Long-Term Forensic Mental Health Services: An Exploratory Comparison of 18 European Countries

Sampson, Stephanie; Edworthy, Rachel; Völlm, Birgit; Bulten, Erik

doi:10.1080/14999013.2016.1221484

Cited by 59 publications

(60 citation statements)

References 44 publications

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“…Most countries allow detention of MDOs beyond the length of prison sentence their offence would have attracted had they been imprisoned [33]. However, some-Croatia, Italy, Portugal-limit the time of psychiatric detention to the time the individual would have served had they not been mentally disordered and had received a custodial sentence.…”

Section: A European Perspective On Forensic Psychiatrymentioning

confidence: 99%

European Psychiatric Association (EPA) guidance on forensic psychiatry: Evidence based assessment and treatment of mentally disordered offenders

et al. 2018

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Forensic psychiatry in Europe is a specialty primarily concerned with individuals who have either offended or present a risk of doing so, and who also suffer from a psychiatric condition. These mentally disordered offenders (MDOs) are often cared for in secure psychiatric environments or prisons. In this guidance paper we first present an overview of the field of forensic psychiatry from a European perspective. We then present a review of the literature summarising the evidence on the assessment and treatment of MDOs under the following headings: The forensic psychiatrist as expert witness, risk, treatment settings for mentally disordered offenders, and what works for MDOs. We undertook a rapid review of the literature with search terms related to: forensic psychiatry, review articles, randomised controlled trials and best practice. We searched the Medline, Embase, PsycINFO, and Cochrane library databases from 2000 onwards for adult groups only. We scrutinised publications for additional relevant literature, and searched the websites of relevant professional organisations for policies, statements or guidance of interest. We present the findings of the scientific literature as well as recommendations for best practice drawing additionally from the guidance documents identified. We found that the evidence base for forensic-psychiatric practice is weak though there is some evidence to suggest that psychiatric care produces better outcomes than criminal justice detention only. Practitioners need to follow general psychiatric guidance as well as that for offenders, adapted for the complex needs of this patient group, paying particular attention to long-term detention and ethical issues.

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Section: A European Perspective On Forensic Psychiatrymentioning

confidence: 99%

European Psychiatric Association (EPA) guidance on forensic psychiatry: Evidence based assessment and treatment of mentally disordered offenders

et al. 2018

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“…In addition, doubts have been raised about the benefits of prolonged inpatient treatment for patients' rehabilitation (3,7). Prolonged duration of inpatient treatment has been discussed as an indicator of economic inefficiency -particularly for forensic inpatient treatment, which constitutes a low-volume high-cost sector (3,(8)(9)(10)(11)(12)(13)(14). The internationally observed prolongation of forensic hospitalizations in the past years (1,3,7,(15)(16)(17), as well as the ever-growing demand for forensic services (18)(19)(20)(21), have become a subject of socio-political debate with urgent need for more research on avenues to reduce the duration of inpatient treatments in order to reduce exploding costs whenever possible (2,4).…”

Section: Background and Objectivesmentioning

confidence: 99%

Factors And Predictors Of Length Of Stay In Offenders Diagnosed With Schizophrenia- A Machine-learning-based Approach

Kirchebner

Günther

King

et al. 2020

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Background Prolonged forensic psychiatric hospitalizations have raised ethical, economic, and clinical concerns. Due to the confounded nature of factors affecting length of stay of psychiatric offender patients, prior research has called for the application of a new statistical methodology better accommodating this data structure. The present study seeks to examine factors responsible for prolonged detentions of schizophrenic offenders referred to a Swiss forensic hospital using machine learning algorithms more apt to reveal non-linear interdependencies between variables.Methods In this retrospective file and registry study, multidisciplinary notes of 143 schizophrenic delinquents were reviewed by using a structured protocol on patients’ characteristics, criminal and medical history and course of treatment. Via a forward selection procedure, the most influential predictors for length of stay were preselected. Machine learning algorithms identified the most efficient model for predicting length-of-stay.Results/ Conclusions Ten factors prolonging forensic hospitalization were identified: Six were related to aspects of the index offence (index offence, number of crimes, extend of injury to the victim of the offence), two were related to psychopathology at admission or even prior to that (hallucinations in psychiatric history), one alluded to the course of therapy (self-harming during inpatient treatment), and one referred to biographical aspects (poverty during childhood/ adolescence). Results are discussed in light of earlier reports on the subject.

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“…and even between different regions within countries, suggesting substantial geographical variation in treatment standards, structural conditions of forensic care, as well as legal procedures (11,16,29,32). Switzerland, the setting of the present study, is not among the 11 countries in which length of stay has been explored so far (6), thus providing new information on geographical inconsistencies.…”

Section: Studies Revealed Considerable Differences In Duration Of Formentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors and Predictors of Length of stay in Offenders diagnosed with schizophrenia- A Machine-learning-based approach

Kirchebner

Günther

Sonnweber

et al. 2020

Preprint

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Background: Prolonged forensic psychiatric hospitalizations have raised ethical, economic, and clinical concerns. Due to the confounded nature of factors affecting length of stay of psychiatric offender patients, prior research has called for the application of a new statistical methodology better accommodating this data structure. The present study attempts to investigate factors contributing to long-term hospitalization of schizophrenic offenders referred to a Swiss forensic institution, using machine learning algorithms that are better suited than conventional methods to detect nonlinear dependencies between variables. Methods: In this retrospective file and registry study, multidisciplinary notes of 143 schizophrenic offenders were reviewed using a structured protocol on patients’ characteristics, criminal and medical history and course of treatment. Via a forward selection procedure, the most influential factors for length of stay were preselected. Machine learning algorithms then identified the most efficient model for predicting length-of-stay. Results: Two factors have been identified as being particularly influential for a prolonged forensic hospital stay, both of which are related to aspects of the index offense, namely (attempted) homicide and the extent of the victim's injury. The results are discussed in light of previous research on this topic. Conclusions: In this study, length of stay was determined by legal considerations, but not by factors that can be influenced therapeutically. Results emphasize that forensic risk assessments should be based on different evaluation criteria and not merely on legal aspects.

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Long-Term Forensic Mental Health Services: An Exploratory Comparison of 18 European Countries

Cited by 59 publications

References 44 publications

European Psychiatric Association (EPA) guidance on forensic psychiatry: Evidence based assessment and treatment of mentally disordered offenders

European Psychiatric Association (EPA) guidance on forensic psychiatry: Evidence based assessment and treatment of mentally disordered offenders

Factors And Predictors Of Length Of Stay In Offenders Diagnosed With Schizophrenia- A Machine-learning-based Approach

Factors and Predictors of Length of stay in Offenders diagnosed with schizophrenia- A Machine-learning-based approach

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