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Dima A, Wazir A, Clark-Castillo R, Zakopoulos I, Smith S, Gaughran F. Factors influencing the length of stay in forensic psychiatric settings: a systematic review. BMC Health Serv Res 2024; 24:400. [PMID: 38553762 PMCID: PMC10981349 DOI: 10.1186/s12913-024-10863-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/13/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Forensic psychiatry is often associated with long admissions and has a high cost of care. There is little known about factors influencing length of stay (LOS), and no previous systematic review has synthesised the available data. This paper aims to identify factors influencing the LOS in forensic psychiatry hospitals to inform care and interventions that may reduce the length of admissions. METHODOLOGY A systematic review was conducted by searching major databases, including PubMed, EMBASE and PsycInfo, from inception until May 2022. Observational studies conducted in forensic hospitals that examined associations between variables of interest and LOS were included. Following data extraction, the Newcastle‒Ottawa Scale was used for quality appraisal. No meta-analysis was conducted due to heterogeneity of information; a quantitative measure to assess the strength of evidence was developed and reported. RESULTS A total of 28 studies met the inclusion criteria out of 1606 citations. A detailed quantitative synthesis was performed using robust criteria. Having committed homicide/attempted homicide, a criminal legal status with restrictions, and a diagnosis of schizophrenia-spectrum disorders were all associated with longer LOS. Higher Global Assessment of Functioning (GAF) scores were associated with a shorter LOS. CONCLUSION High-quality research examining factors associated with LOS in forensic psychiatry is lacking, and studies are heterogeneous. No modifiable characteristics were identified, and thus, practice recommendations were not made. There is an increasing necessity to understand the factors associated with longer admissions to inform care and increase success in reintegration and rehabilitation. This paper provides recommendations for future research.
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Affiliation(s)
- Aikaterini Dima
- South London and Maudsley NHS Foundation Trust, London, UK.
- Institute of Psychiatry Psychology and Neuroscience, London, UK.
| | - Adonis Wazir
- Surrey and Sussex Healthcare NHS Trust, Redhill, UK
- Swansea University, Swansea, UK
| | | | | | - Shubulade Smith
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry Psychology and Neuroscience, Psychosis Studies, London, UK
| | - Fiona Gaughran
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry Psychology and Neuroscience, Psychosis Studies, London, UK
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Moulden HM, Matthew SA, Chaimowitz G. Enhancing Pre-Treatment Motivation Improves Forensic Mental Health Outcomes. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2024:306624X241228229. [PMID: 38314713 DOI: 10.1177/0306624x241228229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Despite evidence that psychological treatments benefit from pre-treatment intervention, there remains no published research on the value of including a pre-treatment intervention in forensic mental health settings. The present study aimed to address this gap by examining the effects of adding a brief motivational preparatory program (MPP) to standard forensic psychiatric care. The MPP was based on hope theory and motivational interviewing within a cognitive-behavioral therapy approach. MPP participants and a waitlist control group completed a battery of self-report measures of hope and motivation to change, which were compared with respect to risk, demographic, offence history, and outcome variables. There was a significant increase in client motivation for change after completing the MPP. Additionally, those who completed the MPP evidenced modest reductions in aggressive behavior, but significantly increased engagement in subsequent forensic treatment and programming.
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Affiliation(s)
- Heather M Moulden
- St. Joseph's Healthcare Hamilton, Forensic Psychiatry Program, Hamilton, ON, Canada
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Samuel A Matthew
- Department of Psychology, Neuroscience, and Behavior, McMaster University, Hamilton, ON, Canada
- Simon Fraser University, Burnaby, BC, Canada
| | - Gary Chaimowitz
- St. Joseph's Healthcare Hamilton, Forensic Psychiatry Program, Hamilton, ON, Canada
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
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Hassan J, Shannon S, Tully MA, McCartan C, Davidson G, Bunn R, Breslin G. Systematic review of physical activity interventions assessing physical and mental health outcomes on patients with severe mental illness (SMI) within secure forensic settings. J Psychiatr Ment Health Nurs 2022; 29:630-646. [PMID: 35426209 PMCID: PMC9544360 DOI: 10.1111/jpm.12832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 01/26/2022] [Accepted: 03/29/2022] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Individuals with a severe mental illness (SMI) are less physically active and have a lower life expectancy than the general population due to increased risks of cardiometabolic diseases (obesity, diabetes and respiratory diseases) and other health risks. Physical activity has been used as an adjunct therapy for individuals with SMI yielding improvements in cognitive functioning, quality of life and a reduction in psychiatric symptoms. Individuals with SMI residing within a secure forensic setting have reduced physical activity opportunities, possibly due to a number of factors including low motivation and restricted access to exercise facilities combined with a lack of knowledge and/or confidence in staff members to assist in physical activity programmes. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This review demonstrates that little is known around the effects of physical activity for people with SMI who reside in secure forensic settings, with little to no long-term effects reported. Physical activity interventions have shown some positive results through decreasing weight and waist circumference as well as a reduction in negative symptom scores in an exercise group compared with the "no treatment" control group post-intervention. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Service users' reluctance to engage in physical activity may be overcome by improving staff commitment, creating a motivational atmosphere and promoting service user decision making. ABSTRACT INTRODUCTION: Participating in physical activity has many benefits, yet those with severe mental illness (SMI) living in forensic settings are less likely to be active, and more likely to experience ill-health. The aim of this study was to systematically review the effectiveness of physical activity programmes on mental and physical health and specifically on reducing symptoms of SMI in forensic settings. METHOD A systematic search of six databases was conducted, in addition to a grey literature search. Studies were included if they had participants with SMI; were based in a forensic setting; involved a physical activity programme and reported physical and mental health outcomes. RESULTS A total of 112 participants were included in four studies. One study showed a significant improvement in negative symptom scores in the exercise group compared with a treatment as usual group. Two studies reported improvements in psychiatric symptoms with no significant difference between groups; however, statistically significant changes in weight and waist circumference were evident (p < .001). No adverse effects were reported. CONCLUSION Only a small number of studies were included and of limited design and quality, with no follow-up assessments; therefore, more research is needed to determine the true effects of physical activity for improving SMI symptoms in a forensic setting. This review highlights the need for further studies exploring the barriers and facilitators of physical activity in secure forensic settings. Studies are required that include a more thorough research design. Furthermore, interventions if designed with patients and caring staff in mind may lead to lowered psychiatric symptoms and increased physical health benefits for all in forensic settings.
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Affiliation(s)
- Jessica Hassan
- School of Sport, Faculty of Life and Health Sciences, Ulster University, Newtownabbey, UK
| | - Stephen Shannon
- School of Sport, Faculty of Life and Health Sciences, Ulster University, Londonderry, UK
| | - Mark A Tully
- School of Health Sciences, Ulster University, Newtownabbey, UK
| | - Claire McCartan
- Centre for Evidence and Social Innovation, School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Gavin Davidson
- Centre for Evidence and Social Innovation, School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Richard Bunn
- Belfast Health & Social Care Trust, Shannon Clinic, Regional Secure Unit, Belfast, UK
| | - Gavin Breslin
- School of Psychology, Faculty of Life and Health Sciences, Ulster University, Coleraine, UK
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Jeandarme I, Goktas G, Boucké J, Dekkers I, De Boel L, Verbeke G. High Security Settings in Flanders: An Analysis of Discharged and Long-Term Forensic Psychiatric Patients. Front Psychiatry 2022; 13:826406. [PMID: 35865302 PMCID: PMC9294226 DOI: 10.3389/fpsyt.2022.826406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Two Forensic Psychiatric Centres (FPC) were implemented the last decade in Flanders in Ghent (2014) and Antwerp (2017). FPCs are forensic institutions for forensic psychiatric patients with a high recidivism risk and a high security need. The objective of FPCs is to create a care process with sufficient flow (from high to lower forms of security), and transitions (from specialized forensic care to regular psychiatric care). AIMS To examine the characteristics of the high security population in FPCs, treatment length, number of discharges, and discharge locations and to determine the profile of long-term patients within an FPC. METHODS A retrospective file study of an admission cohort of 654 patients admitted to FPC Ghent or FPC Antwerp was conducted. Sociodemographic, clinical, judicial and risk characteristics were analyzed. Bivariate analyses were used to test the difference between two groups: the group that was discharged to a lower security level vs. the group of long-term patients. RESULTS Most patients had psychosis and personality disorders, while comorbidity was also high. Judicial histories were extensive, with many sexual index offenses. During a 6-year follow-up period, the number of referrals back to prison was low. Nearly a third of the population was discharged to a setting with a lower security level. Long-term patients typically presented with more personality disorders, higher psychopathy traits and higher risk scores and were more frequently subjected to coercive measures during treatment. CONCLUSIONS The Flemish FPC population is characterized by a high proportion of sex offenders as well as a high proportion of personality-disordered patients. It is this last group, and the group with elevated psychopathy traits, who remain for longer than expected and is difficult to resocialize. This study further highlights the need for clear criteria to assess the conditions of these long-term patients in Flanders.
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Affiliation(s)
- Inge Jeandarme
- FPC Antwerp, Antwerp, Belgium.,Department of Law and Criminology, Catholic University of Leuven, Leuven, Belgium
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Marquant T, Van Nuffel M, Sabbe B, Goethals K. Substance Use Disorders as a Critical Element for Decision-Making in Forensic Assertive Community Treatment: A Systematic Review. Front Psychiatry 2021; 12:777141. [PMID: 34950071 PMCID: PMC8688775 DOI: 10.3389/fpsyt.2021.777141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/29/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: The prevalence of substance use disorders in forensic populations is high. They are an important factor linked to negative outcomes in mentally ill offenders and are detrimental to forensic or non-forensic outcome measures. In contrast, substance use disorders are often underdiagnosed and undertreated, especially in forensic settings. Forensic Assertive Community Treatment is a forensic adaptation of regular assertive community treatment, combined with essential elements of forensic rehabilitation theories. Little is known however on the effectivity of forensic assertive community treatment when it comes to substance use disorders or what their exact role is on the outcome measures. In this paper, we explore how SUD is treated in Forensic assertive community treatment and how it relates to the forensic and non-forensic outcome measures. Methods: We performed a systematic review (PRISMA) of forensic Assertive community treatment teams that followed the main evidence-based principles of regular assertive community treatment and added basic elements of forensic rehabilitation. We analyzed articles the Psychinfo and Medline databases dating from 2005 to 2020. Fifteen studies fit the search criteria and were included in the analysis. The Quality of the studies was assessed using the Newcastle-Ottawa scale. Results: SUD was highly prevalent in all studies. Patients entered FACT through two pathways, either from a care continuum or directly from prison. The severity of SUD at intake emerges as a critical element when deciding which pathway to choose, as a high severity-score at the start of FACT follow-up was linked to recidivism. While differing in method all studies offered integrated SUD treatment. These included evidence-based techniques like CBT, therapeutic communities, and Substance Abuse Management Module. Though results on SUD outcomes were mixed 4 studies mentioned abstinence in 50-75%. The severity of SUD tended to increase initially and to stabilize afterwards. Conclusion: Severity of SUD at intake emerges as a decisive element in decision-making on entering FACT teams directly from prison or through a care-continuum. The ways to provide SUD treatment varied and outcomes for SUD were mixed. SUD was found to be detrimental to forensic and non-forensic outcome measures, such as recidivism or hospitalizations during FACT treatment.
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Affiliation(s)
- Thomas Marquant
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute, Antwerp, Belgium
- Department of Forensic Psychiatry, Fivoor, Rotterdam, Netherlands
- Department of Justice, Brussels, Belgium
| | | | - Bernard Sabbe
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute, Antwerp, Belgium
- Department of Psychiatry, Antwerp University, Antwerp, Belgium
- Department of Psychiatry, Antwerp University Hospital, Antwerp, Belgium
| | - Kris Goethals
- Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute, Antwerp, Belgium
- Department of Psychiatry, Antwerp University, Antwerp, Belgium
- Department of Psychiatry, Antwerp University Hospital, Antwerp, Belgium
- Department of Forensic Psychiatry, University Forensic Center, Antwerp, Belgium
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Markham S. The omnipresence of risk and associated harms in secure and forensic mental health services in England and Wales. SOCIAL THEORY & HEALTH 2021; 21:1-17. [PMID: 34149319 PMCID: PMC8207492 DOI: 10.1057/s41285-021-00167-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2021] [Indexed: 11/30/2022]
Abstract
Current legislation and policy frameworks regulating the detention and treatment of mentally disordered offenders in England and Wales are predicated on the assumption that a minority of patients have enduring violent tendencies and pose a serious long-term risk to the safety of others. This paper seeks to consider the manner in which notions of risk and the imperative to contain and minimise the potential for harm, present and impact patients in secure and forensic mental health settings. Within this, we consider how mental health stigma and Beck's concept of the Risk Society can affect the thoughts and actions of those who may be held accountable for rare but potentially serious harmful events. We consider what changes may need to be enacted within secure and forensic mental health services to reduce the incidence and severity of consequent risks of harm to patients and their mental health recovery.
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Affiliation(s)
- Sarah Markham
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, PO72 De Crespigny Park, Denmark Hill, London, SE5 8AF UK
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Kirchebner J, Lau S, Kling S, Sonnweber M, Günther MP. Individuals with schizophrenia who act violently towards others profit unequally from inpatient treatment-Identifying subgroups by latent class analysis. Int J Methods Psychiatr Res 2021; 30:e1856. [PMID: 33320399 PMCID: PMC8170574 DOI: 10.1002/mpr.1856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 09/26/2020] [Accepted: 10/01/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND People with schizophrenia show a higher risk of committing violent offenses. Previous studies indicate that there are at least three subtypes of offenders with schizophrenia. OBJECTIVES Employing latent class analysis, the goals of this study were to investigate the presence of homogeneous subgroups of offender patients in terms of remission in psychopathology during inpatient treatment and whether or not these are related to subtypes found in previous studies. Results should help identify patient subgroups benefitting insufficiently from forensic inpatient treatment and allow hypotheses on possibly more suitable therapy option for these patients. METHODS A series of latent class analyses was used to explore extensive and detailed psychopathological reports of 370 offender patients with schizophrenia before and after inpatient treatment. RESULTS A framework developed by Hodgins to identify subgroups of offenders suffering from schizophrenia is useful in predicting remission of psychopathology over psychiatric inpatient treatment. While "early starters" were most likely to experience remission of psychopathology over treatment, "late late starters" and a subgroup including patients from all three of Hodgins' subgroups in equal proportions benefited least. Negative symptoms generally seemed least likely to remit. CONCLUSION Psychiatric treatment may have to be more tailored to offender patient subgroups to allow them to benefit more equally.
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Affiliation(s)
- Johannes Kirchebner
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Steffen Lau
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Sabine Kling
- Computer Vision Laboratory, Department of Information Technology and Electrical Engineering, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Martina Sonnweber
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Moritz Philipp Günther
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
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Günther MP, Lau S, Kling S, Sonnweber M, Habermeyer E, Kirchebner J. Different needs in patients with schizophrenia spectrum disorders who behave aggressively towards others depend on gender: a latent class analysis approach. Ann Gen Psychiatry 2021; 20:20. [PMID: 33714266 PMCID: PMC7956105 DOI: 10.1186/s12991-021-00343-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/07/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is limited research with inconsistent findings on differences between female and male offender patients with a schizophrenia spectrum disorder (SSD), who behave aggressively towards others. This study aimed to analyse inhomogeneities in the dataset and to explore, if gender can account for those. METHODS Latent class analysis was used to analyse a mixed forensic dataset consisting of 31 female and 329 male offender patients with SSD, who were accused or convicted of a criminal offence and were admitted to forensic psychiatric inpatient treatment between 1982 and 2016 in Switzerland. RESULTS Two homogenous subgroups were identified among SSD symptoms and offence characteristics in forensic SSD patients that can be attributed to gender. Despite an overall less severe criminal and medical history, the female-dominated class was more likely to receive longer prison terms, similarly high antipsychotic dosages, and was less likely to benefit from inpatient treatment. Earlier findings were confirmed and extended in terms of socio-demographic variables, diseases and criminal history, comorbidities (including substance use), the types of offences committed in the past and as index offence, accountability assumed in court, punishment adjudicated, antipsychotic treatment received, and the development of symptoms during psychiatric inpatient treatment. CONCLUSIONS Female offender patients with schizophrenia might need a more tailored approach in prevention, assessment and treatment to diminish tendencies of inequity shown in this study.
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Affiliation(s)
- Moritz Philipp Günther
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Steffen Lau
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Sabine Kling
- Computer Vision Laboratory, Department of Information Technology and Electrical Engineering, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Martina Sonnweber
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Elmar Habermeyer
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Johannes Kirchebner
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
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Lau S, Kirchebner J, Kling S, Euler S, Günther MP. Childhood Maltreatment, Psychopathology, and Offending Behavior in Patients With Schizophrenia: A Latent Class Analysis Evidencing Disparities in Inpatient Treatment Outcome. Front Psychiatry 2021; 12:612322. [PMID: 33584386 PMCID: PMC7875859 DOI: 10.3389/fpsyt.2021.612322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/04/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Extant research has provided evidence for disparities between patients with schizophrenia spectrum disorder (SSD) who have and have not experienced childhood maltreatment (CM) in terms of treatment outcome, psychopathology and their propensity to engage in offending behavior. However, research addressing all phenomena is scarce. Objective: The current study aims to explore differences between offender patients with SSD and CM and those with SSD and no CM in terms of their offending, psychopathology at different points in time and treatment outcome. Method: In the present explorative study, latent class analysis was used to analyze differences between 197 offender patients with SSD and CM and 173 offender patients with SSD and no CM, who were admitted to forensic psychiatric inpatient treatment between 1982 and 2016 in Switzerland. Results: Three distinct homogenous classes of patients were identified, two of which were probable to have experienced significant CM. One third of patients with SSD and CM were probable to benefit from inpatient treatment, even surpassing results observable in the group without CM, whereas the other group with SSD and CM was probable to benefit less. Patients with SSD and no CM displayed more psychopathology at first diagnosis and prior to their index offense. Interclass differences in offending behavior were minimal. Conclusions: Offender patients with SSD and CM differ not only from offender patients with SSD and no CM, but also amongst themselves. While some with SSD and CM experience a remission in psychopathology and improve their prognosis for future offending behavior, others do not. Directions for future research on SSD and CM are discussed.
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Affiliation(s)
- Steffen Lau
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Johannes Kirchebner
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Sabine Kling
- Computer Vision Laboratory, Department of Information Technology and Electrical Engineering, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital of Zurich, Zurich, Switzerland
| | - Moritz Philipp Günther
- Department of Consultation Psychiatry and Psychosomatics, University Hospital of Zurich, Zurich, Switzerland
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Janković M, van Boxtel G, Masthoff E, Caluwé ED, Bogaerts S. The Long-Term Changes in Dynamic Risk and Protective Factors Over Time in a Nationwide Sample of Dutch Forensic Psychiatric Patients. Front Psychiatry 2021; 12:737846. [PMID: 34603110 PMCID: PMC8481688 DOI: 10.3389/fpsyt.2021.737846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/05/2021] [Indexed: 11/13/2022] Open
Abstract
The long-term changes of dynamic risk and protective factors have rarely been studied in forensic psychiatric patients. We utilized a latent growth curve analysis to investigate trajectories of risk and protective factors over time in all 722 male forensic psychiatric patients who were unconditionally released between 2004 and 2014 from any of 12 Dutch forensic psychiatric centers (FPCs). The study covered the period from juridical observation until unconditional release. Moreover, we investigated whether these trajectories differ between patients depending on their psychiatric diagnosis namely substance use disorders (SUD), psychotic disorders, and cluster B personality disorders (PDs). In addition, we also investigated whether SUD may influence changes in risk and protective factors in a group of psychotic and cluster B PDs patients, respectively. Overall, findings suggest that all changes in dynamic risk and protective factors could be depicted by two phases of patients' stay in the FPCs. Specifically, most changes on dynamic risk and protective factors occurred at the beginning of treatment, that is, from the time of juridical assessment up to the time of unguided leave. Moreover, the moment of unguided leave could be considered the 'turning point' in the treatment of offenders. We also found that SUD and psychotic patients changed the most in the first phase of their stay, while cluster B PDs patients changed the most in the second phase. However, SUD did not modify changes in risk and protective factors in psychotic and cluster B PDs patients. These findings may help improve offender treatment and crime prevention strategies.
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Affiliation(s)
- Marija Janković
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands.,Fivoor Science and Treatment Innovation (FARID), Rotterdam, Netherlands
| | - Geert van Boxtel
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, Netherlands
| | - Erik Masthoff
- Fivoor Science and Treatment Innovation (FARID), Rotterdam, Netherlands
| | - Elien De Caluwé
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands
| | - Stefan Bogaerts
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands.,Fivoor Science and Treatment Innovation (FARID), Rotterdam, Netherlands
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Rytterström P, Rydenlund K, Ranheim A. The meaning of significant encounters in forensic care. Scand J Caring Sci 2020; 35:753-760. [PMID: 32691434 DOI: 10.1111/scs.12889] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/19/2020] [Accepted: 06/21/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Research in forensic psychiatric care focusing on person-oriented care is ambiguous about matters of quality. The encounters between a healthcare professional (HCP) and patient could influence how connections and relations emerge between the caregiver and the patient. OBJECTIVES To better understand caring aspects, this study explores significant encounters in forensic psychiatric care from the perspective of HCPs. METHOD This study is based on 34 written narratives from HCPs from two forensic psychiatric hospitals in Sweden. The narratives concern significant encounters with a patient. These narratives were analysed according to methodologies developed by phenomenological and reflective lifeworld research. FINDINGS The essence of a significant encounter is a temporal extended phenomenon that both precedes as well as is a consequence of the actual encounter as it occurs. The encounter is unforeseeable and being open to an encounter also means to be vulnerable as it is not predetermined how someone will respond. The significant encounter is an act of sharing, and HCPs may come to understand more about their patients as well as about themselves. Moreover, these encounters seem to create repercussions and hope for the future care. CONCLUSIONS The everyday activities of forensic psychiatric care are not trivial activities. Rather, they are important aspects of health care as these everyday encounters can deepen the relationship between the HCPs and their patients and help both the HCPs and their patients develop a sense of hope for the future.
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Affiliation(s)
- Patrik Rytterström
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Kenneth Rydenlund
- Research & Development Unit, Vadstena Forensic Hospital, Vadstena, Sweden
| | - Albertine Ranheim
- Division of Nursing, Department of neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden
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Kasmi Y, Duggan C, Völlm B. A comparison of long-term medium secure patients within NHS and private and charitable sector units in England. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2020; 30:38-49. [PMID: 32173951 DOI: 10.1002/cbm.2141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 02/11/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND In England, forensic psychiatric hospital services are provided at three security levels: high, medium and low. All are publicly funded and similarly regulated, but medium and low secure services are provided in the private and charitable (PCS) sector as well as the National Health Service (NHS). Originally, medium secure hospital services were conceived as for up to 2 years' inpatient stay, but numbers of longer stay patients have been rising. Little is known about their characteristics or whether they differ between NHS and PCS settings. AIMS To describe and compare characteristics of long-stay patients in NHS and in PCS medium security hospital units. METHODS Data were extracted from clinical records in 14 NHS and 9 PCS hospital units for all patients fulfilling criteria for long stay: having been in high security for more than 10 years or medium security for more than 5 years or in a mix of both for more than 15 years in total. RESULTS 178 NHS and 107 PCS patients were eligible for inclusion, respectively, 16 and 22% of the total patient populations in these settings. The mean length of stay in a medium or high secure setting was similar: 163 and 164 months. Characteristics of the patients, however, differed between unit type. NHS services admitted more patients from prison and PCS services more from other hospitals. NHS services included a lower proportion of patients with personality disorder or intellectual disability. 'Challenging behaviour' was more prevalent in PCS; a history of absconding was found more often among NHS patients. CONCLUSIONS The two systems of service appear to be used differently. More research is needed to explain why patients apparently without behavioural disturbances remain in specialist secure facilities for such a long time and whether their needs are truly being met in the least restrictive environment possible.
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Affiliation(s)
| | - Conor Duggan
- Division of Psychiatry and Applied Psychology, University of Nottingham, UK
| | - Birgit Völlm
- Department of Forensic Psychiatry, University of Rostock, Germany
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Senn D, Bulten E, Tomlin J, Völlm B. A Comparison of English and Dutch Long-Stay Patients in Forensic Psychiatric Care. Front Psychiatry 2020; 11:574247. [PMID: 33329112 PMCID: PMC7734324 DOI: 10.3389/fpsyt.2020.574247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background: A significant proportion of forensic patients in England are long-stayers. This can be problematic as individuals are kept in restrictive environments at potentially inappropriate levels of security for many years, sometimes decades. Improvements to the current English forensic mental health system to meet the needs of long-stay forensic patients more effectively might be informed by the Dutch service for long-stay forensic patients. Aims: To compare the characteristics of representative samples of long-stay patients in England and in the Netherlands in an attempt to draw conclusions on the degree to which the Dutch service model might be relevant to England. Method: This cross-sectional study explores the relevance of the Dutch service model by comparing the characteristics of representative samples of long-stay patients in England (n = 401) and the Netherlands (n = 102). Descriptive statistics and analyses of differences between groups are presented. The Risk-Need-Responsivity model was used to guide the selection of the study variables and structure the interpretation of the findings. Results: Compared to their English counterparts, the long-stay Dutch patients were less likely to be diagnosed with schizophrenia, but more likely to have personality disorder and have committed sex offences. The English group were younger at first conviction and at first custodial sentence. The total number of offences and the proportion of violent offenders were similar, but the Dutch HCR-20 scores indicated a significantly higher risk of violence. Conclusions: Whilst there may be barriers to adopting the Dutch service model in England, the differences in the characteristics of the two groups studied here do not necessarily preclude this approach.
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Affiliation(s)
- Dhanuja Senn
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Erik Bulten
- Pompe Foundation, Nijmegen, Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Jack Tomlin
- Department of Forensic Psychiatry, University of Rostock, Rostock, Germany
| | - Birgit Völlm
- Department of Forensic Psychiatry, University of Rostock, Rostock, Germany
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Abstract
SummaryForensic psychiatric services care for patients who present with a mental disorder as well as a risk to themselves or others, and have usually been convicted of an offence. Their needs are complex and the length of stay (LoS) in forensic settings is long. LoS is affected by patient factors as well as legal and policy issues. Owing to the considerable economic and ethical issues surrounding lengthy stays in highly restrictive settings, it is crucial that a strategy is developed for how to deal with this patient group.Declaration of interestNone.
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Di Lorito C, Vӧllm B, Dening T. Ageing patients in forensic psychiatric settings: A review of the literature. Int J Geriatr Psychiatry 2018; 33:1548-1555. [PMID: 30230604 DOI: 10.1002/gps.4981] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 08/06/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The prevalence of ageing patients in forensic psychiatric settings is increasing. However, limited research has reported around this population. The aim of this scoping review is to synthesise the current evidence around ageing forensic psychiatric patients. METHODS The literature was searched through four databases and Google searches. The identified outputs were screened for suitability and assessed for quality. Quantitative data were extracted and analysed on SPSS; qualitative data were extracted and analysed onto NVivo. RESULTS Seven studies were included in the review. Quantitative results reported around demographics, service contact, offending patterns, mental, and physical health of ageing patients. Qualitative findings focused on age-friendliness of services, staff-patient rapport, activities, security issues, and discharge planning. CONCLUSIONS Ageing forensic psychiatric patients present with complex and unique needs in relation to treatment, activities, mental, physical, and support. Further research looking at individual patients' needs is paramount to inform policy development and good practice in this area.
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Affiliation(s)
- Claudio Di Lorito
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Birgit Vӧllm
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tom Dening
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
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Richter MS, O’Reilly K, O’Sullivan D, O’Flynn P, Corvin A, Donohoe G, Coyle C, Davoren M, Higgins C, Byrne O, Nutley T, Nulty A, Sharma K, O’Connell P, Kennedy HG. Prospective observational cohort study of 'treatment as usual' over four years for patients with schizophrenia in a national forensic hospital. BMC Psychiatry 2018; 18:289. [PMID: 30195335 PMCID: PMC6129297 DOI: 10.1186/s12888-018-1862-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 08/27/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND We evaluated change in response to multi-modal psychosocial 'treatment as usual' programs offered within a forensic hospital. METHODS Sixty nine 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 participate and benefit from multi-modal psychosocial programs and the HCR-20 dynamic items, a measure of violence proneness. We report reliable change index (RCI) and reliable and clinically meaningful change (RMC). We assessed patients' cognition using the MCCB, psychopathology using the PANSS. The effect of cognition and psychopathology on change in DUNDRUM-3 was examined using hierarchical multiple regression with age, gender, and baseline DUNDRUM-3 scores. RESULTS The DUNDRUM-3 changed significantly (p < 0.004, d = 0.367, RCI 32% of 69 cases, RMC 23%) and HCR-20-C (p < 0.003, d = 0.377, RCI 10%). Both cognition and psychopathology accounted for significant variance in DUNDRUM-3 at follow up. Those hospitalized for less than five years at baseline changed more than longer stay patients. Mediation analysis demonstrated that the relationship between cognition and change in violence proneness (HCR-20-C) was both directly affected and indirectly mediated by change in DUNDRUM-3. CONCLUSIONS Change in response to multi-modal psychosocial programs (DUNDRUM-3) reduced a measure of violence proneness over four years. Forensic in-patients' ability to benefit from psychosocial treatment appears to be a function of the outcome measure used, unit of measurement employed, degree of cognitive impairment, psychopathology, and length of stay. Lower risk of re-offending may be partially attributable to participation and engagement in psychosocial interventions.
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Affiliation(s)
- Melanie S. Richter
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Department of Psychology, Maastricht University, Maastricht, The Netherlands
| | - Ken O’Reilly
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Danny O’Sullivan
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Padraic O’Flynn
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Aiden Corvin
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Gary Donohoe
- Department of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Ciaran Coyle
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Mary Davoren
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Caroline Higgins
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Orla Byrne
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Tina Nutley
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Andrea Nulty
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Kapil Sharma
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Paul O’Connell
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Harry G. Kennedy
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Department of Psychiatry, Trinity College, Dublin, Ireland
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Chester V, Völlm B, Tromans S, Kapugama C, Alexander RT. Long-stay patients with and without intellectual disability in forensic psychiatric settings: comparison of characteristics and needs. BJPsych Open 2018; 4:226-234. [PMID: 29988967 PMCID: PMC6034466 DOI: 10.1192/bjo.2018.24] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 04/04/2018] [Accepted: 04/30/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In recent years, concerns have been raised that too many patients stay for too long in forensic psychiatric services and that this is a particular problem in those with an intellectual disability. AIMS To compare the characteristics, needs, and care pathways of long-stay patients with and without intellectual disability within forensic psychiatric hospital settings in England. METHOD File reviews and questionnaires were completed for all long-stay patients in high secure and a representative sample of those in medium secure settings in England. Between-group analyses comparing patients with and without intellectual disability are reported. RESULTS Of the 401 long-stay patients, the intellectual disability and non-intellectual disability groups were strikingly similar on many sociodemographic, clinical and forensic variables. The intellectual disability group had significantly lower lengths of stay, fewer criminal sections, restriction orders and prison transfers, and higher levels of behavioural incidents and risk assessment scores. CONCLUSIONS In spite of similar offence histories and higher risk levels, those with intellectual disability appear to be diverted away from the criminal justice system and have shorter lengths of stay. This has implications about the applicability of the Transforming Care programme to this group.
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Affiliation(s)
- Verity Chester
- Research & Projects Associate, Priory Group, St John's House, Diss and PhD candidate, University of East Anglia, UK
| | - Birgit Völlm
- Professor in Forensic Psychiatry, Institute of Mental Health, University of Nottingham, UK
| | - Samuel Tromans
- Speciality Registrar, Leicestershire Partnership NHS Trust, Leicester & Academic Clinical Lecturer, Department of Health Sciences, University of Leicester, UK
| | - Chaya Kapugama
- Speciality Registrar, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Regi T. Alexander
- Consultant Psychiatrist, Hertfordshire Partnership University NHS Foundation Trust and Honorary Senior Lecturer, Department of Health Sciences, University of Leicester, UK
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