Exploring Needs and Quality of Life of Forensic Psychiatric Inpatients in the Reformed Italian System, Implications for Care and Safety

Abstract

The Italian forensic psychiatric system underwent drastic reforms. The newly developed facilities are inspired by psychiatric community services, embracing a recovery-oriented approach. Needs and quality of life are broader concepts that consider the more rehabilitative and humanitarian aspects of treatment. In one of the new Italian forensic psychiatric services, this cross-sectional study aimed to investigate the needs and quality of life of forensic psychiatric patients. A second aim was to validate the Italian version of the Forensic inpatient Quality of Life questionnaire Short Version (FQL-SV). Overall, 42 forensic psychiatric patients were assessed using the Forensic version of the Camberwell Assessment of Need (CANFOR), the Historical-Clinical-Risk-Management-20 (HCR-20), the FQL-SV, and the World Health Organization Quality of Life (WHOQoL-Bref). Patients reported significantly fewer needs, whether met or unmet, than their treating clinicians. The general level of agreement between patients and clinicians on specific needs was low Kappa values were < .40 for 64% of the total needs and 46% of the unmet needs. Risk factors according to the HCR-20 mean scores were 13.1, 4.6, and 6.4 for the historical, clinical and risk management subscale. Quality of life was moderate to high for 74% of the patients. Our results showed that lower numbers of needs, whether reported by patients or clinicians, were associated with a better quality of life. The Italian FQL-SV had a Cronbach's alpha of 0.86 and correlated as expected with the WHOQoL-Bref. The FQL-SV is a valid and reliable tool, justifying its use for routinely assessing QoL in Italian forensic psychiatric services. This study enhances our understanding of needs and quality of life of forensic psychiatric patients and how their assessment could have an additional value for recoveryoriented treatment in forensic psychiatry. Although the detained status of forensic patients imposes real limits on the capacity for autonomy and choice, incorporating the patient's perspective on decision-making processes, in relation to aspects of treatment, care, and daily life, may have benefits such as a better treatment adherence or therapeutic alliance. Future research should clarify how routinely assessing needs and quality of life can contribute to the recovery of these forensic psychiatric patients.

The Perspective of Forensic Inpatients With Psychotic Disorders on Protective Factors Against Risk of Violent Behavior

“…Previous findings have indicated that staff rate service users as having higher needs than indicated by the service users themselves in non-forensic samples (27). Additionally, the forensic version of the Camberwell Assessment of Need (CANFOR) found a gap between the perceived needs of patients as assessed by clinicians and patients themselves (28,29). Forensic patients reported significantly fewer needs, whether met or unmet, than did their treating clinicians (28), which is consistent with findings from non-forensic patients.…”

Needs of forensic psychiatric patients with schizophrenia in five European countries

“…In contrast, patients rated more unmet needs. Nearly all studies reported that staff assessed more total needs than patients [31,34,35]. While in some studies patients reported higher numbers of unmet needs than staff [30,32], others reported higher numbers according to staff [35].…”

“…Nearly all studies reported that staff assessed more total needs than patients [31,34,35]. While in some studies patients reported higher numbers of unmet needs than staff [30,32], others reported higher numbers according to staff [35]. Segal et al [30] hypothesized that higher numbers of unmet needs among patients might exist regardless of current interventions being provided in the inpatient setting.…”

Forensic Mental Health in Europe: Shared Legal Heritage and Contemporary Landscape

“…Some commentators have highlighted a lack of clear and consistent treatment approaches nationally, and raised the need for specialised treatments and pathways for specific patient groups [30]. Studies are investigating the effectiveness of the REMs [31], the results of which are being watched around Europe.…”