Sexual abuse during childhood and all-cause mortality into middle adulthood: an Australian cohort study.

OBJECTIVE: To compare mortality from all causes, internal causes (eg, cancers, circulatory and respiratory system diseases), and external causes (eg, suicide, accidents, assault) among people who were sexually abused during childhood with mortality for the general population. DESIGN: Historical cohort study. SETTING, PARTICIPANTS: 2759 people (2201 women, 79.8%) who had experienced medically assessed contact sexual abuse in Victoria while aged 16 years or younger during 1964-1995, as recorded in Victorian Institute of Forensic Medicine records. MAIN OUTCOME MEASURES: Mortality rate, based on linked National Death Index data (1980-2020), by five-year age group; sex- and age-standardised mortality ratios; comparison of rates with age- and sex-adjusted rates for the general Victorian population (incident rate ratio [IRR]). RESULTS: We included 115 deaths of people under 50 years of age in our analysis (4.2% of people sexually abused as children; 79 women, 36 men); 56 deaths were attributed to external, 56 to internal causes (cause of death information missing in three cases). In each age group from 15-19 years, the mortality rates for people sexually abused as children were higher than for the general population; age- and sex-standardised all-cause mortality ratios were highest for people aged 25-29 years (men: 16.5; 95% confidence interval [CI], 11.0-22.0; women: 19.2; 95% CI, 14.3-24.2). The age- and sex-adjusted mortality rate for people sexually abused as children was higher than in the general population for all-cause (IRR, 8.25; 95% CI, 5.92-11.5), internal cause (IRR, 5.92; 95% CI, 3.89-9.01), and external cause deaths (IRR, 12.6; 95% CI, 9.61-16.6); the differences in external cause mortality were greater for people who had experienced penetrative (IRR, 14.9; 95% CI, 10.9-20.5) than for those who had experienced non-penetrative sexual abuse as children (IRR, 8.92; 95% CI, 5.35-14.9). CONCLUSIONS: Sexual abuse during childhood is associated with higher mortality rates into mid-adulthood. Preventing child sexual abuse and intervening early to reduce the damage it inflicts is not only essential for the welfare of the child, but could also help reduce avoidable deaths later in life.

Neighbourhood characteristics and the treated incidence rate of borderline personality pathology among young people.

OBJECTIVE: The impact of the wider social environment, such as neighbourhood characteristics, has not been examined in the development of borderline personality disorder. This study aimed to determine whether the treated incidence rate of full-threshold borderline personality disorder and sub-threshold borderline personality disorder, collectively termed borderline personality pathology, was associated with the specific neighbourhood characteristics of social deprivation and social fragmentation. METHOD: This study included young people, aged 15-24 years, who attended Orygen's Helping Young People Early programme, a specialist early intervention service for young people with borderline personality pathology, from 1 August 2000-1 February 2008. Diagnoses were confirmed using the Structured Clinical Interview for DSM-IV Personality Disorders, and census data from 2006 were used to determine the at-risk population and to obtain measures of social deprivation and fragmentation. RESULTS: The study included 282 young people, of these 78.0% (n = 220) were female and the mean age was 18.3 years (SD = ±2.7). A total of 42.9% (n = 121) met criteria for full-threshold borderline personality disorder, and 57.1% (n = 161) had sub-threshold borderline personality disorder, defined as having three or four of the nine Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) borderline personality disorder criteria. There was more than a sixfold increase in the treated incidence rate of borderline personality pathology in the neighbourhoods of above average deprivation (Quartile 3) (incidence rate ratio = 6.45, 95% confidence interval: [4.62, 8.98], p < 0.001), and this was consistent in the borderline personality disorder sub-groups. This association was also present in the most socially deprived neighbourhood (Quartile 4) (incidence rate ratio = 1.63, 95% confidence interval: [1.10, 2.44]), however, only for those with sub-threshold borderline personality disorder. The treated incidence of borderline personality pathology increased incrementally with the level of social fragmentation (Quartile 3: incidence rate ratio = 1.93, 95% confidence interval: [1.37, 2.72], Quartile 4: incidence rate ratio = 2.38, 95% confidence interval: [1.77, 3.21]). CONCLUSION: Borderline personality pathology has a higher treated incidence in the more socially deprived and fragmented neighbourhoods. These findings have implications for funding and location of clinical services for young people with borderline personality pathology. Prospective, longitudinal studies should examine neighbourhood characteristics as potential aetiological factors for borderline personality pathology.

Determinants and Outcomes of the Therapeutic Alliance in Treating Justice-Involved Youth: A Systematic Review of Quantitative and Qualitative Research.

A large body of research supports the role of the therapeutic alliance in predicting positive change in psychotherapy. This systematic review examined determinants of alliance quality and its association with treatment outcomes in an under-served and under-researched population-justice-involved youth-with whom several challenges and contextual considerations arise that bear relevance to the alliance. The search strategy yielded 23 independent studies meeting eligibility criteria and describing diverse treatments: 14 quantitative records synthesized narratively and nine qualitative studies that underwent thematic analysis. A complex picture emerged, precluding firm conclusions about factors linked to enhanced alliances and the alliance-outcome relationship with justice-involved youth. Nevertheless, some promising findings were noted across quantitative studies, including potential treatment benefits related to alliance growth and creating positive alliances with caregivers. The review also highlighted the potential relevance of the young person's relationships with peers and parents and their treatment readiness and expectations to alliance quality. Drawing on adolescent, caregiver, and therapist perspectives, the thematic synthesis of qualitative studies generated themes related to key elements of constructive alliances and their role in creating a foundation for initiating change. An integrated discussion is provided, highlighting practical implications and suggestions for addressing methodological limitations and substantive knowledge gaps.

The Role of Cognition in Youth Intimate Partner Abuse.

Research investigating how cognition influences youth intimate partner abuse (IPA) remains limited. Understanding cognitive risk markers is theoretically important and can inform intervention to maximize the chance of behavior change. The current article investigated cognition regarding general antisociality, relationships, and gender-role attitudes on youth IPA perpetration among 275 (123 female) 14- to 18-year-olds. Theoretically derived relationships (based on social information processing theory and the General Aggression Model) were hypothesized, which furthered understanding of how cognition contributes to relationship aggression in adolescents, while controlling for common behavioral correlates. Results showed that, overall, other experiences of aggressive behavior more strongly related to youth IPA perpetration than cognitive correlates. Among boys, general antisocial cognition was more strongly associated with youth IPA perpetration than relationship-specific cognition, with the reverse being true for girls. These findings suggest there is value in exploring theoretically indicated cognitive risk markers for youth IPA in a gender-sensitive and dynamic manner. Findings also provide direction for future studies considering cognition and youth IPA in a more predictive manner and areas for consideration in intervention.

Patterns of Maltreatment Co-Occurrence in Incarcerated Youth in Australia.

Child maltreatment research is increasingly recognizing the need to capture patterns of co-occurrence between different types of abuse/neglect and to consider their associations with psychosocial functioning. Few studies have examined these issues in justice-involved youth despite the fact that rates of maltreatment and trauma-related psychopathology are disproportionately high among this population. This study examined profiles of self-reported child physical abuse, sexual abuse, emotional abuse, and neglect among incarcerated juveniles in Victoria, Australia, using latent class analysis. We also investigated associations between maltreatment profiles and mental health and behavioral problems. Data pertaining to juveniles' experiences of maltreatment and mental health and behavioral functioning were collected from interviews, questionnaires, files, and administrative datasets. A three-class solution provided the best fit for the data and was conceptually meaningful: a "low/rare maltreatment" class (41%); "high physical and emotional abuse" class (23%); and a "poly-victimization" class (36%). Youth in the "poly-victimization" class experienced especially serious mental health and behavioral disturbances, including higher rates of mental illness, greater severity of internalizing and externalizing symptoms, impulsivity, substance abuse, self-harm and suicidal behavior, irritability, and early-onset violence. Results suggest there may be benefit in considering screening and assessment procedures in youth justice settings to identify poly-victimized youth in need of more intensive monitoring and treatment to address their complex clinical and behavioral profiles.

Young People With Borderline Personality Disorder Have an Increased Lifetime Risk of Being the Victim of Interpersonal Violence.

This study aimed to examine the lifetime risk of being the victim of criminal or violent offenses among young people with borderline personality disorder (BPD) features (1-9 DSM-IV criteria). Demographic and diagnostic data from 492 outpatients who attended a specialist public mental health service for 15- to 25-year-olds between January 1998 and March 2008 were linked with offending data from a state-wide police database, collected between March 1993 and June 2017, in order to establish victimization history. This included information on criminal offenses perpetrated against these young people and intervention orders implemented to protect them from being victimized by another person's violent behavior. Logistic regression analyses, adjusted for sex and co-occurring mental state disorders, were conducted on n = 378 who had complete data (76.5% females). As hypothesized, BPD diagnosis and number of BPD criteria were both significantly associated with an increased risk of being the victim of a violent offense and the complainant of a family violence intervention order. Anger and impulsivity independently predicted a higher risk of being the victim of a violent offense, while unstable relationships, impulsivity, and affective instability independently predicted a higher risk of being the complainant of a family violence intervention order. No significant association was found between BPD and the risk of being the victim of a nonviolent offense. These findings indicate that young people with any BPD features (even below the DSM diagnostic threshold) are at increased risk for victimization by interpersonal violence. Moreover, this risk increases according to the number of BPD criteria. This issue needs to be addressed by prevention and early intervention programs (e.g., by working on self-assertion and interpersonal skills, taking into account the possible influence of previous traumatizing relationship experiences).

Borderline Personality Disorder Diagnosis and Symptoms in Outpatient Youth as Risk Factors for Criminal Offenses and Interpersonal Violence.

The aim of the current study was to examine the risk for offending among outpatient youth with borderline pathology. Demographic and diagnostic data from 492 outpatients who attended a public mental health service for 15-to 25-year-olds between January 1998 and March 2008 were linked with information regarding criminal offenses and intervention orders collected from a statewide police database between March 1993 and June 2017. BPD diagnosis and number of BPD criteria were both associated with an elevated risk for violent and nonviolent offenses and family violence intervention orders. Moderation analyses revealed that the number of BPD criteria might affect males and females differently in terms of offending. Both impulsivity and anger independently predicted the risk for violent and nonviolent offenses and family violence intervention orders. Early detection of increased risk of offending among youth with BPD features is essential to develop targeted treatments for criminal or violent behavior.

Testing the Factor Structure of the Psychopathy Checklist: Screening Version (PCL:SV) in an Australian Violent Offender Population.

Although psychopathy is a correlate of recidivism, including violent offending, the inclusion of antisocial behavior items in the Psychopathy Checklist (PCL) assessment instruments has been debated. Further, the latent factor structure underpinning the PCL measures has not been comprehensively validated in Australia. This study examined the construct validity of the PCL:SV in a sample of 192 Australian male violent offenders using structural equation modeling. The incremental validity of including the antisocial behavior items for predicting recidivism was also assessed. Approximately one-third of the sample had high scores on the PCL:SV. Construct analyses indicated strongest support for two distinct three-factor models of PCL psychopathy, with the established two- and four-factor models demonstrating poorer fit. The Antisocial factor improved predictive accuracy incrementally relative to the other three factors (Interpersonal, Affective, and Lifestyle). Area under the curve analyses revealed predictive accuracy for recidivism only for factors containing the antisocial behavior items. Findings contribute to the construct and predictive validity of the PCL measures and are discussed relative to contemporary forensic risk assessment practice.

Australian Adolescents' Experiences of Aggression and Abuse by Intimate Partners.

International research has shown that intimate partner abuse affects many young people throughout adolescence. Despite a recent focus on family and intimate partner violence in Australia, there is almost no Australian data on the frequency or nature of youth intimate partner abuse (YIPA). The current study sought to better understand the frequency and nature of YIPA in Australian adolescents. To this end, 423 participants aged between 14 and 18 from Victorian (Australian) high schools completed an anonymous questionnaire regarding experiences of perpetration and victimization in their most difficult intimate relationship. Results showed high rates of both YIPA victimization and perpetration among boys and girls who had been in intimate relationships. As was expected, verbally and psychologically aggressive behaviors were reported more frequently than physically or sexually aggressive actions. Mutual YIPA was detected more frequently than unidirectional YIPA, and most commonly involved high severity reciprocal aggression. The current study further confirmed that YIPA is a complex and heterogeneous issue, involving a range of behaviors, patterns of use, and severities. A gender-sensitive approach to the current study allowed for consideration of the similarities and differences between male and female experiences of YIPA. The current study provides a novel method of ascertaining both the frequency and severity of YIPA experiences in a sample of young people, expands on both Australian and international literature, and identifies important gender considerations for future research.

Long-term healthcare utilisation following child sex abuse: A follow-up study utilising five years of medical data.

BACKGROUND: Limited attention has been paid to the long-term physical health consequences experienced by CSA survivors. Research has found that CSA is often associated with increased health burden in adulthood. However, research in this area is plagued by a range of methodological difficulties, rendering it difficult to draw conclusions regarding the health status of CSA survivors. OBJECTIVE: This research sought to investigate associations between child sexual abuse (CSA) victimisation and rates of subsequent healthcare utilisation. METHOD: The forensic medical records of 2759 cases of CSA between 1964 and 1995 were linked to commonwealth Australian medical data recorded between 2010 and 2015. Differences in rates of health service utilisation during this five-year period were compared between CSA victims and a age and gender matched comparison cohort without known abuse history. FINDINGS: CSA was associated with increased levels of attendance at health professionals (OR = 1.51, p < .001) for medical care and for consultations related to dental (OR = 1.28, p < .001) and chronic disease (OR = 1.23, p <.001). CSA was associated with lower mean rates of attendance at gynaecologists. Gender and age at abuse significantly influenced the relationship between CSA and frequency of health service utilisation. CONCLUSIONS: Experiencing CSA was associated with increases in rates of contact with health professionals. Abused females and victims abused after 12 years of age demonstrated the greatest elevations in rates of service utilisation. These findings have significance for both researchers in this field, and medical practitioners providing primary care.

A follow-up study of mental health service utilisation in a cohort of 2433 sexually abused Australian children utilising five years of medical data.

BACKGROUND AND OBJECTIVES: There are well established links between child sex abuse (CSA) and a range of mental health adversities in the literature. However, there has been very limited examination of mental health care needs of CSA survivors, indicated by contacts with mental health professionals. Similarly, no existing research has examined rates of prescription of psychopharmacology to CSA survivors. Service utilisation is a vital component of the health landscape, and a clear understanding of the mental health care needs of CSA survivors is central to policy formation regarding mental health funding. Therefore, this study aimed to assess differences in rates of mental health care utilisation and rates of prescription of psychopharmacology during adulthood between individuals with a history of CSA and a comparison sample from the general population without a known abuse history. PARTICIPANTS, SETTING, AND METHOD: The forensic medical records of 2433 CSA victims identified between 1964 and 1995 were linked to Australian medical and medication-use data accessed between 2010 and 2015, when victims were, on average, aged between 28.78 and 33.78 years. CSA cases were compared to a matched comparison cohort on rates of contact with mental health professionals and prescriptions for mood stabilisers, anxiolytics, antipsychotics, stimulants, analgesics and addiction treatment medication. RESULTS: CSA was associated with increased levels of attendance at psychiatrists (OR = 1.29, p < .001), psychologists and clinical social workers (OR = 6.68, p < .001) and general practitioners (OR = 1.76, p < .001) for mental health care. CSA was also associated with increased frequency of prescription of all categories of psychopharmacology (ORs ranging from 1.40 to 6.18). Outcomes differed by victim gender and age at abuse. Abused females demonstrated greater overall service and medication utilisation than abused males. Females abused after puberty (age 12 years) had more frequent contacts with general practitioners for mental health care and greater frequency of prescription of psychopharmacology than females abused under age 12 years, including elevated frequency of analgesic and mood stabiliser use. Males abused after puberty also demonstrated higher frequency of service utilisation, including inflated rates of antipsychotic and anxiolytic prescriptions and visits to psychiatrists. CONCLUSIONS: Experiencing CSA was associated with increased use of psychopharmacology and contact with health professionals for mental health care. Abused females and participants abused after age 12 demonstrated most inflated use of services. These findings have important implications for policy decisions regarding the provision of mental health care to CSA survivors deemed to be at risk of developing mental health difficulties.

Violent offending in schizophrenia spectrum disorders preceding and following diagnosis.

OBJECTIVE: People affected by schizophrenia spectrum disorders are at a higher risk of offending violently. This study aims to investigate risk factors in relation to the peri-diagnostic period and possible predictors of post-diagnostic violence of people diagnosed for the first time in the public mental health system. METHODS: The study compared various risk factors for post-diagnostic violence in patients ( n = 1453) diagnosed with a schizophrenia spectrum disorder. Patients were grouped according to the occurrence of peri-diagnostic violence. Of the 246 violent offenders, 164 committed their first offence pre-diagnosis. Mental health and criminological variables were evaluated across the lifespan (median age at end of follow-up = 34.22 years, range = 17.02-55.80 years). RESULTS: Gender, employment, non-violent offending, family incidents, violent and non-violent victimisation, substance use, personality disorder, number of in-patient admissions and history of non-compliance differed significantly across violent and non-violent subgroups (all p ⩽ 0.01 and at least small effect size). More frequent and longer inpatient admissions were found in the violent subgroups (all p ⩽ 0.01). For the whole sample, sex, number of violent offences, non-violent offences, violent victimisation, substance use and number of inpatient admissions predicted post-diagnostic violence (χ2 (6) = 188.13, p < 0.001). Among patients with a history of pre-diagnostic violence, a history of non-violent offending in the 18-month period pre-diagnosis was the strongest predictor of future violence (odds ratio = 3.08, 95% confidence interval [1.32, 7.21]). CONCLUSION: At triage, violence risk assessment should consider the presence of antisocial behaviour and violent victimisation, substance use, male gender and frequency of inpatient admissions. Common treatment targets for the prevention of post-diagnostic violence include criminality and victimisation. Treatment of positive symptoms should be of greater emphasis for individuals without a history of pre-diagnostic violence.

Further victimization of child sexual abuse victims: A latent class typology of re-victimization trajectories.

The association between child sexual abuse (CSA) and risk for re-victimization is well-documented; however, less is known about the temporal progression of re-victimization experiences over the early life-course among CSA survivors, and whether this differs from that of those without known sexual abuse histories. This study investigated whether there are distinct temporal pathways of interpersonal re-victimization between the ages of 10-25 years among medically confirmed CSA cases, and considered whether abuse variables, re-victimization variables, and the presence of other adverse outcomes, were associated with heterogeneity in re-victimization pathways. The data were collected as part of a large-scale data-linkage study in which the medical records of 2759 cases of contact-CSA between 1964 and 1995 were linked, between 13 and 44 years following abuse, to police and public psychiatric databases; cases were compared to a matched community sample (n=2677). Using a subsample of 510 (401 victims; 109 comparisons) individuals with an interpersonal (re)victimization history, we examined the aggregate 'age-(re)victimization' curves for CSA victims and comparisons, respectively. Further, we applied longitudinal latent class analysis to explore heterogeneity in re-victimization trajectories among abuse survivors across their early life-course. Four latent pathways were identified, labeled: Normative; Childhood-Limited; Emerging-Adulthood; and Chronic re-victimization trajectories. Older age at abuse, a criminal history, and mental health problems were uniquely predictive of membership to the more problematic and persistent re-victimization trajectories. Findings indicate that individuals exposed to CSA during adolescence may be particularly vulnerable to poorer re-victimization trajectories, characterized by multiple risk indices, and thus may warrant increased service provision.

Exploring the longitudinal offending pathways of child sexual abuse victims: A preliminary analysis using latent variable modeling.

Very little research has been conducted to show the way in which criminal behavior unfolds over the life-course in children who have been sexually abused, and whether it differs from the 'age-crime' patterns consistently documented in the criminology literature. This study investigated the temporal pathways of criminal offending between the ages of 10-25 years among medically confirmed cases of child sexual abuse (CSA), and considered whether abuse variables, offense variables, and the presence of other adverse outcomes, were associated with heterogeneity in offending pathways among CSA survivors. This study utilized data gathered as part of a large-scale study involving the linkage of forensic examinations on 2759 cases of medically ascertained CSA between 1964 and 1995, to criminal justice and public psychiatric databases 13-44 years following abuse, together with a matched comparison sample of 2677 individuals. We used the subsample of 283 offending individuals (191 victims; 92 comparisons) for whom complete offending data were available. We compared the aggregate age-crime curves for CSA victims and comparisons, and applied longitudinal latent class analysis to identify distinct subgroups of offending pathways between ages 10-25 years within the abuse sample. Four latent pathways emerged among sexually abused offenders, labeled: Early-Onset/High-Risk/Adolescence-Limited; Intermediate-Onset/Low-Risk/Adolescence-Limited; Late-Onset/Low-Risk/Slow-Declining; and Early-Onset/High-Risk/Persistent offenders. Age at abuse, the nature and frequency of offending, and mental health problems, were associated with the offending pathway followed by CSA victims. Consistent with criminological literature, findings indicate considerable heterogeneity in the longitudinal offending patterns of offenders exposed to CSA. Implications for clinical practice and directions for research are highlighted.

The long-term co-occurrence of psychiatric illness and behavioral problems following child sexual abuse.

OBJECTIVES: There is a growing body of research investigating the relationship between child sexual abuse and a range of adverse outcomes. However, very little is known about the long-term co-occurrence of psychiatric disorders and behavioral problems among this vulnerable population, or the interaction between characteristics of the abuse, such as the nature and timing of the child sexual abuse, and the extent of subsequent adversities. This study aimed to determine the rate and co-occurrence of mental health morbidity, criminal justice system contact, and fatal self-harm among medically confirmed victims of child sexual abuse, and to identify abuse variables associated with a greater likelihood of cumulative adverse experiences. METHODS: The forensic medical records of 2759 cases of child sexual abuse assessed between 1964 and 1995 were linked with public psychiatric, criminal justice and coronial administrative databases between 13 and 44 years following abuse. Cases were compared to 2677 matched comparisons from the general population. RESULTS: Abuse victims were more likely (odds ratio = 7.2, 95% confidence interval = [4.9, 10.4], p < 0.001) to experience cumulative adverse psychiatric and behavioral problems relative to comparisons. Almost half (47.6%) of victims who died of suicide or drug overdose had a history of offending, further victimization and mental illness. Relative to comparisons, female victims demonstrated the largest increase in odds for cumulative outcomes (odds ratio = 9.8, 95% confidence interval = [5.8, 16.8], p < 0.001), whereas in absolute terms, male victims were at an elevated risk for all types and combinations of adverse outcomes, except fatal self-harm. Boys who were older at abuse, had multiple abuse episodes or who were abused by an extra-familial perpetrator were most likely to experience poorer clinical trajectories. Only being older at abuse was associated with cumulative adverse experiences for females. CONCLUSIONS: Sexual abuse, particularly during adolescence (ages 12-16 years), appears to be a risk factor for co-occurring adverse experiences. This study identifies particular groups of child sexual abuse victims as at-risk and requiring targeted intervention.

A case-linkage study of crime victimisation in schizophrenia-spectrum disorders over a period of deinstitutionalisation.

BACKGROUND: Despite high rates of self-reported crime victimisation, no study to date has compared official victimisation records of people with severe mental illness with a random community sample. Accordingly, this study sought to determine whether persons with schizophrenia-spectrum disorders have higher rates of recorded victimisation than the general population, and to explore whether there have been changes in rates of recorded victimisation over a period of deinstitutionalisation. METHODS: The schizophrenia-spectrum cases were drawn from a state-wide public mental health register, comprising all persons first diagnosed with a schizophrenic illness in five year cohorts between 1975 - 2005. The criminal histories of 4,168 persons diagnosed with schizophrenic-spectrum disorders were compared to those of a randomly selected community sample of 4,641 individuals. RESULTS: Compared to community controls, patients with schizophrenia-spectrum disorders were significantly more likely to have a record of violent (10.1% vs. 6.6%, odds ratio 1.4) and sexually violent victimisation (1.7% vs. 0.3%, odds ratio 2.77), but less likely to have an official record of victimisation overall (28.7% vs. 39.1%, odds ratio 0.5). Over the approximate period of deinstitutionalisation, the rate of recorded victimisation has more than doubled in schizophrenia-spectrum patients, but stayed relatively constant in the general community. CONCLUSIONS: People with schizophrenic-spectrum disorders are particularly vulnerable to violent crime victimisation; although co-morbid substance misuse and criminality both heighten the chances of victimisation, they cannot fully account for the increased rates. Deinstitutionalisation may have, in part, contributed to an unintended consequence of increasing rates of victimisation amongst the seriously mentally ill.

Validity of assessing people experiencing mental illness who have offended using the Camberwell Assessment of Need-Forensic and Health of the Nation Outcome Scales-Secure.

Evidence-based practices for forensic mental health services have been slow to develop, and there is a lack of measures that assess the mental health and criminogenic needs of people experiencing mental illness who have offended. The present study aimed to investigate the interrelationship between a clinician-rated forensic mental health needs assessment (Health of the Nation Outcomes Scales-Secure (HoNOS-S)), a forensic mental health needs assessment that considers both clinician and patient perspectives (Camberwell Assessment of Need-Forensic (CANFOR)), and measures of general and violent recidivism (Level Service-Case Management Inventory (LS-CMI) and HCR-20 Violence Risk Assessment Scheme (HCR-20)). Needs were assessed for 72 forensic patients aged between 20 and 62 years of age, located in a secure forensic mental health facility. The findings revealed significant positive correlations between the HoNOS-S, CANFOR, and HCR-20. Only the CANFOR was positively correlated with the LS-CMI, and uniquely contributed variance to the HCR-20. Patients and nurses differed in the total number of needs and met needs they identified as present. The findings suggest that the collaborative approach of the CANFOR might be more appropriate for measuring outcomes in the treatment of individuals experiencing mental illness who have offended.

Utilization of public mental health services in a random community sample.

OBJECTIVE: The aim of this study was to examine patterns of service utilization in the public mental health service in the Australian state of Victoria. Lifetime contact with the public mental health system will be used to approximate lifetime prevalence for schizophrenia in the community. METHOD: A case-linkage design joined a statewide psychiatric register with a random sample of community members drawn from a statewide electoral roll (n = 4830). In cases where individuals had been in contact with public mental health services, their full contact history was extracted. RESULTS: Members of the community come into contact with public mental health services for a variety of reasons, including those beyond the scope of psychiatric diagnosis and treatment, with 23% of those who made contact not receiving a psychiatric diagnosis and/or ongoing treatment. Although only 0.7% of the sample had a lifetime diagnosis of schizophrenia, these persons accounted for a significant proportion of public mental health service use. Schizophrenia-spectrum disorders were particularly prevalent among psychiatric crisis and extended care and supervision services. CONCLUSIONS: The Australian public mental health system has undergone significant reform in recent years. As a result, there has been a shift towards community-based care and a marked reduction in inpatient facilities. The public mental health system is a service that primarily serves those with a psychotic illness, thereby dictating that persons with so-called high-prevalence disorders, including affective and/or substance use disorders, seek psychiatric treatment elsewhere.