Long-Term Forensic Psychiatric Care Clinical, Ethical and Legal Challenges

This book provides an overview of forensic psychiatry, focusing on the provision of care in Europe as well as the legal and ethical challenges posed by long-term stays in forensic settings. Forensic psychiatric services provide care and treatment for mentally disordered offenders (MDOs) in secure in-patient facilities as well as in the community. These services are high-cost/low-volume services; they pose significant restrictions on patients and hence raise considerable ethical challenges. There is no agreed-upon standard for length of stay (LoS) in secure settings and patients’ detainment periods vary considerably across countries and even within the same jurisdiction. Thus far, little research has been conducted to identify factors associated with length of stay; consequently, it remains unclear how services should be configured to meet the needs of this patient group. This volume fills some of those gaps. Furthermore, it presents new research on factors associated with length ofstay, both patient-related and organisational. Various approaches to the provision of care for long-term patients in different countries are explored, including a few best practise examples in this specific area of psychiatry. The book also addresses the perspective of those working in forensic care by reviewing quality-of-life research and interviews with patients. The authors of this volume come from a range of professional backgrounds, ensuring a certain breadth and depth in the topic discussion, and even includes patients themselves as (co-)authors.

Preface.-Introduction.- Part I – The context: Asylums and deinstitutionalization: The Penrose hypothesis in the 21st century.-Challenges in comparing healthcare systems across different countries.- Long-term in forensic care in Europe.- Characteristic and needs of long-term patients in the UK.- Challenges in the provision of forensic services in Eastern Europe.- Ethical and human rights aspects of long-term.- Part II – Clinical aspects of long-term: What works for long-term forensic patients.- How to measure progress in forensic care.- Enhancing protective factors in the management of violence risk in long-term stay patients.- Challenges in the treatment of sex offenders.- Occupational therapy with long-term service users.- The importance of ward climate.- Quality of life in forensic settings.- Patient experiences of long-term.- A service user perspective.- Involving carers in forensic settings.- Part III – Alternative provision.- The closure of forensic-psychiatric institutions inItaly.- The Dutch model of long stay.- German long-term services in forensic settings.- Complementary model of long-term service as the result of reform of forensic psychiatry system after political transformation.- Attitudinal and organizational barriers to the introduction of long-term services.