Places in protecting housing per 100 000 inhabitants from 1990 to 2012, Western Europe

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How has the extent of institutional mental healthcare changed in Western Europe? Analysis of data since 1990.

Chow WS¹, Priebe S¹.

¹Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK.

BMJ Open. 2016 Apr 29;6(4):e010188. doi: 10.1136/bmjopen-2015-010188.

Forensic beds per 100 000 inhabitants from 1990 to 2012, Western Europe

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How has the extent of institutional mental healthcare changed in Western Europe? Analysis of data since 1990.

Chow WS¹, Priebe S¹.

¹Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK.

BMJ Open. 2016 Apr 29;6(4):e010188. doi: 10.1136/bmjopen-2015-010188.

Resilience & Professional Quality of Life in Staff Working with People with Intellectual Disabilities & Offending Behavior in Community Based and Institutional Settings

Staff in forensic services for people with intellectual disabilities (ID) are expected to deal with a wide range of emotional challenges when providing care. The potential impact of this demanding work has not been systematically explored previously. This article explores the professional quality of life (QoL) and the resilience (hardiness) of the staff in this setting. The Professional QoL questionnaire and the Disposional Resilience Scale were completed by staff (n=85, 80% response rate) in the Norwegian forensic service for ID offenders. Responses from staff working in institutional settings were compared to those from staff in local community services. Staff in the local community services had higher resilience scores compared to the staff in the institutional setting, (t=2.19; P<0.05). However in the other QoL and resilience domains there were no differences between the staff in the two settings. The greater sense of resilient control among community staff may be a function of both the number of service users they work with and the institutional demands they face. Even though these participants worked with relatively high risk clients, they did not report significantly impaired quality of life compared to other occupations.

...People with intellectual disabilities (ID) who are also offenders are some of the most difficult health service users to treat and historically they have also received little attention from researchers or the wider society.⁵The research that has been conducted has concentrated on offenders with mild ID within secure placements. Offenders with a moderate or more severe level of ID seldom enter the criminal justice system (CJS), as they are diverted into mental health services, ID services, or forensic mental health services. As a result, there is a dearth of studies exploring the needs and living conditions of offenders with moderate ID compared with offenders with mild ID.

Offenders with ID have many characteristics in common with offenders in the general population.^6,7 They tend to be young and male and have experienced social disadvantage, unstable environments, and financial instability.⁸ There is little research on how the characteristics of people with ID who are labeled offendersmay differ from those with ID who do not offend.⁹ Holland et al.⁷ proposed that two groups of offenders with ID can be distinguished according to whether they are known to the ID services. Amongst the smaller group who are known to services the term offence may often be confused with challenging behavior.¹⁰

The Norwegian system has quite restrictive policies regarding diversion of offenders with ID from the criminal justice system. There has been some focus on intellectual impairment among offenders,¹¹ but the government’s priorities are focused elsewhere on, for instance, building more prison accommodation, encouraging multidisciplinary cooperation in preventing recidivism, developing alternatives to imprisonment alongside better rehabilitation services and evidence-based research...¹²

Full article at:   http://goo.gl/EnYyTD

By:  Erik Søndenaa,1,2 Christian Lauvrud,1 Marita Sandvik,3 Kåre Nonstad,1 and Richard Whittington1,4

¹St. Olavs University Hospital, Forensic Department, Brøset, Trondheim, Norway, UK

²University College of Sør-Trøndelag, Department of Social Education, Trondheim, Norway, UK

³St. Olavs University Hospital, Forensic Unit for Offenders with Intellectual Disabilities, Brøset, Trondheim, Norway, UK

⁴University of Liverpool, Institute of Psychology, Health and Society, Health & Community Care Research Unit, Liverpool, UK

St. Olavs University Hospital, Forensic dep. Brøset, Postbox 1803, Lade, 7440 Trondheim, Norway. Phone: +47.992.44771.

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Boldness and Its Relation to Psychopathic Personality: Prototypicality Analyses among Forensic Mental Health, Criminal Justice, and Layperson Raters

Research on psychopathic personality has been dominated by a focus on criminality and social deviance, but some theoretical models argue that certain putatively adaptive features are important components of this construct. In 3 samples (forensic mental health practitioners, probation officers and a layperson community sample), we investigated adaptive traits as conceptualized in the Triarchic model of psychopathy (Patrick et al., 2009), specifically the relevance of boldness to construals of psychopathic personality. 

Participants completed prototypicality ratings of psychopathic traits, including 3 items created to tap components of boldness (Socially bold, Adventurous, Emotionally stable), and they also rated a series of attitudinal statements (e.g., perceived correlates of being psychopathic, moral judgments about psychopaths). 

The composite Boldness scale was rated as moderately to highly prototypical among forensic mental health practitioners and probation officers and positively associated with other theoretically relevant domains of psychopathy. Across samples, higher composite Boldness ratings predicted greater endorsement of adaptive traits (e.g., social skills) as characteristic of psychopathy. For the individual items, Socially bold was rated as highly prototypical and was associated with theoretically relevant correlates. Adventurous also was seen as prototypical, though to a lesser degree. Only forensic mental health practitioners endorsed Emotionally stable as characteristic of psychopathy. 

Our results provide partial support for the contention that the boldness concept is viewed as an important component of psychopathy, particularly among professionals who work directly with offender populations. 

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By:  Sörman K, Edens JF, Smith ST, Clark JW, Kristiansson M, Svensson O.

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Policies on Sexual Expression in Forensic Psychiatric Settings in Different European Countries

Background

Sexual expression by forensic psychiatric patients is poorly researched.

Methods

Forensic experts representing 14 European countries were interviewed to explore the diverse ways in which sexual expression within forensic settings is handled.

Results

No country had a national policy, although many had local policies or shared practices. Progressive approaches to patient sexuality were evident in nine of the countries sampled. The UK appeared the most prohibiting and excluding, its protocols apparently based on risk aversion and lack of emphasis or consideration of patients’ sexual needs.

Conclusions

Uniform national policy supporting patients’ sexual expression would provide significant improvements.

Summary of responses to online questionnaire

Country	Application of policy rules	Direction	Other forms of expression allowed	Patient/visitor interaction	Resources available to patients	Staff training	Patient awareness and involvement
Belgium	Hetero- & homosexual relationships treated the same Same policies regardless of case history	Sexual intercourse prohibited inside institution Romantic/non-sexual relationships between patients prohibited Patients can marry	Holding hands Access to sexually explicit DVDs, magazines & novels	Patients not allowed into each other’s bedrooms Visitors allowed unsupervised access to patients’ bedrooms ‘Blind eye’ turned to potential sexual activity with spouse No conjugal visiting suite	Sexual education Condoms/contraception	Provided	No written policy; patients informed verbally Patients have opportunity to complain about policy Patient perspective not considered
Denmark	Hetero- & homosexual relationships treated the same Decided on case-by-case basis	Sexual relationships with existing long-term partner permitteda Sexual and non-sexual relationships between patients prohibited Patients can marry	Access to sexually explicit DVDs, magazines & novels	Patients not allowed in each other’s bedrooms Visitors not allowed in patients’ bedrooms Conjugal visiting suite available	Condoms/contraception	No specific training	No written policy; patients informed verbally Patients have opportunity to complain about policy Patient perspective not considered
Finland	Hetero- & homosexual relationships treated the same Same policies regardless of case history	Sexual relationships permitteda between patients or between patient and outside partner, including prostitutes Non-sexual relationships supported and seen as positive and prosocial Patients can marry	Kissing Hugging Caressing Massage Holding hands Access to sexually explicit DVD’s, adult magazines, erotic novels & pornographic websites	Patients not allowed into each other’s bedrooms Visitors not allowed into patient bedrooms No conjugal suite Visits take place in visiting area and can be unsupervised	Relationship counselling Sexual education Condoms/contraception	No specific training	No written policy; patients informed verbally Patients have opportunity to complain about policy Patient perspective not considered
FYR Macedonia	Homosexual relationships not taken into consideration Decided on case-by-case basis	Sexual relationships permitteda between patient and existing long-term partner Sexual relationships between patients prohibited Non-sexual relationships allowed Patients cannot marry	Kissing Hugging Caressing Massage Holding hands Access to adult magazines	Patients allowed supervised access to each other’s bedrooms Visitors allowed unsupervised access to patient bedroomsa	Relationship counsellinga Condoms/contraception	No specific training	Not available for patients to see Patient perspective not considered
Germany	Hetero- & homosexual relationships treated the same Decided on case-by-case basis	Sexual relationships permitteda between patient and existing long-term partner, and new partner outside the institution, including prostitutes Sexual relationships between patients prohibited Non-sexual relationships alloweda Patients can marry	Kissing Hugging Caressing Massage Holding hands Access to adult magazines & erotic novels	Patients allowed unsupervised access to each other’s roomsa Visitors allowed unsupervised access to patient bedroomsa Conjugal visiting suite available	Relationship counselling Sexual education Condoms/contraception	Provided	Policy readily available for patients to see Patient perspective not considered
Latvia	Hetero- & homosexual relationships treated the same Same policies regardless of case history	Sexual intercourse prohibited within unit Sexual relationships permitted with partners from outside the institution Non-sexual relationships alloweda Patients can marry	No form of sexual expression allowed	Patients not allowed into each other’s bedrooms Visitors not allowed into patient bedrooms Conjugal visiting suite available in some facilities	None	Not known	Policy available for patients to see Patient perspective not considered
Netherlands	Hetero- & homosexual relationships treated the same Decided on case-by-case basis	Sexual relationships permitteda between patient and existing long-term partner, and new partner outside the institution, including prostitutes Non-sexual relationships alloweda Patients can marrya	Kissing Hugging Caressing Massage Holding hands Access to sexually explicit DVD’s, adult magazines, erotic novels alloweda	Patients allowed unsupervised access to each other’s bedrooms Visitors allowed unsupervised access to patient bedroomsa Conjugal visiting suite available	Relationship counselling Sexual education Condoms/contraception	General training provided	Policy available for patients to see Patient perspective not considered
Spain	Not known	Sexual relationships permitteda between patient and existing long-term partner Non-sexual relationships alloweda Patients can marry	Kissing Hugging Caressing Massage Holding hands Access to erotic novels	Patients not allowed into each other’s bedrooms Visitors not allowed into patient bedrooms Conjugal visiting suite available	Sexual education	No specific training	Not readily available for patients to see Patient perspective not considered
Switzerland	Hetero- & homosexual relationships treated the same Same policies regardless of case history	Sexual relationships discouraged amongst patients Sexual relationships permitted between patient and existing long-term partner, and new partner Non-sexual relationships alloweda Patients can marry	Kissing Hugging Caressing Massage Holding hands No access to sexually explicit DVD’s, adult magazines, erotic novels or pornographic websites	Patients not allowed into each other’s bedrooms Visitors not allowed into patient bedrooms Sexual activity with partners allowed when patient is on leave	Relationship counselling Sexual education Condoms/contraception	Provided	Not readily available for patients to see Patient perspective considered in drafting of shared practice
United Kingdom	Hetero- & homosexual relationships treated the same Officially, decided on case-by-case basis but in practice policy implemented uniformly	Sexual relationships between patients and between patient and partner outside the institution prohibited Patients can marry	Minor forms of physical contact but no intimate or extended contact Access to erotic novels alloweda	Patients not allowed into each other’s bedrooms Visitors not allowed into patient bedrooms Conjugal visiting suite not available	Relationship counselling Sexual educationa	No specific training	Abbreviated version available for patients to see Patient perspective not considered

adepending on circumstance

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By:  Rajveer Tiwana, Stephanie McDonald, and Birgit Völlm

School of Psychology, University of Nottingham, Nottingham, NG7 2RD UK

School of Psychology, University of Nottingham, Nottingham, NG9 2RD UK

Section Forensic Mental Health, Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Rd, Nottingham, NG7 2TU UK

Rajveer Tiwana, Email: ku.oc.oohay@anawit_reevjar.

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Neuropsychological Impairment and Its Association with Violence Risk in Japanese Forensic Psychiatric Patients

Background

In Japan, the legislation directing treatment of offenders with psychiatric disorders was enacted in 2005. Neuropsychological impairment is highly related to functional outcomes in patients with psychiatric disorders, and several studies have suggested an association between neuropsychological impairment and violent behaviors. However, there have been no studies of neuropsychological impairment in forensic patients covered by the Japanese legislation. This study is designed to examine the neuropsychological characteristics of forensic patients in comparison to healthy controls and to assess the relationship between neuropsychological impairment and violence risk.

Methods

Seventy-one forensic patients with psychiatric disorders and 54 healthy controls (matched by age, gender, and education) were enrolled. The CogState Battery (CSB) consisting of eight cognitive domains, the Iowa Gambling Task (IGT) to test emotion-based decision making, and psychological measures of violence risk including psychopathy were used.

Results

Forensic patients exhibited poorer performances on all CSB subtests and the IGT than controls. For each group, partial correlational analyses indicated that poor IGT performance was related to psychopathy, especially antisocial behavior. In forensic patients, the CSB composite score was associated with risk factors for future violent behavior, including stress and noncompliance with remediation attempts.

Conclusion

Forensic patients with psychiatric disorders exhibit a wide range of neuropsychological impairments, and these findings suggest that neuropsychological impairment may increase the risk of violent behavior. Therefore, the treatment of neuropsychological impairment in forensic patients with psychiatric disorders is necessary to improve functional outcomes as well as to prevent violence.

Below:  Magnitude of impairment in forensic patients relative to healthy controls on each CSB measure

Below:  The IGT net scores for the 5 blocks for forensic patients and healthy controls

Full article at:   http://goo.gl/TpZu9X

By:  

Hirofumi Nishinaka, Kenji Hashimoto

Division of Clinical Neuroscience, Center for Forensic Mental Health, Chiba University, Chiba, Japan

Jun Nakane

National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan

Takako Nagata, Mayu Omori, Naotsugu Hirabayashi

Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan

Atsushi Imai, Noriomi Kuroki, Noriko Sakikawa, Osamu Kuroda

Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan

Yoshito Igarashi

Division of Law and Psychiatry, Center for Forensic Mental Health, Chiba University, Chiba, Japan

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Maternal Filicide among Women Admitted to Forensic Psychiatric Institutions in Malaysia: Case Series

OBJECTIVES:

To examine the characteristics of maternal filicide and describe the adverse life events experienced by women who have committed filicide and been hospitalised in forensic psychiatric institutions in Malaysia.

METHODS:

Registration records from 2000 through 2012 of female patients from 2 main forensic psychiatric institutions in Malaysia were reviewed. The medical records of patients who had committed maternal filicide were selected and descriptively evaluated.

RESULTS:

A total of 18 cases of maternal filicide were identified. Family dysfunction that presented with marital discord, domestic violence, or husband with substance abuse was the main stress experienced by the women. Three social circumstances, including an adolescent who became a victim of date rape; immigrants who experienced sexual abuse; and filicide-suicide precipitated by financial difficulties were highlighted.

CONCLUSION:

Women who committed filicide had experienced various difficulties in their life. The presence of such life events might alert mental health professionals to investigate the possibility of filicide among their patients.

Via:  http://goo.gl/KGbPY5 

Full PDF article at:  http://goo.gl/0L9nCc

  

By:  Razali S1, Salleh RM2, Yahya B3, Ahmad SH1.

• 1Psychological and Behavioural Medicine Discipline, Faculty of Medicine, Universiti Teknologi MARA, Malaysia.
• 2Forensic Psychiatry Unit, Hospital Bahagia Ulu Kinta, Perak, Malaysia.
• 3Forensic Psychiatry Unit, Hospital Permai, Tampoi, Johore, Malaysia.

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Does the Organized Sexual Murderer Better Delay and Avoid Detection?

According to the organized-disorganized model, organized sexual murderers adopt specific behaviors during the commission of their crimes that contribute to avoiding police detection. 

The current study examines the effect of sexual murderers' organized behaviors on their ability to both delay and/or avoid police detection. Using a combination of negative binomial and logistic regression analyses on a sample of 350 sexual murder cases, findings showed that although both measures of delaying and avoiding detection are positively correlated, different behavioral patterns were observed. 

For instance, offenders who moved the victim's body were more likely to avoid detection but the victim's body was likely to be recovered faster. Moreover, victim characteristics have an impact on both measures; however, this effect disappears for the measure of delaying detection once the organized behaviors are introduced. Implications of the findings are discussed.

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By:  Beauregard E1, Martineau M2.

• 1Simon Fraser University, Burnaby, British Columbia, Canada ebeaureg@sfu.ca.
• 2Royal Canadian Mounted Police, Ottawa, Ontario, Canada.
• J Interpers Violence. 2016 Jan;31(1):4-25. doi: 10.1177/0886260514555129. Epub 2014 Oct 29. 

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The Role of Forensic Factors and Potential Harm to the Child in the Decision Not to Act among Men Sexually Attracted to Children

To date, sexual abuse prevention efforts have largely focused on tertiary prevention strategies designed to prevent recidivism among forensic samples of men with a history of sex offending behavior. 

The present study used mixed methodology to investigate the role of several forensic and related factors on the decision not to commit a sex offense among two groups of community men who self-reported a sexual attraction to children: those who reported a history of acting on their attractions (Acted, n = 29) and those who reported never acting on their attractions (Not Acted, n = 71). 

Participants from both groups described in their own words the factors that contributed to their decision not to act on their attractions. They also responded to quantitative and qualitative questions regarding the influence and role of the following factors on their decision not to act: 

1. the possibility of jail or punishment,
2. mental health treatment, and 
3. not wanting to hurt the child. 

Results were compared across groups, and across prompted and unprompted responses. Analyses highlighted harm to the child as a particularly salient factor in the decision not to act among men in the community at risk for sexually offending. 

The present study suggests that investigating potential protective factors may be an important direction for future research among samples of community men at risk for both first-time and repeat offenses against children.

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By:  Mitchell RC¹, Galupo MP².

¹Towson University (http://www.towson.edu/), MD, USA.

²Towson University, MD, USA pgalupo@towson.edu.

J Interpers Violence. 2016 Jan 12. pii: 0886260515624211.

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Research Priorities in Mental Health, Justice, and Safety: A Multidisciplinary Stakeholder Report

This paper is based on the report following the National Research Agenda Meeting on Mental Health, Justice, and Safety held in Montreal on November 19, 2014, which convened academics; health, social, and legal professionals; and people with lived experience of mental illness from across Canada. The goal was to identify research priorities addressing relevant knowledge gaps and research strategies that can translate into public policy action and improvements in evidence-based services.

Participants identified key challenges: (1) inadequate identification and response to needs by civil mental health services and frontline law enforcement, (2) limited specialized resources in forensic and correctional settings, (3) fragmented care and gaps between systems, (4) limited resources for adequate community reintegration, and (5) poor knowledge transfer strategies as obstacles to evidence-based policies. Knowledge gaps were identified in epidemiology and risk reduction, frontline training and programs, forensic and correctional practices, organizations and institutions, knowledge transfer, and rehabilitation. Finally, participants identified potential sources of support to conduct real time research with regard to data collection and sharing. The findings represent a roadmap for how forensic mental health systems can best proceed to address current challenges through research and practice initiatives, drawing from lived, clinical and research experiences of a multidisciplinary group of experts.

Key Principles

There was a general consensus among participants that the following key principles guided the discussion regarding key knowledge gaps, research priorities, and opportunities.

1. Prevention: Taking forensic experience upstream (e.g., bring knowledge of assessment and management of risk into civil psychiatric and community mental health organizations and services; target risk factors for early intervention efforts).
2. Recovery Orientation: Incorporating recovery orientation at all levels of clinical care, research, police, and knowledge transfer and exchange.
3. Public Safety: Emphasizing the potentially positive relationship between recovery/rehabilitation and public safety.
   • Break the dualism opposing rehabilitation and “tough on crime”, or rehabilitation and public safety, or victim and perpetrator;
   • Seek societally optimal policy;
   • Change the conversation/language around severe mental illness and crime.
4. Holistic Individualized Approach: Following the person across systems (i.e., sharing information between civil psychiatry, forensic psychiatry, and correctional and social services agencies); seeking to fill the gaps when patients/clients are transitioning between systems of care / moving through an individual agency's continuum of care (e.g., it is often when persons are discharged from institutional settings that there is insufficient planning and resources in place to ensure that transportation, medication, housing, etc. are in place to facilitate community integration).
5. Intersectoral Collaborations: Creating more opportunities for cross-ministerial panels in order to promote data consistency, information sharing, transparency, and communication.
6. Inclusion of People with Lived Experience:
   • Including persons with lived experience of homelessness, criminal justice involvement, and/or mental illness as partners in research from inception to dissemination and as collaborators in KTE efforts;
   • Involving families and victims in the production, exchange and translation of knowledge.

Information Sharing and Data Consistency (e.g., through research-friendly administrations).
Knowledge Transfer and Exchange Agenda

A common theme across the discussions was the importance of knowledge transfer and exchange between researchers and practitioners, across sectors, etc. The following principles and considerations were identified.

What?

1. Evidence-based policy making
2. Paradigm of risk reduction, rehabilitation services, and recovery orientation
3. Holistic perspective that includes social determinants of health
4. Thread of recovery message
5. Cost-effectiveness
6. Data access

How?

1. Promote tailored, confident, concise and consistent communication to the public
2. Make use of personal stories, success stories; become positive and proactive rather than reactive and defensive
3. Target media, swing voters, and political leaders to position optimal policy solutions

Top Research Priorities

Following the presentations from the small groups formed for Part Two of the one-day agenda meeting, all participants discussed research priorities in Part Three and agreed that the following were key priorities for an agenda on mental health, criminal justice, and public safety research.

First Contact

1. Evaluation of diversion programs and community supports (e.g., Mental Health Courts in Canada)
2. Examination of contexts and factors related to police-driven fatalities of people living with mental illness
3. Initiation of multi-site cohort studies of early interactions with criminal justice personnel
4. Evaluation of training for frontline service providers on criminal justice, and recovery outcomes
5. Evaluation of longitudinal impacts of legislation or policy change, including on families and suicide rates

Assessment

1. Examination of factors associated with crime and recidivism among people living with mental illness
2. Risk assessment and communication, including shared risk understanding between service user and provider
3. Risk assessment and management: Research on closing the gap between research and practice
   1. Improving the relevance of research and knowledge transfer strategies on risk management and assessment beyond psychometric properties of tools
   2. The role of management and treatment efforts in the moderation of the relationship between risk factors and adverse outcomes

Treatment and Rehabilitation

1. The 3 Rs (Recovery, Recidivism, Research): Evaluation of recovery approaches and recovery-oriented care on recidivism and other outcomes, including future mental health service use, housing, employment, and quality of life
2. Cost-benefit analysis of forensic interventions and legislative practices from a health economics perspective
3. Research transitions and success/failure outcomes to develop best practices
4. Exploratory and pilot research on alternatives to segregation in correctional settings
5. Studies that deconstruct and identify active ingredients of successful programs in terms of lower recidivism

Systems

1. Creation of a national data sharing coalition among researchers in the field
2. Creation of a national database with common indicators (e.g., national scorecard)
3. Edition of a scoping review on international legislation and approaches at the intersection of mental health, justice, and safety
4. Evaluation of best knowledge transfer and exchange strategies to support evidence-based practices and practice-based evidence. Answering the questions and addressing the problems of direct care providers and of those with lived experience
5. Creation of a national research network on mental health, justice, and safety with a strong focus on knowledge transfer and public communication.

Full article at:   http://goo.gl/j6zUk0

By:   Anne G. Crocker, a , * Tonia L. Nicholls, b Michael C. Seto, c Laurence Roy, d Marichelle C. Leclair, e Johann Brink, gAlexander I. F. Simpson, f and Gilles Côté h

^aDepartment of Psychiatry, McGill University and Douglas Mental Health University Institute Research Center, Montreal, Quebec, Canada

^bDepartment of Psychiatry, University of British Columbia and BC Mental Health and Substance Use Services, Coquitlam, British Columbia, Canada

^cRoyal Ottawa Health Care Group, Brockville, Ontario, Canada

^dSchool of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute Research Center, Montreal, Quebec, Canada

^eDouglas Mental Health University Institute Research Center, Montreal, Quebec, Canada

^fCentre for Addiction and Mental Health, Complex Mental Illness, Forensic Division, Toronto, Quebec, Canada; Department of Psychiatry, University of Toronto, Quebec, Canada

^gForensic Psychiatric Services Commission, BC Mental Health and Substance Use Services, Coquitlam, British Columbia, Canada

^hDepartment of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières Québec, Canada; Philippe-Pinel Institute, Research Center, Montreal, Quebec, Canada

Address correspondence to Anne G. Crocker, Douglas Mental Health University Institute Research Center, 6875 LaSalle Blvd., Montreal,Quebec, H4H 1R3Canada. E-mail: ac.lligcm@rekcorc.enna

 

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