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 of stay, 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.
Birgit Völlm has been the Medical Director of the Forensic psychiatric hospital and Professor in Forensic Psychiatry at the University of Rostock since 2018. Before that she was a Professor of Forensic Psychiatry at the University of Nottingham and an Honorary Consultant Forensic Psychiatrist in the Enhanced Service for Personality Disorders (previously Dangerous & Severe Personality Disorders) at Rampton high secure hospital in the UK. Prof Völlm is a member (previously Chair) of the Board of the Forensic Section of the European Psychiatric Association and the Vice-Chair of the Forensic Section of the World Psychiatric Association. She was one of the experts on the NICE guidance group on the management of violence. Her main research interests include the neurobiology of antisocial personality disorders and social cognition, treatment of personality disorders, service development, comparisons between service delivery in different European countries and ethical issues in forensic psychiatry. She has held national and European grants on long-stay in forensic settings, the effectiveness of Individual Placement Support for forensic patients and on Circles of Support and Accountability for the reintegration of sex offenders into the community. She has published over 100 scientific papers and book chapters.
Peter Braun is a psychologist and psychotherapist of the Pompe Foundation which is the forensic service of the Mental Health Organization Pro Persona in the Netherlands. He is also member of the Netherlands Register of Court Experts, member of the Dutch Institution for Psychologists (N.I.P.) and E.M.D.R. trained therapist. He was Chair of the European COST Action IS 1302 concerning a European Research Framework for (longterm) Forensic Psychiatry. He is member of the International Association for Forensic Mental Health Services and Chair of the Special Interest Group of that organization on Longterm Forensic Psychiatry. He is the Head of the Longterm Forensic Psychiatric Services in the Netherlands. He is interested in longterm forensic care and the effects of treatment atmosphere and nursing environment on quality of life and treatment results. He has cooperated in some studies concerning Quality of Life. He wrote a few chapters and articles on longterm forensic care
1. IntroductionPart-1: The context2. Asylums and deinstitutionalisation: The Penrose hypothesis in the 21st century3. Challenges in comparing healthcare systems across different countries4. Long stay in Europe: a system oriented approach5. Ethical aspects of long-stay forensic psychiatric care6. Prevalence and characteristics of long-stay patients: Results from a study in EnglandPart-2: Clinical aspects of long-stay7. Recovery and strength-based practice in long-term forensic psychiatry8. How to measure progress in forensic care9. Enhancing protective factors in the management of violence risk in long-term psychiatric care 10. Quality of life in long-term clinical forensic psychiatry11. Occupational therapy with long-stay service users12. Challenges in the treatment of sex offenders13. Long-stay and ageing14. The experience of long-stay in secure psychiatric hospitals in the UK: the patient perspective15. Forensic carers and secure inpatient servicesPart-3: Service models and alternative provision16. Long-term forensic psychiatric care: The Dutch perspective17. Long-stay services in German forensic settings18. Forensic psychiatric care in Belgium 19. Challenges in the provision of forensic services in the Baltic states20. Complementary model of long-term care in Poland as a result of the political transformation, law reform and service changes in forensic psychiatry21. History and organization of long-stay forensic care in Croatia22. The closure of forensic-psychiatric institutions in Italy 23. Attitudinal and organisational barriers to the introduction of long-stay services