Forensic mental health in Europe: some key figures

Abstract

Purpose While the number of forensic beds and the duration of psychiatric forensic psychiatric treatment have increased in several European Union (EU) states, this is not observed in others. Patient demographics, average lengths of stay and legal frameworks also differ substantially. The lack of basic epidemiological information on forensic patients and of shared indicators on forensic care within Europe is an obstacle to comparative research. The reasons for such variation are not well understood. Methods Experts from seventeen EU states submitted data on forensic bed prevalence rates, gender distributions and average length of stay in forensic in-patient facilities. Average length of stay and bed prevalence rates were examined for associations with country-level variables including Gross Domestic Product (GDP), expenditure on healthcare, prison population, general psychiatric bed prevalence rates and democracy index scores. Results The data demonstrated substantial differences between states. Average length of stay was approximately ten times greater in the Netherlands than Slovenia. In England and Wales, 18% of patients were female compared to 5% in Slovenia. There was a 17-fold difference in forensic bed rates per 100,000 between the Netherlands and Spain. Exploratory analyses suggested average length of stay was associated with GDP, expenditure on healthcare and democracy index scores. Conclusion The data presented in this study represent the most recent overview of key epidemiological data in forensic services across seventeen EU states. However, systematically collected epidemiological data of good quality remain elusive in forensic psychiatry. States need to develop common definitions and recording practices and contribute to a publicly available database of such epidemiological indicators.

Outcome measures in forensic mental health services: A systematic review of instruments and qualitative evidence synthesis

“…While seven instruments had some evidence for responsiveness, this property was only deemed adequate for the VRS and SAPROF. Demonstrating reliable change in this population can be challenging, due to the long timescales involved [59]. Admissions to inpatient forensic psychiatric care often last years.…”

“…Forensic mental health services provide care for people with mental illness who pose a risk to others and have typically perpetrated acts of violence or other antisocial behaviors [1]. The structure and legal framework governing such services varies considerably between and even within countries [2,3]. Demand for such services is rising in many high income countries, with increasing inpatient capacity [4].…”

A Comparison of English and Dutch Long-Stay Patients in Forensic Psychiatric Care

“…It would be a valuable exercise to investigate patient-level, as well as cultural, legal and systemic differences, across a wider number of countries. Some studies have attempted this (50), and whilst all acknowledge the difficulties of international comparison, call for more effort in this line of inquiry (55). A fruitful addition to such research would be the inclusion of a validated need assessment tool, such as the CANFOR or HoNOS-Secure (56).…”

Clinical Characteristics and Self-Harm in Forensic Psychiatric Patients

“…Forensic psychiatric patients (~1,800) ( 16 ) are a relatively small group compared with the significantly larger group of people imprisoned in Sweden (~5,000) each year ( 17 ). In international comparisons, it has been demonstrated a significant variation in both the number of forensic beds available, length of care and patient group characteristics [e.g., gender distribution; ( 18 )] Nevertheless, a common denominator for all forensic psychiatric contexts is that forensic psychiatric patients require substantial effort and skill in terms of health care and intervention. These patients' clinical presentations are characterized by a complex spectrum of mental disorders and comorbid psychosocial problems, antisocial behaviors, and early adverse experiences ( 16 , 19 ).…”