eHealth in Treatment of Offenders in Forensic Mental Health: A Review of the Current State

Abstract

BackgroundTreatment of offenders in forensic mental health is complex. Often, these in- or outpatients have low treatment motivation, suffer from multiple disorders, and have poor literacy skills. eHealth may be able to improve treatment outcomes because of its potential to increase motivation and engagement, and it can overcome the predominant one-size-fits-all approach by being tailored to individual patients.ObjectiveTo examine its potential, this systematic review studies the way that eHealth has been used and studied in forensic mental health and identifies accompanying advantages and disadvantages for both patients and treatment, including effectiveness.MethodsA systematic search in Scopus, PsycINFO, and Web of Science was performed up until December 2017. Studies were included if they focused on technological interventions to improve the treatment of forensic psychiatric patients.ResultsThe search resulted in 50 studies in which eHealth was used for treatment purposes. Multiple types of studies and technologies were identified, such as virtual reality, web-based interventions, and videoconferencing. The results confirmed the benefits of technology, for example, the acquisition of unique information about offenders, effectiveness, and tailoring to specific characteristics, but indicated that these are not fully taken advantage of.DiscussionTo overcome the barriers and obtain the benefits, eHealth has to have a good fit with patients and the forensic psychiatric context. It has to be seamlessly integrated in existing care and should not be added as an isolated element. To bridge the gap between the current situation and eHealth’s potential, further research on development, implementation, and evaluation should be conducted.

Peer Review #2 of "mHealth technology for ecological momentary assessment in physical activity research: a systematic review (v0.1)"

“…Although mHealth technologies can help to provide objective EMA recordings, they also have some difficulties. For instance, the high cost of development and maintenance for mHealth Apps, the lack of standardization, data management, technical problems, slow connections, and so on are possible problems that should be borne in mind (128). In addition, mEMA devices could be expensive if they are only used for research purposes.…”

Putting the Value in VR

“…A recent systematic review pointed out that technology can be of added value for patients, therapists and the quality of care in forensic mental health in multiple ways [14]. This review included 50 studies that focused on a broad range of technologies, for example web-based interventions, serious games, videoconferencing, social platforms and virtual reality.…”

“…Furthermore, multiple studies found that therapists and even patients often have a positive attitude towards working with technologies such as VR in treatment, which might increase the usually low treatment motivation of patients [10]. Also, an important benefit of technology is that it can be tailored to individual patient characteristics to overcome a one-size-fits-all approach that does not fit the diverse forensic patient population [14]. A technology which has characteristics that are aligned with these benefits is virtual reality.…”

“…A technology that seems to fit the forensic psychiatric patient population is virtual reality (VR). Multiple studies indeed point out the added value of VR for forensic patients [14][15][16]. A recent qualitative study we conducted showed a broad range of potential advantages of VR for forensic mental healthcare [17].…”

“…Partly because of the complex and unique nature of this population, existing eHealth technologies cannot be copypasted into this domain and are often not as successful as expected [13]. Consequently, more attention should be paid to the development of useful technologies for this target group and accompanying development methods that suit its unique characteristics [14].…”