

Qualifications

Applicants must have a recent Ph.D. in a related discipline (e.g., Psychology, Psychiatry, Epidemiology, Sociology, Criminology etc.), have a demonstrated record of experience in advanced quantitative statistical methods. Applicants must have demonstrated ability in preparing and publishing research papers. The applicant must be interested in pursuing a career that focuses broadly on mental health, antisocial behaviour, justice safety, mental health and the law.

Environment

The position is to be held at the Institut national de psychiatrie légale Philippe-Pinel research Center and the Department of Psychiatry & Addictions of the Université de Montréal. It is funded through a CIHR operating grant and a bursary from the Centre international de criminologie comparée. Supervision will be ensured by Professor Anne Crocker.

The postdoctoral fellow will be integrated into the national team and be offered the necessary supervision to develop all of the abilities necessary to become an independent scientist. Teaching and student (co)supervision opportunities will also be offered.

We are seeking to fill the position as soon as possible.

Application deadline: February 28th 2021

To apply, please send to Dr Anne Crocker: [email protected]

• Curriculum Vitae • Cover letter detailing research interests, experience and career goals • Two letters of recommendations • Two manuscripts

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HIGHLIGHTONCOVID-19INFORENSICMENTALHEALTH

FeatureAr=cle

AshleyLemieuxa,Audrey-AnneDumaisMichaudab,JeanDamassec,Julie-Ka=aMorin-Majorc,ToNhuNguyenc,AlainLesagec,d,&AnneG.Crockera,d,e

Thisrapidreviewwasconductedinresponsetothegrowingneedsofforensicandcorrec=onalins=tu=onstocare forpa=ents in themidstofaglobalpandemic,which increasedpa=ents’ vulnerabilityand turnedtheirins=tu=onsintopoten=aloutbreaksites.Ourgoalwastoiden=fybestprac=ceswhichwoulddecreasetransmissionriskstakingintoaccountpa=ents’mentalhealthrecovery.BecauseourreviewtookplaceoverthecourseofthefirstCOVID-19wave(fromDecembertoAugust2020),mostpapersiden=fiedarederivedfromopinionpieceswhicheitherdescribed:(1)theexperiencesofspecificins=tu=onsand(2)lessonstheylearned or descrip=ons of poten=al hazards rela=ve to previous research conducted on confinement.Nevertheless, the themes highlighted have helped iden=fy poten=al areas that need to be taken intoaccountwhenins=tu=onsimplementnewpoliciesandproceduresduringapandemic.Moreover,theyhavepointed towards research opportuni=es to iden=fy best prac=ces for implementa=on in the currentpandemicandintheeventoffuturehealthcrises.GivenextensiveCOVID-19researchfunding, it ishopedthatnewempiricalresearchwillbepublished,inopenaccessonanongoingbasis.Oneimportantconclusionto bemindful of is to increase the integra=onof individualswith lived experiences in both research andclinicalendeavors.Whilethisunprecedentedhealthcrisishasshakenthefounda=onsofourhealthcareandsocialservices,ithasalsoprovidedanopportunityforincreasedcollabora=onbetweenpa=ents,clinicians,andresearcherstomovetowardsevidence-basedandperson-centeredcare.

Abstract:MostcountrieshaveimplementedguidelinesandpoliciesinresponsetoCOVID-19thathavehadadirect impact on ins=tu=onalized or incarcerated persons with mental health problems. Although thesestrategies are essen=al to protect these vulnerable persons from the pandemic, they can also havesignificantconsequencesonrecovery,well-being,aswellasrightsandfreedoms.Accordingly,weconducteda rapid review to iden=fy strategies, challenges and recommenda=ons for dealing with the COVID-19outbreak in secure seQngs for persons with mental illness. While most available publica=ons are notempirical innature, thisknowledgesynthesiscanneverthelessguidemanagersofpsychiatricandforensicpsychiatricins=tu=ons,andcorrec=onalfacili=esindealingwiththeCOVID-19pandemic.

aIns=tutna=onaldepsychiatrielégalePhilippe-Pinel,Montréal,Québec,Canada;bDepartmentofSocialWork,UniversitéduQuébecenOutaouais,St-Jérôme,Québec,Canada;cCentreintégréuniversitaireensantéetservicessociaux(CIUSSS)del’Est-de-l’Île-de-Montréal,Montréal,Québec,Canada;dDepartmentofPsychiatryandAddic=ons,UniversitédeMontréal,Montréal,Québec,Canada;eSchoolofCriminology,UniversitédeMontréal,Montréal,Québec,Canada

Thefullar=clecanbefoundhere.

ManagementofCOVID-19forPersonswithMentalIllnessinSecureUnits:ARapidInterna=onalReviewtoInformPrac=ceinQuébec

CALLFORCOVID-19SUBMISSIONS


As we enter 2021 and face the uncertainty, concern, and restric=ons of the second wave of theCOVID-19 pandemic, we invite contribu=ons to share reflec=ons, adapta=ons, and impacts that theglobal pandemic has had on forensic mental health prac=ce. We hope to be able to showcase thedifferencesand similari=esbetweenour countries. Please send submissions to theNewsleBerEditor,[email protected]

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The EUropean Study on VIOlence Risk and MEntalDisorders (EU-VIORMED, www.eu-viormed.eu) is aEuropean project that aims to improve the quality offorensicpsychiatriccareallaroundEurope.Differentworkpackages (WP), including WP4 Iden.fying violence riskfactors (coordinated by P2-KCL), WP5 Evalua.on ofeffec.vetreatments(coordinatedbyP4-MUW),andWP6Mapping of forensic services (coordinated by P3-MANN)were linked to projectManagement (WP1, coordinatedby P1-IRCCS Fatebenefratelli), Evalua.on (WP2,coordinated by P5-IPIN), Dissemina.on (WP3,coordinated by P8-UNIMIB), and Data analysis (WP7coordinatedbyP1-IRCCSFatebenefratelli).Fivecountriescontributed to work package 4: Italy (coordina=ngcentre), Austria, Germany, Poland and the UnitedKingdom.

ObjecRvesThemainaimsofWP4were:

•  to test if new puta=ve risk factors, such as socialcogni=ondeficits,contributedtotheriskofviolenceinforensic pa=ents with schizophrenia spectrumdisorders and a history of significant violence (cases)compared to pa=ents with no history of significantviolence (controls) using a five-na=on case-controlstudydesign;

•  to describe the needs and unmet needs of pa=entswithschizophreniaspectrumdisordersandtocomparepa=ents’ and staffmembers’ views of those needs inforensicpsychiatryseQngs;

•  toestablishforthefirst=meinaninterna=onalsampleforensicpa=ents’competence(capacity)toconsenttotheir treatment, and explore what factors maycontributetolackofcompetence;

•  to test and compare for the first =me the validity ofthreeviolenceriskassessmentguides, theHCR-20v3,and two novel risk assessment guides, the ForensicPsychiatry and Violence (FoVOx) and Mental Illnessand Suicide (OxMIS) guides in pa=ents withschizophrenia spectrum disorders and a history ofsignificantviolence.

Summaryofprogress

Overall,wesucceeded inrecrui=ng398pa=ents in total,221 forensic cases and177matched controls over a 22-monthperiod(fromJune2018toApril2020).Allpa=entsprovided wriBen informed consent before entering thestudy.

Each subject was assessed using the study baBery ofstandardized instruments, including the Posi=ve andNega=ve Syndrome Scale (PANSS), the WHO DisabilityAssessment Schedule, the Modified Overt AggressionScale (MOAS), and the Camberwell Assessment of Need(CAN). In addi=on, in Italy and Poland, both cases andcontrols underwent a sophis=cated social cogni=onbaBery to explore if deficits in risk taking, decisionmaking,andmoraldomainscontributedtoviolenceriskinpa=entswithschizophreniaspectrumdisorders.Analysesare currently underway, and we look forward to futurepublica=ons exploring these areas. In line with theEuropean Commission policy to make research datafindable, accessible, interoperable and reusable (FAIR),we welcome the ac=ve collabora=on of scien=sts andclinicians in theop=mal exploita=onof data collected inthe framework of this project. For any informa=onwiththisregard,pleasecontacttheprojectPIDr.deGirolamo([email protected]).Twosystema=creviewsinves=gatedtheeffectofdis=nctinterven=ons on violent behaviors in pa=ents withschizophreniaacrosslargedatabases(MEDLINE,EMBASE,SCOPUS,Web Of Science, CINAHL, PSYNDEX, PsycINFO).TheyhavebeensubmiBedtohigh impact journals inthefield.(Con.nued...)

RESEARCHUPDATE

TheEU-VIORMEDInterna=onalCollabora=on:ViolenceRiskAssessmentandTreatmentforForensicPa=entswithSchizophreniaSpectrumDisordersGiovannideGirolamo,StJohnofGodClinicalResearchCentre,Italy|GiuseppeCarra,UniversityofMilanBicocca,Italy|HeinerFangerau,Heinrich-Heine-UniversityDuesseldorf,Germany|PawelGosek,Ins=tuteofPsychiatryandNeurology,Poland|MarcoPicchioni,King’sCollege,UK|HansSalize,CentralIns=tuteofMentalHealth,Germany|JohannesWancata,MedicalUniversityofVienna,Austria|MargaretWalker,EUFAMI,Belgium


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RESEARCHUPDATE

EU-VIORMEDProject

DüsseldorfUnitThe task of the Düsseldorf Unit is twofold: 1) ethicalassessment of the arguments for or against coercivemeasures towards forensic pa=ents in the EU MemberStates; and 2) ethical analysis of the results of theMacArthur Competence Assessment Tool-Treatment(MacCAT-T)survey.

Noneoftheissuesabovecanbeaddressedindependentlyofthena=onallegalframeworksregula=ngdeten=onandtreatmentofjus=ce-involvedpersonswithmentalillness.These vary significantly across Europe, star=ng fromcompetence over forensic psychiatry (the Ministry ofHealth, the Ministry of Jus=ce, or both). We haveapproachedthedifferentregula=onsasdynamicsystemswith a double perspec=ve: as the result of ethically-informedstrugglesoverthebalancebetweencareoftheindividual and protec=on of society; and as frameworkswithinwhich further ethical dilemmas and conflictsmayarise. Taking themove from an in-depth analysis of thecountries involved in the EU-VIORMED study, weproceeded to an ethical mapping of the differentjurisdic=onsunderthefollowingrubrics:defini=onofthecriterion of criminal responsibility and its degrees (full,absent or diminished); its role in determining admissionto a forensic psychiatric ins=tu=on; stakeholders andexperts involved in the decision-making; the process ofreview of deten=on measures; the maximal length ofstay; service provisions; and ra=onales for treatment,includingtheuseofcoercivemeasures.

Special aBen=on has been devoted to recent stateinterven=onsexpectedtostronglyimpacttheins=tu=onaltrajectories of the forensic pa=ents, as well as theconceptsofcare.Suchinterven=onsrangebetweensinglejudicial acts and comprehensive structural reforms. Anexemplary instance is the 2011 verdict by the GermanFederal Cons=tu=onal Court, declaring involuntarytreatment uncons=tu=onal. At the opposite end of thespectrumstandsthelonghistoryoftheItalianpsychiatricreform, culmina=ng in the 2014 closure of forensicpsychiatric hospitals and the implementa=on of small-scale residen=al facili=es (REMS), where internalmanagement is exclusively medical and, consequently,the responsibility over confinement and treatment isdecisivelyshi[edfromthejudicialtothemedicaldomain.In-between these extremes stand more complex anddiffuse examples of interac=on among na=onal andtransna=onal subjects, such as the efforts at a na=onalleveltowardsimplementa=onoftheEuropeanPsychiatricAssocia=on guidance on forensic psychiatry (case ofPoland, 2018), or towards avoiding sanc=ons from theEuropeanCourtofHumanRights(caseofBelgium,2016).

In order to allow a systema=c and consistent na=on-based evalua=on of all these levels and aspects (and inviewofacountry-to-countrycomparison)weploBedtheabove-listed features against the four bioethicalprinciples of Beauchamp and Childress: respect ofautonomy(ofthepa=ent),nonmaleficence,beneficenceandrespectforjus=ce.Theseareassumedasabasicand“culturally neutral” interpreta=ve grid allowing us tostructure and analyse situated tensions (pa=ent vs.caregiver,forensicpa=entvs.society,forensicpa=entvs.pa=ent in general psychiatry, forensic pa=ents vs. theircounterpartswhohavecommiBedthesameoffencebuthave nomental illness). The picture emerging from thisscru=ny,which iss=llon-going, iswidelyheterogeneous,notonlyacrossthedifferentcountries,butalsowithinthesingle na=onal jurisdic=ons. We could not iden=fy onesingle ethical principle consistently informing the wholesystem, but rather dynamic equilibria among theindividual principles cuQng through the levels abovespecified. Finally,wehave conducteda cri=cal reviewoftheliteratureontheMacCAT-T.Weareeagertostarttheethicalevalua=onofthedatacollectedbyourpartners!

WP6:Mappingofforensicservices

TheEU-VIORMEDprojectWP6(PI:Prof.Dr.HansJoachimSalize, Central Ins=tute of Mental Health, Mannheim,Germany) included a survey among experts on forensicpsychiatriccarefromallEUMemberStatesinordertogetinforma=ononthevarietyof forensicpsychiatricmodelsand approaches that are implemented across theEuropean Union. The survey was based on a detailedques=onnairethateachexpertwassupposedtofillinfortheir country. The ques=onnaire addressed essen=alaspects of forensic psychiatry such as basic juridicalconcepts forplacingand trea=ng jus=ce-involvedpeoplewithmental illness,assessmentand treatmentconcepts,provided capaci=es (number of forensic psychiatric bedsorplaces inthevarioussectors),prevalenceor incidencedataandmuchmore.

A[er iden=fying, contac=ng and recrui=ng the experts,the survey started in autumn 2018 and ended inNovember 2019 when the last ques=onnaire wasreturned to the study centre at the Central Ins=tute ofMental Health in Mannheim, Germany. The final list ofpar=cipants of the survey included 22 countries plusSwitzerlandasanon-EUMemberStatewhovolunteeredto contribute. The analyses anddissemina=onprocessesstarteda[erwardsandarecurrentlyongoing.

(Con.nued...)


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RESEARCHUPDATE

EU-VIORMEDProjectResults so far confirmed an ongoing serious knowledgegap on basic characteris=cs and features of forensicpsychiatric systems in European Union Member Statesthatwas found in similar studies already 15 or 20 yearsago.Inmanycountries,evenna=onalexpertsinthefieldwereunabletoreportvalidnumbersor=meseriesofthemost essen=al indicators such as number of services,number of beds or mean length of stay in forensicpsychiatriccare.Similarly,na=onaldataonthe incidenceandprevalenceofconcomitantmental illnessandjus=ceinvolvement is fragmentary. Outcome data allowing forevalua=ng the effec=veness of the various systems suchas the rate of recidivism or re-offending of formerforensicpsychiatricpa=entsiscompletelyunknown.

Na=onal repor=ng systems on these crucial topics andindicators seem to be grossly underdeveloped. Thisfinding is even more striking considering the repeatedcri=cismofthisomissionbyexpertsinthefieldduringthelastdecades.

Available data and informa=on collected by the WP6-survey suggest and confirmed awide variety of in partsdivergent approaches across the EuropeanUnion.Manyforensic psychiatric systems were implemented orreorganized on a very narrow or completely missingevidence base. Therefore, research and health care

planninginthiscrucialfieldlackessen=alinforma=onforanalysing the quality, outcomes or effec=veness of thesystems in ques=on. Currently, there is no rou=ne dataavailabletoiden=fyineffec=veconcepts,poortreatment,inappropriateseQngs,overcrowdingofservicesorotherweaknessesintheprac=ceofplacingandtrea=ngjus=ce-involvedpersonswithmentalillnessinEurope.

Although the analyses are ongoing, one majorrecommenda=on from the findings of WP6 will be tos=mulate research on the issue on a na=onal and aninterna=onallevel.

Alsohighlyrecommendedistheco-ordinatedandEurope-wide implementa=on of standardized na=onal repor=ngsystems in the field. Such registers - whose mainindicators should be summarized annually in a Europe-wideforensicpsychiatricreport-areessen=alforhavingavailablevalidandreliableindicatorsacrosscountriesandwill enable to describe, to evaluate and to compare thevarioussystemsimplementedinEurope–apre-requisitefordevelopingguidelinesandstandardsoftheplacementand treatment of jus=ce-involved persons with mentalillnessandpromo=ngmodelsofbestprac=ce in forensicpsychiatryinthefuture.


INTERNATIONALJOURNALOFFORENSICMENTALHEALTH

FeatureAr=cle

StephanieR.Penneya,b,AaronProsserc,TeresaGrimbosd,EgagEgaga,&AlexanderI.F.Simpsona,b

Foreign-bornmigrantsareatelevatedriskfordevelopingseriousformsofmentalillness,andareover-representedincriminaljus=ceandforensicmentalhealthseQngs.Thisstudycomparestheclinicalcharacteris=csofforced(n = 60)andvoluntary(n = 226)migrantpa=entsinaCanadianforensicservicetona=ve-bornpa=ents(n = 234),andcontrastsregionsofbirthrepresented in thecurrentsampletothetotaladultmigrantpopula=on inourcatchmentcity (N = 2,537,410).ComparedtoCanadian-bornpa=ents,migrantpa=entsweremore likelytohavea later-onsetpsycho=cdisorderas theironlydiagnosis,and less likely tohaveapersonalitydisorderdiagnosis.Migrantpa=entshadmorefamilialsupportspriortoillnessonset,butweresociallyisolatednearthe=meofforensicadmission.Comparedtothetotal adult migrant popula=on, higher propor=ons of Caribbean, Central American, Eastern and Western Africanpersonswererepresentedintheforensicsystem,whilefewerindividualsfromEastandSouthAsiawererepresented.Therewasnoeffectofmigrancystatusonthedura=onofforensichospitaliza=onorcommunitysupervision.Findingssuggest dispropor=onate minority representa=on among users of forensic services, and highlight what may beineffec=vepathwaystoadequatementalhealthcareamongcertainmigrantgroups.

aComplexCareandRecoveryProgram,ForensicDivision,CentreforAddic=onandMentalHealth,Toronto,Ontario,Canada;bDepartmentofPsychiatry,UniversityofToronto,Toronto,Ontario,Canada;cMichaelG.DeGrooteSchoolofMedicine,McMasterUniversity,Hamilton,Ontario,Canada;dChild,YouthandFamilyProgram,CentreforAddic=onandMentalHealth,Toronto,Ontario,Canada

VoluntaryandForcedMigrantsinForensicMentalHealthCare

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STUDENTSECTION

Welcomefromthe2020-2021StudentBoardSarahSchaaf,M.S.-FairleighDickinsonUniversity,USA|IAFMHSStudentBoardPresident


Thenewstudentboardismoreinterna=onalthanever,withmostmembershavingmovedaroundtheworldtocompletetheirstudiesinafieldrelevanttoforensicmentalhealth.Asaninterna=onalgroup,weareeagertocombineourdiverseexperiencesandknowledgetofosterstudent-ledresearch,leadershipopportuni=esandresourcesforourmembershipacrosstheglobe.Pleasereviewourcurrentstudentopportuni=esandgetinvolved!

•  Wearecurrentlyrecrui=ng…•  CampusrepresentaRveswhowilldisseminateemailsandopportuni=estolocalstudentsin

theirins=tu=ons.Campusrepresenta=vesareimportantalliesinraisingawarenessofourorganiza=onandrecruitmentofnewmembers.

•  Peermentors(i.e.,seniorgradstudentsandearlycareerprofessionals)andmentees(i.e.,undergradandgradstudents)forourPeerMentorshipProgram.

•  Visitusonourwebsiteandsocialmediaprofiles(TwiBer;Facebook;LinkedIn)forstudentresourcesandhelpfultoolstoenrichyoureduca=onandprofessionaldevelopment.

•  Stayconnectedandreachouttouswithsugges=onsonhowwecanimproveyourexperienceasanIAFMHSstudentmember.Yourfeedbackisimportanttous!([email protected]).

Onbehalfofthestudentboard:Thankyouforyourtrust!Welookforwardtocrea=ngnewopportuni=esandmakingthemostofthenewyear.Staytunedforfurtherannouncementsthroughemailandsocialmedia.Cheerstoafulfillingyear!

Theyear2020isslowlycomingtoanendandweareexcitedlypreparingfortheupcomingterm!Aswereflectuponthechallengesallofushadtoconquerthisyear,wewouldliketogiveaspecialthankstoourpaststudentboardmembersandtherelentlesscommitment,flexibilityandthoughoulnesswithwhichtheyhaveapproached2020’smanychangesandlosses.AlthoughmostplansforIAFMHS’s20thanniversaryyearhadtobeputonhold,wewouldliketoexpressouradmira=onforthestudentboard’smanyaccomplishmentsthisyear:increaseofonlinepresence,introduc=onofnewstudentresources,newsleBercontribu=onsonavarietyoftopics,designofanniversarymerchandise(staytuned!),distribu=onof2000CADinstudentawardsandmostnotablythestudentboard’seffortstoraiseawarenessondiversityissues.Thenewstudentboardisreadytocon=nuethehardworkandcommiBedtomakingtheupcomingyeararewardingexperienceforourstudentmembers.Withoutfurtherado,Iampleasedtointroducetoyouthenew2020-2021studentboard:

SarahSchaaf,M.S.,IAFMHSStudentPresident

12

JoinaTeamofDedicatedProfessionalsAreyouaClinicalPsychologistwithexperienceandapassionforworkingwithindividualswithcomplexmentalhealthandbehaviouralneeds?Joinourteamtomakeadifferenceinthelivesofmarginalizedcommunitymembers.

AsaForensicPsychologistwithForensicPsychiatricServices,youwillprovideindividualandgrouppsychologicalinterven=onsforpeopleorderedbytheCourt,cer=fiedundertheMentalHealthAct,orfoundunfittostandtrialornotcriminallyresponsibleonaccountofamentaldisorderundertheCriminalCodeofCanada.WecurrentlyhaveseveralexciRngopportuniResforForensicPsychologists:

ForensicPsychiatricHospital,CoquitlamBCRegularfull-=meopportunityandregularpart-=meopportunity

Whatyoubring•  Adoctoraldegree(PhDorPsyD)inClinicalForensicPsychologyOR

•  Adoctoraldegree inClinicalPsychology (PhDorPsyD)withaminimumof two (2)years’experience ina forensicmentalhealthcontext.

•  Prac=cingclinicalregistra=onoreligibilityforregistra=onwiththeCollegeofPsychologistsofB.C.

•  One(1)yearofdirect,clinicalexperienceperformingdiagnos=cassessmentandtreatmentofadults inaForensicMental Health seQng including risk assessment, cogni=ve behavioral therapy or other relevant assessment andtreatmentmodali=es.

For more informa=on about these exci=ng opportuni=es, contact Linda Hand, Manager, Talent Acquisi=on [email protected]

What’sinitforyouForensic Psychiatric Services is part of BC Mental Health & Substance Use Services (BCMHSUS) bcmhsus.ca, aprogramoftheProvincialHealthServicesAuthority(PHSA)whichcaresforpeoplewithcomplexmentalhealthandsubstanceusechallenges.

Every PHSA employee enables the best possible pa=ent care for our pa=ents and their families.Whether you areprovidingdirectcare,conduc=ngresearch,ormaking itpossible forothers todotheirwork,you impact the livesofBri=sh Columbians today and in the future. That’swhywe’re focused on your care too – offering health,wellness,developmentprogramstosupportyou–atworkandathome.

JoinoneofBC’slargestemployerswithprovince-wideprograms,servicesandopera=ons–offeringvastopportuni=esforgrowthanddevelopment.

•  Accesstomorethan2,000in-housetrainingprograms.

•  Enjoyacomprehensivebenefitspackage,includingmunicipalpensionplan.

•  12annualstatutoryholidayswithgenerousvaca=onen=tlementandaccruement.

•  Perksincludeonsitefitnessclassesanddiscountsto350BC-widerecrea=onalprograms,travel,technology,carandbikesharing,andmore.

•  Reloca=onassistanceofupto$5,000mayalsobeavailable.

•  Extendedworkdayschedules(4-daycompressedworkweek)areavailableforfull-=mepsychologistposi=ons.

WhatwedoTheProvincialHealthServicesAuthority(PHSA)plans,coordinatesandevaluatesspecializedhealthserviceswiththeBChealthauthori=estoprovideequitableandcost-effec=vehealthcareforpeoplethroughouttheprovince.Ourvaluesreflectourcommitmenttoexcellenceandinclude:Respectpeople–Becompassionate–Daretoinnovate–Cul=vatepartnerships–Servewithpurpose.LearnmoreaboutPHSAandourprograms:jobs.phsa.ca/programs-and-services

PHSAiscommiBedtoemploymentequityandhiresonthebasisofmerit,encouragingallqualifiedindividualstoapply.Werecognizethatourabilitytoprovidethebestcareforourdiversepa=entpopula=onsreliesonarichdiversityofskills,knowledge,backgroundsandexperiences,andvalueasafe,inclusiveandwelcomingenvironment.

international association of forensic mental health …

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