Characteristics associated with criminal responsibility assessment outcomes among women in Central Canada.

The number of women involved with forensic mental health systems internationally is rising, however, limited research has explored the characteristics of those assessed for criminal responsibility. We investigated the demographic, psychiatric, and criminological characteristics of women recommended as eligible or ineligible for the defence of Not Criminally Responsible (NCR) on account of mental disorder following a criminal responsibility assessment in Central Canada. Data were collected through retrospective chart reviews of court-ordered criminal responsibility assessments for 109 women referred for evaluations between 2003 and 2019. Accused were an average age of 34.55 years, predominately identified as Indigenous (37.7%) or Caucasian (20.8%), and had often been charged with assault (47.7%). Women identified in the reports as NCR-eligible were significantly more likely to be employed, experience delusions during the index offence, and have expert reports linking their mental health symptoms to NCR legal criteria. They were also significantly less likely to have a personality disorder, substance-related diagnosis, or have used substances during the index offence. Delusions during the index offence significantly predicted assessment recommendations when controlling for age at assessment order, current substance-related diagnosis, and whether the expert report linked mental health symptoms to NCR legal criteria. Findings indicate the key factors considered by forensic mental health professionals when conducting criminal responsibility assessments with women. Meaningful differences exist between women identified as NCR-eligible and ineligible, with findings illustrating who may be more likely to receive services within the Canadian forensic mental health system.

COVID-19 and indigenous youth wellbeing: A review.

Indigenous youth in Canada and the United States of America (USA) have been disproportionately affected by the COVID-19 pandemic due to the compounding of increased illness risk and legacies of colonization. This article reports the findings of a Cochrane rapid review of 23 studies that examined mental wellbeing outcomes for Indigenous youth from March 2020 to April 2023 in Canada and the USA. Reported pandemic-related mental wellbeing impacts included changes in alcohol and substance use, anxiety, depression, sleep, and suicidality. Protective factors emerged including cultural and community connection. Results suggest that mental wellbeing worsened for many Indigenous youth during COVID-19. Clinical implications are discussed alongside guidance for service provision improvements to support Indigenous youth wellbeing, from a lens of self-determination.

Comparing the Ability of MMPI-2 and MMPI-2-RF Validity Scales to Detect Feigning: A Meta-Analysis.

Several meta-analyses of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) have examined these instruments' ability to detect symptom exaggeration or feigning. However, limited research has directly compared whether the scales across these two instruments are equally effective. This study used a moderated meta-analysis to compare 109 MMPI-2 and 41 MMPI-2-RF feigning studies, 83 (56.46%) of which were not included in previous meta-analyses. Although there were differences between the two test versions, with most MMPI-2 validity scales generating larger effect sizes than the corresponding MMPI-2-RF scales, these differences were not significant after controlling for study design and type of symptoms being feigned. Additional analyses showed that the F and Fp-r scales generated the largest effect sizes in identifying feigned psychiatric symptoms, while the FBS and RBS were better at detecting exaggerated medical symptoms. The findings indicate that the MMPI-2 validity scales and their MMPI-2-RF counterparts were similarly effective in differentiating genuine responders from those exaggerating or feigning psychiatric and medical symptoms. These results provide reassurance for the use of both the MMPI-2 and MMPI-2-RF in settings where symptom exaggeration or feigning is likely. Findings are discussed in the context of the recently released MMPI-3.

Identifying positive impression management using the MMPI-2 and the MMPI-2-RF: A meta-analysis.

Objective:Individuals may be motivated to conceal or minimize psychological symptoms and engage in positive impression management (PIM) in order to achieve desired outcomes across high stakes contexts (e.g. fitness for duty evaluations, pre-sentencing assessments, medical procedure evaluations, civil commitment). Despite the importance of this topic, the most recent meta-analysis of the MMPI-2, a widely used instrument for detecting PIM, was conducted more than two decades ago. Method:Using a Robust Variance Estimation method, this meta-analysis synthesized the results of 27 studies that examined the MMPI-2 (k = 22) and MMPI-2-RF (k = 5) validity scales' ability to discriminate individuals who engage in PIM from genuine responders, with a particular focus on the L, K, and S scales. Results:The MMPI-2 L scale produced the largest effect size (g = 1.30), whereas the MMPI-2-RF L-r scale effect size was moderate (g = 1.16). Moderate effect sizes were also found for the K (g = 1.01) and K-r (g = 1.21) scales, and for the MMPI-2 S scale (g = 1.23). Conclusions: Effect sizes did not significantly vary between the two versions of the MMPI. Findings suggest that both versions of the MMPI have demonstrated utility in identifying PIM, but clinicians should interpret T scores conservatively to account for the modest elevations associated with defensiveness. Findings are discussed in the context of the recently released MMPI-3.

The impact of coaching on feigned psychiatric and medical symptoms: A meta-analysis using the MMPI-2.

Coaching individuals on test-taking strategies presents legal and ethical concerns and threatens the validity of psychological test score interpretations, which could lead to inaccuracies in clinical settings and injustices within the legal system. This meta-analysis examined the impact of coaching on the detection of symptom exaggeration or feigning on the MMPI-2. A total of 99 feigning studies (N = 19,536) comparing validity subscale scores between genuine and nongenuine (coached or non-coached) responders were analyzed. Potential moderating effects of control group, type of symptoms, publication status, financial incentive, and non-content validity screening were also examined regarding their impact on the effectiveness of coaching. Findings suggested that detection-based coaching (i.e., coaching regarding the presence of validity scales and detection avoidance strategies within the MMPI-2) improved individuals' ability to elude detection by the MMPI-2 validity scales. Nonetheless, the MMPI-2 validity scales still generated moderate to very large effect sizes in detecting symptom exaggeration or feigning even in the context of coaching (range g = .89 to 1.95). The findings provide reassurance for detection efforts, indicating that while the effectiveness of the MMPI-2 is somewhat diminished, it remains useful in detecting non-genuine responders even in the context of coaching. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Prospective study of mental health court and life satisfaction.

Many communities have created specialized mental health courts (MHCs) to reduce unnecessary criminal justice involvement of persons with mental disorders. Although MHCs have shown favorable public safety outcomes, such as reducing risk for criminal recidivism and violent behavior, there has been little study of issues important to consumers, such as life satisfaction. This study prospectively evaluated the association between MHC participation and life satisfaction using data from 140 participants in a quasi-experimental research project on the San Francisco MHC. A fixed-effects regression model was used to examine whether MHC involvement predicted life satisfaction at 6-month follow-up while controlling for baseline life satisfaction, age, gender, and schizophrenia diagnosis. MHC involvement, baseline life satisfaction, and schizophrenia diagnosis significantly predicted life satisfaction at 6-months. Although the public safety benefits of MHCs are important, the present study also shows the potential for MHC to enhance important outcomes such as life satisfaction.

Detection of feigned posttraumatic stress disorder: A meta-analysis of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2).

OBJECTIVE: This study synthesized the results of 22 studies (N = 3,912) of feigned posttraumatic stress disorder (PTSD) symptoms that used the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). METHOD: Robust variance estimation was used to analyze variables that affected the accuracy of scales used to detect feigned symptoms. RESULTS: The FB scale (g = 1.60), the Obvious-Subtle scale (g = 1.57), and the Gough Dissimulation Index (F-K; g = 1.56) produced very large effect sizes after controlling for study design. Large and significant effect sizes were also observed for the F scale (g = 1.46), the FP scale (g = 1.43), and the Ds scale (g = 1.39). CONCLUSIONS: The findings of this study suggest that the MMPI-2 validity scales are useful for identifying individuals who are exaggerating or fabricating psychological symptoms. However, there were differences across validity scales and study designs, with some scales demonstrating stronger performances than others. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The effect of literacy and culture on cognitive effort test performance: An examination of the Test of Memory Malingering in Colombia.

Introduction: Cognitive efforts tests, such as the Test of Memory Malingering (TOMM), are widely used internationally, yet emerging research suggests that performance on the TOMM can be affected by culture and education. This study examined the specificity of the TOMM and performance differences among Colombian adults, contrasting those with varying levels of literacy in order to evaluate the impact of these variables on error rates. It was hypothesized that literacy would be positively correlated with TOMM scores. Method: The sample consisted of 256 participants: the Absolute Illiterate participants had no formal education and no ability to read or write (n = 58), Functional Illiterate participants had no formal education and only basic reading and writing skills (n = 66), Literate participants had up to 12-years of education (n = 66), and Highly Literate participants had some post-secondary education (n = 66). Group differences for Trial 1 (T1) and Trial 2 (T2) were analyzed using ANOVAs and chi-square tests, along with post-hoc comparisons. Results: Mean T2 scores for the four groups were all above the suggested cutoff score of 45: the Highly Literate group had the highest mean score (49.3, range 41 to 50), and the Absolute Illiterate group had the lowest mean score (45.5, range 30 to 50). The Absolute and Functional Illiterate groups performed significantly worse on the TOMM trials than the literate participants. Cognitive performance as measured by indicators of verbal fluency and executive control significantly correlated with TOMM performance. However, when evaluated together in hierarchical logistic regressions, only age and literacy significantly predicted TOMM scores. Conclusions: Although the performance of Colombian adults suggests that the TOMM can be used cross-culturally with literate individuals, Colombian adults with poorer literacy skills performed significantly worse, raising concerns regarding the use of this measure with educationally-diverse samples. Research and clinical implications are discussed.

A cross-cultural analysis of the Test of Memory Malingering among Latin American Spanish-speaking adults.

Cognitive efforts tests, such as the Test of Memory Malingering (TOMM; Tombaugh, 1997), are widely used internationally, yet there is a dearth of research that has assessed the utility of these measures in different cultures, countries, and languages. This study evaluated the specificity of the TOMM Trial 2 among a sample of 3,590 Spanish-speaking adults residing in 8 Latin American countries (Argentina, Bolivia, Chile, Colombia, Mexico, Paraguay, Peru, and Puerto Rico). Trial 2 TOMM scores were negatively associated with participants' age and positively associated with level of education. Country development, as measured by the United Nations Human Development Index, was also positively associated with TOMM scores. With the widespread use of cognitive efforts tests, this study offers useful insights into the utility of the TOMM in the assessment of Spanish speakers and highlights potential cultural biases that may impact test performance. Furthermore, this study raises concerns about the cross-cultural applicability of the TOMM, particularly when using cut scores established and evaluated primarily on North American, English-speaking samples. Forensic psychologists should be cautious when interpreting TOMM performance with Spanish-speaking adults from Latin American countries because it appears that there are cross-cultural differences that influence test performance. (PsycINFO Database Record

Determining when to conduct a violence risk assessment: Development and initial validation of the Fordham Risk Screening Tool (FRST).

Techniques to assess violence risk are increasingly common, but no systematic approach exists to help clinicians decide which psychiatric patients are most in need of a violence risk assessment. The Fordham Risk Screening Tool (FRST) was designed to fill this void, providing a structured, systematic approach to screening psychiatric patients and determining the need for further, more thorough violence risk assessment. The FRST was administered to a sample of 210 consecutive admissions to the civil psychiatric units of an urban medical center, 159 of whom were subsequently evaluated using the Historical Clinical Risk Management-20, version 3, to determine violence risk. The FRST showed a high degree of sensitivity (93%) in identifying patients subsequently deemed to be at high risk for violence (based on the Case Prioritization risk rating). The FRST also identified all of the patients (100%) rated high in potential for severe violence (based on the Serious Physical Harm Historical Clinical Risk Management-20, version 3, summary risk rating). Sensitivity was more modest when individuals rated as moderate risk were included as the criterion (rather than only those identified as high risk). Specificity was also moderate, screening out approximately half of all participants as not needing further risk assessment. A systematic approach to risk screening is clearly needed to prioritize psychiatric admissions for thorough risk assessment, and the FRST appears to be a potentially valuable step in that process. (PsycINFO Database Record

Cross-cultural feigning assessment: A systematic review of feigning instruments used with linguistically, ethnically, and culturally diverse samples.

The cross-cultural validity of feigning instruments and cut-scores is a critical concern for forensic mental health clinicians. This systematic review evaluated feigning classification accuracy and effect sizes across instruments and languages by summarizing 45 published peer-reviewed articles and unpublished doctoral dissertations conducted in Europe, Asia, and North America using linguistically, ethnically, and culturally diverse samples. The most common psychiatric symptom measures used with linguistically, ethnically, and culturally diverse samples included the Structured Inventory of Malingered Symptomatology, the Miller Forensic Assessment of Symptoms Test, and the Minnesota Multiphasic Personality Inventory (MMPI). The most frequently studied cognitive effort measures included the Word Recognition Test, the Test of Memory Malingering, and the Rey 15-item Memory test. The classification accuracy of these measures is compared and the implications of this research literature are discussed. (PsycINFO Database Record

Using social bonding theory to examine 'recovery' in a forensic mental health hospital: A qualitative study.

BACKGROUND: For people living with mental illness, recovery involves learning to overcome and manage their symptoms and striving to live fulfilling lives. The literature on achieving recovery emphasises the importance of social connections and positive role models. Hirschi's social bonding theory posits that an individual's attachment to others, belief in social norms, and their commitment and involvement in conventional activities are the major contributors to normalising social behaviour. AIMS: The aim of this study is to understand the qualities of service identified by patients in a forensic hospital as being important and meaningful to recovery. METHODS: Semi-structured interviews with 30 inpatients in a forensic mental health hospital in British Columbia, Canada, were audio recorded, and the transcriptions were analysed using thematic analysis. RESULTS: Five themes emerged: involvement in programmes, belief in rules and social norms, attachment to supportive individuals, commitment to work-related activities and concern about indeterminacy of stay. CONCLUSIONS: The first four themes map closely onto Hirschi's criminologically derived social bonding theory; however, indeterminacy of stay also arose as a common theme. In addition, the theory was too simple in its separation of elements; our data suggested the complex integration of themes. Our findings may be useful for informing evaluation of forensic mental health services.

Supporting recovery by improving patient engagement in a forensic mental health hospital: results from a demonstration project.

BACKGROUND: Mental health services are shifting toward approaches that promote patients' choices and acknowledge the value of their lived experiences. OBJECTIVE: To support patients' recovery and improve their experiences of care in a Canadian forensic mental health hospital, an intervention was launched to increase patient engagement by establishing a peer support program, strengthening a patient advisory committee, and creating a patient-led research team. DESIGN: The effect of the intervention on patient- and system-level outcomes was studied using a naturalistic, prospective, longitudinal approach. Quantitative and qualitative data were gathered from inpatients and service providers twice during the 19-month intervention. RESULTS: Despite succeeding in supporting patients' participation, the intervention had minimal impacts on internalized stigma, personal recovery, personal empowerment, service engagement, therapeutic milieu, and the recovery orientation of services. Peer support demonstrated positive effects on internalized stigma and personal recovery. CONCLUSIONS: Strengthening patient engagement contributes toward improving experiences of care in a forensic hospital, but it may have limited effects on outcomes.

A tale of two cultures: examining patient-centered care in a forensic mental health hospital.

Several questions remain unanswered regarding the extent to which the principles and practices of patient-centered care are achievable in the context of a forensic mental health hospital. This study examined patient-centered care from the perspectives of patients and providers in a forensic mental health hospital. Patient-centered care was assessed using several measures of complementary constructs. Interviews were conducted with 30 patients and surveys were completed by 28 service providers in a forensic mental health hospital. Patients and providers shared similar views of the therapeutic milieu and recovery orientation of services; however, providers were more likely to perceive the hospital as being potentially unsafe. Overall, the findings indicated that characteristics of patient-centered care may be found within a forensic mental health hospital. The principles of patient-centered care can be integrated into service delivery in forensic mental health hospitals, though special attention to providers' perceptions of safety is needed.