Exploring Cognitive Functioning among Forensic Mental Health Inpatients

AbstractA large proportion of forensic mental health (FMH) inpatients experience cognitive impairments, which may impact the extent to which they benefit from interventions aimed at reducing their risk of recidivism. These impairments should be identified and responded to as quickly and accurately as possible. The current study explored when and how FMH inpatients’ cognition is assessed during their stay at a forensic hospital, with a cognitive profile being constructed of the sample. The medical files of inpatients who resided at the hospital in Melbourne (Australia) during January 2016 and December 2019 were reviewed retrospectively. A total of 99 medical files were identified. The type, timing and results of each cognitive assessment were collected. Frequency analysis revealed more than half of the sample received a cognitive assessment, with most of the cognitive assessments being conducted within the first year of an inpatient’s admission to hospital. Between 19% and 31% of inpatients with available cognitive data demonstrated a global cognitive impairment, depending on the cognitive measure being used. These results highlight the value of assessing FMH inpatients for cognitive impairments to respond to them appropriately to increase their chances of rehabilitation. Careful consideration should be given to the type of cognitive assessment tool used among this demographic.Keywords: Neuropsychologycognitive assessmentsforensic inpatientsforensic psychiatric hospitalcognitive dysfunctionclinical practice AcknowledgementsThe authors would like to acknowledge Dr Stuart Lee and thank him for the contributions he made to this study.Conflict of interestThe authors have no conflicts of interest to report.Notes1 Inpatients admitted under a Custodial Supervision Order receive compulsory mental health treatment whilst under forensic care.2 A brief cognitive assessment was operationalised as the use of a cognitive screening tool (e.g., RBANS, WASI, Neuropsychiatric Unit Cognitive Screening Tool [NUCOG; Walterfang et al., Citation2003], Mini Mental State Exam [MMSE; Folstein, Folstein, & McHugh, Citation1975]) or a standalone measure (e.g., WAIS, Card Sorting Test, etc.)3 A more comprehensive cognitive assessment was operationalised as the use of two or more cognitive measures (e.g., WAIS and WMS).4 Some of these measures included cognitive assessment batteries (e.g., WAIS, WMS), as well as subtests of larger cognitive assessment batteries that were used as stand-alone measures (e.g., using only the Stroop test or TMT from the DKEFS battery).Additional informationFundingThis work was supported by an Australian Government Research Training Program Scholarship (H.C.), and Senior National and Medical Research Council (NHMRC) Fellowship (S.R., GNT1154651).