Remorse in psychotic violent offenders: An overvalued idea?

Expressing remorse - or not - appears to influence criminal justice outcomes, but preliminary exploration of both judicial and psychological concepts suggests they lack clarity. We asked the following questions: does psychosis impair capacity for, or expression of, remorse for a homicide or other serious harm to others? Is failure to express remorse for an offence associated with recidivism? We conducted systematic reviews of empirical literature on remorse for serious violence while psychotic, and on relationships between remorse and reoffending regardless of mental state. No articles on remorse for homicide or other serious violence while psychotic were identified. There is weak evidence that lack of remorse is associated with reoffending generally, but nothing specific to psychosis. The literature is strong enough to support a case for research into valid measurement of remorse for offending, associations of such measures with recidivism, and whether a change in remorse can be effected - or matters. It is not strong enough to support reliance on perceptions of the presence or absence of remorse as a basis for judicial decisions.

Learning from research: Adapting interventions for sexual offending to improve outcomes.

BACKGROUND: Sexual behaviour towards another person who does not or cannot consent to it causes serious harm to its victims. Understandable tendencies towards isolating or shaming the offenders, however, may actually increase risks of recidivism and further such harms. AIM: The study aims to consider evidence for the effectiveness of interventions for sex offenders, mainly in a U.K. context, across four areas: criminal justice system programmes, medication, interventions for sex offenders with personality disorder and a community-based model for the reintegration-Circles of Support and Accountability, and identify key evidence gaps. METHODS: We searched for reviews in the following four strands of work-psychosocial programmes, medication, personality focused therapies, and Circles of Support and Accountability-and identified gaps in knowledge. FINDINGS: Randomised controlled trials in this field are rare but have been achieved. Findings from more naturalistic outcome studies of sex offender treatment programmes are disappointing, but recidivism rates among released sex offender prisoners are low, regardless. Medication relying on substantial physiological change raises substantial ethical concerns. Not all sex offenders have a mental disorder but up to half have been diagnosed with a personality disorder, which may need specific treatment. Evidence is growing that lay work such as Circles of Support and Accountability is a valuable adjunct to other interventions. CONCLUSIONS AND IMPLICATIONS FOR FUTURE RESEARCH: In this field, where tensions between attributions swing between "madness" and "badness," there is growing evidence for optimism that complexity of history and presentation can be met through cooperation between the many disciplines, integrative strategies, and wider community engagement. The need now is for large, prospective controlled trials of interventions, with long periods of follow-up. Perhaps, the most exciting developments have come from the wider public. More research into the qualities of these volunteers might inform public education and health strategies supporting wider safety.

An evaluation of case formulation training and consultation with probation officers.

BACKGROUND: Formulation is a core competency of mental health professionals, drawing on a variety of sources of information. In England and Wales, the current strategy for offenders with personality disorder places formulation-led management, generally by probation staff, at its core, but reliability and validity of the process remain unclear. AIMS: The first aim was to evaluate a checklist previously designed to establish quality of formulation, and the second to measure the impact of training and consultation on the ability of probation officers to formulate cases. METHODS: The inter-rater reliability, test-re-test reliability and internal consistency of the McMurran formulation checklist were calculated from the scores derived from randomised formulations completed by probation officers from fictitious case vignettes. The impact of training was measured by comparing pre- and post-training formulations of these vignettes. Practice cases formulated by probation officers at psychologist-facilitated consultation meetings over a 6-month period were used to measure the impact of consultation. All formulations were scored blind by independent experts. RESULTS: Inter-rater reliability, test-re-test reliability and internal consistency of the scale were all acceptable. Training and practice did not significantly improve the probation officers' formulations. CONCLUSIONS: The purpose and utility of formulation may vary according to the context in which it is applied. Progress in developing formulation skills may depend on the nature and length of the previous experience of this skill. Future research should take account of such variance, with this scale as a potentially useful aid in monitoring progress. IMPLICATIONS: The capacity for teaching formulation to probation officers could be investigated further by comparing the process with formulation development by mental health experts with previously extensive formulation experience. Formulation will probably need to be adapted to meet the needs of the context in which it is developed. The relationship between formulation and management outcome was not investigated here and would be a further important step.

A community service for high-risk mentally disordered sex offenders: a follow-up study.

There is sparse literature on mentally disordered sex offenders, and little is published on treatment participation and outcomes for this group. This article aims to describe the characteristics of a cohort of high-risk mentally disordered-largely personality disordered-sex offenders at risk in the community in southeast London. Drawing on various measures of personality dysfunction-including key developmental variables, a self-report personality disorder questionnaire Millon Clinical Multi-axial Inventory-III (MCMI-III) and psychopathy as measured by the Psychopathy Checklist: Screening Version (PCL:SV)-the researchers describe the characteristics of a cohort of mentally disordered sex offenders referred to the Challenge project. Follow-up data for those placed in treatment are reported and include consideration of treatment completion and reconviction: the relationship between personality dysfunction and a dynamic measure of risk are also explored. Of the 137 participants, 53% were placed in the community treatment project. Seventy five percent completed treatment, and were followed up for an average of 40 months. Eleven percent were sexually reconvicted, 3% violently reconvicted. Community failure was best predicted by a combination of static risk and personality-related variables.

The London Pathways Project: evaluating the effectiveness of a consultation model for personality disordered offenders.

BACKGROUND: A recent government strategy has been developed to meet the challenges posed by personality disordered offenders. A 'pathways project' was piloted in four London boroughs to assess the implementation of some elements of the strategy. AIMS: This paper focuses on the scope and the effectiveness of 2 years of the project. METHOD: Probation caseloads were screened for personality disorder. Risk information and pathways were monitored and recorded over 2 years. Psychologists provided consultation, training and direct co-working as interventions. RESULTS: The findings include a description of the samples identified, the range of project activity, pathway outcomes and factors associated with or predictive of successes and failures. CONCLUSIONS: The findings supported the implementation of the pathways model to fulfil aspects of the offender personality disorder strategy, such as facilitating entry into treatment and interventions and to a lesser extent planning safer return to the community. The consultation model, including low-intensity direct contact with project psychologists, improved outcomes for personality disordered offenders. IMPLICATIONS: Observations from experiences of the 2-year pilot and ideas to assist with a wider implementation of the strategy are provided.

The role of affect in the estimation of risk.

BACKGROUND: Risk assessment decisions have profound consequences. The contribution of affect to decision making is well established in the psychology literature, but this body of knowledge has had little influence in the field of violence risk assessment. AIMS: We sought to establish the relative contribution of actuarial and emotive information in determining risk ratings of violence. METHOD: In a repeated measures design, mental health professionals rated four vignettes according to perceived level of risk of violence. Vignettes were designed to contain information likely to maximize or minimize emotive and actuarial information. RESULTS: Both actuarial and emotive factors contributed significantly to the rating of risk. However, emotive information had a far greater influence. Reasons given for ratings tended to relate to emotive factors. CONCLUSIONS: Despite the growth of actuarial knowledge amongst mental health professionals, clinicians tend to disregard this information and are heavily and disproportionately influenced by emotive material. This detracts from the accurate assessment of risk. Actuarial factors tend to have little appeal to clinicians. This may be attributable to their apparent lack of relevance to the clinical task. Further research on clinically meaningful psychological variables and their relation to the risk of enactment is required.

The development of a specialist hostel for the community management of personality disordered offenders.

BACKGROUND: Since the late 1990s, in England and in Wales, there has been increasing interest in the particular challenges of managing offenders with personality disorder (PD). In 1999, a specialist hostel, managed by the probation service but with a high level of forensic mental health service input, was opened to high-risk PD offenders. AIMS: To describe the first 93 high-risk residents with PD who were completing sentences under life licence, parole or probation, and their outcome. METHODS: We investigated the nature of the offences residents had previously committed, their psychological profile in terms of personality patterns on the Millon Clinical Multiaxial Inventory (MCMI-III) and the Psychopathy Checklist-Revised (PCL-R), as well as staff commentary on their progress, to establish whether these factors related to outcome in terms of completion of stay in the hostel or premature discharge. Curfew failures and rearrest rates were also measured. RESULTS: Of the 80 men who completed their residency within the two years of the study, the majority (50) left the hostel for positive reasons under mutual agreement. One-fifth were rearrested while resident, which is a lower rate than would be expected for such a group of offenders. PCL-R scores were predictive of outcome, but so was previous offending history. Self-defeating traits on the MCMI-III and negative comments written by hostel staff were also associated with failure. CONCLUSIONS: The hostel development demonstrated that probation and health services can work together to manage violent offenders with high levels of psychological dysfunction, and the evaluation provided some indications of how such arrangements might be enhanced.

The relationship between developmental variables, personality disorder, and risk in sex offenders.

Previous research on the evaluation of the Challenge Project, a community treatment program for sex offenders in southeast London, identified the potential role of key developmental variables as enhancing actuarial risk measures to identify individuals at highest risk for community failure. The aim of the current study was to assess the relationship between developmental variables and later personality dysfunction in adult-hood, and the contribution of these factors to assessing risk for sexual recidivism, in a wider group of sex offenders managed in the community by the probation service. Over an 8-month period, 241 participants were assessed, including 162 child molesters and 79 rapists. A wide range of background data were collected, including the administration of several psychometric measures. A strong relationship was found between key developmental variables and adult mental health and personality difficulties, as well as a range of risk measures. The implications of the findings for further research are discussed.

The characteristics of a geographical sample of convicted rapists: sexual victimization and compliance in comparison to child molesters.

The limited research literature that relates specifically to sexual offenders against adults (rapists) would suggest that they are more likely to demonstrate a greater criminogenic profile but to have experienced fewer childhood and adult psychological difficulties than child molesters. The aim of this study is to describe the characteristics of an urban sample of convicted rapists (n =80), comparing them to a sample of child molesters (n = 230) on background and offense-related variables. Although there were a number of similarities between the two groups, rapists were less likely to have been sexually victimized as a child. The sexual recidivism rate was low (5%) for rapists after an average time at risk of 3 years despite a trend toward them being less compliant in the community. This article comments on the treatment needs of those with a range of psychological difficulties and indicates future directions for research.

The parental bonding experiences of sex offenders: a comparison between child molesters and rapists.

OBJECTIVE: It has often been hypothesized that because of a lack of early satisfactory attachments, sex offenders grow up unable to form relationships with adults, which makes them susceptible to pursue intimacy in maladaptive ways. This research aims to empirically examine the parental bonding patterns for a group of sex offenders, comparing child molesters and rapists. METHOD: Seventy-six men convicted of a sexual offense (57 child molesters and 19 rapists) completed the parental bonding instrument (PBI), and were assessed by means of a semi-structured clinical interview. RESULTS: Affectionless control style of parental bonding was highly prevalent amongst the sex offenders. There was some suggestion that low parental care was associated with childhood abuse and disturbances, particularly for child molesters. High overprotection in mothers was linked with parental separation and sex play with male peers in childhood. CONCLUSIONS: There is a need to replicate the study with non-sexual offenders as a comparison group, and to establish whether the PBI provides a useful adjunct to studies of adult romantic attachment in sex offenders.

Characteristics of perpetrators of child sexual abuse who have been sexually victimized as children.

This paper reports on a study of all convicted child sexual abusers in S.E. London. Almost half the offenders reported experiences of sexual victimization in childhood, and the authors aimed to explore the differences between the abused and nonabused child sexual abusers. A range of background and offending variables were examined. It was found that sexually victimized child abusers were significantly more likely to have experienced a range of childhood abuse and associated difficulties; they were more likely to have a range of psychosexual difficulties, to report greater levels of deviant offence-related attitudes on psychometric measure, to be recidivists, and to offend against boys. Both emotional abuse/physical neglect in childhood and having homosexual contacts in adulthood significantly contributed to a predictive model, reliably distinguishing between sexually victimized and nonsexually victimized child sexual abusers. The implication of these findings for treatment approaches for sex offenders is discussed.