Defining outcome measures of hospitalization for assessment in the Japanese forensic mental health scheme: a Delphi study

A narrative review of international legislation regulating fitness to stand trial and criminal responsibility: Is there a perfect system?

Mentally ill offenders have a right to a fair trial and adequate treatment in terms of the law. The diversion of mentally ill offenders between the criminal justice and the mental health care systems is linked to the forensic psychiatric assessment and based on two psycho-legal constructs, fitness to stand trial (FTST) and criminal responsibility (CR). Forensic psychiatric assessment is therefore an important element in criminal law and plays a major role in the court's decisions regarding the sentence, detention, placement, or treatment of mentally ill offenders. The legislation aims to ensure balancing the rights of mentally ill offenders to psychiatric care and society's safety. A narrative overview of the literature summarizing the findings on legislation regulating FTST and CR assessment and their practice in different areas of the world was conducted. It offers insight into the advantages and disadvantages of the various approaches and examines the way court proceedings function in these different geographical and psychosocial-legal contexts. This may have policy implications for individual systems and allow countries to consider feasible mechanisms to refine the relevant legislation to improve their practices in forensic psychiatric assessments. Worldwide, relevant legislation is considered as essential in protecting mentally ill offender's right; it has been established for many years regarding specifying the procedures and responsibilities for the mental health care and criminal justice systems. Despite similarities in the principles of the psycho-legal constructs in different countries, there are differences in the way legislations are implemented, often depending on the available resources.

Developing medical record-based, healthcare quality indicators for psychiatric hospitals in China: a modified Delphi-Analytic Hierarchy Process study

OBJECTIVES

To develop a medical record-based, comprehensive system of healthcare quality indicators for psychiatric hospitals in China.

DESIGN

A modified Delphi process with analytic hierarchy process (AHP) was used.

PARTICIPANTS

Twenty nationally-recognized experts were invited to participate in two rounds of Delphi expert consultation and AHP.

METHODS

Fifty potential indicators were included based on literature review, and 20 experts were asked to rate the importance of each indicator using two rounds of email surveys. The AHP was used to determine the relative importance of the finalized quality indicators.

RESULTS

The average authoritative coefficient was 0.92 ± 0.07. After two rounds of Delphi consultation, 47 healthcare quality indicators were identified for Chinese psychiatric hospitals. The mean importance ratings ranged from 7.06 to 8.84 on a nine-point scale, with variation coefficients ranging from 0.04 to 0.22. The percentage of full score for potential indicators ranged from 16% to 74%. In two rounds, the Kendall's W coefficients ranged from 0.423 to 0.535. The weights of structure, process and outcome were 0.175, 0.211 and 0.614, respectively.

CONCLUSION

We developed the first set of healthcare quality indicators for psychiatric hospitals in mainland China, and it will provide a standardized and meaningful guide to evaluate the healthcare quality of psychiatric hospitals across the country.