“Trapped in their Shame”: A Qualitative Investigation of Moral Injury in Forensic Psychiatry Patients

Individuals who engage in criminal behavior for which they are found not criminally responsible (NCR) may be at increased vulnerability to experience moral pain and, in extreme circumstances, moral injury after regaining insight into the consequences of their behavior. Yet, almost no research exists characterizing the nature, severity, or impact of moral pain in this population. Semi-structured interviews were conducted with nine forensic psychiatric patients and 21 of their care providers. Narratives were explored using thematic analysis. Findings demonstrate that NCR patients endorse symptoms consistent with moral injury, including feelings of guilt toward victims, shame for one’s behavior, and a loss of trust in one’s morality. Moral pain is a strong driver of behavior and must be understood as part of a constellation of factors influencing criminality, risk, and recovery. Future research must develop adequate tools to measure and characterize offense-related moral injury to understand its impact on this population

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Aircraft-assisted suicide: The rarity of attempts, ideation, or underreporting?

Introduction: Aircraft-assisted suicide is a rare but serious event, with immediate consequences for the pilot, crew, and passengers. The overt linkage between mental illness and suicidal behaviour is well-known, however, the infrequency of these events in the context of aviation, coupled with poor record-keeping and reluctance to disclose, likely disguises the true extent of mental illness among pilots. One critical research gap in Canada has been the lack of investigation of crashes linked to suicide or a mental disorder. Research on aircraft-assisted suicide will address the key issues of pilots’ reluctance to disclose, report, and seek mental health services. Our study investigates the frequency of aircraft-assisted suicide in Canada, reviews current medical standards, and discusses preventative interventions to manage future risk. Materials and methods: Our study examined investigations and reports conducted by the Transport Safety Board to explore the frequency of aircraft-assisted suicide over a ten year period. Results: Aircraft-assisted suicides in Canada are rare, however, mentally ill pilots involved in fatal crashes are likely underestimated. Our study highlights key barriers in aviators’ disclosure of mental health symptoms, an ineffective screening process, and a consequence-based system that deters pilots from their duty to report. Discussion: our investigative analysis addresses key limitations in screening of mentally ill pilots, explores current medical standards and aeromedical exams, infrequency of fitness assessments, and demonstrates the critical need for continuous evaluation of pilots in this safety-sensitive occupation. Conclusion: The current paper addresses the need for continuous evaluation of pilot’s mental health and a more rigorous screening process to accurately identify suicide risk in pilots and prevent aircraft-assisted suicide

Working positively with sexual offenders : maximizing the effectiveness of treatment

In this article, the authors draw on literatures outside sexual offending and make suggestions for working more positively and constructively with these offenders. Although the management of risk is a necessary feature of treatment, it needs to occur in conjunction with a strength-based approach. An exclusive focus on risk can lead to overly confrontational therapeutic encounters, a lack of rapport between offenders and clinicians, and fragmented and mechanistic treatment delivery. The authors suggest that the goals of sexual offender treatment should be the attainment of good lives, which is achieved by enhancing hope, increasing self-esteem, developing approach goals, and working collaboratively with the offenders. Examples are provided of how these targets may be met. When this is done within a therapeutic context where the treatment providers display empathy and warmth and are rewarding and directive, the authors suggest that treatment effects will be maximized