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The purpose of this study was to survey practitioners’ use and perceptions of psychopathy assessments in Canadian forensic psychiatric settings. Psychopathy assessments are widely used in forensic settings to inform decisions about sentencing, placement, rehabilitation and parole. Recent empirical evidence suggests that the utility of psychopathy assessments might be overestimated, leading to a debate about their legal and ethical justification. However, one shortcoming of these discussions is that they rely heavily on anecdotal evidence about how exactly psychopathy assessments influence forensic decisions, due to a general lack of survey data on field uses. Some data are available in European and American contexts, but little is known about Canadian clinical practice.

To address this shortcoming in the literature, the authors conducted a pilot study of practitioners in forensic psychiatric units in Ontario (N = 18), evaluating their use of psychopathy assessments, reporting habits and their perceptions of psychopathic offenders.

Practitioners reported that they primarily used the Hare Psychopathy Checklist-Revised (PCL-R) as a risk assessment tool, often in combination with other tools. Most clinicians reported using psychopathy assessments infrequently, that there was a low base rate of psychopathic offenders and their attitudes and beliefs about psychopathy were generally consistent with the empirical literature.

This pilot study provides novel insights into the use of psychopathy assessments in Canadian forensic psychiatry with the potential to inform current debates.

A major difficulty identified many years ago in psychiatric care is the shortage of appropriate instruments with which to carry out valid and reliable therapeutic assessments which are behaviourally based and therefore appropriate for use in a variety of contexts. The aim of this project was to ascertain the utility of a forensic nursing risk assessment tool - Behavioural Status Index (BEST-Index). The paper aims to discuss these issues.

A multi-site cross-sectional survey was undertaken using mixed method design. Quantitative data was generated using BEST-Index to allow comparisons across three different levels of security (high, medium and low) in Scotland and Ireland. Qualitative data were gathered from patients and multi-disciplinary team (MDT) members using semi-structured interviews and questionnaire.

Measured over an 18-month period, there was a statistically significant improvement in behaviour, when comparing patients in high and medium secure hospitals. Two key themes emerged from patient and staff perspectives: “acceptance of the process” and “production and delivery of information”, respectively. The wider MDT acknowledge the value of nursing risk assessment, but require adequate information to enable them to interpret findings. Collaborating with patients to undertake risk assessments can enhance future care planning.

Studies using cross-section can only provide information at fixed points in time.

The BEST-Index assessment tool is well established in clinical practice and has demonstrated good utility.

This project has served to highlight the unique contribution of BEST-Index to both staff and patients alike and confirm its robustness and versatility across differing levels of security in Scottish and Irish forensic mental health services.

The purpose of this paper is to review the impact of a new, brief forensic rotation for general psychiatry residents on the variety of residents’ forensic exposures.

The authors surveyed residents who trained before and after the implementation of the new rotation to assess the impact of the rotation on the residents’ forensic experiences during training across a variety of domains.

Even in a highly clinical forensic setting, residents participating in the required rotation reported significantly greater variety of forensic experiences than those who had not completed the required rotation, including types of settings and assessments, Rotation completers reported greater exposure to various types of settings and assessments, and courtroom-related experiences, as well as the overall number of forensic exposures. The two groups did not differ in their forensic exposures in general psychiatry settings, civil-forensic evaluations or diverse forensic populations. Secondary analyses showed that increased exposure to court-based experiences and multiple forensic settings was associated with forensic fellowship interest.

This study demonstrates that a brief, mandatory forensic clinical rotation may increase residents’ exposure to forensic settings, assessments and courtroom-related experiences and that increased exposure to courtroom-based experiences in particular may increase interest in forensic fellowship. While not surprising, the results demonstrate that residents were not otherwise having these forensic experiences and that even time-limited forensic rotations can enhance the breadth of residents’ forensic exposures. Further, the rotation achieved these outcomes without using typical forensic sites but instead highly clinical sites, which may be particularly encouraging to residency programs without ready access to classic forensic rotation sites. This study contributes to the small but expanding body of the literature describing the value of increasing psychiatry residents’ training in clinical forensic psychiatry.

The purpose of this paper is to explore the experience and possibilities for misdiagnosis of women with ASD in secure and forensic hospitals, via the medium of a lived experience case study. To consider the clinical value of the patient perspective of and insight into their disorder. The case study is supplemented by relevant associations to the MHA Code of Practice, the CQC report, Monitoring the Mental Health Act (MHA) 2016–2017, published on 27 February 2018 and current research findings in the fields of service provision, quality of care and treatment of female patients with a diagnosis of ASD.

A review and commentary of the author’s lived experience of a formal diagnostic assessment for ASD as a female patient in a secure and forensic hospital. In reviewing aspects of the author’s clinical assessment, the author has made contextual reference to the MHA Code of Practice, the CQC report, Monitoring the MHA 2016–2017, published on 27 February 2018, and current research findings. The account focuses on aspects of the author’s recent experience assessment and treatment for ASD which the author believes may be of use in informing clinical practice.

Open-ended exploration of a lived experience account/case study of a diagnostic assessment of an adult female patient for ASD, demonstrating the possible ambiguity of responses to questionnaire-based assessment tools and other deficiencies inherent to the assessment process and care and treatment of adult female ASD sufferers in secure and forensic hospitals.

The author uses the lived experience as a patient to review and provide commentary on the clinical assessment for ASD. This review is, therefore, informed by an authentic patient perspective and not clinical perspectives. This paper highlights the need for further research into the diagnostic assessment of females for ASD in a secure and forensic hospitals.

First, to encourage practitioners to extend their range of thinking to be more inclusive of the patient perspective when performing a diagnostic assessment. Second, to increase practitioner awareness of the deficiencies in the current service provision for adult female patients diagnosed with ASD in secure and forensic hospitals.

To improve patient experience of diagnostic assessment for ASD and the quality of the assessment and patient outcomes in secure and forensic hospitals.

The paper is original in concept in that it considers the inclusion of patient experience/views in assessment and formulation and links them to wider social policy and practice guidance. The case study is an authentic patient account informed by the author’s experience of secure and forensic psychiatric hospitals. The value of the paper may be determined by the extent to which the paper encourages practitioners to consider the patient perspective and experience of the diagnostic assessment and how this and subsequent care and treatment may affect the adult female patient in secure and forensic hospitals.

The aim of the paper is to share the experience of multi‐national, funded research practice and to explore some of the issues related to conducting such studies in forensic practice. The BEST Index is a normative forensic risk assessment instrument that can be implemented through the different levels of security. It benefits the patient as it is a structured assessment instrument for assessing, planning, implementing and evaluating care in the context of risk assessment. A large‐scale, five‐country EU‐funded study was conducted to validate the instrument and to develop educational tools. Some published description of research experience exists but does not cover the issues for people new to high‐level research studies or the partnership working that is required to make multi‐national, multi‐lingual studies work to the benefit of the patient. Many issues arose during the study and those considered important to deal with, and the actions taken, are described, including ethical issues, management and organisational issues, and ‘the long haul’. Being new to research and coming straight in to this kind of large‐scale clinical research requires preparation and thought.

The Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV) (Wechsler, 2008) is a cognitive assessment that is often used in secure forensic settings, however it has not been normed on this population. The purpose of this paper is to develop forensic normative data.

Patient files in a high secure forensic hospital were reviewed in order to obtain completed WAIS-IV (Wechsler, 2008) assessments and scores from the five indexes (verbal comprehension, perceptual reasoning, working memory, processing speed and full scale intelligence quotient (FSIQ)). This included reviewing patient files from all directorates, including male mental health, male learning disability, male personality disorder and the women’s service, yielding a sample size of n=86.

The qualitative descriptors obtained across the hospital ranged between extremely low and superior. The learning disability service scored significantly lower than the mental health and personality disorder services in verbal comprehension index, perceptual reasoning index, working memory index and FSIQ, and significantly lower than the mental health, personality disorder and women’s services in processing speed index. Mean scores from this study were significantly lower in comparison to those from the UK validation study (Wechsler, 2008).

The significant difference between scores from the current study and those from the UK validation study (Wechsler, 2008) highlights the need to have appropriate normative data for forensic populations. Clinicians should consider interventions that may serve to increase cognitive function, such as cognitive remediation therapy.

Whilst several special group studies have previously been conducted, this study is the first to develop forensic normative data for the WAIS-IV (Wechsler, 2008). Whilst the sample size was relatively small with limited female participants, the data collated will enable clinicians working in forensic establishments to interpret their assessments in light of this information.

Libraries supporting a forensic psychology undergraduate and/or graduate level college program need to collect materials from a range of disciplines – psychology, law, psychiatry and criminal justice. This guide identifies the major reference works, journals, databases and other resources that should be in a good forensic psychology collection.

This paper aims to explore advances in indirect personality assessment, with emphasis on the psychology of digital behavior based on the analysis of new technological devices and platforms for interpersonal relationships, identifying – along the way – those findings that may be useful to carry out a reconstructive psychological assessment (RPA) of applicability in the legal context.

Different fields of knowledge are explored, transferring the findings to the field of psychology of digital behavior, analyzing the publications that report findings on the analysis of new technological devices and platforms for interpersonal relationships and identifying – along the way – those findings that may result useful to carry out an RPA of applicability in the legal context.

The application of RPA represents a significant advance in the integration of criminal psychology and forensic technology in legal contexts, opening new fields of action for forensic psychology.

The article has transferred advances in computer science to the field of forensic psychology, with emphasis on the relevance of RPA (from the analysis of digital behavioral residues) in the interpretation of behavioral evidence for the indirect evaluation of the personality and within the judicial context (when the victim and/or accused are not included).

Forensic nursing is a term applied to nurses working in many different areas of clinical practice, such as high security hospitals, medium secure units, low secure units, acute mental health wards, specialised private hospitals, psychiatric intensive care units, court liaison schemes, and outpatient, community and rehabilitation services. Rarely is the term defined in the general literature and as a concept it is multifaceted. Concept analysis is a method for exploring and evaluating the meaning of words. It gives precise definitions, both theoretical and operational, for use in theory, clinical practice and research. A concept analysis provides a logical basis for defining terms and helps us to refine and define a concept that derives from practice, research and theory. This paper uses the strategy of concept analysis to explore the term ‘forensic nursing’ and finds a working definition of forensic mental health nursing. The historical background and literature are reviewed using concept analysis to bring the term into focus and to define it more clearly. Forensic nursing is found to derive from forensic practice. A proposed definition of forensic nursing is given.

A significant number of people held within the secure forensic hospital estate in this country suffer from neuropsychological deficits (e.g. Lowings, 2010; Williams et al., 2010). These deficits, many of them cognitive, have a detrimental impact on patient's abilities to benefit from psycho-educational materials thereby slowing the progress of their rehabilitation. Understanding these difficulties enables interventions to be more effectively targeted and facilitated to the patients’ cognitive strengths. It was against the backdrop of the evidence that a review was commissioned into neuropsychological activity at Rampton Hospital.

The review of the neuropsychological assessment activity was confined to the male patients residing within Mental Health Services (MHS) and the National High Secure Learning Disability Service (NHSLDS) of the hospital. With regards to the MHS, 129 patient files were examined in order to identify the volume of neuropsychological assessment previously undertaken and the make up of the neuropsychological test batteries administered with the current patient group. With regard to the NHSLDS 48 files were similarly examined. In addition, MHS psychologists were surveyed to assess their knowledge of patients within that service who to their knowledge had previously suffered an acquired brain injury (ABI) or had suffered a significant neurological illness likely to have resulted in cognitive impairment.

A scoping exercise identified that a significant amount of neuropsychological assessment was being undertaken, albeit in an unstructured way. This led to a number of patients being subjected to a significant delay before the need for neuropsychological testing and rehabilitation possibilities became apparent. There was a huge variance on when a patient was tested ranging from one month to 14 years and the size of the test battery used, with the number of tests conducted per patient ranging between one single test to 16 tests during a patients stay at the hospital.

Opportunities to more appropriately place patients based upon their abilities could be achieved if the hospital were to adopt a policy of conducting neuropsychological assessments, including cognitive functioning, for all patients upon admission to the hospital. A proportion of patients were known to have had a ABI or a significant illness likely to have resulted in cognitive impairment. This was considered to be an underrepresentation and the taking of a thorough history specifically covering ABI and specific illnesses known to have an impact on cognitive ability and behaviour was also recommended.

In light of this review, services are to take a more systematic approach to assessing neuropsychological difficulties. Consideration is being given to neuropsychological screening becoming part of the admission process.