Forensic psychiatric inpatient treatment: creating a therapeutic milieu

Management of aggressive behaviour among adolescents in forensic units: a four-country perspective

Management of aggressive behaviour is a challenge in adolescent forensic units. Aggressive behaviour endangers the safety of the treatment milieu for patients and nursing and multidisciplinary staff. However, there is a paucity of literature about how the staff manage aggressive behaviour among patients in adolescent forensic settings, and whether the nursing practices are similar across countries. The purpose of this study was to explore nursing practices used to manage adolescent aggressive behaviour in adolescent forensic units in four European countries. An exploratory, descriptive research approach was adopted for the study. A convenience sampling was used by selecting the staff members working in adolescent forensic units (Belgium n= 15, Finland n= 18, the Netherlands n= 16, the UK n= 9). Personal thematic interviews were used to collect the data; and for data analysis, qualitative content analysis was applied. Staff members preferred using verbal and less restrictive interventions when intervening in escalated situations and perceived the use of coercive measures as the last option. Differences between countries were found in the use of restrictive methods. The principles of aggression management were fairly similar across Europe, even if differences were reported in practical solutions.

Goals of inpatient treatment for psychiatric disorders

The purpose of the psychiatric hospital changed dramatically during the twentieth century. Formerly the primary location for psychiatric treatment, the hospital now plays a more circumscribed role within a community-based system of care. Crisis stabilization, safety, and a focus on rapid discharge are the critical components of the acute inpatient stay. Subspecialized units focus on geriatrics, children, adolescents, dual diagnosis (substance abuse and mental illness), trauma disorders, eating disorders, and forensics. When integrated with the general medical system and a comprehensive base of community-delivered day treatment, residential services, and outpatient services, psychiatric hospitalization is a humane alternative to long-term institutional care.