The current study aimed to advance our understanding of the factors that influence mental health diversion in Local Courts in New South Wales, Australia. Logistic regression was used to systematically identify the factors that are correlated with diversion in a cohort of individuals (N = 7283) diagnosed with psychosis. Those with a substance-induced psychotic disorder were less likely to be diverted than those with an affective psychosis or schizophrenia, after adjusting for age, gender, Indigenous status, offence seriousness, violence and criminal history. Unexpectedly, those with psychotic disorders committing violent or serious offences were more likely to be diverted than those committing non-violent, less serious offences. Legal representation should be provided to all individuals with serious mental illnesses facing criminal charges. The State-wide Community and Court Liaison Service should be expanded to more Local Courts. Further research is required into why Aboriginal defendants with a psychotic illness are less likely to be diverted.

The current study aimed to explore the relationships between attachment and childhood trauma on recidivism risk in a sample of Canadian offenders with mental disorder (OMDs). N = 56 OMDs completed the Adverse Childhood Experiences (ACE) questionnaire, a measure of adult attachment (Experiences in Close Relationships Scale), and interview to determine recidivism risk (Level of Service/Case Management Inventory; LS/CMI). The variables of interest had small to moderate correlations. Multivariable regression analysis found that ACE scores but not attachment insecurity were associated with LS/CMI scores. Mediation analyses demonstrated that ACE scores fully mediated the association between attachment anxiety and attachment avoidance and recidivism risk. Results demonstrate that as exposure to diverse ACEs increased so did the risk to recidivate and this exposure mediated the relationship between attachment insecurity and recidivism risk. This study highlights the necessity of addressing both attachment insecurity and the experience of ACE when providing psychiatric services to OMDs.

BACKGROUND: Epidemiological criminology refers to health issues affecting incarcerated and nonincarcerated offender populations, a group recognized as being challenging to conduct research with. Notwithstanding this, an urgent need exists for new knowledge and interventions to improve heath, justice, and social outcomes for this marginalized population.
OBJECTIVE: To better understand research outputs in the field of epidemiological criminology, we examined the lead author\'s affiliation by analyzing peer-reviewed published outputs to determine countries and organizations (eg, universities, governmental and nongovernmental organizations) responsible for peer-reviewed publications.
METHODS: We used a semiautomated approach to examine the first-author affiliations of 23,904 PubMed epidemiological studies related to incarcerated and offender populations published in English between 1946 and 2021. We also mapped research outputs to the World Justice Project Rule of Law Index to better understand whether there was a relationship between research outputs and the overall standard of a country\'s justice system.
RESULTS: Nordic countries (Sweden, Norway, Finland, and Denmark) had the highest research outputs proportional to their incarcerated population, followed by Australia. University-affiliated first authors comprised 73.3% of published articles, with the Karolinska Institute (Sweden) being the most published, followed by the University of New South Wales (Australia). Government-affiliated first authors were on 8.9% of published outputs, and prison-affiliated groups were on 1%. Countries with the lowest research outputs also had the lowest scores on the Rule of Law Index.
CONCLUSIONS: This study provides important information on who is publishing research in the epidemiological criminology field. This has implications for promoting research diversity, independence, funding equity, and partnerships between universities and government departments that control access to incarcerated and offending populations.

The purpose of this descriptive study was to investigate overkill in a representative sample of Greek psychiatric patients found not guilty by reason of insanity (NGRIs) from a forensic psychiatric - criminological standpoint and explore possible correlations of the phenomenon with socio-cultural or psychiatric factors. Overall, 24 forensic psychiatric records of overkill offenders were identified throughout the 5-year records of the national forensic psychiatric service in northern Greek mainland. The pattern that has emerged from the statistical results of the present study on the victims of overkill within the Greek borders was generally in line with global literature on homicide perpetrators. The mean age of overkill offenders (at the time of enactment of the crime) was estimated at 36.3 years ranging from 19 to 55 years (variance = 146.72; standard deviation = 12.11). The number of male single-offence killers was ten-times larger compared to their female counterparts, while the number of male multiple-offence killers were three-times larger compared to their female counterparts. Male offenders were averagely 15 years younger (mean 33.7; variance = 81.69; standard deviation = 9) in comparison to female offenders, and single-offence killers were averagely ten years younger compared to multiple-offence killers (mean 40.2; variance = 185.19; standard deviation = 13.6). The phenomenon correlated more strongly with homicides in the context of schizophrenia spectrum disorders (80-100%) as well as domestic violence. Overall, males outnumbered females both as offenders (approximately five-times) and victims (approximately three-times), but regarding domestic violence, the sad majority of overkill victims stood for females murdered by their male relatives. Close female relatives (especially mothers and grandmothers) were most often victimized. Female-perpetrated overkill was directed against male individuals with whom offenders shared a relationship (intimate partners and minors). An important finding was the fact that three-quarters of the overall perpetrator sample were under prescribed medication at the time of offence, but with a very low compliance rate (5.6%). This last particular finding of the present study demonstrated that mental health services within community in Greece may unfortunately have been ineffective in addressing issues requiring risk assessment and timely intervention.

People typically have a strong bias in attention toward faces to help them understand social interactions. Nonetheless some people, like incarcerated offenders and psychopaths, exhibit deficits in \"face reading,\" which may impair their interpretations, especially in case of attribution allocation in harmful events. In these cases, the ascription of intentionality is key in understanding the allocation of blame and structuring social information processing. Consequently, in the current study, in addition to typically studied intentionality and blame ascription levels (subfactors of hostile attributions), we also propose a new indicator of hostile attributions: intentionality/blame isomorphism, indicating reduced differentiation between those two factors. Violent prison inmates (N = 63) and community-based adults without previous history of incarceration (N = 63) took part in an eye-tracking study. In line with our hypotheses, offenders exhibited reduced attention orienting to faces as well as greater intentionality/blame isomorphism. In the case of both groups, people looked longer at the faces of the harm doer compared with the harm receiver. Additionally, greater intentionality/blame isomorphism predicted reduced attention to faces; however, when group status was included in the model, it became the only significant predictor of the attention to faces. Future studies should examine the origins of these gaze and attribution patterns and investigate consequences related to social perception and interactions of people prone to violence.

BACKGROUND: This study aimed to analyze the estimated prevalence of mental disorders among offenders and compare the estimated crime rate between mentally ill patients and the total population in Hong Kong.
METHODS: Service data of offenders referred to psychiatrists at the Siu Lam Psychiatric Centre from January 2011 to December 2020 were analyzed. Demographic data of gender, age on admission, educational level, principal psychiatric diagnosis, index offense, and assessment outcome were collected.
RESULTS: Data of 7535 offenders (74.8% males) aged 14 to 97 (mean: 41.3 ± 13.7) years were analyzed. More than 60% (66.2%) had a diagnosable mental disorder. The most prevalent principal psychiatric diagnosis was schizophrenia and related disorder (22.8%), followed by mental and behavioral disorders due to psychoactive substance use (18.6%), and mood disorders (8.8%). The commonest index offenses were theft and related offenses (20.5%), followed by acts intended to cause injury (19.7%), and illicit drug offenses (11.6%). The estimated prevalence of mental illness among prison population was 7.1% (male: 8.2%, female: 5.0%). The estimated crime rate for mentally ill patients was found to be 43.3 to 263.2 per 100 000 population.
CONCLUSIONS: The estimated prevalence of mental disorders among offenders and the estimated crime rate for mentally ill patients are relatively low in Hong Kong. The result was an important effort to document the changing characteristics of mentally ill offenders and provide an estimation of the prevalence and crime rate for mentally ill patients in Hong Kong.

This research, using data from the Community Criminal Courts where a majority of elderly offenders are tried and sentenced, investigates the socio-economic profile of elderly offenders and the factors influencing their criminal motivation in Singapore. It revisits conceptualizations of offending in older age which until now has received scant attention even in Asian societies where ties to conventional institutions are thought to be \"protective.\" The majority of elderly offenders in this study were \"revolving door prisoners\" and were never in possession of any efficacious social capital that would have prevented them from committing a crime or enabled their re-entry process, a problem compounded by the study\'s findings that almost 70% of the sampled offenders had experienced mental health issues. This would have spelled adverse consequences for their desistance and, conversely, their recidivist behavior, a finding that was consistent with many other studies that had examined the association between psychosis and crime.

OBJECTIVE: Sexual violence is a problem that affects children and adolescents regardless of social class, age, origin, religion, education level, marital status, race, or sexual orientation. This study aimed to analyze the associations between victim-offender relationships and the victim\'s age in cases of sexual violence involving female victims.
METHODS: This cross-sectional, retrospective observational study used data from the Brazilian Ministry of Health\'s Department of Public Health Surveillance in Brasília regarding the reportable crime of rape as informed by female victims in the Federal District between January 1, 2012, and December 31, 2018. The age of the victim was classified as <15 years or 15-19 years. The offenders were classified into eight different categories according to their relationship with the victim: father, stepfather, brother, husband, boyfriend, friend, stranger, and others. The association between the victim-offender relationship and the victim\'s age was assessed.
RESULTS: Overall, there were 4,617 reported cases of sexual violence, with 78.3% of these (n = 3614) corresponding to children under 15 and 21.7% to adolescents 15-19 years old (n = 1003). Close relatives, including brothers, and friends were the main perpetrators in cases of girls < 15 years old. Strangers and friends were the principal perpetrators in the group of girls 15-19 years old.
CONCLUSIONS: Children under 15 are the group most affected by sexual violence. Strategies must be developed to prevent the sexual abuse of children and adolescents and to facilitate the rehabilitation of victimized children.

OBJECTIVE: To understand how registered nurses implement their nursing practice in correctional institutions with healthcare governance by a health authority (e.g. Ministry of Health).
METHODS: Straussian grounded theory.
METHODS: Simultaneous data collection and analysis were undertaken using theoretical sampling, constant comparison and memo writing. Thirteen registered nurses engaged in semi-structured telephone interviews about implementing their correctional nursing practice including, providing direct care to adult offenders. Data were collected (December 2018 to October 2019) until saturation occurred. Analytic coding (open, axial and final theoretical integration) was performed to identify the core category and subcategories around which the substantive theory was developed.
RESULTS: The theory of Caring Behind Bars refers to the process of how registered nurses implemented their correctional nursing practice to care for offenders. The core category of Caring Behind Bars is comprised of five subcategories: tension between custody and caring, adaptability and advocacy, offender population, provision of care, and challenging and positive elements.
CONCLUSIONS: Caring Behind Bars required registered nurses to address tension between custody and caring by adapting and advocating to access offenders. The provision of care required registered nurses to use assessment skills and numerous resources to provide a variety of patient focused care to offenders. The consequences of Caring Behind Bars had challenging and positive elements.
CONCLUSIONS: The tension provides purposeful space to continue improving teamwork among correctional officers and registered nurses. More research is required about the impact of correctional healthcare governance models on professional practice and health outcomes. Frontline registered nurses can use the theory to make informed choices when providing care. Registered nurses practising in other domains of correctional nursing (i.e. administration, education and research) can also use this theory to advance and inform practice with the goal of promoting offender health.

BACKGROUND: Antisocial personality disorder (ASPD), although associated with very significant health and social burden, is an under-researched mental disorder for which clinically effective and cost-effective treatment methods are urgently needed. No intervention has been established for prevention or as the treatment of choice for this disorder. Mentalization-based treatment (MBT) is a psychotherapeutic treatment that has shown some promising preliminary results for reducing personality disorder symptomatology by specifically targeting the ability to recognize and understand the mental states of oneself and others, an ability that is compromised in people with ASPD. This paper describes the protocol of a multi-site RCT designed to test the effectiveness and cost-effectiveness of MBT for reducing aggression and alleviating the wider symptoms of ASPD in male offenders subject to probation supervision who fulfil diagnostic criteria for ASPD.
METHODS: Three hundred and two participants recruited from a pool of offenders subject to statutory supervision by the National Probation Service at 13 sites across the UK will be randomized on a 1:1 basis to 12 months of probation plus MBT or standard probation as usual, with follow-up to 24 months post-randomization. The primary outcome is frequency of aggressive antisocial behaviour as assessed by the Overt Aggression Scale - Modified. Secondary outcomes include violence, offending rates, alcohol use, drug use, mental health status, quality of life, and total service use costs. Data will be gathered from police and criminal justice databases, NHS record linkage, and interviews and self-report measures administered to participants. Primary analysis will be on an intent-to-treat basis; per-protocol analysis will be undertaken as secondary analysis. The primary outcome will be analysed using hierarchical mixed-effects linear regression. Secondary outcomes will be analysed using mixed-effects linear regression, mixed-effects logistic regression, and mixed-effects Poisson models for secondary outcomes depending on whether the outcome is continuous, binary, or count data. A cost-effectiveness and cost-utility analysis will be undertaken.
CONCLUSIONS: This definitive, national, multi-site trial is of sufficient size to evaluate MBT to inform policymakers, service commissioners, clinicians, and service users about its potential to treat offenders with ASPD and the likely impact on the population at risk.
BACKGROUND: ISRCTN 32309003 . Registered on 8 April 2016.