Expert opinions on criminal law cases in Switzerland - an empirical pilot study.

BACKGROUND: Criminal courts of law rely on forensic psychiatric/psychological reports when clarifying legal questions of culpability, dangerousness, and the need for therapeutic measures for offenders. Incorrect decisions owing to a lack of expert report quality and comprehensibility can have serious consequences for potential victims, offenders themselves, or societal use of resources. In this pilot study, we started from the hypothesis that forensic psychiatric/psychological reports meet the minimum requirements for legally admissible expert opinions. METHODS: Within the framework of assessment by the Concordat Expert Commission of Northwestern and Central Switzerland, 58 adult criminal law reports were randomly selected. Two researchers extracted and analyzed standardized data descriptively. For quality assurance, they followed the extended codebook of the Research and Development Department of the Zürich Office of Corrections and Reintegration. RESULTS: Psychopathological findings accounted for only 1% of the reports, which seemed problematic considering that these findings reflect the personality traits of offenders. Furthermore, only 7% of offenders underwent physical examinations, and the reasons for not performing physical examinations were noted in fewer than half of these offenders. Of 26 sexual offenders, only one was physically assessed. Additional imaging or neurophysiological examinations (e.g. electroencephalogram) were conducted in only one offender. Furthermore, published baseline recidivism rates were used in only 37.9% of the reports. CONCLUSIONS: The results of this study suggest that current forensic psychiatric assessment is deficient. The infrequent use of published recidivism rates for risk communication denies prosecutors and judges solid reference values for the actual recidivism probability. Moving away from somatic medicine contradicts the federal court judgment, which disqualifies psychologists from providing a forensic report owing to their lack of expertise in physical examination. The authors recommend the multidisciplinary involvement of forensic psychiatrists and psychologists and, in certain cases, of specialists in somatic medicine to produce accurate and well-founded reports.

Exploring the mental healthcare needs of Swiss pre-trial detainees: A pilot investigation of an on-site psychiatric day clinic.

Introduction: Research has established that justice-involved individuals experience significant mental health problems. However, mental healthcare in correctional settings is often not sufficiently accessible to meet the demand. Hence, to improve the availability of mental healthcare services, especially for pre-trial detainees, the first Swiss on-site psychiatric day clinic (PDC) was established in 2019. The present cross-sectional observational study aimed to evaluate the need of psychiatric care in pre-trial detention and the PDC's potential to improve it. Methods: File record data were collected from the Office of Corrections and Rehabilitation of the Canton of Zurich. Differences in primary psychiatric care consultations and psychiatric hospital admissions between pre-trial detainees and sentenced prisoners were examined. In addition, a total cohort of pre-trial detainees of the first 18 months of PDC operations was examined to identify differences between three treatment groups: (1) pre-trial detainees exclusively treated in the PDC (n = 41), (2) pre-trial detainees exclusively treated in a psychiatric hospital (n = 58), and (3) pre-trial detainees treated in both the PDC as well as a psychiatric hospital (n = 16). Results: In the 5 years before the PDC opened, pre-trial detainees had significantly more primary psychiatric care consultations and were admitted to psychiatric hospitals on significantly more occasions than were sentenced prisoners. In the first 18 months of the PDC, psychiatric hospital admission rates for pre-trial detainees decreased by 18.5% and pretrial detainees exclusively treated in the PDC differed significantly from other treatment groups concerning mental disorder, gender, and alleged index offense. They were more likely to be diagnosed with adjustment disorders and were less likely to be diagnosed with schizophrenia spectrum disorder. Conclusion: The use of mental health care among pre-trial detainees is significantly more frequent than among sentenced prisoners concerning both primary care and inpatient treatment. Since establishment of the novel on-site PDC admissions to psychiatric hospitals were found to decrease. Data indicates that especially male pre-trial detainees with adjustment disorders benefitted from this innovative path forward in correctional healthcare. Further research is needed to improve the PDC's service for female pre-trial detainees.

What Kind of Therapy Works With Juveniles Who Have Sexually Offended? A Randomized-Controlled Trial of Two Versions of a Specialized Cognitive Behavioral Outpatient Treatment Program.

There is ongoing debate about whether specialized treatment is effective to reduce sexual recidivism in juveniles who have sexually offended (JSOs). Although most treatment programs are based on cognitive behavioral therapy principles for preventing sexual offending, accordant scientific evidence is poor. Following CONSORT guidelines, the present study aimed to evaluate two versions of a short-term outpatient treatment program for JSOs in Switzerland: (a) the Therapy Program for Adequate Sexual Behaviors Version 1 (ThePaS-I), which included offending-specific skills training; (b) the ThePaS-II, which included general socioemotional skills training. Based on changes in self-reported mental health, sexual behaviors, victim empathy, and therapist-rated risk, as well as comprehensive data on sexual and general recidivism, we found some similarities regarding the effects of the two treatments. ThePaS-II showed better short-term changes in self-reported mental health than the ThePaS-I. However, JSOs in the ThePaS-I showed lower rates of sexual reoffending (but not general reoffending) after treatment than those in the ThePaS-II. Despite some methodological limitations, the current findings favor offending-specific skills-based therapy over general skills-based ones for preventing sexual reoffenses. The findings may encourage further methodologically sound studies to examine different treatment approaches for juveniles and adults who have committed criminal offenses.

Recidivism in Switzerland: the influence of custodial sanctions.

AIMS OF THE STUDY: Although many studies have investigated the influence of personal characteristics on recidivism, knowledge about the impact of correctional policies remains limited. The present study adds to this debate by investigating the effect of the dualistic system of custodial sanctions in Switzerland over time. Specifically, we: (1) tested the influence that different types of custodial sanctions – sentences (offering regular prison treatment) and measures (offering crime-related rehabilitation programmes) – have on reconviction rates; and (2) forecasted future reconviction rates to estimate their value in the year 2020. METHODS: National level data from the Swiss Federal Statistical Office were collected, including 3-year reconviction rates after release from custody and the number of persons serving custodial sentences and measures. A time series framework was used for the analyses, which included data available from 1988 to 2013 (n = 26 years). RESULTS: The number of persons serving custodial sentences had no effect on recidivism (p = 0.582); however, a higher number of persons serving custodial measures was significantly associated with a decrease in recidivism (p = 0.003). For the year 2020, a reconviction rate of 28% (range 23–33%) was predicted. CONCLUSIONS: Custodial measures seem to be associated with a reduction in recidivism. However, owing to the indeterminate time associated with some custodial measures, often at the cost of the prisoners’ rights and the criminal justice system, future studies are needed to determine the optimal serving time for custodial measures.

COVID-19 Inmate Risk Appraisal (CIRA): development and validation of a screening tool to assess COVID-19 vulnerability in prisons.

OBJECTIVES: To develop and validate a screening tool designed to identify detained people at increased risk for COVID-19 mortality, the COVID-19 Inmate Risk Appraisal (CIRA). DESIGN: Cross-sectional study with a representative sample (development) and a case-control sample (validation). SETTING: The two largest Swiss prisons. PARTICIPANTS: (1) Development sample: all male persons detained in Pöschwies, Zurich (n = 365); (2) Validation sample: case-control sample of male persons detained in Champ-Dollon, Geneva (n = 192, matching 1:3 for participants at risk for severe course of COVID-19 and participants without risk factors). MAIN OUTCOME MEASURES: The CIRA combined seven risk factors identified by the World Health Organization and the Swiss Federal Office of Public Health as predictive of severe COVID-19 to derive an absolute risk increase in mortality rate: Age ≥60 years, cardiovascular disease, diabetes, hypertension, chronic respiratory disease, immunodeficiency and cancer. RESULTS: Based on the development sample, we proposed a three-level classification: average (<3.7), elevated (3.7-5.7) and high (>5.7) risk. In the validation sample, the CIRA identified all individuals identified as vulnerable by national recommendations (having at least one risk factor). The category "elevated risk" maximised sensitivity (1) and specificity (0.97). The CIRA had even higher capacity in discriminating individuals vulnerable according to clinical evaluation (a four-level risk categorisation based on a consensus of medical staff). The category "elevated risk" maximised sensitivity and specificity (both 1). When considering the individuals classified as extremely high risk by medical staff, the category "high risk" had a high discriminatory capacity (sensitivity =0.89, specificity =0.97). CONCLUSIONS: The CIRA scores have a high discriminative ability and will be important in custodial settings to support decisions and prioritise actions using a standardised valid assessment method. However, as knowledge on risk factors for COVID-19 mortality is still limited, the CIRA may be considered preliminary. Underlying data will be updated regularly on the website (http://www.prison-research.com), where the CIRA algorithm is freely available.

Reducing recidivism using the Reasoning and Rehabilitation program: a pilot multi-site-controlled trial among prisoners in Switzerland.

OBJECTIVES: This study evaluated whether the Reasoning and Rehabilitation (R&R2) program was effective in reducing recidivism, minimizing dropout rates, and improving outcomes related to attitudes, behaviors, and personality among people living in detention. METHODS: Data were collected in eight Swiss German-speaking prisons among males detained for violent offenses using a quasi-experimental controlled design (R&R2: n = 129, treatment as usual [TAU]: n = 84). Measures included recidivism, dropout rate, and self-report questionnaires (hostile attribution bias, aggressiveness, interpersonal problems, and willingness to accept responsibility). Data were analyzed using mixed-effect models. RESULTS: Participants in the R&R2 group were less likely to reoffend in comparison with the TAU group in the intention-to-treat (n = 51, odds ratio = 0.75, p = .060) and the per-protocol (excluding dropouts; n = 38, odds ratio = 0.65, p = .068) analyses. They also had lower self-reported scores of spontaneous and reactive aggressiveness (p = .047 and p = .070) and excitability (p = .086). CONCLUSIONS: The findings of this pilot project were promising, with the R&R2 program leading to reduced recidivism and dropout rate. Even though these results should be considered preliminary, the R&R2 program appeared to be a relevant approach in reducing recidivism after prison.

Predictive Validity of the Static-99 and Static-99R in Switzerland.

This study evaluated the validity of the Static-99 and Static-99R in assessing sexual recidivism in Switzerland, based on a sample of 142 male sex offenders. Both tools showed predictive validity, but the Static-99R had better discrimination (OR = 1.82, AUC = .81) and calibration (Brier = .078, P/E = 0.96) than the Static-99. A cut score of four on the Static-99R maximized sensitivity (92.9%) and specificity (60.2%). However, although most offenders (98.7%) with a score < 4 did not commit sexual offenses in the 5-year follow-up period, only one in five (20.3%) offenders with a score ≥ 4 actually recidivated. Furthermore, the predicted number of recidivists in the well above average risk category (Static-99R ≥ 6) was 24% higher than expected in routine samples. The results suggest that the Static-99R may be a useful screening tool to identify low-risk individuals but offenders with scores ≥ 4 should be subjected to a more thorough assessment.

Sexual Sadism Among Sex Offenders in Switzerland.

The Sexual Sadism Scale (SeSaS) was developed to assist in the diagnosis of sexual sadism, and it revealed adequate psychometric properties in prior research. This study cross validated the SeSaS in Switzerland using a sample of 179 male sex offenders. Specifically, the SeSaS conformed to a Mokken model of double monotonicity (scalability coefficient [H] = .46, coefficient of reproducibility [CR] = .89), indicating that it measures a unidimensional construct of sexual sadism with hierarchically ordered items. The reliability of the scale was acceptable to high (ρ = .80, λ2 = .75, κ = .88). In addition, the SeSaS was strongly associated with sexual sadism diagnoses based on mental health manuals (rpb = .60, odds ratio [OR] = 13.02, area under the curve [AUC] = 1) but not with recidivism. The results suggest that the use of the SeSaS may improve the validity and reliability of sexual sadism diagnoses, therefore playing a role in the assessment and management of sex offenders.

A longitudinal study of mental health symptoms in young prisoners: exploring the influence of personal factors and the correctional climate.

BACKGROUND: Despite the high prevalence rate of mental health problems among young prisoners, little is known about the longitudinal course and covariates of their mental health symptoms during incarceration, especially the influence of the correctional climate. The current study aimed: (1) to examine changes in young prisoners' mental health symptoms during incarceration, (2) to identify personal factors associated with their mental health symptoms and perceptions of the correctional climate, and (3) to test the incremental effect of perceptions of the correctional climate on mental health symptoms. METHODS: Data were obtained from a sample of 75 youths (aged 17 to 22 years) detained in a Portuguese young offender prison. Data were gathered 1, 3, and 6 months after their admission in this facility. Socio-demographic, clinical and criminological variables were collected. Mental health symptoms and perceptions of the correctional climate were assessed through self-report assessment tools. Linear and logistic (multi-level) regressions and tests for differences between means were performed to analyze the data. RESULTS: Overall, mental health symptoms marginally declined by the sixth month in prison. Prisoners with a history of mental health treatment were more likely to have increased symptoms. Higher levels of mental health symptoms were associated with a history of mental health treatment, remand status, and a lower educational level. Better perceptions of the correctional climate were associated with Black race and participation in prison activities. A negative perception of the correctional climate was the strongest covariate of young prisoners' mental health symptoms and had incremental validity over that of personal variables. CONCLUSIONS: The results highlight that both characteristics of the prisoners and of the prison environment influence young prisoners' mental health. Prison management can try to reduce young prisoners' mental health problems by developing scientific procedures for their mental health assessment and creating a more beneficial correctional climate.

Replicating the violence risk appraisal guide: a total forensic cohort study.

INTRODUCTION: The performance of violence risk assessment instruments can be primarily investigated by analysing two psychometric properties: discrimination and calibration. Although many studies have examined the discrimination capacity of the Violence Risk Appraisal Guide (VRAG) and other actuarial risk assessment tools, few have evaluated how well calibrated these instruments are. The aim of the present investigation was to replicate the development study of the VRAG in Europe including measurements of discrimination and calibration. METHOD: Using a prospective study design, we assessed a total cohort of violent offenders in the Zurich Canton of Switzerland using the VRAG prior to discharge from prisons, secure facilities, and outpatient clinics. Assessors adhered strictly to the assessment protocol set out in the instrument's manual. After controlling for attrition, 206 offenders were followed in the community for a fixed period of 7 years. We used charges and convictions for subsequent violent offenses as the outcomes. Receiver operating characteristic analysis was conducted to measure discrimination, and Sanders' decomposition of the Brier score as well as Bayesian credible intervals were calculated to measure calibration. RESULTS: The discrimination of the VRAG's risk bins was modest (area under the curve = 0.72, 95% CI = 0.63-0.81, p<0.05). However, the calibration of the tool was poor, with Sanders' calibration score suggesting an average assessment error of 21% in the probabilistic estimates associated with each bin. The Bayesian credible intervals revealed that in five out of nine risk bins the intervals did not contain the expected risk rates. DISCUSSION: Measurement of the calibration validity of risk assessment instruments needs to be improved, as has been done with respect to discrimination. Additional replication studies that focus on the calibration of actuarial risk assessment instruments are needed. Meanwhile, we recommend caution when using the VRAG probabilistic risk estimates in practice.

Adolescent delinquency and antisocial tendencies as precursors to adult violent offending: a prospective study of a representative sample of swiss men.

Studies on adult sex and violent offenders have found high rates of adolescent delinquency, while early delinquency has been shown to be significantly associated with adult offending. The examined subsample (n = 123) of a longitudinal prospective study (n = 6,315) includes all men who at the age of 19 had an entry in the criminal records. During the observation period of 34 years, 68.3% of the sample had been reconvicted as adults, 23.6% for violent or sex offenses. The odds of adult sex or violent offending were 2.8 times higher for those who had committed a violent offense in adolescence and 1.05 times higher for any offense committed before the age of 19. The characteristics of criminal history showed the highest discriminative values (area under the curve [AUC] = 0.61-0.65). The most important finding of this study was that characteristics of adolescent delinquency predicted adult violent or sex offending, whereas socioeconomic and psychiatric characteristics did not.

Current obstacles in replicating risk assessment findings: a systematic review of commonly used actuarial instruments.

An actuarial risk assessment instrument can be considered valid if independent investigations using novel samples can replicate the findings of the instrument's development study. In order for a study to qualify as a replication, it has to adhere to the methodological protocol of the development study with respect to key design characteristics, as well as ensuring that manual-recommended guidelines of test administration have been followed. A systematic search was conducted to identify predictive validity studies (N = 84) on three commonly used actuarial instruments: the Violence Risk Appraisal Guide (VRAG), the Sex Offender Risk Appraisal Guide (SORAG), and the Static-99. Sample (sex, age, criminal history) and design (follow-up, attrition, recidivism) characteristics, as well as markers of assessment integrity (scoring reliability, item omissions, prorating procedure), were extracted from 84 studies comprising 108 samples. None of the replications matched the development study of the instrument they were attempting to cross-validate with respect to key sample and design characteristics. Furthermore none of the replications strictly followed the manual-recommended guidelines for the instruments' administration. Additional replication studies that follow the methodological protocols outlined in actuarial instruments' development studies are needed before claims of generalizability can be made.

[Impaired resonance in offenders with psychopathic traits]. / Empathische Resonanzfähigkeit bei Straftätern mit psychopathischen Persönlichkeitszügen.

BACKGROUND: Resonance is the phenomenon of unconsciously mirroring the motor actions of another person. Beside autism and schizophrenia psychopathic personality traits are associated with empathy dysfunction. METHODS: We explore empathic resonance in terms of contagion by laughing and yawning in a group of offenders with psychopathic traits. Offenders with psychopathic traits (n = 12) and matched controls (n = 10) were video-taped while watching short video sequences of yawning, laughing or neutral faces. They were rated regarding contagion. Further, we assessed a self-report on psychopathy and on empathic tendencies. RESULTS: Compared to the control group, the offenders showed significantly less contagion and less self-reported empathic tendencies. Individuals who rated themselves as more empathic showed more contagion. CONCLUSIONS: The observed reduced resonance in terms of contagion may illuminate the cold-heartedness, with which some psychopathic offenders treat their victims: When embodied experiencing of other's physical and emotional situation is missing, a natural inhibition of violence may be overcome. The small sample size limits the generalisability of these findings.

Neurobiological determinism: human freedom of choice and criminal responsibility.

Several authors have argued that criminal behavior is generally caused by neurobiological deficits. This assumption not only questions the concept of free will and a person's responsibility for his or her own actions but also the principle of guilt in criminal law. When critically examining the current state of research, it becomes apparent that the results are not sufficient to support the existence of a universally valid neurobiological causality of criminal behavior. Moreover, the assumption of total neurobiological determination of human behavior and the impossibility of individual responsibility are characterized by both faulty empiricism and methodical misconceptions. The principle of relative determinism and the analysis of the offender's behavior at the time of the offense thus remain the central and cogent approach to the assessment of criminal responsibility.

Procedures for preventing juvenile violence in Switzerland: the Zurich model.

The Swiss legal system places strong emphasis on risk assessment and treatment of potentially violent offenders. Especially after the 2001 Zug massacre, there is close cooperation between the judicial and mental health systems to prevent violence through early detection and intervention. A case study of a risk management program for a dangerous seventeen-year-old delinquent youth illustrates this approach.

Internet-based self-assessment after the Tsunami: lessons learned.

BACKGROUND: In the aftermath of the Tsunami disaster in 2004, an online psychological self-assessment (ONSET) was developed and made available by the University of Zurich in order to provide an online screening instrument for Tsunami victims to test if they were traumatized and in need of mental health care. The objective of the study was to report the lessons learnt that were made using an Internet-based, self-screening instrument after a large-scale disaster and to discuss its outreach and usefulness. METHODS: Users of the online self-assessment decided after finishing the procedure whether their dataset could be used for quality control and scientific evaluation Their answers were stored anonymously only if they consented (which was the case in 88% of the sample), stratified analyses according to level of exposure were conducted. RESULTS: A total of 2,914 adult users gave their consent for analysis of the screenings. Almost three quarter of the sample filled out the ONSET questionnaire within the first four weeks. Forty-one percent of the users reported direct exposure to the Tsunami disaster. Users who were injured by the Tsunami and users who reported dead or injured family members showed the highest degree of PTSD symptoms. CONCLUSION: ONSET was used by a large number of subjects who thought to be affected by the catastrophe in order to help them decide if they needed to see a mental health professional. Furthermore, men more frequently accessed the instrument than women, indicating that Internet-based testing facilitates reaching out to a different group of people than "ordinary" public mental health strategies.

Risk assessment instruments in repeat offending: the usefulness of FOTRES.

Research in the area of predicting recidivism has produced several well-validated standardized risk assessment instruments. The question arises, which instruments best serve which purposes? The objective of this study was to evaluate and compare several actuarial and dynamic risk assessment instruments as to their predictive accuracy and their usefulness in forensic practice. The sample consisted of 109 violent and sex offenders who had been released from prison in Switzerland between 1994 and 1999, and for whom the Psychopathy Checklist-Revised (PCL-R); Historical, Clinical, Risk Management-20; Level of Service Inventory-Revised; Violence Risk Appraisal Guide (VRAG); and the Swiss assessment instrument FOTRES were scored. Using bivariate logistic regression analyses, all instruments were able to discriminate between recidivists and nonrecidivists. The receiver operating characteristic analyses yielded area under the curve values between 0.70 (VRAG) and 0.84 (PCL-R). Furthermore, it was shown that solely examining AUC values does not suffice to determine usefulness. A comprehensive evaluation of an instrument's usefulness for forensic practice should also look at qualitative criteria such as area of application, specificity of risk assessed, and inclusion of dynamic items among others.

Women convicted for violent offenses: adverse childhood experiences, low level of education and poor mental health.

BACKGROUND: In past years, the female offender population has grown, leading to an increased interest in the characteristics of female offenders. The aim of this study was to assess the prevalence of female violent offending in a Swiss offender population and to compare possible socio-demographic and offense-related gender differences. METHODS: Descriptive and bivariate logistic regression analyses were performed for a representative sample of N = 203 violent offenders convicted in Zurich, Switzerland. RESULTS: 7.9% (N = 16) of the sample were female. Significant gender differences were found: Female offenders were more likely to be married, less educated, to have suffered from adverse childhood experiences and to be in poor mental health. Female violent offending was less heterogeneous than male violent offending, in fact there were only three types of violent offenses females were convicted for in our sample: One third were convicted of murder, one third for arson and only one woman was convicted of a sex offense. CONCLUSIONS: The results of our study point toward a gender-specific theory of female offending, as well as toward the importance of developing models for explaining female criminal behavior, which need to be implemented in treatment plans and intervention strategies regarding female offenders.

The consumption of Internet child pornography and violent and sex offending.

BACKGROUND: There is an ongoing debate on whether consumers of child pornography pose a risk for hands-on sex offenses. Up until now, there have been very few studies which have analyzed the association between the consumption of child pornography and the subsequent perpetration of hands-on sex offenses. The aim of this study was to examine the recidivism rates for hands-on and hands-off sex offenses in a sample of child pornography users using a 6 year follow-up design. METHODS: The current study population consisted of 231 men, who were subsequently charged with consumption of illegal pornographic material after being detected by a special operation against Internet child pornography, conducted by the Swiss police in 2002. Criminal history, as well as recidivism, was assessed using the criminal records from 2008. RESULTS: 4.8% (n = 11) of the study sample had a prior conviction for a sexual and/or violent offense, 1% (n = 2) for a hands-on sex offense, involving child sexual abuse, 3.3% (n = 8) for a hands-off sex offense and one for a nonsexual violent offense. When applying a broad definition of recidivism, which included ongoing investigations, charges and convictions, 3% (n = 7) of the study sample recidivated with a violent and/or sex offense, 3.9% (n = 9) with a hands-off sex offense and 0.8% (n = 2) with a hands-on sex offense. CONCLUSION: Consuming child pornography alone is not a risk factor for committing hands-on sex offenses - at least not for those subjects who had never committed a hands-on sex offense. The majority of the investigated consumers had no previous convictions for hands-on sex offenses. For those offenders, the prognosis for hands-on sex offenses, as well as for recidivism with child pornography, is favorable.