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Ojansuu I, Latvala A, Kautiainen H, Forsman J, Tiihonen J, Lähteenvuo M. General and violent recidivism of former forensic psychiatric patients in Finland. Front Psychiatry 2023; 14:1157171. [PMID: 37457767 PMCID: PMC10339800 DOI: 10.3389/fpsyt.2023.1157171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/31/2023] [Indexed: 07/18/2023] Open
Abstract
Background Forensic psychiatric care in Finland is provided to individuals who have committed a crime due to a serious mental disorder and are in need of psychiatric care. The reconviction (recidivism) rates for this patient group vary in time and between countries, likely due to different treatment practices and requirements for forensic care. Materials and methods We set out to study criminal recidivism in a national cohort of all patients released from forensic psychiatric care in Finland between 1999 and 2018. National registries were used to identify the patients and gain information on their criminal sentences. Forensic psychiatric examinations were used to record demographic information for the cohort. The cohort was followed up from hospital discharge to the end of 2019. Results We identified a total of 501 patients who were released from forensic psychiatric care (mean age: 46.6 years [SD 13.4), 434 (86.6%) were male). The mean and median times spent in treatment for the cohort was 10.0 years [SD 6.5] and 8.7 years, respectively. 91% of the patients had schizophrenia spectrum disorder (F2*), and 63.5% had a substance use disorder. A total of 83 patients (16.6%) committed any crime after being released from care, and the mean time to recidivism was 3.8 years. The recidivism rate was 2015 per 100,000 person years. A total of 48 patients (9.6%) committed a violent crime. The mean time to violent recidivism was 4.2 years. The violent recidivism rate was 1,083 per 100,000 person years. A longer duration of treatment was associated with a decreased risk of general recidivism (HR 0.95, 95% CI 0.90 to 1.00, p = 0.05). Factors associated with higher recidivism were male sex, having a comorbid substance use disorder and younger age at discharge. Conclusion The recidivism rate in Finland was markedly lower than has been previously reported for other Western countries, and the mean duration of treatment was also longer. A longer treatment time may reduce the risk of criminal recidivism in forensic psychiatric patients. The results suggest, as previous studies have found, that more effort is indicated on the treatment of substance abuse.
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Affiliation(s)
- Ilkka Ojansuu
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Antti Latvala
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Jonas Forsman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Swedish National Board of Forensic Medicine, Stockholm, Sweden
| | - Jari Tiihonen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Markku Lähteenvuo
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
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Forget K, Gagné P, Douyon SS, Poirier C, LeBlanc J, Bilodeau MC, Corff YL. Psychiatric Relapse and Criminal Recidivism of Individuals Found Not Criminally Responsible on Account of Mental Disorder After Absolute Discharge. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:864-866. [PMID: 35929073 PMCID: PMC9561695 DOI: 10.1177/07067437221116983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Karine Forget
- Département de psychiatrie, 12370Université de Sherbrooke, Sherbrooke, Quebec, Canada.,Groupe de recherche et d'intervention sur les adaptations sociales de l'enfance de l'Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Pierre Gagné
- Département de psychiatrie, 12370Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | | | - Clémence Poirier
- Département de psychiatrie, 12370Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jolène LeBlanc
- Département de psychiatrie, 12370Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marie-Claude Bilodeau
- Département de psychiatrie, 157801Hôpital Sainte-Croix, Drummondville, Quebec, Canada
| | - Yann Le Corff
- Département de psychiatrie, 12370Université de Sherbrooke, Sherbrooke, Quebec, Canada.,Groupe de recherche et d'intervention sur les adaptations sociales de l'enfance de l'Université de Sherbrooke, Sherbrooke, Quebec, Canada.,Département d'orientation professionnelle, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Wirove RL, Olver ME, Haag A. Discrimination and Calibration Properties of the Violence Risk Appraisal Guide-Revised in a Not Criminally Responsible Provincial Population. Assessment 2022:10731911221116564. [PMID: 36031861 DOI: 10.1177/10731911221116564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined the discrimination and calibration properties of the Violence Risk Appraisal Guide-Revised (VRAG-R) within a large subset of the population of 574 individuals who had been found Not Criminally Responsible on Account of Mental Disorder (NCRMD) in Alberta. The VRAG-R was scored on all individuals identified via The Alberta NCR Project database from every file that contained sufficient relevant information and recidivism data were obtained via official criminal records. The VRAG-R demonstrated strong discrimination properties for general and violent recidivism over 5-year, 10-year, and global follow-ups. Calibration analyses, however, indicated that the VRAG-R substantially over estimated violence risk and that there was poor agreement between expected and observed recidivism rates for this population. When examined in the male subsample, these issues remained but to a lesser degree; examination of VRAG-R discrimination and calibration for females was not possible due to a lack of recidivists. Results indicated strong discrimination but poor calibration properties of the VRAG-R in this NCRMD population. Overall, the results support the use of the VRAG-R within a population of persons found NCRMD when employed in tandem with other measures as part of a comprehensive psychological risk assessment.
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Affiliation(s)
| | | | - Andrew Haag
- Alberta Hospital Edmonton, Canada.,University of Alberta, Edmonton, Canada
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4
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Fovet T, Baillet M, Horn M, Chan-Chee C, Cottencin O, Thomas P, Vaiva G, D'Hondt F, Amad A, Lamer A. Psychiatric Hospitalizations of People Found Not Criminally Responsible on Account of Mental Disorder in France: A Ten-Year Retrospective Study (2011-2020). Front Psychiatry 2022; 13:812790. [PMID: 35449565 PMCID: PMC9016162 DOI: 10.3389/fpsyt.2022.812790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/17/2022] [Indexed: 12/04/2022] Open
Abstract
Background Criminal responsibility is a key concept in the criminal sanctioning of people diagnosed with mental health disorders who have committed crimes. In France, based on the recommendations of one or more expert psychiatrists, a judge can declare a person not criminally responsible on account of mental disorder (NCRMD) if, at the time of the offense, the person was presenting a psychiatric disorder that abolished or altered his/her capacity for discernment and/or ability to control his/her actions. In such a case, the judge also generally orders an involuntary psychiatric hospitalization. The objectives of this study were to (1) describe longitudinal retrospective administrative data of psychiatric hospitalizations for people found NCRMD, (2) identify the age, sex, and principal diagnoses of these individuals, and (3) characterize the trajectories of their psychiatric care before and after NCRMD psychiatric hospitalization. Methods We used discharge reports from the French national hospital database called Programme de médicalisation des systèmes d'information (PMSI) to gather longitudinal data that describe psychiatric hospitalizations for people found NCRMD between 2011 and 2020, the age, sex, and principal diagnoses of these patients, the length of their hospitalization, and the trajectories of their psychiatric care before and after their NCRMD psychiatric hospitalization. Results We identified 3,020 patients who were hospitalized for psychiatric care after having been found NCRMD between 2011 and 2020. The number of admissions on these grounds has remained stable over this period, ranging from 263 in 2011 to 227 in 2021. They were mostly young men diagnosed with a psychotic disorder (62%). The majority (87%) were hospitalized in general psychiatric hospitals, and only 13% were admitted to maximum-security units (Unités pour malades difficiles, UMD). The median duration of hospitalization for these patients was 13 months. Our results show that 73% of the patients had already been hospitalized prior to their NRCMD hospitalization. The rehospitalization rate within 5 years of discharge from NCRMD psychiatric hospitalization was 62%. Conclusion We conducted the first study investigating the psychiatric hospital treatment of people declared NCRMD in France. There is an urgent need for further studies to investigate the clinical characteristics of these patients.
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Affiliation(s)
- Thomas Fovet
- Univ. Lille, Inserm, CHU Lille, U1172 - Lille Neuroscience & Cognition, Lille, France
- Psychiatry and Addiction Medicine Department, CHU Lille, Lille, France
- Centre national de ressources et de résilience Lille-Paris (CN2R), Lille, France
| | - Maëlle Baillet
- Univ. Lille, Faculté Ingénierie et Management de la Santé, Lille, France
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de santé et des Pratiques médicales, Lille, France
| | - Mathilde Horn
- Univ. Lille, Inserm, CHU Lille, U1172 - Lille Neuroscience & Cognition, Lille, France
- Psychiatry and Addiction Medicine Department, CHU Lille, Lille, France
| | | | - Olivier Cottencin
- Univ. Lille, Inserm, CHU Lille, U1172 - Lille Neuroscience & Cognition, Lille, France
- Psychiatry and Addiction Medicine Department, CHU Lille, Lille, France
| | - Pierre Thomas
- Univ. Lille, Inserm, CHU Lille, U1172 - Lille Neuroscience & Cognition, Lille, France
- Psychiatry and Addiction Medicine Department, CHU Lille, Lille, France
| | - Guillaume Vaiva
- Univ. Lille, Inserm, CHU Lille, U1172 - Lille Neuroscience & Cognition, Lille, France
- Psychiatry and Addiction Medicine Department, CHU Lille, Lille, France
- Centre national de ressources et de résilience Lille-Paris (CN2R), Lille, France
| | - Fabien D'Hondt
- Univ. Lille, Inserm, CHU Lille, U1172 - Lille Neuroscience & Cognition, Lille, France
- Psychiatry and Addiction Medicine Department, CHU Lille, Lille, France
- Centre national de ressources et de résilience Lille-Paris (CN2R), Lille, France
| | - Ali Amad
- Univ. Lille, Inserm, CHU Lille, U1172 - Lille Neuroscience & Cognition, Lille, France
- Psychiatry and Addiction Medicine Department, CHU Lille, Lille, France
| | - Antoine Lamer
- Univ. Lille, Faculté Ingénierie et Management de la Santé, Lille, France
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de santé et des Pratiques médicales, Lille, France
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Rossetto I, Clerici M, Franconi F, Felthous AR, Carabellese F, Di Vella G, Gandellini MG, Parente L, Carabellese F. Differences Between Readmitted and Non-readmitted Women in an Italian Forensic Unit: A Retrospective Study. Front Psychol 2021; 12:708873. [PMID: 34744870 PMCID: PMC8563585 DOI: 10.3389/fpsyg.2021.708873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022] Open
Abstract
The main objective of this study was to compare readmitted (RW) and non-readmitted (NRW) female psychiatric patients after being conditionally or unconditionally released from Italian inpatient forensic psychiatry services, in order to identify variables that were significantly linked with readmission. This study included all patients who were discharged from the female Residences for the Execution of the Security Measure (REMS) of Castiglione delle Stiviere from January 2008 to June 2015 who were not readmitted until December 31, 2018 (48). In addition, data were collected on female patients who were discharged from the same REMS before 2008 and readmitted from January 2008 to December 2018 (42). A key finding of our study was that the readmission into a female REMS was positively associated with the presence of substance use disorders (SUD) and a primary diagnosis on Axis II. To a lesser extent, younger age, being unconditionally discharged when first released, having had a shorter length of inpatient stay and having committed a crime against property for the first REMS admission was also variables that were apparently linked with readmission. The present research continues the previous research on gender-specific mentally ill offenders. Hence, the decision to proceed separately with a sample of men only and one of women only. For all these reasons, young female patients with personality disorder and SUD perhaps should remain longer in REMS and be released with conditions. In most European countries, the length of stay depends on the clinical condition and risk assessment, with some exceptions where the courts set a maximum length of stay at the outset, as in Italy. All the factors listed above influence the risk assessment. Finally, from integrating these findings into the increasing international literature on conditional release and considering the recent changes in the Italian forensic treatment model, we recommend continuing research on individual risk and protective factors as well as risk assessment instruments on conditionally and unconditionally released inpatients with genders studied separately.
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Affiliation(s)
- Ilaria Rossetto
- Poli-REMS Castiglione delle Stiviere, ASST Mantova, Mantova, Italy
| | | | - Filippo Franconi
- Poli-REMS Castiglione delle Stiviere, ASST Mantova, Mantova, Italy
| | - Alan R Felthous
- Forensic Psychiatry Division, Department of Psychiatry and Behavioral Medicine, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Fulvio Carabellese
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | | | | | - Lia Parente
- Section of Criminology and Forensic Psychiatry, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Felice Carabellese
- Section of Criminology and Forensic Psychiatry, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
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Stempkowski M. Professionalising release management for mentally disordered perpetrators: Benefits in terms of recidivism rates-Results from a study within the Austrian prison system. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2020; 30:312-320. [PMID: 33186473 PMCID: PMC7756423 DOI: 10.1002/cbm.2179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/11/2020] [Accepted: 10/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND In Austria, mentally ill perpetrators not guilty for reasons of insanity are committed into a custodial measure to receive treatment. The rate of these detainees returning after their conditional release because of reoffending or revocation decreased significantly over a period of 15 years. AIMS This study aims at examining this system and the adjustments made over a period of 10 years, in order to identify changes responsible for the observable decline of the recidivism rate. METHOD Therefore, a quantitative study of 807 prison and court files was conducted, extracting information concerning former detainees either released in 2001 & 2002 (n = 67) or 2011 & 2012 (n = 134) and subsequently comparing the groups. Additionally, expert interviews were conducted. RESULTS As one major change, the data revealed improvements regarding the preparation and management of the time on parole. The possibility for detainees to test their readiness for life outside the confinement through temporary interruptions of custody was enhanced, as were post-release housing opportunities in care facilities. Additionally, the courts issued more directives concerning measures such as medication or abstinence from alcohol. CONCLUSION Concerning mentally ill offenders, this study highlights the importance of a comprehensive preparation and management of the conditional release, providing support and treatment as well as a certain level of control.
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Affiliation(s)
- Monika Stempkowski
- Department of Criminal Law and CriminologyUniversity of ViennaWienAustria
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7
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Decriminalizing severe mental illness by reducing risk of contact with the criminal justice system, including for forensic patients. CNS Spectr 2020; 25:687-700. [PMID: 32248861 DOI: 10.1017/s109285292000125x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Risk of contact with the criminal justice system (CJS) is greater among those with mental illness, including severe mental illness-an observation that many argue reflects a process of "criminalizing" mental illness. Forensic patients represent a subgroup at one end of a spectrum of such criminalization, typically with histories of serious violence and psychotic illness. Strategies for decriminalizing mental illness in this context should consider a range of approaches, including intervening to prevent CJS contact in those with severe mental illness, particularly in the early or emerging stages of psychosis. However, it may be that even gold standard mental healthcare applied universally is insufficient to address CJS contact risks. While there is now an extensive literature documenting the relatively low rates of repeat CJS contact for forensic patients released from secure care, appropriate comparison groups are lacking and the key ingredients of any benefits of treatment are unknown. The CJS may well have something to learn from forensic mental health systems and services given the abject failure to stem rates of prison-release reoffending internationally. Understanding how to best identify risk and effectively intervene to prevent CJS contact in those with mental illness, whether early in the course of psychosis or following release from secure care, remains a priority for those seeking to address the criminalization of mentally illness in our communities.
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Kapoor R, Wasser TD, Funaro MC, Norko MA. Hospital treatment of persons found not guilty by reason of insanity. BEHAVIORAL SCIENCES & THE LAW 2020; 38:426-440. [PMID: 32897589 DOI: 10.1002/bsl.2484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/08/2020] [Accepted: 08/08/2020] [Indexed: 06/11/2023]
Abstract
After being found not guilty by reason of insanity (NGRI), individuals are typically admitted to a secure forensic hospital for evaluation and treatment. This patient population can pose a challenge to clinicians in the hospital setting due to significant violence risk, complex psychiatric presentations, and scrutiny from oversight boards and the public. This article reviews the scientific literature around several key aspects of hospital-based treatment of insanity acquittees, including the management of inpatient aggression, the provision of specific treatments to acquittees, the assessment of violence risk and readiness for release, and the process of community transition. The authors conclude that the existing literature is heavily weighted toward the study of risk assessment and recidivism, with relatively little attention paid to the study of therapeutic modalities and recovery-oriented care in this population.
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Affiliation(s)
- Reena Kapoor
- Law & Psychiatry Division, Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06519, USA
| | - Tobias D Wasser
- Law & Psychiatry Division, Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06519, USA
| | - Melissa C Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, 333 Cedar St, New Haven, CT, 06520-8014, USA
| | - Michael A Norko
- Law & Psychiatry Division, Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06519, USA
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9
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Felthous AR. The question of sanity restoration in jail. BEHAVIORAL SCIENCES & THE LAW 2020; 38:441-455. [PMID: 32914501 DOI: 10.1002/bsl.2482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/14/2020] [Accepted: 07/26/2020] [Indexed: 06/11/2023]
Abstract
Severe mental illness, especially psychotic disorders that are worsening, acute or complicated, normally require intensive psychiatric care and treatment that is most appropriately provided in a mental hospital. For criminal defendants, transfer to a forensic security hospital has traditionally been the means of achieving hospital care for mentally disordered defendants who have been found incompetent to stand trial or not guilty by reason of insanity. In recent years, with the shortage of intermediate and long-term hospital beds in the United States, including forensic security hospital beds, jail-based competency restoration programs are being established, seemingly obviating hospital transfer. Potential advantages of and concerns about jail-based, as opposed to hospital-based, competency restoration programs are discussed in the literature. If defendants with severe mental illness traditionally treated in a forensic security hospital for competency restoration are now treated for competency restoration in jail, it is not inconceivable that insanity acquittees could one day be treated in jail for sanity restoration. With the premise that it is better to consider the potential consequences before this becomes a serious proposal and is implemented, this analysis examine the advantages and concerns that have been put forth for jail-based competence restoration programs as they may or may not apply to jail-based sanity restoration programs. Substantial commonality is recognized, but also some differences, as well as reason for skepticism of the purported virtues of either alternative to care and treatment in forensic security hospitals.
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Affiliation(s)
- Alan R Felthous
- Forensic Psychiatry Division, Department of Psychiatry and Behavioral Neuroscience, St Louis University School of Medicine, St Louis, MO, USA
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10
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McDermott BE, Ventura MI, Juranek ID, Scott CL. Role of Mandated Community Treatment for Justice-Involved Individuals With Serious Mental Illness. Psychiatr Serv 2020; 71:656-662. [PMID: 32212909 DOI: 10.1176/appi.ps.201900456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Research has suggested that increased length of mandated community treatment for individuals with a serious mental disorder leads to better outcomes, but few studies have described whether these outcomes are maintained after treatment ends. The goal of this study was to evaluate the impact of court-mandated treatment on outcomes for individuals found not guilty by reason of insanity (NGRI) and released to the community. METHODS Ninety-three patients who were found to be NGRI participated in this study. Rearrest rates were compared for three groups: patients released to the community with court-mandated treatment (conditional release), patients who were conditionally released but later "restored to sanity" with no further court supervision, and patients released from the hospital to the community by the court with no court-imposed conditions. Patients were followed for an average of 4.83 years after discharge. RESULTS Nearly half (43.8%) of the patients released to the community without court-mandated supervision were arrested for another offense in the study period, compared with 8.2% of patients released under the supervision of the conditional release program. In contrast, those who were restored to sanity and ultimately released unconditionally had higher arrest rates (25%). CONCLUSIONS This study suggests that court oversight on an ongoing basis may be necessary to help justice-involved individuals with a serious mental disorder avoid the criminal justice system and remain engaged in community treatment. More research is needed to determine whether these findings can be extrapolated to civil commitment procedures.
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Affiliation(s)
- Barbara E McDermott
- Department of Psychiatry, University of California (UC), Davis, School of Medicine (all authors); California Department of State Hospitals-Napa (DSH-NAPA) (McDermott, Juranek)
| | - Maria I Ventura
- Department of Psychiatry, University of California (UC), Davis, School of Medicine (all authors); California Department of State Hospitals-Napa (DSH-NAPA) (McDermott, Juranek)
| | - Isah Dualan Juranek
- Department of Psychiatry, University of California (UC), Davis, School of Medicine (all authors); California Department of State Hospitals-Napa (DSH-NAPA) (McDermott, Juranek)
| | - Charles L Scott
- Department of Psychiatry, University of California (UC), Davis, School of Medicine (all authors); California Department of State Hospitals-Napa (DSH-NAPA) (McDermott, Juranek)
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Keune LH, de Vogel V, van Marle HJC. The evaluation stage of the Hoeven Outcome Monitor (HOM): Towards an evidence based groundwork in forensic mental health. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2017; 51:42-53. [PMID: 28256255 DOI: 10.1016/j.ijlp.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study examined if a macro-, meso-, and micro outcome measurement instrument that constitutes the evaluation stage of a Dutch forensic psychiatric outcome monitor, the Hoeven Outcome Monitor (HOM), can provide a first step towards a more evidence based groundwork in forensic mental health. General, serious, very serious, special, and tbs meriting recidivism during treatment, after treatment, and overall were charted for forensic psychiatric patients discharged from a Dutch forensic psychiatric centre between 1999 and 2008 (N=164). Re-conviction data were obtained from the official Criminal Records System, and the mean follow-up time was 116.2months. First, the results showed that the macro-measurements provide comparative outcome measures to generate insight into the overall effectiveness of forensic psychiatric treatment. Second, the meso-measurements yielded clinically relevant treatment outcome data for all discharged patients to generate a complete view of treatment effectiveness. Finally, the micro-measurements allowed access to detailed patient and treatment effectiveness assessments that provides the empirical foundation to conduct aetiological research into the prediction and control of high-risk behaviour. Thus, an outcome measurement instrument in line with Evidence Based Medicine and best practice guidelines was designed that provides an empirically sound evaluation framework for treatment effectiveness, and an impetus for the development of effective interventions to generate an evidence based groundwork in forensic mental health.
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Affiliation(s)
- Lobke H Keune
- Research Department De Forensische Zorgspecialisten, P.O. Box 174, 3500 DA Utrecht, The Netherlands.
| | - Vivienne de Vogel
- Research Department De Forensische Zorgspecialisten, P.O. Box 174, 3500 DA Utrecht, The Netherlands.
| | - Hjalmar J C van Marle
- Erasmus University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam DP-0424, The Netherlands; Erasmus School of Law Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam DP-0424, The Netherlands.
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