A Thorn in the Flesh? Forensic Inpatients in General Psychiatry

Abstract

Nationwide training and teaching as well as knowledge exchange between specialized forensic psychiatry and general psychiatry are recommended. Further exploration is needed on patient perspectives and on avenues to increase efficiency and decrease bottlenecks throughout the clinical pathways. Furthermore, we need additional knowledge of the impact on general patient populations' resources for treatment and their safety.

Modern forensic psychiatric hospital design: clinical, legal and structural aspects

“…The process of deinstitutionalization of psychiatric care in many Western nations is coming to be understood, rather, as a more complex process of trans- or reinstitutionalization from traditional psychiatric hospitals to supported housing, prisons and, not least, forensic psychiatric units [ 19 , 22 , 27 ]. As a result, authorities in many countries have come under increased pressure to both expand and update their forensic psychiatric services [ 17 , 90 – 93 ], so as to respond more effectively to the needs of mentally ill offenders and other psychiatric patients with similar needs. Simultaneously, an increased focus on patient and carer rights and involvement has emerged throughout the development and implementation of healthcare services [ 94 , 95 ], as have international monitoring standards to uphold human rights within psychiatric institutions [ 68 ].…”

“…In some EU member states, not only mentally disordered offenders, but other aggressive, violent or otherwise high-risk patients referred from general psychiatric facilities may be admitted to forensic facilities [ 12 , 14 ]. This can cause strain between services, as general psychiatry may develop a tendency towards outsourcing to forensic psychiatry the treatment—particularly coercive interventions—of patients viewed as somehow troublesome [ 16 ] and, on the other hand, forensic patients may be seen to block beds needed for patients with more acute presentations [ 17 ]. In any case, interaction between general psychiatric services and forensic psychiatry is essential, and inevitable: the majority of patients in forensic units have had previous contact with general psychiatric services and will require transfer back to communal care at some point in their psychiatric treatment [ 18 ].…”

“…The trend is being reinforced by developments in information technology, which are continually offering new treatment possibilities and environments for psychiatric care [ 20 ]. Arguably, the trend towards deinstitutionalization of general psychiatric patients has contributed to increasing the number of placements in forensic psychiatric facilities and raising the demand for supported housing, in a process of re- or trans-institutionalization [ 17 , 19 , 21 , 22 ]. This is not a new area of enquiry; the relationship between the decrease in general psychiatric bed numbers and the expansion of the prison population suffering from mental health issues has been a focus of intense research and debate since the 1930’s, when Penrose introduced his “Law”, according to which the size of the prison population is inversely related to the available number of psychiatric hospital beds [ 23 ].…”

Long-Term Violent Reoffending Following Forensic Psychiatric Treatment: Comparing Forensic Psychiatric Examinees and General Offender Controls

“…However, throughout Europe (5) and North America, FP patient care is organized and administered differently due to dissimilar legislation, judicial and court practices, and organization of forensic and mental health services. Such variability even occurs across otherwise quite comparable Nordic welfare states (6). In clinical practice with FP patients, on the other hand, treatment goals are generally two-sided—optimal treatment of psychopathology and reduction of criminal re-offending (7).…”

Forensic psychiatric patients’ perceptions of situations associated with mechanical restraint: A qualitative interview study

“…In line with the aim of this study, only those currently categorized as being forensic patients were interviewed. However, in Denmark, the treatment of forensic patients is not restricted to forensic settings (Møllerhøj et al 2016) and, as a consequence, many of the participants had been restrained in either or both forensic and general psychiatric settings (and a few in prison settings).…”