Many forensic psychiatric inpatients have difficulties regulating aggressive behavior. Evidence of effective aggression treatments is limited. We designed and investigated the effectiveness of a transdiagnostic application of a virtual reality aggression prevention training (VRAPT). In this randomized controlled trial at four Dutch forensic psychiatric centers, 128 inpatients with aggressive behavior were randomly assigned to VRAPT (N = 64) or waiting list control group (N = 64). VRAPT consisted of 16 one-hour individual treatment sessions twice a week. Assessments were done at baseline, post-treatment and at 3-month follow-up. Primary outcome measures were aggressive behavior observed by staff and self-reported aggressive behavior. Analysis was by intention to treat. This trial was registered in the Dutch Trial Register (NTR, TC = 6340). Participants were included between 1 March 2017, and 31 December 2018. Compared to waiting list, VRAPT did not significantly decrease in self-reported or observed aggressive behavior (primary outcomes). Hostility, anger control, and non-planning impulsiveness improved significantly in the VRAPT group compared to the control group at post-treatment. Improvements were not maintained at 3-month follow-up. Results suggest that VRAPT does not decrease aggressive behavior in forensic inpatients. However, there are indications that VRAPT temporarily influences anger control skills, impulsivity and hostility.

Forensic assessment of personality disorders (PDs) is often hampered by patients' invalid self-reports. A less frequently used alternative in forensic settings is basing PD diagnoses on information provided by knowledgeable informants. Our research examined whether patients and informants in forensic settings differ in how they view PD symptoms, and whether that changes over time. For the purpose of our study, we adapted the informant version of the Schedule for Nonadaptive and Adaptive Personality-2nd Edition (SNAP-2) for forensic settings. Twenty-four male forensic inpatients with DSM-IV PDs were assessed with the informant SNAP-FI (completed by three treatment providers per patient) and a self-report version, the SNAP-FP. The SNAP-FI and SNAP-FP scales showed acceptable to excellent reliability. Across all time points, the SNAP-FI revealed more PD pathology than did the SNAP-FP. These initial findings support the value of informant reports in PD assessment in forensic settings.

In the last few decades, the forensic literature has been dominated by violence risk and instruments that assess risk for violent and criminal behavior. Typically, these instruments are guided by the theoretical risk-need-responsivity model. According to this model, criminogenic needs are the cornerstone for forensic treatment. Criminogenic and general needs, such as mental health, quality of life, and social factors, are important for care planning in offenders because unmet needs can have significant implications for offenders’ future violence risk. However, needs assessment in forensic mental health services is still underdeveloped when compared to the long tradition of needs assessment in general psychiatric mental health services. Recently, internationally validated instruments that measure needs in psychiatric populations, such as the Camberwell Assessment of Need (CAN), Health of the Nations Outcome Scales (HoNOS), and international Resident Assessment Instrument (interRAI) have been adapted for forensic purposes. In this article, we review the forensic adaptations of these and potential other instruments including its psychometric evidence base.