OBJECTIVE: Clinical services for early psychosis seek to improve prognosis for a range of adverse outcomes. For some individuals, perpetration of violence is an important potential outcome to reduce. How these clinical services currently assess this risk however is uncertain. This study aimed to address this gap by using qualitative methods to examine in depth current approaches, attitudes and challenges to assessing violence risk in this clinical setting, from the perspectives of multidisciplinary clinicians, patients and carers.
METHODS: Participants were recruited from two UK Early Intervention in Psychosis services. Semi-structured individual interviews were undertaken using a topic guide. In addition, clinical vignettes were presented to clinician participants as a probe to prompt discussion. Data were analysed using thematic analysis, informed by the constant comparative method.
RESULTS: We conducted 30 qualitative interviews, of 18 clinicians and 12 patients and carers. Themes developed from clinician interviews included key difficulties of low confidence, limited training, accessing collateral information and variation in how risk is appraised and communicated. Potential stigma and sensitivity of the topic of violence were perceived as barriers to its discussion. Patient and carer perspectives provided insight into how to address barriers, and highlighted the importance of an open approach, including with families.
CONCLUSIONS: We recommend developing contextually appropriate pathways to collaboratively assess violence risk and identify modifiable needs to reduce this risk, and for practical improvements in training and information-sharing.

Most studies on the predictors and effectiveness of community treatment orders (CTOs) are restricted to health-related variables and do not consider forensic contacts as established by criminal justice databases or predictors from birth. We used linked administrative health and criminal justice data for a birth cohort in Queensland, Australia to investigate the characteristics and outcomes of people placed on CTOs.
CTOs were identified from administrative data for hospital admissions and community mental health service contacts for a population cohort of 45,141 individuals born in Queensland in 1990. These data were linked with administrative court records, with individuals followed up to age 23/24 years. Logistic regression analyses were used to examine characteristics associated with CTO placement and Tobit regression analyses to examine factors predicting health and criminal justice outcomes in the following year.
There were 211 CTO cases by age 23/24 years, for whom it was possible to identify 413 controls on voluntary treatment. Non-affective psychoses [F20-F29] were the strongest predictors of CTO placement (ORadj = 4.07, 2.77-5.99) followed by a court appearance (ORadj = 1.99, 1.28-3.09). CTOs were associated with greater, not lower, subsequent psychiatric hospital admissions, inpatient bed-days and community mental health service contacts, although on sensitivity analyses psychiatric hospital admissions were the same as voluntary controls. CTOs were not associated with more subsequent court appearances despite higher rates of offending before CTO placement.
Both clinical and forensic variables can determine CTO placement and, on adjustment for these covariates, CTOs were not associated with reductions in psychiatric hospital admission, time spent as an inpatient, or subsequent court appearances. The latter finding might mean that CTOs reduce the risk of offending to that of voluntary controls.

Research suggests that convicted persons are more likely than non-convicted persons to suffer poor health. However, few longitudinal studies have investigated associations between health and offending across generations. Using the Cambridge Study in Delinquent Development, this article prospectively investigates the relationship between health and offending across generations and between genders. At the average age of 25, third generation convicted males and females reported a higher incidence of serious drug use than non-convicted persons. Convicted males reported a higher incidence of mental illness and self-harm, whereas convicted females reported a lower incidence of physical illness, mental illness, self-harm and hospitalizations when compared to non-convicted females. Convicted males reported a higher incidence of industrial accidents, sports injuries and fight injuries, but a lower incidence of road accidents, whereas convicted females were more likely to report road accidents. Like their fathers, convicted males show worse health compared to non-convicted individuals.

Fetal alcohol spectrum disorder (FASD) is an increasingly important issue in the New Zealand (NZ) Criminal Justice System (CJS). FASD may impact an offender\'s ability to participate meaningfully in the trial process, giving rise to the issue of unfitness to stand trial. Capacity to apprehend, comprehend, participate in, make decisions about and communicate within legal process intersect with the complexity and severity of charges. Courts are required to make a nuanced analysis of multiple and complex factors, merging medical and legal expertise into decisions made. We explore the nature of FASD and its implications for criminal justice in NZ. The legal and clinical issues in relation to fitness and FASD will be discussed.

Background: Early treatment (considered as early contact with community mental health services) and treatment retention are associated with reduced reoffending among those with a previous diagnosis of psychosis, yet the attributes of care required to best achieve this is largely unexplored for people with psychosis leaving prison. This study sought consensus from a sample of experts and consumers regarding the attributes of an \"optimal model of care\" for those with a prior episode of psychosis leaving prison in New South Wales, Australia. Methods: A Delphi method was used, which involved establishing a consensus from a panel of 25 experts and consumers. Following three meetings, 34 model of care attributes and 168 attribute levels were generated for two rounds of online scoring. All attributes and levels were included in the final model if they scored \"very important\" or \"extremely important;\" or if the attribute was agreed on by 70% or more of participants. The participant retention rate across scoring rounds was 96% for Round 1 and 84% for Round 2, where consensus was reached. Two \"member checking\" procedures were undertaken to enhance the integrity of findings: a model \"stress test\" and an online consumer poll. Results: Thirty-two attributes and 72 attribute levels were included in the final model across four components: pre-release care planning and coordination; treatments in community; diversion from prison; and evaluation. Member checking endorsed a person-centered approach with carers and peer-support central to care. Conclusions: Participants agreed that an optimal model of care should involve a specialized team who works independent of community health service teams to directly deliver certain treatments and services while helping consumers to access external social an economic supports and services.

Background: Emotion dysregulation has been linked to sexual offending and reoffending across a number of different theories. Interventions focused on improving emotion regulation in sexual offenders have been recommended. Objectives: The current study explored the feasibility and impact of biofeedback in improving an emotion regulation strategy linked to arousal control/response modulation in a sample of eight sexual offenders with intellectual disability. Method: The study delivered a heart rate variability (HRV) biofeedback intervention on eight occasions over a period of four weeks. Success of the intervention was assessed using average heart coherence. Emotion dysregulation was assessed through self-report using the modified Difficulties in Emotion Regulation Scale (DERS), and behavioral observations. Results: Participants were able to apply themselves well to the biofeedback intervention however there were no significant improvements observed for the sample on the outcome measures. There were some improvements at an individual level. Conclusion: This study demonstrated the feasibility of this novel treatment with this offender population and outlines the future directions for research to further explore this intervention.

Although studies point to a relationship between debt and crime, there is a limited understanding of their reciprocal relationship and possible mediating risk factors. Moreover, knowledge about the prevalence and scope of debt among offenders is lacking. Therefore, the present study analyzed 250 client files including risk assessment data from the Dutch probation service on the prevalence of debt and possibly related risk factors. The results show that debt is highly prevalent and complex, which underlines the importance of acquiring more knowledge about debt as a potential risk factor for relapse during supervision. It was found that problems with regard to childhood and living situation, education and work/daytime activities, and mental and physical health may be possible underlying risk factors in the relationship between debt and crime. These insights can help professionals adequately support clients with regard to debt in order to prevent recidivism.

Research suggests that antisocial lifestyles constitute significant health risks. However, there are marked individual differences in the stability of antisocial behaviour. These different offending pathways may bear differential risks for adult health.
Injury and illness data were collected prospectively in the longitudinal Cambridge Study in Delinquent Development.
Working-class inner-city area of South London.
Participants included the 411 men from the Cambridge Study in Delinquent Development, with interview data collected at ages 18, 32 and 48 years for each individual.
Organic illness, hospitalisation and injuries.
By age 48, adjusted odds ratios showed that the incidence of organic illness was higher among Life-Course-Persistent, Late-Onset offenders and offenders in general. Based on adjusted odds ratios at age 32, the incidence of hospitalisations was higher for Late-Onset offenders. Adjusted odds ratios at age 48 also showed that the incidence of hospitalisations was higher for all three offender types and offenders in general. Our results also provide evidence that offenders were more likely to suffer injuries than non-offenders.
The findings of this study imply that preventing individuals from offending is likely to have substantial benefits for health.

BACKGROUND: Aspects of the school environment, such as school attachment levels, are linked to adolescent offending. Previous research has not clarified whether a school- or individual-level intervention approach to improving pupil school attachment and commitment is most likely to reduce adolescent offending.
OBJECTIVE: The present study assessed the impact of individual- and school-level variables on offending behaviour from ages 14-16 years.
METHODS: The participants were 4,049 young people from 42 mainstream schools who took part in the Belfast Youth Development Study.
METHODS: Multilevel modelling was used to examine the relative influence of individual- and school-level variables on offending behaviour in adolescence.
RESULTS: Pupils who had high levels of school commitment and attachment and were involved in fewer fights at age 13 reported lower levels of offending at age 14 years. Differences between schools accounted for 7% of the variation in offending. Lower individual-level commitment was associated with higher initial levels of offending at age 14 if the school-level ethos was of higher commitment. Lack of safety at the school level appeared to be detrimental for young people not exposed to socio-economic deprivation.
CONCLUSIONS: Individual-level targeted interventions are likely to be a more cost-effective approach of reducing offending behaviour in adolescence. Additional, albeit smaller, reductions in offending levels could be achieved through school-level interventions in some school types (e.g., deprived areas).

A proportion of ex-military personnel who develop mental health and social problems end up in the Criminal Justice System. A government review called for better understanding of pathways to offending among ex-military personnel to improve services and reduce reoffending. We utilised data linkage with criminal records to examine the patterns of offending among military personnel after they leave service and the associated risk (including mental health and alcohol problems) and socio-economic protective factors.
Questionnaire data from a cohort study of 13 856 randomly selected UK military personnel were linked with national criminal records to examine changes in the rates of offending after leaving service.
All types of offending increased after leaving service, with violent offending being the most prevalent. Offending was predicted by mental health and alcohol problems: probable PTSD, symptoms of common mental disorder and aggressive behaviour (verbal, property and threatened or actual physical aggression). Reduced risk of offending was associated with post-service socio-economic factors: absence of debt, stable housing and relationship satisfaction. These factors were associated with a reduced risk of offending in the presence of mental health risk factors.
Ex-military personnel are more likely to commit violent offences after leaving service than other offence-types. Mental health and alcohol problems are associated with increased risk of post-service offending, and socio-economic stability is associated with reduced risk of offending among military veterans with these problems. Efforts to reduce post-service offending should encompass management of socio-economic risk factors as well as mental health.