The impact of COVID-19 restrictions on social relationships of forensic psychiatric outpatients with preexisting social network-related problems: A mixed methods study

This study aimed to explore the impact of the COVID-19 restrictions on social relationships of forensic psychiatric outpatients with preexisting social network-related problems. Data from 70 participants of an ongoing randomized controlled trial, investigating the effectiveness of a social network intervention among forensic psychiatric outpatients, were examined. Demographic characteristics, quality of social relationships, loneliness, and social support were assessed at baseline. During the COVID-19 pandemic, an additional questionnaire that contained quantitative and qualitative questions regarding the impact of COVID-19 restrictions on social relationships was administered. Participants showed high levels of loneliness and dissatisfaction with social relationships before COVID-19. The majority of forensic outpatients perceived no changes on social relationships due to the COVID-19 restrictions. Qualitative results revealed some participants already lived socially isolated. Negative changes on social relationships were related to deterioration of social contacts, interruption of daytime activities, changed mental health care, and well-being. Emotional loneliness predicted deteriorated general and romantic relationships. These findings suggest that social relationships of forensic patients with preexisting social network-related problems remain of concern throughout the COVID-19 pandemic. [ FROM AUTHOR] Copyright of Journal of Forensic Psychology Research & Practice is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

The First Wave of COVID-19 in Forensic Psychiatry: A Rapid Review Series

At the beginning of the pandemic, experts expected an increasing number of hospitalizations in forensic settings, uncontrollable outbreaks of COVID-19, and deterioration of mental health of residents within institutions. Certain publications corroborated these concerns;however, no synthesis of the results of empirical publications at the initial stage of the pandemic has yet been conducted. Three rapid reviews were conducted on these topics. Besides almost a two-fold decrease in the total number of urgent consultations/hospitalizations, there were no changes in the number of involuntary hospitalizations, suicide attempts, and psychoses. The COVID-19 morbidity and mortality rates in secure institutions were compatible with the general population. However, the lockdown period was associated with a significant increase in self-harm in secure settings.

Inpatient forensic psychiatry in the time of COVID-19: a survey study of perceived mental health implications on people with schizophrenia spectrum disorder

Background: The aim of our study was to assess the perceived mental health impact of the COVID-19 pandemic on people with schizophrenia spectrum disorder (SSD) in an inpatient forensic psychiatric institution and to identify personal networks most crucial for the patient during the pandemic. Method(s): In this cross-sectional survey study, 44 patients with SSD took part in a COVID-19-specific interview. The data was correlated with the Positive and Negative Syndrome Scale (PANSS) to evaluate the patients' psychopathology. In addition, we investigated subgroups of vaccinated and unvaccinated patients to analyze possible differences in psychopathology. Result(s): Less contact with family members was associated with significantly higher PANSS scores (p < 0.05). Patients who reported to feel less relaxed and more stressed during the pandemic than they had been before the outbreak of the virus showed significantly higher PANSS scores (p < 0.05). Unvaccinated patients demonstrated significantly higher PANSS scores than their vaccinated controls (p < 0.05). Conclusion(s): Social support from family members played an important role for people with SSD in inpatient forensic psychiatric institutions during the pandemic. Moreover, individuals with SSD seemed to be more emotionally vulnerable during the pandemic. A more pronounced symptomatology in patients with SSD might be a potential barrier to immunization against COVID-19.Copyright © 2022 Informa UK Limited, trading as Taylor & Francis Group.

COVID-19: What can we learn from shared experiences of social distancing within secure services?

COVID-19 is an infectious disease that has spread across the globe with a social, economic and psychological impact that will undoubtedly change the world in which we live. Those working in mental health services will have experienced major changes in working practices, including navigating the challenges of infection control, whilst caring for some of the most vulnerable members of our society. There have been a number of publications considering many of the practicalities of the COVID-19 challenges in mental health. However, deeper reflections of philosophical issues regarding our own shared experiences have not yet been well covered in the professional press. This commentary describes some experiences of working within a low secure forensic service at the beginning of the COVID-19 pandemic in the UK. It aims to explore some of the key themes arising from this unprecedented situation, proposing areas for reflection and shared learning within the mental health inpatient community. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Forensic psychiatry in times of COVID-19: A qualitative study into the concerns and needs of patients

Purpose: The aim of this study is to gain a better understanding of the concerns and needs of forensic psychiatric patients regarding the impact of the COVID-19 crisis on their mental health and treatment. Design/methodology/approach: Semi-structured interviews were conducted with nine patients from various wards of the hospital. Using the consensual qualitative research method, these interviews were coded by a team of three researchers. Findings: Four domains emerged from the analysis, namely, restrictions, emotional consequences, coping and communication. One of the primary restrictions for patients was not being allowed to have physical contact with the people in their network/visitors. This prompted patients, in some cases, to decline visitors altogether. Emotional consequences of the COVID-19 measurements included anxiety, frustration and passivity. Ambiguity about the rules added to this frustration. Furthermore, a cut in autonomy was felt by patients due to them not being able to do their own grocery shopping. Despite these restrictions that were imposed on patients, the relationship between patients and staff was perceived as good and even improved according to the participants. Practical implications: A lack of autonomy emerged as a salient issue related to the restrictions within the hospital. Certain degrees of control may be inevitable, but it is nonetheless important to focus on the effect of control within forensic settings. This could be done by aiming to actively include patients in decisions that affect their living climate. Furthermore, it appeared that the "ballet dancer" approach was used by the staff of the hospital, leaving more room for individualized care. As perceived support is important to increase willingness to accept the treatment being offered, a focus on this approach in times of rapid change such as during a pandemic, would be recommended. Originality/value: Because few pandemics have occurred in the past century, little information is available about how a pandemic might affect patients residing in forensic psychiatric hospitals. To the best of the authors' knowledge this is one of the first studies to assess concerns and needs of forensic psychiatric patients regarding the COVID-19 pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Forensic mental telehealth assessment (FMTA) in the context of COVID-19.

Due to the present COVID-19 pandemic, forensic mental telehealth assessment (FMTA) is an increasingly utilized means of conducting court-sanctioned psychiatric and psychological evaluations. FMTA is not a novel development, and studies have been published during the past two decades that opine on the positive and negative implications of conducting testing and interview procedures online, in forensic and traditionally clinical matters alike. The present article examines prospects for eventual legal challenges to FMTA, describes considerations for conducting FMTA in both institutional and residential settings, and concludes that FMTA is now-due to predicted accommodations on the part of courts, attorneys, institutions, and professional guilds-a permanent part of the forensic evaluation landscape, even once the present COVID-19 pandemic has subsided.

Emerging trends in domestic homicide/femicide in Greece over the period 2010-2021.

Temporal trends in epidemiological parameters of domestic homicide and femicide in Greece over the last decade have not yet been studied. We conducted this study to fulfill this purpose. Specifically, we conducted a retrospective epidemiological study using 11-year data from the official nationwide Hellenic Police Archives and statistically analyzed data regarding domestic homicide and femicide. Overall, 1370 records of homicides among which 236 domestic homicides were identified. The pattern emerging from the statistical results of the present study highlighted the phenomenon of femicide as the gravest current issue to be interpreted and addressed. Nationally, the average number of homicides was 114.2/year, among which 19.7 domestic homicides. However, in 2021, while a decrease was recorded in homicides in general to 89 incidents per year, domestic homicides skyrocketed to 34 cases, reaching the highest annual number ever nationally recorded. On average, domestic homicides account for 18.2% of all homicides in Greece. In 2021, however, this percentage rose to 38.2%. The number of male victims of domestic homicide has declined over the years, with a further decline in 2021, in stark contrast to the number of women escalating over time and even more sharply in 2021. The proportion of female victims of domestic homicides in Greece was fourfold higher on average. The fact that cases of domestic homicide and femicide have received a lot of media attention, the recent Greek financial crisis, as well as increased alcohol and drug consumption due to the COVID-19 pandemic constitute possible aggravating factors.

Polish Experiences of Safety Measures Involving Forensic Psychiatric Inpatients Implemented During the SARS-CoV-2 Pandemic.

The SARS-CoV-2 pandemic has made it necessary for us to adapt our healthcare systems to a very different sort of reality. This clearly also applies to psychiatric services. The restrictions and safeguards associated with the pandemic particularly concern adherence to social distancing and medical treatment safety procedures. The implementation of these procedures is generally complicated by conditions of forensic psychiatry where, in line with demands made by courts, the treatment and isolation of mentally unwell offenders must be carefully managed. In most countries, forensic psychiatric treatment is an inpatient service where patients are kept in restricted and cramped spaces, making social distancing difficult to implement as patients participate in compulsory group therapeutic activities. As a result, it is necessary to introduce unique recommendations relating to patient safety and treatment adapted to the realities of forensic psychiatry. All this requires the implementation of additional restrictions, over and above those arising from the essential aspects of forensic psychiatry. In this paper, we present and discuss the Polish guidelines for forensic psychiatric care during the SARS-CoV-2 pandemic, developed as a result of discussions on essential measures introduced to reduce the spread of the virus and the unique needs of the forensic patient population.

International Survey on the Use of Emerging Technologies Among Forensic and Correctional Mental Health Professionals

Although the global diffusion of e-mental health has increased in recent years, research on the use of technologies in criminal justice settings is limited. To bridge this knowledge gap, we conducted an international online survey (N = 555) of forensic and correctional mental health professionals from Germany, Switzerland, the United Kingdom, the United States, and 20 additional countries. Telecommunication technologies and mental health platforms had the highest numbers of users, the broadest scope, and the largest increase in use due to the coronavirus disease 2019 (COVID-19) pandemic. In contrast, the use of social media and advanced technologies was lower, narrower in scope, and remained the same or decreased during the COVID-19 pandemic. Respondents' age, professional discipline, country, and clinical setting significantly predicted total technology use in clinical practice. The study findings provide an overview of the current patterns of technology use and point to opportunities for research and development.

Technological Innovations in Forensic and Correctional Mental Health: An Introduction to the Special Issue

Although research on e-mental health in criminal justice settings continues to accumulate, the evidence base on this topic remains limited. In recent years, technological innovations have increasingly entered forensic and correctional mental health care, and the COVID-19 pandemic has accelerated their diffusion. The present special issue aims to promote evidence-based best practices and inform clinical decision-making in criminal justice settings by presenting recent developments and findings relevant to the use of e-mental health. In this introduction, we summarize the eight articles in the special issue and discuss directions for future research.

Legal and Forensic Issues in Telepsychiatry

Covid-19 has induced many changes to society, including some in the practice of medicine and psychiatry. Among them is increasing use of telecommunications. A previous editorial outlined the possible uses and dangers of telemedicine with prisoners (Gunn et al 2020). Forensic psychiatry is also concerned with providing expert evidence to courts and other arbitration bodies and, increasingly, these bodies too are relying on such technology. Further in addition to traditional paper-style records (many now held electronically rather than literally on paper) there is increasing use of video recording of interviews, of day to day behaviour on secure hospital units and by bodycams when intervening in a tense, potentially violent situation. To what extent are these being used in court? Is there a European framework for guiding us on how to proceed? How has this been interpreted to date in countries across Europe? In this paper these issues will be addressed.

When COVID-19 Is Not All: Femicide Conducted by a Murderer with a Narcissistic Personality "Masked" by a Brief Psychotic Disorder, with a Mini-Review.

Several cases of COVID-19-related mental disorders have emerged during the pandemic. In a case of femicide that occurred in Italy during the first phase of the pandemic, coinciding with a national lockdown, a discrepancy arose among forensic psychiatry experts, particularly toward the diagnosis of Brief Psychotic Disorder (BPD) related to COVID-19. We aimed to discuss the evaluation of the case through an integration of information and a literature review on comparable reported cases. An analysis of the diagnosis of brief acute psychosis was then performed, as well as a mini-review on cases of COVID-19-related psychosis. Results showed that psychotic symptomatology was characterized by polythematic delusions that always involved a SARS-CoV-2 infection. To a lesser extent, the delusions were accompanied by hallucinations, bizarre cognitive and associative alterations, insomnia, hyporexia, dysphoria, and suicidal behavior. No particularly violent acts with related injury or death of the victim were described. Finally, we could hypothesize that our case was better represented by a diagnosis of personality with predominantly narcissistic and partly psychopathic traits. The present case highlighted the importance, in the context of forensic psychiatry, of integrating assessments with the crime perpetrators, namely through accurate clinical interviews, neuropsychological tests, diachronic observations, and comparison with similar cases present in the literature. Such an integrated approach allows precise evaluation and reduces the odds of errors in a field, such as forensic psychiatry, where a diagnostic decision can be decisive in the judgment of criminal responsibility. Moreover, discerning forensics from health cases represents an important issue in risk management.

"Freedom and Dignity Are Worth More than Life": The Dramatic Suicide of an Anti-Vax Man.

Since the beginning of the COVID-19 public health emergency, we have witnessed an increase in psychiatric problems and pathologies, such as depression, anxiety, isolation, posttraumatic stress disorder, substance abuse, and burnout. The world's collective sentiment finally turned toward optimism after authorization was granted for the COVID-19 vaccines' emergency use by the FDA in December 2020. With the increase in vaccine coverage in Western countries, case counts and deaths gradually plummeted while activity restrictions were progressively lifted. At the same time, however, a new COVID-19-related public health issue has arisen, as a substantial number of eligible individuals refused vaccination. Behaviors assumed by the so-called anti-vax people in manifesting their own opposition towards COVID-19 vaccination are various, and sometimes assume the forms of dramatic gestures with symbolic value, such as suicide. Here, we present the case of a healthy, convinced anti-vax, 58-year-old man, who allowed himself to be run over by a moving train in the presence of eyewitnesses, bringing with him a demonstrative note of his reasons. The present article aims to raise awareness against the social and psychological impact of COVID-19 vaccination refusal and to point out the need of a specific support net to avoid the spread of psychological impairment, social isolation and suicidal behaviors among the "anti-vax community".

Responding to the COVID-19 outbreak as a therapeutic community in a forensic psychiatric ward in Japan-A reconsideration of the role of therapeutic community in disasters.

The global impact of COVID-19 outbreak on psychiatric hospitals and prisons is unfathomable and unprecedented, and information is needed on how best to mitigate widespread infection whilst safeguarding the community's well-being. This study reports on how the staff and patients in a forensic psychiatric ward in Japan worked together during the COVID-19 outbreak as a "therapeutic community." The "Non-Three Cs" Karaoke Project, with infection prevention guidelines designed by inpatients, was safely conducted and its humor released the staff and patients' anxiety and tension. Through these discussions, the patients and staff gained a better understanding of viruses, transmission routes, countermeasures, and coping with stress. The study highlights the importance of disclosing information to inpatients, conducting open discussions, and involving patients in the prevention and management of infectious diseases. This report is the world's first report showing a concrete example of the therapeutic community's significance during the COVID-19 outbreak. It is an experience that offers an opportunity to reconsider the significance of the therapeutic community, in which patients are seen as a presence that brings change, strength, growth, and creativity into the therapeutic setting. We believe that such an approach in a future disaster would lead to an increase in the patients' problem-solving ability, and recovery and autonomy after discharge could be promoted. A shared difficult situation can be an opportunity to build a therapeutic alliance and make a difference.

CHANGES IN BODY MASS, DRUG USE AND AGGRESSIVE BEHAVIOUR IN FORENSIC PATIENTS DURING THE COVID-19 PANDEMIC

The main objective of this study was to assess behavioural changes in forensic patients (those assessed as not guilty by reason of insanity and sent for an involuntary forensic treatment) during the COVID-19 pandemic restrictions. There were 82 patients treated at the Department for Forensic Psychiatry of the University Psychiatric Hospital Vrapce in 2020, 45 of which stayed in the department for the whole year. Data were extracted from their charts and from the nurses' reports about their body masses, additional therapy prescribed and incidents at the ward. During the lock-down due to the COVID-19 pandemic, the body masses of the forensic patients decreased significantly in the first weeks of the lock-down and stayed low during the rest of 2020. Patients used fewer additional antipsychotics, benzodiazepines, hypnotics and pain killers in April 2020 as compared to February 2020. In June 2020, the use of these drugs returned to pre-pandemic levels, with the exception of antipsychotics. In August 2020, painkiller use increased to higher than pre-pandemic levels. The number of incidents during lock-down was lower compared to pre-pandemic levels.

Forensic psychiatry in times of COVID-19: a qualitative study into the concerns and needs of patients

Purpose The aim of this study is to gain a better understanding of the concerns and needs of forensic psychiatric patients regarding the impact of the COVID-19 crisis on their mental health and treatment. Design/methodology/approach Semi-structured interviews were conducted with nine patients from various wards of the hospital. Using the consensual qualitative research method, these interviews were coded by a team of three researchers. Findings Four domains emerged from the analysis, namely, restrictions, emotional consequences, coping and communication. One of the primary restrictions for patients was not being allowed to have physical contact with the people in their network/visitors. This prompted patients, in some cases, to decline visitors altogether. Emotional consequences of the COVID-19 measurements included anxiety, frustration and passivity. Ambiguity about the rules added to this frustration. Furthermore, a cut in autonomy was felt by patients due to them not being able to do their own grocery shopping. Despite these restrictions that were imposed on patients, the relationship between patients and staff was perceived as good and even improved according to the participants. Practical implications A lack of autonomy emerged as a salient issue related to the restrictions within the hospital. Certain degrees of control may be inevitable, but it is nonetheless important to focus on the effect of control within forensic settings. This could be done by aiming to actively include patients in decisions that affect their living climate. Furthermore, it appeared that the "ballet dancer" approach was used by the staff of the hospital, leaving more room for individualized care. As perceived support is important to increase willingness to accept the treatment being offered, a focus on this approach in times of rapid change such as during a pandemic, would be recommended. Originality/value Because few pandemics have occurred in the past century, little information is available about how a pandemic might affect patients residing in forensic psychiatric hospitals. To the best of the authors' knowledge this is one of the first studies to assess concerns and needs of forensic psychiatric patients regarding the COVID-19 pandemic.

THE FIRST ADOLESCENT FORENSIC PSYCHIATRY SERVICE IN THE NORTHERN TERRITORY

Background: On the backdrop of the Royal Commission into the Protection and Detention of Children in the Northern Territory, an adolescent forensic psychiatry service was commenced at Don Dale Youth Detention Centre in 2020. Objectives: To discuss the service set up, the model of care, along with the successes and challenges facing the service. Findings: A narrative and chronological review of the service is presented. The immediate and longterm challenges are discussed, including staff retention, competing political priorities, increasing numbers of young people in detention, new bail laws and Covid-related issues. Conclusion: Despite improved access to specialist mental health care for young people in detention in the Northern Territory, there are multiple barriers to overcome before adequate care can be achieved.

Child and Adolescent Forensic Psychiatry Experiences During the COVID-19 Pandemic

Objective: Coronavirus disease-2019 (COVID-19) changed the status-quo in psychiatric interview with the advent of telemental health practices, save for a select group of patients;forensic psychiatric interviews among them. The present study aimed to identify the predictors of completing forensic psychiatric evaluations mandated by the judicial authorities in the hospital setting during the COVID-19 outbreak. Method: Twenty-six patients who had completed an initial forensic psychiatric assessment and were required to complete a child and adolescent forensic psychiatry board interview during the height of the COVID-19 pandemic were recruited. Their records were retrospectively examined, sociodemographic data, Beck Depression Inventory (BDI), the Screen For Child Anxiety Related Disorders (SCARED), and Wecshler Intelligence Scale for Children-revised scores were recorded and analyzed. Results: Statistical analysis revealed an association between conduct disorder and concomitant substance use with missed appointments, and maternal employment and completed interviews. BDI and SCARED total scores showed no difference between the patients who missed or completed their mandatory forensic psychiatry board assessment. BDI individual items of loss of pleasure (item 4), suicidality (item 9), and loss of interest (item 12) were associated with missed appointments. Conclusion: The results of this study support the established relationship between conduct problems and depressive symptoms, and this demographic group may be among the most affected by the limitation of access to mental health services during the COVID-19 pandemic, as they are already less likely to seek help overall.

Loneliness and social isolation among the older person in a Swiss secure institution: a qualitative study.

BACKGROUND: A pandemic of loneliness is hitting the aging population. As COVID19 forced us to isolate ourselves, we are in a better position to understand consequences of social distancing. The recent literature showed that older incarcerated adults are particularly at risk of health-related complications due to isolation in the prison environment, reducing their social capital. Mental and physical health can be severely affected by loneliness and social isolation, especially in prison. METHODS: Our qualitative study investigates the view of older persons deprieved of their liberty on loneliness and social isolation pertaining to their mental health. We interviewed 57 older participants, including imprisoned individuals and forensic patients, following a semi-structured interview guide. During the data management and data analysis process, we excluded 7 interviews which were of poorer quality. Thereafter, we analyzed the remainders following a thematic approach. RESULTS: Most interviewees experience loneliness following lack of significant human relationships in prison. Making friends appears to be a challenge for all the participants, because, for one thing, they do not find people with similar interests. Also, secure institution setting aggravates isolation due to the restrictions of movement placed such as rules concerning movement between floors, hindering intimate relationship, and separation between friends. Moreover, contact with prison personnel is limited and lack social capital (e.g. trust). CONCLUSION: To our knowledge, this study is one of the first to present incarcerated persons' perspective on loneliness, social isolation and poor social capital in the Swiss prison setting. These has been reported to cause health problems both somatic and psychological. Our participants experience these deleterious factors in detention. As prisons have the possibility to become a health-promoting environment through connectedness, friendship, and trust promotion, stakeholders need to better their social capital.