Harry G Kennedy

Trinity College Dublin | TCD · Department of Psychiatry

The legislative process that led to the closure of the Judicial Psychiatric Hospitals (OPG), replaced by the Residences for the Execution of Security Measures (REMS), constituted a significant step forward towards the establishment of a community model of care of offenders with severe socially dangerous mental disorders more respectful of human rig...

Background and objectives There is sparse evidence that modern hospital architecture designed to prevent violence and self-harm can prevent restrictive practices (RP). We examine if the use of RPs was reduced by the structural change of relocating a 170-year-old psychiatric university hospital (UH) in Central Denmark Region (CDR) to a new modern pu...

Achtergrond Problemen met het voltooien van de behandeling komen vaak voor in forensische psychiatrische instellingen. Het niet afmaken van een behandeling is problematisch omdat het een grote invloed kan hebben op het risico op recidive. Mogelijks is het niet afmaken van behandeling deels te verklaren door een foutieve inschatting van de beveiligi...

Among forensic patients with schizophrenia spectrum disorders, the association between symptomatology and violence is still not entirely clear in literature, especially because symptoms shift both during the acute phase of the illness and after. The aims were to investigate the level of symptomatology in forensic patients and to evaluate if there a...

Introduction Secure forensic mental health services offer care and treatment to mentally disordered offenders, with high rates of schizophrenia and major mental illness in these groups. Much of the excess morbidity and mortality seen among patients with schizophrenia is due to cardiovascular disease and obesity. Sedentary behaviour is associated wi...

Introduction Impairment in decision-making capacity is a serious consequence of executive dysfunction secondary to serious mental disorders like schizophrenia. Functional mental capacity (FMC) refers to an individual’s ability to make and communicate legally competent decisions autonomously. Studies have shown that FMC is dependent on severity of p...

Introduction Patients with schizophrenia suffer from increased mortality rates equivalent to 15-20 years shorter life expectancy. Up to 60% of this excess mortality can be explained by preventable, somatic conditions like cardiovascular, metabolic, and respiratory comorbidities. As forensic psychiatric (FP) patients often experience the triple stig...

Introduction Secure forensic mental health services have a dual role, to treat mental disorder and reduce violent recidivism. Quality of life is a method of assessing an individual patients’ perception of their own life and is linked to personal recovery. Placement in secure forensic hospital settings should not be a barrier to achieving meaningful...

Introduction Frailty is defined as a clinical syndrome that encompasses a combination of decreased physiological reserve and low resistance to stressors. There is an association between mental illness and frailty among elderly cohorts. Frailty is also associated with obesity and smoking. There are high rates of treatment resistant schizophrenia amo...

Introduction There is an established association between serious mental illness and violence. Secure forensic psychiatric services provide care and treatment to mentally disordered offenders. The majority of patients in forensic services suffer from severe mental illnesses such as schizophrenia, with co-morbid polysubstance abuse and maladaptive pe...

About 40 years after the reforms leading to the closure of psychiatric hospitals (Ospedale Psichiatrico [OP]) in Italy in favor of a widespread model with a strong rehabilitation emphasis, Italy has chosen to close High Security Hospitals as well (Ospedale Psichiatrico Giudiziario [OPG]). The new forensic treatment model is expected to be more resp...

Introduction Secure forensic mental health services are low volume, high cost services. They offer care and treatment to mentally disordered offenders who pose a high risk of serious violence to others. It is therefore incumbent on these services to systematically evaluate the outcomes of the care and treatment they deliver to ensure patient benefi...

Aims We endeavoured to ascertain if using a specific tool rating insight adds benefit over and above the insight ratings on violence risk assessment or recovery based tools currently in use and to see if they may be helpful in guiding clinical decision making. Methods A cross sectional study of 104 forensic in-patients was completed. All current i...

Aims The aim of this study was to ascertain the correlations between patients’ views of their recovery and clinicians’ views of patients recovery, symptoms and risk, in a cohort of patients in the National Forensic Service Dundrum (NFMHS). Methods A cross sectional study was performed of all inpatients in the NFMHS Dundrum. The self-rated Dundrum...

What is known on the subject? • Frontline forensic mental health staff often face challenges when providing recovery-orientated care, as they must balance between caring for the forensic psychiatric patient and at the same time ensuring safety and security for all other patients and staff at the ward. • Research shows that balancing between care an...

Introduction In recovery-oriented care, forensic psychiatric nurses must engage in care relationships with patients (FPs) while focusing on ward security. Online video games (OVG) may provide a platform for negotiating power and social relations. Studies showing how OVG interventions may influence power balances in forensic psychiatric care are nee...

Objectives: There has been a notable increase in requests for psychiatric reports from District Courts for persons remanded to Ireland's main remand prison, Cloverhill. We aimed to identify if reports were prepared for persons with severe mental illness and if they led to therapeutic benefits such as diversion to healthcare. Measures of equitabili...

The Italian mafia organizations represent a subculture with values, beliefs, and goals that are antithetical to and undermining of the predominant society. The conduct of individual members includes such extreme violence for material gain, it may at least superficially suggest a severe personality disorder. Since the first edition of the DSM and in...

Background: Treatment completion difficulties are common in forensic mental health settings and may have a profound impact on recidivism rates. Aims: To test for associations between measures of risk and of security needs on the one hand and treatment non-completion on the other among male offender-patients in one medium security hospital. Methods...

Forensic psychiatry services have grown and become more complex in structures, processes and pathways. Legacy customs, practices and changing policy are now organised into formal models of care. These are written accounts of how a health service is delivered, outlining best practice and services for patients progressing through the stages of their...

Consumer-focused healthcare mobile applications have seen widespread adoption in recent years. Enterprise mobile applications in hospital settings have been slower to gain traction. In this study we examine the Dynamic Appraisal of Situational Aggression: Inpatient version (DASA), a short-term risk assessment tool which is well validated and widely...

Introduction The majority of homicides in society are not associated with mental illness, however there is an established association between homicide and schizophrenia. Homicide perpetrated by mentally disordered offenders is a leading reason for admission to secure forensic psychiatric hospitals. Objectives To investigate the clinical characteri...

Introduction Recently video gaming, have attracted considerable attention for its possible beneficial therapeutic effects, the possibility for testing behavior in safe artificial environments and as a tool for professionals and patients to build specific competencies for the everyday life. Also, a substantial amount of research suggests that videog...

Introduction Prevention and treatment of aggression in psychiatric hospitals is achieved through appropriate medical treatment, professional skills, and optimized physical environment and architecture. Coercive measures are used as a last resort. In 2018 Aarhus University Hospital Psychiatry moved from 19th-century asylum buildings to a newly built...

Introduction In February 2020, the Central Mental Hospital Dundrum moved to a complete ban on cigarette smoking. Concerns were raised that this might represent a ‘restrictive practice’ and that patients might gain weight or see changes in their blood pressure if they were not permitted to smoke. Objectives The aim of the study was to ascertain if...

Introduction Recovery orientated care emphasizes equality in relations. Forensic psychiatric professionals need to engage in care-relationships with patients in ways where power is symmetrically distributed among them. However, professionals also need to focus on security at the ward. This promotes patient-professional power-relations that are asym...

Introduction Secure forensic mental health services treat patient with high rates of treatment resistant psychoses, typically schizophrenia. These groups have high rates of obesity and medical co-morbidities. Population based studies have identified high risk groups in the event of SARS-CoV-2 infection, including those with long term medical condit...

Introduction Secure forensic mental health services have a dual role, to treat mental illness and reduce violent recidivism. Those admitted to secure forensic services have a significant history of violence and treatment needs in multiple domains including psychiatric illness, violence and other areas such as substance misuse and physical health....

Background Secure forensic mental health services treat patients with high rates of treatment-resistant psychoses. High rates of obesity and medical comorbidities are common. Population-based studies have identified high-risk groups in the event of SARS-CoV-2 infection, including those with problems such as obesity, lung disease and immune-compromi...

The Law of 30 May 2014, n. 81 represents the point of arrival of an important reform of the Italian psychiatric forensic system. With it, in fact, Italy passed from a forensic psychiatric model based on OPGs to one based on REMS. The structural and functional characteristics of the REMS are aimed at assuring general security, individual care, rehab...

PurposeWhile the number of forensic beds and the duration of psychiatric forensic psychiatric treatment have increased in several European Union (EU) states, this is not observed in others. Patient demographics, average lengths of stay and legal frameworks also differ substantially. The lack of basic epidemiological information on forensic patients...

Background Prevention of violence due to severe mental disorders in psychiatric hospitals may require intrusive, restrictive and coercive therapeutic practices. Research concerning appropriate use of such interventions is limited by lack of a system for description and measurement. We set out to devise and validate a tool for clinicians and secure...

Purpose While the number of forensic beds and the duration of psychiatric forensic psychiatric treatment have increased in several European Union (EU) states, this is not observed in others. Patient demographics, average lengths of stay and legal frameworks also differ substantially. The lack of basic epidemiological information on forensic patient...

This study examined an information processing model of delusions, namely that delusions are maintained by either ongoing anomalous perceptions or neuropsychological impairment or both. In a cohort of forensic in-patients with schizophrenia (n=40, 19 actively deluded), we examined two specific neuropsychological impairments, impaired ability to ask...

Swift medically led scientifically informed responses to the Covid-19 epidemic nationally have been demonstrably superior to other, non-scientific approaches. In forensic psychiatry and across all psychiatric services, urgent and clinically led responses have underlined redundancies and confusions in the governance of mental health services and a v...

Criteria to determine in which level of security forensic patients should receive treatment are currently non-existent in Belgium. Research regarding the assessment of security level is minimal, and limited instruments are available. This study investigated the instruments that measure the need for security level: DUNDRUM-1 and the HoNOS-Secure. Th...

Background: Prevention of violence due to severe mental disorders in psychiatric hospitals may require intrusive, restrictive and coercive therapeutic practices. Research concerning appropriate use of such interventions is limited by lack of a system for description and measurement. We set out to devise and validate a tool for clinicians and secure...

Background: Prevention of violence due to severe mental disorders in psychiatric hospitals may require intrusive, restrictive and coercive therapeutic practices. Research concerning appropriate use of such interventions is limited by lack of a system for description and measurement. We set out to devise and validate a tool for clinicians and secure...

Background: Prevention of violence due to severe mental disorders in psychiatric hospitals may require intrusive, restrictive and coercive therapeutic practices. Research concerning appropriate use of such interventions is limited by lack of a system for description and measurement. We set out to devise and validate a tool for clinicians and secure...

Background: People with schizophrenia are ten times more likely to commit homicide than a member of the general population. The relationship between symptoms of schizophrenia and acts of violence is unclear. There has also been limited research on what determines the seriousness and form of violence, such as reactive or instrumental violence. Moral...

We propose that excellence in forensic and other mental health services can be recognised by the abilities necessary to conduct randomised controlled trials (RCTs) and equivalent forms of rigorous quantitative research to continuously improve the outcomes of treatment as usual (TAU). Forensic mental health services (FMHS) are growing, are high cost...

Routine outcome measurement in forensic mental health has a history as long as the subject itself, though as yet this has seldom been reviewed. In forensic mental health, the outcome measurements of greatest relevance are those relating to risk of violence, need for therapeutic security and responses to interventions and treatments.

Background: Criteria to determine in which level of security forensic patients should receive treatment are currently non-existent in Belgium. Courts largely rely on the evaluations of the prison psychiatrists and psychologists to form their decision. None of the few available instruments - e.g., the DUNDRUM-1 - is currently used to provide struct...

The Semistructured Interview for Moral cognitionS - SIMS provides a radical new way of conceptualising violence. Namely that the majority of acts of violence are morally motivated with the remainder being egoistic in nature. Preliminary research indicates that the interview possesses excellent internal consistency and good construct validity when e...

Purpose Criteria to determine in which level of security forensic patients should receive treatment are currently non-existent in Belgium. Research regarding the assessment of security level is minimal and few instruments are available. The DUNDRUM toolkit is a structured clinical judgement instrument that can be used to provide support when determ...

Background Evidence is accumulating that Cognitive Remediation Training (CRT) is effective for ameliorating cognitive deficits experienced by patients with schizophrenia and accompanying functional impairment. There has been no randomized controlled trial of CRT using a nationally representative population of forensic patients, despite the signific...

Aims There is renewed interest in the inverse association between psychiatric hospital and prison places, with reciprocal time trends shown in more than one country. We hypothesised that the numbers of admissions to psychiatric hospitals and committals to prisons in Ireland would also correlate inversely over time (i.e. dynamic measures of admissio...

Background: Prison mental health services have tended to focus on improving the quality of care provided to mentally disordered offenders at the initial point of contact with the prison system and within the prison environment itself. When these individuals reach the end of their sentence and return to the community, there is an increased risk of m...

Forensic psychiatric care must be provided within the least restrictive setting possible, whilst simultaneously maintaining appropriate levels of security. This presents particular challenges for the design of forensic psychiatric hospitals, which are required to provide both a therapeutic and a safe material environment, often for extended periods...

Background: We evaluated change in response to multi-modal psychosocial 'treatment as usual' programs offered within a forensic hospital. Methods: 69 patients with a diagnosis of schizophrenia or schizoaffective disorder were followed for up to four years. Patient progress was evaluated using the DUNDRUM-3, a measure of patient ability to particip...

Mental health and substance misuse disorders are associated with unnatural deaths in prisoners. Deaths in Irish prisons between 2009 and 2014 were retrospectively analysed using coroner's findings, including post-mortem toxicology. There were 69 deaths in custody, 38 of which met inclusion criteria. All deaths by overdose (16) were positive for ill...

Purpose While individuals with an intellectual disability form a significant minority in the worldwide prison population, their healthcare needs require specialist attention. In Ireland, services for prisoners with intellectual disabilities need development. However, there is little substantive data estimating the prevalence of intellectual disabil...

This study examined the predictive validity of the Spanish version of the Suicide Risk Assessment Manual (S-RAMM) and the Historical-Clinical-Risk Management-20 (HCR-20) in a sample of violent offenders with schizophrenia and other psychosis, who had committed violent crimes and had been sentenced to compulsory psychiatric treatment by the criminal...

Mental health and substance misuse disorders are associated with unnatural deaths in prisoners. Deaths in Irish prisons between 2009 and 2014 were retrospectively analysed using coroner's findings including post mortem toxicology. There were 69 deaths in custody, 38 deaths met inclusion criteria. All deaths by overdose (16) were positive for illici...

This chapter sets out to describe the range of services currently provided for mentally disordered offenders in order to describe the teaching and training needs for forensic mental health professionals who will provide sustainable high-quality services. Other chapters in this book will have to serve that purpose in such areas as specialist persona...

The Semi-structured interview of moral cognitionS (SIMS) assesses six broad domains associated with violence (O’Reilly et. al. 2017). Five of the domains concern moral themes, whereas the sixth focuses on egoism. The SIMS is based on a radically new way of conceptualizing violence and may be useful for informing violence risk assessment, management...

Background: Because of the potential gravity of finding a person incompetent, assessment of mental capacity is challenging for clinicians. We aimed to test validity of a new structured professional judgement tool designed to assess functional mental capacity in three domains - finances, welfare and healthcare. Methods: Fifty-five male forensic p...

Background Optimising quality of life (QOL) for service users in a forensic hospital is an important treatment objective. The factors which contribute to QOL in this setting are currently unclear. The aim of this study was to analyse the predictors of QOL amongst service users within an inpatient forensic mental health hospital. Methods This study...

Introduction: The truest form of progression within forensic mental health is the movement of a patient from a higher secure environment to a lower secure environment or to the community. Furthermore, there are many clinical factors that may be considered by multidisciplinary teams in making clinical judgements about moving a patient to a lesser se...

Objectives We sought to identify and review published studies that discuss the ethical considerations, from a physician’s perspective, of managing a hunger strike in a prison setting. Methods A database search was conducted to identify relevant publications. We included case studies, case series, guidelines and review articles published over a 20-...

Forensic patients with schizophrenia who had carried out a homicide scored higher on a measure of moral cognition (MFQ-30) than other violent patients. Neurocognitive impairment was associated with homicide by mediation via higher scores for in-group loyalty.

From 2013 to 2015, the number of mobile Health applications (165,000) available in the Apple iTunes and Android app stores had almost doubled. (IMS institute for healthcare informatics) The applications are primarily commercial enterprises targeted at service users. They aim to improve patient awareness and adherence thus enhancing an individual’s...

Background There is limited data on the recovery of factors associated with decisional capacity in patients with psychosis. Aims To study the relationship between changes in mental capacity, symptoms and global functioning using structured measures during treatment for psychosis. Method Fifty-six patients with psychosis were assessed for capacity...

Create an overview of characteristics of patients in long-term forensic psychiatric care (LFPC) with a higher length of stay (LOS) care compared to patients in regular forensic psychiatric care (RFPC) with a shorter LOS. Data were collected from 139 patient records. This study examined whether patients in LFPC differ from patients in RFPC on sociod...

Background People with major mental illness are over-represented in prison populations however there are few longitudinal studies of prison in-reach services leading to appropriate healthcare over extended periods. AimsWe aimed to examine measures of the clinical efficiency and effectiveness of a prison in-reach, court diversion and liaison service...

Background. Many medications administered to patients with schizophrenia possess anticholinergic properties. When aggregated, pharmacological treatments may result in a considerable anticholinergic burden. The extent to which anticholinergic burden has a deleterious effect on cognition and impairs ability to participate in and benefit from psychoso...