Exploring the victim offender overlap among people with an intellectual disability.

BACKGROUND: While there is growing international evidence pointing to the increased risks of crime perpetration and victimisation for some people with an intellectual disability, the overlap between offending and victimisation (the victim-offender overlap) remains unclear. METHOD: This study utilised a data linkage methodology of 2600 people with an intellectual disability, exploring their contacts with public mental health services and the police in Victoria, Australia. RESULTS: Victim-offenders accounted for a small proportion of the sample (n = 148, 5.7%). The victim-offender overlap was evident for both violent and nonviolent nonsexual crimes, particularly for theft, burglary, and threat-related crimes. Key differences were also noted between males and females. CONCLUSIONS: People with an intellectual disability who are both victim and offenders comprise a small but particularly complex justice-involved population. Future research should explore the victim offender overlap for males and females separately, as well as any additional risks and vulnerabilities associated with specific mental health diagnoses.

A critical review of research into mental health consumers' perspectives on their physical health: Is there an absence of consumers in the design, conduct, analysis and reporting of this research?

We conducted a critical review, using systematic methods, of the literature examining mental health consumer perspectives on their physical and mental health in academic research published between 2005 and 2021. This review examined the inclusion, extent, type and centrality of consumer perspectives regarding their mental and physical health. The search produced 1,865 papers from which 116 met the inclusion criteria. Studies predominantly focused on consumers' individual experiences of their physical and mental health, including but not limited to their understandings and experiences of medication and associated risk factors. They also captured some social aspects of mental health consumers' physical health, including factors that impacted individual agency, stigma, and social and interpersonal factors. Structural factors affecting physical and mental health, such as accessibility of services and financial constraints, were also identified. The review revealed that in comparison to clinician perspectives, the direct representation of consumer perspectives was lacking. Similarly, while clinician and carer perspectives on structural factors were investigated, the consumer perspective in this area was missing. The review also found few genuine codesigned or coproduced research studies. To better identify and respond to the health needs as prioritized by consumers, this paper argues it is imperative that future studies prioritize codesigned and coproduced research. It is argued that a focus on "services as provided" rather than "services as received" has contributed to a lack of progress in addressing the life expectancy gap for consumers. It is recommended that journals, ethics committees and research policy organizations develop guidelines and standards to inform best practice in research on consumer perspectives and experience and to support the implementation of codesigned and/or coproduced approaches in future research. Respecting and including consumers as equal partners in the research process will lead to more meaningful insights to inform policy and practice and reduce the life expectancy gap for people living with mental health concerns.

Perspectives on person-centred care for borderline personality disorder: a critical research agenda.

Borderline Personality Disorder (BPD) is a highly contentious psychiatric diagnosis with ongoing tensions over nomenclature, aetiology and treatment recommendations. This article examines a number of these tensions and assesses how greater attention to the voices of people living with BPD may help inform the delivery of new modes of person-centred care. To this end, we present a critical social science research agenda for investigating the experiences, social contexts and support needs of people living with BPD. We canvass issues pertaining to the diagnosis of BPD (including its name), the strongly gendered dimensions of BPD, and the pressing need to improve support for people living with this condition. Throughout our analysis, we indicate how critical interdisciplinary inquiry may drive new responses to these challenges. Our analysis is illustrated with reference to experiences of BPD recounted in two Australia-wide surveys conducted in 2011 and 2017. We argue that greater progress towards person-centred care requires novel forms of evidence grounded in critical social inquiry into experiences of treatment and support among people living with BPD, and the varied social, cultural and political contexts underpinning these experiences.

Crime and victimization among people with intellectual disability with and without comorbid mental illness.

BACKGROUND: Accumulating evidence internationally points to an increased risk of crime perpetration and victimization among people with an intellectual disability (ID). This study aimed to examine the impact that comorbid mental illness had on the association between intellectual disability, crime perpetration and criminal victimization. METHOD: A case linkage methodology involving 2,220 individuals with an intellectual disability from an Australian State. RESULTS: One in four (27%) had contacts with public mental health services; 8.2% had a comorbid mental illness. This "dual disability" group was between 2.97 and 3.22 times more likely than those with intellectual disability alone to have a history of criminal charges, and between 2.76 and 2.97 times more likely to have been a victim of crime. CONCLUSIONS: The extent of criminality and victimization found among people with dual disability indicates a potentially multiply stigmatized group for whom the need for a coordinated cross-agency service response remains paramount.

A pilot study exploring mental health consumers' experiences with the police.

Police encounters with people experiencing mental illness are both common and problematic. While there is an international body of literature on police officers' perceptions of mental-health-related incidents, few studies have sought to understand these encounters from the perspectives of people experiencing mental illness. This pilot study recruited 26 people through a state-wide Consumer Advisory Group who completed an online survey regarding their encounters with police. Results indicated that when people perceived procedurally just treatment from police they were more likely to co-operate with them and to evaluate the encounter positively. The nature of police involvement and levels of internalised stigma moderated the association between perceived procedural justice and their evaluation. Prior contacts were also important in shaping participants' overall attitudes towards police. Findings highlight the importance of officers treating people experiencing mental illness fairly and respectfully to facilitate peaceful encounters and help foster more positive perceptions of the police.

The risks, needs and stages of recovery of a complete forensic patient cohort in an Australian state.

BACKGROUND: Routine outcome measures are increasingly being mandated across mental health services in Australia and overseas. This requirement includes forensic mental health services, but their utility in such specialist services and the inter-relationships between the measures remain unclear. This study sought to characterise the risks, needs and stages of recovery of an entire cohort of forensic patients in one jurisdiction in Australia. METHODS: Local expert groups, comprising of members of the forensic patient treating teams, were formed to gather information about the status and needs of all forensic patients in the State of New South Wales, Australia. The expert groups provided demographic information and completed three assessment tools concerning the risks, needs and stages of recovery of each forensic patient. RESULTS: The cohort of 327 forensic patients in NSW appears to be typical of forensic mental health service populations internationally when considering factors such as gender, diagnosis, and index offence. A number of important differences across the three structured tools for forensic patients in different levels of secure service provision are presented. The DUNDRUM Quartet demonstrated interesting findings, particularly in terms of the therapeutic security needs, the treatment completion, and the stages of recovery for the forensic patients in the community. The CANFOR highlighted the level of needs across the forensic patient population, whilst the HCR-20 data showed there was no significant difference in the mean clinical and risk management scores between male forensic patients across levels of security. CONCLUSIONS: To the authors' knowledge this is the first study of its kind in New South Wales, Australia. We have demonstrated the utility of using a suite of measures to evaluate the risks, needs, and stages of recovery for an entire cohort of forensic patients. The data set helps inform service planning and development, together with providing various avenues for future research.

Striking the Right Balance: Police Experience, Perceptions and Use of Independent Support Persons During Interviews Involving People with Intellectual Disability.

BACKGROUND: Several jurisdictions mandate the presence of an independent support person during police interviews with vulnerable people. The current study investigated police officers' experiences and perceptions of these volunteers during interviews with people with intellectual disability(ies) (ID). METHODS: The sample comprised 229 police officers who attended a mandatory firearms training course in Melbourne, Australia, in 2010. RESULTS: Participants commonly reported utilizing independent support persons and displayed a fair understanding of their role. Overall, volunteers were engaged more frequently than family/friends; police considered the volunteers to be more impartial during interviews, whereas family/friends provided a greater level of emotional support to interviewees. CONCLUSIONS: Independent support persons need to demonstrate two quite different types of support to people with intellectual disability(ies) during police interviews; these require quite different skill sets and suggest the need for more tailored training and support for these volunteers. Implications for future research and policy are discussed.

Estimating the risk of crime and victimisation in people with intellectual disability: a data-linkage study.

PURPOSE: People with intellectual disability (PWID) appear more likely to be victims and perpetrators of crime. However, extant evidence pertaining to these risks is limited by methodological weaknesses and the absence of consistent operational definitions. This research aimed to estimate the prevalence of criminal histories and victimisation using a large, well-defined sample of PWID. METHODS: A case-linkage study was conducted comprising 2220 PWID registered with disability services in Victoria, Australia, whose personal details were linked with a state-wide police database. Criminal charges and reports of victimisation were compared to a non-disabled community comparison sample (n = 2085). RESULTS: PWID were at increased risk of having a history of criminal charges, particularly for violent and sexual offences. Although the non-disabled comparison group had a greater risk of criminal victimisation overall, PWID had a greatly increased risk of sexual and violent crime victimisation. CONCLUSIONS: PWID are at increased risk of victimisation and perpetration of violent and sexual crimes. Risk of sex offending and victimisation is particularly elevated, and signalling the need for specialised interventions to prevent offending and to ensure victims is assisted with access to justice, support, and treatment.

Crime and victimisation in people with intellectual disability: a case linkage study.

BACKGROUND: Studies have suggested that people with intellectual disability are disproportionately involved in crime both as perpetrators and victims. METHOD: A case linkage design used three Australian contact-level databases, from disability services, public mental health services and police records. Rates of contact, and official records of victimisation and criminal charges were compared to those in a community sample without intellectual disability. RESULTS: Although people with intellectual disability were significantly less likely to have an official record of victimisation and offending overall, their rates of violent and sexual victimisation and offending were significantly higher. The presence of comorbid mental illness considerably increased the likelihood of victimisation and offending; several sex differences were also noted. CONCLUSIONS: People with intellectual disability are at increased risk for both violent and sexual victimisation and offending. The presence of comorbid mental illness aggravates the risk of offending and victimisation. Future research should focus on a more nuanced exploration of the risks associated with intellectual disability and specific mental disorders and related indices of complexity.

Children's implicit recall of junk food, alcohol and gambling sponsorship in Australian sport.

BACKGROUND: In Australia, sport is saturated by the promotion of junk food, alcohol and gambling products. This is particularly evident on player jerseys. The effect of this advertising on children, who are exposed to these messages while watching sport, has not been thoroughly investigated. The aim of this research study was to investigate: (1) the extent to which children implicitly recalled shirt sponsors with the correct sporting team; (2) whether children associated some types of sponsors with certain sporting codes more than others; and (3) whether age of the children influenced the correct recall of sponsoring brands and teams. METHOD: This experimental study conducted in New South Wales, Australia used projective techniques to measure the implicit recall of team sponsorship relationships of 85 children aged 5-12 years. Participants were asked to arrange two sets of magnets - one which contained sporting teams and one which contained brand logos - in the manner deemed most appropriate by them. Children were not given any prompts relating to sporting sponsorship relationships. RESULTS: Three quarters (77 %) of the children were able to identify at least one correct shirt sponsor. Children associated alcohol and gambling brands more highly with the more popular sporting code, the National Rugby League compared to the Australian Football League sporting code. Results showed that age had an effect on number of shirt sponsors correctly recalled with 9-12 year olds being significantly more likely than 5-8 year olds to correctly identify team sponsors. CONCLUSIONS: Given children's ability to implicitly recall shirt sponsors in a sporting context, Australian sporting codes should examine their current sponsorship relationships to reduce the number of unhealthy commodity shirt sponsors. While there is some regulation that protects children from the marketing of unhealthy commodity products, these findings suggest that children are still exposed to and recall these sponsorship relationships. Results suggest that the promotion of unhealthy commodity products during sporting matches is contributing to increased awareness amongst children of unhealthy commodity brands. Further investigation is required to examine the extent and impact of marketing initiatives during televised sporting matches on children.

Bipolar disorder and criminal offending: a data linkage study.

PURPOSE: The current study explored criminal offending among people diagnosed with bipolar disorder with and without comorbid substance use and compared this with a community sample with no history of bipolar disorder. METHODS: A case-linkage design was used to compare patterns of officially recorded criminal offending between 1,076 people with bipolar disorder drawn from a state-wide psychiatric case register with a community comparison group. RESULTS: Those with bipolar disorder were significantly more likely than community members to be charged with, convicted of, and be found guilty of, violent, non-violent and intermediate level criminal offences. Those with a comorbid substance use disorder were two times more likely than those without a substance use disorder to offend; both groups had a significantly higher chance of offending than the community sample. Females with bipolar disorder were significantly more likely to have been convicted of violent offences, irrespective of substance use. Significant interactions were found between bipolar disorder and substance use for males and females with respect to violent offending and for males with respect to non-violent offending. CONCLUSIONS: There is a statistically significant association between bipolar disorder and the likelihood of having a criminal history. Co-occurring substance use differentially impacts on the likelihood of criminal offending for males and females.

The frequency and nature of resolution of potential police provoked shooting encounters.

Helping people in acute psychiatric crisis has become an increasingly common part of modern community policing. In certain extreme cases, police may be faced with a suicidal individual who intends to intentionally provoke police to shoot them. While fatalities are fortunately rare, anecdotal reports from frontline police suggest that these kinds of encounters are occurring on a regular basis. This paper explores 2350 psychiatric crisis incidents over an eight-month period in Victoria, Australia, and assesses the frequency and nature of potential police-provoked shootings resolved through non-fatal means. Contextual factors relating to the person's behaviour and police responses, and the person's psychiatric and criminal histories were considered to elucidate characteristics common to these incidents. Results suggest that police are potentially encountering a person who is suicidal and trying to provoke police to shoot them more than twice a week. These individuals share a number of common characteristics with those who have been fatally shot in similar circumstances and are quite different from those who attempt self-inflicted suicide. Results are discussed in relation to the impact of previous criminal contact from both the suspect and police perspectives.

Do prior histories of violence and mental disorders impact on violent behaviour during encounters with police?

Despite sustained large-scale educational campaigns, public attitudes towards mental illness have remained persistently negative. Associated with this, recent research from Victoria, Australia, reported that police commonly associated violent behaviour with mental illness. The present study examined 4267 cases of police use of force and considered what differentiated and characterised violent from non-violent behaviours reported by police in the context of a use of force incident. The specific focus was to examine the effects that historical variables such as age, gender, prior violent offending and having a prior diagnosis of mental disorder, as well as incident specific factors such as exhibiting signs of mental disorder and substance intoxication have on violent behaviour during the use of force incident. The proximal factors of apparent mental disorder and alcohol intoxication were significantly associated with violent behaviour towards police, whilst having a history of prior violence and prior mental disorder diagnoses was not associated with violence. The results challenge traditional stereotyped views about the violence risk posed by people with prior contact with mental health services and those with prior violent offending histories. A service model that allows for psychiatric triage would be able to assist with streamlining police involvement and facilitating timely access to mental health services.

Police officers' views of absconding from mental health units in Victoria, Australia.

Patients regularly abscond from mental health units and at times the consequences for patients and for others can be serious. The police are involved with absconding events, but are rarely considered in the mental health literature. In most jurisdictions, the police can take missing person reports for involuntary patients whose whereabouts are unknown and there are genuine concerns for their safety or welfare. Those people remain active cases for the police until located. This paper presents extracts of 25 police officers' narratives from a qualitative research project. Officers viewed absconding as a regular event, and workload burden that was exacerbated when mental health staff rarely initiated any search for the absconded patient and abdicated responsibility too quickly to the police. The officers were concerned about communication with mental health services and reported that information about the absconded patient could be inadequate or not given to police, and police often were not informed when the patient was found or discharged. Improved liaison and cooperative working that promote effective communication could strengthen police and mental health nursing collaboration and ensure better outcomes for patients.

Estimated rates of mental disorders in, and situational characteristics of, incidents of nonfatal use of force by police.

PURPOSE: To examine the estimated rates of mental disorders and associated situational characteristics in people involved in nonfatal use of force incidents with police in VIC, Australia. METHODS: A random sample of 4,267 cases between 1995 and 2008 from a dedicated police Use of Force Register were linked with the state-wide public mental health database and a police contacts database. Rates of ICD 9 and ICD 10 mental disorders recorded on the public mental health database were examined, as well as rates of criminal offending and the characteristics of force used by both parties. RESULTS: More than a third of people on whom the police resorted to using force (n = 1,621, 38%) had a history of mental disorder. Significant overrepresentations of the estimated prevalence of psychosis [12.5%, OR = 9.03, 95% CI (7.41, 11.01), p < 0.001] and schizophrenia [9.1%, OR = 9.73, 95% CI (7.59, 12.47) p < 0.001] were found. Those diagnosed with mental disorders were 1.52 times more likely to use or threaten to use weapons on police, even after taking into account age, sex, substances intoxication and violent behaviour [95% CI (1.23, 1.91), p < 0.001]; however, they were no more likely to injure or be injured by police than those without a recorded history of mental disorder. There was a noted trend for police to use, or threaten to use, weapons on people with a history of psychosis (other than schizophrenia) [OR = 1.40, 95% CI (1.11, 1.78), p = 0.005]. CONCLUSIONS: Psychoses and schizophrenia are dramatically overrepresented in cases where police resort to using force. Situational characteristics evident in the encounters are suggestive of a sub-group of people with mental disorders presenting with aggressive and otherwise problematic behaviours coupled with histories of criminal offending; this presents significant ongoing challenges for the police.

Should clinicians use average or peak scores on a dynamic risk-assessment measure to most accurately predict inpatient aggression?

Recent advancements in risk assessment have led to the development of dynamic risk-assessment measures that are predictive of inpatient aggression in the short term. However, there are several areas within this field that warrant further empirical investigation, including whether the average, maximum, or most recent risk state assessment is the most valid for predicting subsequent aggression in the medium term. This prospective study compared the predictive validity of three indices (i.e. mean score, peak score, and most recent single time-point rating) of the Dynamic Appraisal of Situational Aggression (DASA) for inpatient aggression. Daily risk ratings were completed for 60 psychiatric inpatients (from the acute wards of a forensic psychiatric hospital) for up to 6 months; a total of 1054 DASA ratings were obtained. Results showed that mean and peak scores on the DASA were better predictors of interpersonal violence, verbal threat, and any inpatient aggression than the DASA single time-point most recent ratings. Overall, the results support the use of the prior week's mean and peak scores to aid the prediction of inpatient aggression within inpatient forensic psychiatric settings in the short to medium term. These results also have practical implications for clinicians considering risk-management strategies and the scoring of clinically-relevant items on risk-assessment measures.

The short- to medium-term predictive accuracy of static and dynamic risk assessment measures in a secure forensic hospital.

Although violence risk assessment knowledge and practice has advanced over the past few decades, it remains practically difficult to decide which measures clinicians should use to assess and make decisions about the violence potential of individuals on an ongoing basis, particularly in the short to medium term. Within this context, this study sought to compare the predictive accuracy of dynamic risk assessment measures for violence with static risk assessment measures over the short term (up to 1 month) and medium term (up to 6 months) in a forensic psychiatric inpatient setting. Results showed that dynamic measures were generally more accurate than static measures for short- to medium-term predictions of inpatient aggression. These findings highlight the necessity of using risk assessment measures that are sensitive to important clinical risk state variables to improve the short- to medium-term prediction of aggression within the forensic inpatient setting. Such knowledge can assist with the development of more accurate and efficient risk assessment procedures, including the selection of appropriate risk assessment instruments to manage and prevent the violence of offenders with mental illnesses during inpatient treatment.

Psychiatric disorders and unmet needs in Australian police cells.

OBJECTIVE: To determine the prevalence of current psychiatric disorders and unmet needs in a sample of police cell detainees in Victoria. METHOD: A cross-sectional descriptive study was conducted, including data linkage with the Victoria Police database and the Victorian Psychiatric Case Register. In Melbourne, Australia, 150 detainees were recruited from two busy metropolitan police stations. Outcome measures included estimated rates of psychiatric disorders, using the Structured Clinical Interview for DSM-IV-TR, and individual needs, using the Camberwell Assessment of Need - Forensic Version. RESULTS: One quarter (n = 32, 25.4%) of detainees had a prior admission to a psychiatric hospital, and three quarters met current criteria for a diagnosable mental disorder. The most common disorders were substance dependence (n = 81, 54%) and mood disorders (n = 60, 40%). A third met diagnostic criteria for both a mental illness and a substance use disorder. The odds of being classified with mood (OR = 10.1), anxiety (OR = 2.2), psychotic (OR = 15.4) and substance use disorders (OR = 26.3) were all significantly higher in the current sample as compared with the general population. Detainees with a mental illness identified significantly more needs and significantly more unmet needs (e.g. psychological distress) than those who did not rate as having a current mental illness. CONCLUSIONS: There remains a pressing need to evaluate standardized screening tools for mental illnesses in police cells to provide timely access to assessment and treatment services. The need for functional interagency collaborations are highlighted and discussed.

Schizophrenia and other psychotic disorders in a cohort of sexually abused children.

CONTEXT: The evidence for an association between child sexual abuse and subsequently developing psychotic disorders, including the schizophrenias, remains inconclusive. OBJECTIVE: To explore whether child sexual abuse is a risk factor for later psychotic disorders. DESIGN: Case-control study. SETTING: Sample drawn from all notified cases of child sexual abuse over a 30-year period in Victoria, Australia. PARTICIPANTS: A cohort of 2759 individuals ascertained as having been sexually abused when younger than 16 years had their subsequent contacts with mental health services established by data linkage. They were compared with a community-based control group matched on sex and age groupings whose rates of disorder were established using identical methods. MAIN OUTCOME MEASURES: Rates of psychotic and schizophrenic illnesses. RESULTS: Rates were significantly higher among child sexual abuse subjects compared with controls for psychosis in general (2.8% vs 1.4%; odds ratio, 2.1; 95% confidence interval, 1.4-3.1; P < .001) and schizophrenic disorders in particular (1.9% vs 0.7%; odds ratio, 2.6; 95% confidence interval, 1.6-4.4; P < .001). Those exposed to penetrative abuse had even higher rates of psychosis (3.4%) and schizophrenia (2.4%). Abuse without penetration was not associated with significant increases in psychosis or schizophrenia. The risks were highest for those whose abuse involved penetration, occurred after age 12 years, and involved more than 1 perpetrator, the combination producing rates of 8.6% for schizophrenia and 17.2% for psychosis. CONCLUSIONS: Child sexual abuse involving penetration is a risk factor for developing psychotic and schizophrenic syndromes. The risk is greater for adolescents subjected to penetration. Irrespective of whether this statistical association reflects any causal link, it does identify an at-risk population in need of ongoing support and treatment.

Psychopathology in a large cohort of sexually abused children followed up to 43 years.

OBJECTIVE: To determine the rate and risk of clinical and personality disorders diagnosed in childhood and adulthood in those known to have been sexually abused during childhood. METHODS: Forensic medical records of 2,759 sexually abused children assessed between 1964 and 1995 were linked with a public psychiatric database between 12 and 43 years later. Cases were compared to control subjects matched on gender and age groupings drawn from the general population through a random sample of the national electoral database. RESULTS: A lifetime record of contact with public mental health services was found in 23.3% of cases compared to 7.7% of controls. The rate of contact among child sexual abuse victims was 3.65 times higher (95% CI, 3.09-4.32, p<0.001). It was estimated that child sexual abuse accounted for approximately 7.83% of mental health contact. Exposure to sexual abuse increased risks for the majority of outcomes including psychosis, affective, anxiety, substance abuse, and personality disorders. Rates of clinical disorders diagnosed in adulthood and childhood remained significantly higher among child sexual abuse cases. Older age at sexual abuse and those exposed to severe abuse involving penetration or multiple offenders were associated with greater risk for psychopathology. CONCLUSIONS: This study confirms that child sexual abuse is a substantial risk factor for a range of mental disorders in both childhood and adulthood. PRACTICE IMPLICATIONS: Those treating victims of sexual abuse must assess not only disorders commonly associated with trauma, but also low prevalence disorders such as psychosis.