Teleconferencing model for forensic consultation, court testimony, and continuing education

A medical center-based forensic clinic that provides the necessary comprehensive consultation, continuing education, court testimony, and clinical services through an applied model of teleconferencing applications is addressed. Telemedicine technology and services have gained the attention of both legal and clinical practitioners, examining trends and models of health care for underserved populations, and identifying where consultation with a team of professionals may benefit service providers in rural communities. The contribution offered herein provides an understanding of the history of the development of the clinic, a theoretical model that has been applied to a clinical forensic program that employs telepsychiatry services, and the ethical and malpractice liability issues confronted in using teleconferencing services. This model is examined through a child and adolescent forensic evaluation clinic. The goals of this model are offered, as are a number of applications within the broad spectrum of services utilizing telemedicine. Finally, changing patterns are addressed in clinically based health-care delivery for criminal justice, social services, and forensic mental health.

Ethics education

This article briefly describes the background and status of medical education in the areas of ethics and professionalism. Methods of teaching and assessment are described for medical students, residents, and practitioners within the core competency framework of medical education. Key areas of content for child and adolescent psychiatrists are described.

Die forensisch-psychiatrische Versorgung in Mitgliedstaaten der Europäischen Union - Versorgungskonzepte und Kapazitäten

OBJECTIVE

Internationally, there is a variety of approaches and concepts for placing and treating mentally disordered offenders in forensic-psychiatric care. European overviews are missing. Major indicators have not been standardized yet, which is a serious obstacle for cross-boundary comparisons.

METHODS

Basic concepts, legal frameworks, service provision and prevalences in forensic care of 15 European Union Member States were assessed by an expert evaluation. Administrative data was compared and conclusions for a possible harmonization of approaches were drawn.

RESULTS

The placement and treatment of mentally disordered offenders in the European Union Member States is characterized by a considerable variety of concepts and practice routines. National health reporting standards and the quality of available administrative data is poor. On the basis of available information, models of good practice are hard to choose.

CONCLUSIONS

National and cross-boundary research should be intensified. Defining European quality and training standards in forensic psychiatry seems to be an activity to be started on a short term basis.

Evaluation of a forensic psychiatric setting to provide a graduate nurse programme

There has been growth in the number and diversity of models of Australian graduate nurse programmes in psychiatric nursing. Programmes have also been established in specialist areas, and evidence is needed regarding best models of graduate nurse programmes and the ability of specialist areas to prepare nurses for psychiatric nursing. This paper reports on a qualitative project that examined the adequacy of a forensic psychiatric hospital to provide a graduate nurse programme. Individual, semistructured interviews were undertaken with nurses participating in the programme, and nurses who had completed the programme and had remained at the hospital or were nursing in other areas. Participants identified that the environment was safe and supportive of professional practice and development, and that skilled nurses were willing to encourage and teach graduates. Processes such as orientation, preceptorship and academic study were appreciated; however, their colleagues' willingness to be available, to teach, and to support were more valued. Participants reported that they felt confident and prepared as psychiatric nurses. Although limitations of undertaking a graduate nurse programme in a forensic setting were identified, the participants from past programmes who had gone on to work in other services did not report that their nursing careers had been disadvantaged. It can be concluded that as long as the context of the programme has adequate resources to support and assist graduates to develop the skills, knowledge and attitudes of psychiatric nursing, then the specialist nature may not be a limitation.

Cognitive-attitudinal aspects of key-worker's talk about their patients in forensic psychiatric institutions

SCOPE

Within an international network study involving four European countries (COMSKILLS), results on clinical-qualitative data are reported and discussed. A total of 103 semi-structured interviews were conducted, representing 45 per cent of the patients involved in the project (N=231).

METHOD

The coding framework represents a means of identifying and measuring aspects of complexity and specificity in the way in which key workers talk about care in relation to individual patients.

RESULTS

Respondents talked about patient care most frequently in terms of coping behavior and working relationships with patients. The commonest method cited for information gathering was observation. Out of three conceptual levels, ranging from complex and specific responses (conceptual level 3), to relatively general and unspecific remarks (level 1), most responses were coded at Levels 1 or 2.

CONCLUSIONS

Taking into account the apparent reluctance of many clinical staff to make use of standardized assessment instruments, systematic treatment-oriented methods able to both allow for valid and reliable assessments and to structure clinical experience is needed. It is expected that complexity and specificity care is referred to will profit from the regular use of such a method (e.g. the BEST-Index).

Authorship in forensic psychiatry: a perspective

Authorship in forensic psychiatry is a life-long commitment to learning, creativity, and professional growth. Forensic psychiatrists are writers, by choice and by necessity. The key concepts to effective writing in forensic psychiatry are "process" and a "workman-like approach." The process of writing is not a dash to the finish line, but is more akin to a leisurely, enjoyable walk. A workman-like approach to writing ensures that the author's writing is a process, not an event. Effective writing enhances clarity of communications with attorneys, judges, and others in the legal system. Writing with clarity and precision is a core competency in forensic psychiatry.

Commentary: authorship and training in forensic psychiatry

This commentary is written in praise of Dr. Simon's Presidential Address with exemplification of certain of his themes. Forensic fellowships have now become the training ground for the next generation of forensic psychiatrists, who need to be encouraged to find their own best way to write. They should also be encouraged to participate in research with senior mentors and researchers, as published research will lead to the challenging of stereotyping and misinformation about the populations served by forensic psychiatry.

The forensic mental health nurse - a literature review

Forensic mental health nursing has developed in the UK since the commissioning of Broadmoor Hospital in 1863. Little has been documented about the role until the early 1990s. There is debate over the usefulness of defining the role. It is suggested here that in order to meet the multifaceted, complex needs of the mentally disordered offender (MDO) patient group, the role of forensic mental health nurses (FMHNs) needs to be further developed, and this process is assisted by understanding its current status. This literature review examines the FMHN role in England and Wales. The literature pertinent to issues of task-orientated competence, knowledge and skills required, and desirable personal qualities that the role demands are examined. The latter of these attributes concerned with attitudes, values and morals is likely to be the most difficult to assess. Being able to isolate the composite elements of the role of FMHNs will enable the development of a competency framework, which will ensure quality assurance in contemporary health care for the thousands of FMHNs in practice and many more thousands of MDOs and other patients that the nurse has the potential to affect.

Forensic psychiatric assessment in European Union member states

OBJECTIVE

To provide a structured description and cross-boundary comparison of legal frameworks and training standards relevant for forensic psychiatric assessment in European Union member states before the extension in May 2004.

METHOD

Information on legislation and practice concerning the assessment of mentally disordered offenders was gathered by means of a detailed, structured questionnaire which was filled in by national experts.

RESULTS

Legal frameworks for the assessment and reassessment of mentally disordered offenders and professional training standards in forensic psychiatry vary markedly across EU member states.

CONCLUSION

Currently a cross-boundary harmonization of legal concepts appears hard to achieve. At least a formal construction and implementation of specialist training standards in forensic psychiatry would appear desirable.

Verbal and social interactions in Swedish forensic psychiatric nursing care as perceived by the patients and nurses

Patients and nurses in a Swedish forensic psychiatric unit filled in a questionnaire Verbal and Social Interactions designed to survey patients' and nurses' views on the frequency and importance of nursing interactions in forensic psychiatric care. The patients perceived the 'supportive/encouraging interactions' and the 'reality orientation interactions' as the most frequent interactions and the 'supportive/encouraging interactions' and the 'social skills training' as the most important interactions. The nurses perceived the 'supportive/encouraging interactions' and the 'practical skills training' as the most frequent and the 'supportive/encouraging interactions', 'interpretative interactions' and the 'practical skills training' as the most important interactions. There were significant differences between patients' and nurses' perceptions about the frequency of all the different groups of interactions, but greater agreement as to the importance. In general, the patients perceived that the interactions occurred less frequently than the nurses. The differences between patients' and nurses' perceptions on the interactions as well as the clinical implications of these differences are discussed.

Use of a routine mental health measure in an adolescent secure unit

We examined the use of a staff-completed measure, the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), to record mental health problems in adolescents in local authority secure accommodation. It proved possible to train staff and implement completion of the HoNOSCA on 64 consecutive admissions. Interrater reliability was high. The HoNOSCA identified high levels of psychological problems on admission (mean 18.5, s.d.=5.5). Follow-up HoNOSCA ratings proved sensitive to change; however, correlation between HoNOSCA and adolescent-completed questionnaires was poor. We concluded that HoNOSCA can be helpful in documenting mental health problems among young people admitted to secure local authority units.

[Current problems in psychiatric health care in Poland (2005)]

The paper is a presentation of the most important and actual psychiatric health care problems in Poland: the financial situation of hospitals, the risk faced by the out-patient psychiatric care,ethical problems related to clinical practice, as well as issues on postgraduate education.

Clinician perceptions of personal safety and confidence to manage inpatient aggression in a forensic psychiatric setting

Inpatient mental health clinicians need to feel safe in the workplace. They also require confidence in their ability to work with aggressive patients, allowing the provision of therapeutic care while protecting themselves and other patients from psychological and physical harm. The authors initiated this study with the predetermined belief that a comprehensive and integrated organizational approach to inpatient aggression was required to support clinicians and that this approach increased confidence and staff perceptions of personal safety. To assess perceptions of personal safety and confidence, clinicians in a forensic psychiatric hospital were surveyed using an adapted version of the Confidence in Coping With Patient Aggression Instrument. In this study clinicians reported the hospital as safe. They reported confidence in their work with aggressive patients. The factors that most impacted on clinicians' confidence to manage aggression were colleagues' knowledge, experience and skill, management of aggression training, use of prevention and intervention strategies, teamwork and the staff profile. These results are considered with reference to an expanding literature on inpatient aggression. It is concluded that organizational resources, policies and frameworks support clinician perceptions of safety and confidence to manage inpatient aggression. However, how these are valued by clinicians and translated into practice at unit level needs ongoing attention.

Assessing decision-making capacity: a survey of psychiatrists' knowledge

We aimed to survey the knowledge of psychiatrists on the assessment of decision-making capacity. Ninety-two psychiatrists of all grades and three other doctors attending a regional conference were marked on their verbal response to the question 'What are the key elements in the assessment of a patient's capacity?' On average, participants mentioned three out of the five elements in testing decision-making capacity. Scores were negatively correlated with age (Pearson's coefficient 0.275, sig 0.007). Section 12 status and grade had no impact on knowledge. Most psychiatrists of all grades have a reasonable knowledge of assessing decision-making capacity. Over a third of participants mentioned two or fewer of the five points, suggesting inadequate knowledge. Assessing decision-making capacity needs to be emphasised in training throughout psychiatrists' careers--not just at the start.