Download 5_Forensic+Debate

FORENSIC PSYCHOLOGY
Forensic Psychologists
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Masters in Forensic Psychology and supervised practice
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Work in prisons or Probation Service
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Interventions for offending behaviour, often through accredited programs
Forensic Clinical Psychologists
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Doctorate in Clinical Psychology, may include forensic placement or research
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Work in secure hospitals and community forensic teams
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Interventions for psychological distress and offending behaviour
-Member of multidisciplinary team, includes psychiatrists, social workers, occupational therapists, nurses
-Providing care to mentally disordered offenders
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Violent & sexual offences, arson, criminal damage, theft, drugs
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Psychosis, substance misuse, childhood trauma, self harm, depression, anxiety, unstable mood
Individual assessment & therapy, Group treatments (e.g.: anger management, self esteem),Staff training and
supervision,Research / audit, Expert witness
PSYCHOLOGICAL DISTRESS AND OFFENDING
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People with psychosis generally not violent.
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May be a link with command hallucinations and persecutory delusions, although someone’s response to these
experiences may be more important than the experiences themselves.
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People with a diagnosis of personality disorder or psychopathy may be more likely to be violent.
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Childhood trauma may lead to difficulties with emotional regulation, impulsivity and empathy, which may lead to
violence or anti-social behaviour and also underlie personality disorder.
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Confounding variables:
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social inequalities experienced by psychiatric patients
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circular definition of personality disorder
HEARING VOICES
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Education in model of hearing voices as misattributed inner speech.
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Identify fluctuations in voice activity, develop and build simple coping strategies to increase sense of control
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Identify problematic beliefs about voices (e.g.: I have to do what my voices tell me) and elicit evidence for these
beliefs.
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Challenge beliefs about voices, by looking for alternative explanations, the strength of the evidence, reality
testing experiments.
TREATMENT APPROACH TO SEXUAL OFFENDING
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Education in model of offending (wanting to offend, giving self permission, creating situation, overcoming the
victim)
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Increasing self-awareness of thoughts, feelings and situations that increase the risk of offending, including
seemingly irrelevant decisions
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Addressing cognitive distortions and building victim empathy
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Developing coping strategies to deal with high risk situations,
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e.g. avoiding situations, self talk
ANGER MANAGEMENT
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Education in a cognitive behavioural model of anger, showing how thoughts impact on feelings and behaviour
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Understanding the ‘think – feel – act’ relationship
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Use of an anger diary to increase awareness of triggers, negative automatic thoughts, feelings and behaviour
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Teaching relaxation techniques to reduce angry arousal
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Challenging negative thoughts and using self talk
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Teaching assertiveness as a constructive alternative to aggressive or passive behaviour
ASSESSMENT
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The aim of assessment is to develop a formulation
a hypothesis about causal factors that can be addressed in therapy
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Methods
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Interview
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Psychometric tests e.g.: personality, cognitive functioning
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Observations
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File review
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Discussion with other key individuals, e.g.: nursing staff, relatives
RISK ASSESSMENT
Clinical approach-Based on clinical judgement, experience of individual
Actuarial approach- Assessment of scores on standardised tests known to be correlated with recidivism
-Interpretation of large datasets
ACTUARIAL ASSESSMENT
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Actuarial
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Assessment of scores on standardised tests known to be correlated with recidivism
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Interpretation of large datasets
Test to classify recidivists is 90% accurate
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Characteristics also shown by 10% of non-recidivist population
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Common crime - 50% likelihood of reoffending
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Test to classify recidivists is 90% accurate
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Characteristics also shown by 10% of non-recidivist population
Rarer crime - 10% likelihood of reoffending
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Important to:
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Maximise TRUE POSITIVE diagnoses
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Minimise FALSE POSITIVE diagnoses
Rarer crimes result in poorer outcomes for prediction
Milner & Campbell (1995)
Colour circle – “radex” (Canter, 2000) –THEME SPECIFICITY
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Actuarial estimates of risk are statistically more accurate, although more frequent events (forms of offending) are
predicted more accurately


domestic violence predicted more accurately than murder
Clinical judgement is important when considering individuals and the impact of treatment
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Actuarial assessment would not alter after therapeutic intervention
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Actuarial methods should inform multiple clinical judgements (second opinion)
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Instruments such as the HCR-20 & SVR-20 are based on research and can be used to guide clinical judgement
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Risk factors are:
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static (e.g. gender, previous history) or;
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dynamic (e.g. age, level of alcohol use)
Risk assessment should identify strategies for managing dynamic risk factors
-Offending and Mental Illness.
-Risk assessment
WHOLE LIFE SENTENCES ARE A LEGITIMATE COURT DISPOSAL OPTION
PRO
READING
ANTI
Review of treatments for severe personality disorder (Warren, 2003) –Home office
DSPD (Dangerous and Severe Personality Disorder) – severe personality disorder and also pose a significant risk of serious
harm to others. Review of 1 700 studies-The therapeutic Community (TC) model in which all members have a significant involvement in decision-making and
practicalities of the day-to-day running of the community, currently offers the most promising evidence. One study in
porion setting- moderate evidence for lower recidivism up to 7y post treatment.
-Pharmacological- very poor. SSRI antidepressants may ameliorate PD symptomatology and anger and MOIs may
ameliorate avoidant PD and symptoms of social anxiety.
Punishment without reason: Isolating retribution in lay punishment of criminal offenders (Aharoni, 2012)
Participants’ sentencing recommendations were strongly provoked by indices of retribution (criminal intent) even when
the most common consequentialist resons for punishment (offender dangerousness and publicity of punishment) were
minimized. –they persisted even when unable to justify reasons.
Emanuel Kant – just deserts- “categorical imperative” to punish- not for any practical end-goal but for its own sake.
(deontological punishment)
-consequentialist motive- practical –deterrence.
Noninstrumental heuristic processes (Greene, 2001) – when deciding whether to kill one innocent bystander in order to
save 5 others, study participants are far less likely to do so when required to use personal contact to kill the bystander
rather than by a mechanical switch, even though outcomes are equivalent 0> unable to articulate a rationale for it)
Moral intuition – consensual incest among adult siblings – with protection, no negative feelings etc- but all participants
said “it’s wrong” although they coulnd’t explain why.
Diagnosis of antisocial personality disorder and criminal responsibility (Spaans, 2011)
Recently, the tenability of the claim that individuals with personality disorders and psychopathy can be held fully
responsible for crimes has been questioned on theoretical basis.
Full criminal resp = indiv was fully aware of the illegal nature, character and consequences of that crime. Severe mental
disorder that leads to a crime- agrred in most jurisdictions that he or she cannot be held criminally responsible and
should be exempt from penal conseq. (US – alternative is viewed as criminally insane and court imposes enforced
treatment in high security forensic psychiatric hospital)
-absence of empathy (Mei-Tal,2002) or Herpertz (2000) – emotional deficiency . Ciocchetti (2003) – punishment is
inappropriate for persons with high psychopathy scores due to their failure to understand the wrongfulness of their
actions.
Three Strikes and You are Out, but why? Psych of Public Support for Punishing Rule Breakers (Tyler, 97)
California- life in prison for repeat felons (the “three strikes “ law. ).
Mad or Bad (Wilczynsiki, 97)
Child killing by parents or parent substitutes. CJS reponds differently – “men are bad and normal, women are mad and
abnormal”. Women are less likely to be prosecuted, they receive psychiatric or non-custodial sentences.
The “chivalry hypothesis” – women receive more lenient treatment when they commit crimes due to paternalistic and
non-punitive attitudes by decision makers. VS feminist theory – female offenders are dealt with in a discriminatory way
and sentenced not only for their crime but the degree to which they conform to standards of appropriate female beh
(Edwards, 84).
Gender and other stereotypes may become more relevant when the crime is more unusual or serious.
When and why should mentally ill prisoners be transferred to secure hospitals: A proposed algorithm (Vogel, 2013)
Forensic psychiatry must deal not only with the typically young criminal population, vulnerable to mental illness due to
social stress and at an age when rates of schizophrenia, suicide, drug abuse and P.D are highest, but also with an
increasingly older population with age-related diseases such as dementia.
From a medical point of view- they should be in hospital – but – dangerousness?
Psych treatment should be feasible under the conditions of incarceration, otherwise the mentally ill prisoner should be
transferred to a forensic psych hospital, complying with the political demand for equal treatment of imprisoned persons.
(Council of Europe, 2006).
The mere existence of mental disorder does not necessarily result in unfitness for imprisonment from a medical point of
view.