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Polat H, Karakaş SA, Erçel Ş, Taşci G. Alexithymia and Forgiveness Levels of Forensic Psychiatric Patients. J Psychosoc Nurs Ment Health Serv 2024; 62:27-35. [PMID: 37879088 DOI: 10.3928/02793695-20231018-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
The current cross-sectional study was performed to examine levels of alexithymia and forgiveness in forensic psychiatric patients. Data were collected between March 2022 and August 2022 at a high-security forensic psychiatric hospital affiliated with a city hospital in Turkey. A personal information form prepared by the researchers, the Toronto Alexithymia Scale, and the Heartland Forgiveness Scale were used to obtain data. Participants comprised 132 forensic psychiatric patients who agreed to participate in the study. A significant negative correlation was found between alexithymia and forgiveness levels of participants (p < 0.01, r = -0.259). In other words, as alexithymia levels increased, participants were found to be less forgiving. In addition, results suggest that forensic psychiatric patients are susceptible to alexithymia and higher levels of forgiveness. Determining forgiveness and alexithymia levels of forensic psychiatric patients will contribute to the structuring of care to be offered to these patients. [Journal of Psychosocial Nursing and Mental Health Services, 62(6), 27-35.].
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Spaan P, van den Boogert F, Bouman YHA, Hoogendijk WJG, Roza SJ. How are you coping? Stress, coping, burnout, and aggression in forensic mental healthcare workers. Front Psychol 2024; 14:1301878. [PMID: 38274695 PMCID: PMC10808574 DOI: 10.3389/fpsyg.2023.1301878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Perceived stress at work has been linked to several adverse outcomes in workers, including increased risk of burnout and aggression (e.g., anger and irritability). However, much remains unknown about factors that might mitigate the negative influences of perceived stress on workers' well-being. This study focusses on coping as a possible protective factor against perceived stress and its consequences in forensic mental healthcare workers. We aimed to identify which higher-order coping factors were present in this worker sample and to investigate whether these coping factors modify the associations between perceived stress and burnout or aggression. Methods For this observational survey study, 116 forensic mental healthcare workers completed questionnaires assessing changes in work situation since the start of COVID-19, perceived stress, coping, burnout symptoms, and aggression. Results Results from principal component analysis indicated that four higher-order coping factors could be distinguished: social support and emotional coping, positive cognitive restructuring, problem-focused coping, and passive coping. Higher perceived stress levels were associated with higher levels of both burnout and aggression in workers. Problem-focused coping was associated with less burnout symptoms in workers. Furthermore, positive cognitive restructuring was associated with less aggression in workers. Discussion In conclusion, problem-focused coping and positive cognitive restructuring may protect workers against burnout symptoms and aggression and these results may inform future studies on preventive interventions aimed at promoting worker's well-being.
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Affiliation(s)
- Pascalle Spaan
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Research, Transfore, Deventer, Netherlands
| | - Frank van den Boogert
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands
- Science and Treatment Innovation, Fivoor, Rotterdam, Netherlands
| | | | | | - Sabine J. Roza
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, Netherlands
- Netherlands Institute for Forensic Psychiatry and Psychology, Utrecht, Netherlands
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McLaughlin P, Brady P, Carabellese F, Carabellese F, Parente L, Uhrskov Sorensen L, Jeandarme I, Habets P, Simpson AIF, Davoren M, Kennedy HG. Excellence in forensic psychiatry services: international survey of qualities and correlates. BJPsych Open 2023; 9:e193. [PMID: 37828908 PMCID: PMC10594163 DOI: 10.1192/bjo.2023.578] [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] [Received: 01/27/2023] [Revised: 08/30/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Excellence is that quality that drives continuously improving outcomes for patients. Excellence must be measurable. We set out to measure excellence in forensic mental health services according to four levels of organisation and complexity (basic, standard, progressive and excellent) across seven domains: values and rights; clinical organisation; consistency; timescale; specialisation; routine outcome measures; research and development. AIMS To validate the psychometric properties of a measurement scale to test which objective features of forensic services might relate to excellence: for example, university linkages, service size and integrated patient pathways across levels of therapeutic security. METHOD A survey instrument was devised by a modified Delphi process. Forensic leads, either clinical or academic, in 48 forensic services across 5 jurisdictions completed the questionnaire. RESULTS Regression analysis found that the number of security levels, linked patient pathways, number of in-patient teams and joint university appointments predicted total excellence score. CONCLUSIONS Larger services organised according to stratified therapeutic security and with strong university and research links scored higher on this measure of excellence. A weakness is that these were self-ratings. Reliability could be improved with peer review and with objective measures such as quality and quantity of research output. For the future, studies are needed of the determinants of other objective measures of better outcomes for patients, including shorter lengths of stay, reduced recidivism and readmission, and improved physical and mental health and quality of life.
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Affiliation(s)
- Patrick McLaughlin
- National Forensic Mental Health Service, Central Mental Hospital, Portrane, Dublin, Ireland; and DUNDRUM Centre for Forensic Excellence, Academic Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Philip Brady
- National Forensic Mental Health Service, Central Mental Hospital, Portrane, Dublin, Ireland; and DUNDRUM Centre for Forensic Excellence, Academic Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Felice Carabellese
- Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari ‘Aldo Moro’, Puglia, Italy
| | - Fulvio Carabellese
- Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari ‘Aldo Moro’, Puglia, Italy
| | - Lia Parente
- Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari ‘Aldo Moro’, Puglia, Italy
| | - Lisbeth Uhrskov Sorensen
- Department for Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark; and Institute of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Ingeborg Jeandarme
- Knowledge Centre for Forensic Psychiatric Care (KeFor), OPZC Rekem, Rekem, Belgium; and KU Leuven, Leuven, Belgium
| | - Petra Habets
- Knowledge Centre for Forensic Psychiatric Care (KeFor), OPZC Rekem, Rekem, Belgium; and Tilburg University, Tilburg, The Netherlands
| | - Alexander I. F. Simpson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, Temerty School of Medicine, University of Toronto, Toronto, Canada
| | - Mary Davoren
- National Forensic Mental Health Service, Central Mental Hospital, Portrane, Dublin, Ireland; DUNDRUM Centre for Forensic Excellence, Academic Department of Psychiatry, Trinity College Dublin, Dublin, Ireland; and Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari ‘Aldo Moro’, Puglia, Italy
| | - Harry G. Kennedy
- DUNDRUM Centre for Forensic Excellence, Academic Department of Psychiatry, Trinity College Dublin, Dublin, Ireland; Interdisciplinary Department of Medicine, Section of Criminology and Forensic Psychiatry, University of Bari ‘Aldo Moro’, Puglia, Italy; and Institute of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
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4
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Koch M, Dvorak A, Hobersdorfer M, Yeghiazaryan L, Rabl U, Komorowski A. The impact of the COVID-19 pandemic on the psychosocial rehabilitation of forensic psychiatric patients in Austria. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 88:101889. [PMID: 37121203 PMCID: PMC10110938 DOI: 10.1016/j.ijlp.2023.101889] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 03/28/2023] [Accepted: 04/15/2023] [Indexed: 05/04/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic led to increased psychological distress and far-reaching restrictions of freedom. In March 2020, Austrian penal authorities enacted various safety and protection measures to mitigate the propagation of COVID-19. While infection rates in penal institutions were low, restrictive conditions of detention limited the forensic care of offenders. This retrospective longitudinal observational study aimed to evaluate the impact of the pandemic on the psychosocial rehabilitation in forensic psychiatry. Administrative and clinical data obtained from 97 males treated at an inpatient forensic mental health institution were compared before (January 2019 - mid-March 2020) and after (mid-March 2020 - May 2021) the enactment of pandemic-related restrictive measures. The study outcomes related to rehabilitative activities, social contacts, psychopathological stability, and compliance with institutional regulations. During the pandemic, a decrease in individual one-day temporary releases (64 vs. 3, p < .001) and one-day group excursions (103 vs. 10, p < .001) was observed. Likewise, visits by relatives (1440 vs. 429, p < .001) and legal guardians (286 vs. 130, p = .009) decreased. Regarding compliance with institutional regulations, illegal activities decreased from 27 to 8 after enactment of restrictive measures (p = .024). In contrast, long-term temporary releases (122 vs. 188 weeks, p = .131) and admissions to the acute ward (141 vs. 143, p = .712) remained unchanged. Overall, this study demonstrates the substantial impact of COVID-19 on the psychosocial care of forensic psychiatric patients and implies the necessity for guidelines to uphold an appropriate standard of forensic rehabilitation during future pandemics.
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Affiliation(s)
- Marlene Koch
- Department of Psychiatry and Psychotherapy, Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Vienna, Austria
| | | | | | - Lusine Yeghiazaryan
- Center for Medical Data Science, Institute of Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Ulrich Rabl
- Department of Psychiatry and Psychotherapy, Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Vienna, Austria
| | - Arkadiusz Komorowski
- Department of Psychiatry and Psychotherapy, Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Vienna, Austria.
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Sturge J, Starrenburg F. The Reorganization of a Psychiatric Unit During COVID-19: A Reflection for Psychiatric Hospital Design. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 15:354-368. [PMID: 35549742 PMCID: PMC9520130 DOI: 10.1177/19375867221098982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has impacted healthcare systems worldwide. Although this disease has primarily impacted general medicine intensive care units, other areas of healthcare including psychiatry were modified in response to corona measures to decrease the transmission of the disease. Reflecting on the modifications to the environment provides an opportunity to design psychiatric environments for future pandemics or other demands for healthcare. BACKGROUND The therapeutic environment of psychiatric wards was modified in Friesland, the Netherlands, in response to COVID-19. During this time, an interdisciplinary team met consistently to contribute to the preliminary design of a new psychiatric hospital. METHODS During the first 18 months of the pandemic, clinical reflections were made to describe the impact of COVID-19 on the psychiatric care environment. Architects have created a preliminary design of a new psychiatric hospital based on these reflections, monthly collaborative design discussions based on virtual mock-ups and evidence-based design based on theoretical concepts and research. RESULTS AND CONCLUSIONS This theoretical and reflective study describes how an inpatient psychiatric environment was restructured to manage infection during COVID-19. The therapeutic environment of the psychiatric ward and patient care changed drastically during COVID-19. The number of patients accessing care decreased, patient autonomy was restricted, and the function of designated behavioral support spaces changed to manage the risk of infection. However, these challenging times have provided an opportunity to reflect on theories and consider the design of new hospital environments that can be adapted in response to future pandemics or be restructured for different care functions.
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Affiliation(s)
- Jodi Sturge
- Adema Architecten, Groningen, the Netherlands.,Population Research Centre, University of Groningen, the Netherlands
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Crocker AG, Leclair M, Bélanger FA, Livingston J. Survol de l’organisation des services de santé mentale forensique à travers le monde : vers un modèle hiérarchisé-équilibré. SANTÉ MENTALE AU QUÉBEC 2022. [DOI: 10.7202/1094150ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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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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Hélène K, Gourret Baumgart J, El Hage W, Deloyer J, Maes C, Lebas MC, Marazziti D, Thome J, Fond-Harmant L, Denis F. Uses of digital technologies in the time of Covid-19: opportunities and challenges for professionals in psychiatry and mental health care. JMIR Hum Factors 2021; 9:e30359. [PMID: 34736224 PMCID: PMC8820762 DOI: 10.2196/30359] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/06/2021] [Accepted: 10/09/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The Covid-19 pandemic has required psychiatric and mental health professionals to change their practices to reduce the risk of transmission of SARS-CoV-2, in particular by favoring remote monitoring and assessment via digital technologies. OBJECTIVE As part of a research project that was co-funded by the French National Research Agency (ARN) and the Centre-Val de Loire Region, we carried out a systematic literature review to investigate how such uses of digital technologies have been developing. METHODS The present systematic review was conducted following the PRISMA guidelines. The search was carried out in MEDLINE (PubMed) and Cairn databases, as well as in a platform specializing in mental health, Ascodocpsy. The search yielded 558 results for the year 2020. After applying inclusion and exclusion criteria, first on titles and abstracts, and then on full texts, 61 articles were included. RESULTS The analysis of the literature revealed a heterogeneous integration of digital technologies, not only depending on countries, contexts, and local regulations, but also depending on the modalities of care. Notwithstanding these variations, the use of videoconferencing has developed significantly, affecting working conditions and therapeutic relationships. For many psychiatric and mental health professionals, the pandemic has been an opportunity to build up an experience of remote care, and thus better identify the possibilities and limits of these digital technologies. CONCLUSIONS The new uses of such technologies essentially consist in a transition from the classic consultation model towards teleconsultation and makes less use of the specific potential of artificial intelligence. As professionals were not prepared for these uses, they were confronted with practical difficulties and ethical questions, such as the place of digital technology in care, confidentiality and protection of personal data, and equity in access to care. The health crisis questions how the organization of health care integrates the possibilities offered by digital technology, in particular so as to promote the autonomy and empowerment of mental health service users. CLINICALTRIAL
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Affiliation(s)
- Kane Hélène
- Laboratoire éducation, éthique, santé, Université de Tours, Boulevard Tonnellé, Tours, FR
| | - Jade Gourret Baumgart
- Laboratoire éducation, éthique, santé, Université de Tours, Boulevard Tonnellé, Tours, FR
| | - Wissam El Hage
- Centre d'Investigation Clinique, Institut national de la santé et de la recherche médicale (INSERM), Tours, FR.,Centre Hospitalier Régional Universitaire Tours (CHRU), Tours, FR
| | - Jocelyn Deloyer
- Centre Neuro Psychiatrique St. Martin (CNP St. Martin), Dave Namur, BE
| | - Christine Maes
- Centre Neuro Psychiatrique St. Martin (CNP St. Martin), Dave Namur, BE
| | - Marie-Clotilde Lebas
- Département des Sciences de la Santé Publique et de la Motricité, Haute Ecole de la Province de Namur (HEPN), Namur, BE
| | - Donatella Marazziti
- Department of Experimental and Clinical Medicine, Section of Psychiatry, University of Pisa, Pisa, IT.,Unicamillus, University of Rome and Brain Research Foundation, Lucca, IT
| | - Johannes Thome
- Department of Psychiatry, University of Rostock, Rostock, DE
| | - Laurence Fond-Harmant
- Agence de Coopération Scientifique Europe-Afrique-Luxembourg (ASCAL), Luxembourg, LU.,Education et Pratiques en Santé, Paris 13, Université Sorbonne Paris Nord, Paris, FR
| | - Frédéric Denis
- Laboratoire éducation, éthique, santé, Université de Tours, Boulevard Tonnellé, Tours, FR
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The Early Impacts of the COVID-19 Pandemic on Mental Health Facilities and Psychiatric Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158034. [PMID: 34360334 PMCID: PMC8345711 DOI: 10.3390/ijerph18158034] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: While in many countries, the psychiatric and mental health sectors had been in crisis for years, the onset of a novel coronavirus pandemic impacted their structures, organizations, and professionals worldwide. (2) Methods: To document the early impacts of the COVID-19 health crisis on psychiatry and mental health sectors, a systematic review of the international literature published in 2020 was conducted in PubMed (MEDLINE), Cairn.info, and SantéPsy (Ascodocpsy) databases. (3) Results: After applying inclusion and exclusion criteria, 72 articles from scientific journals were selected, including papers documenting the early impact of the COVID-19 pandemic on the organization of psychiatric care delivery, work processes in psychiatry and mental health units, and personal experiences of mental health professionals. This review identified the contributions aimed at preventing the onset of mental disorders in the early stages of the health crisis. It lists the organizational changes that have been implemented in the first place to ensure continuity of psychiatric care while reducing the risk of SARS-CoV-2 transmission. It questions the evolution of the rights and duties of mental health professionals in the first months of the pandemic. (4) Discussion and conclusions: Although this literature review exclusively documented the early impacts of the COVID-19 health crisis, it is of significant interest, as it pictures the unprecedent situation in which psychiatry and mental health care professionals found themselves in the first stages of the pandemic. This work is a preliminary step of a study to be conducted with mental health professionals on an international scale—the Psy-GIPO2C project—based on more than 15 group interviews, 30 individual interviews, and 2000 questionnaires. The final aim of this study is to formulate concrete recommendations for decision-makers to improve work in psychiatry and mental health.
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Praus P, Biebinger E, Dreßing H. [COVID-19: challenges for forensic therapy and quality of treatment in institutions for forensic commitment]. DER NERVENARZT 2021; 93:297-299. [PMID: 33683388 PMCID: PMC7938695 DOI: 10.1007/s00115-021-01102-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Peter Praus
- Klinik für Psychiatrie und Psychotherapie, J5, Zentralinstitut für Seelische Gesundheit, 68159, Mannheim, Deutschland. .,Klinik für Forensische Psychiatrie, Pfalzklinikum für Neurologie und Psychiatrie, Weinstraße 100, 76889, Klingenmünster, Deutschland.
| | - Eva Biebinger
- Klinik für Forensische Psychiatrie, Pfalzklinikum für Neurologie und Psychiatrie, Weinstraße 100, 76889, Klingenmünster, Deutschland
| | - Harald Dreßing
- Klinik für Psychiatrie und Psychotherapie, J5, Zentralinstitut für Seelische Gesundheit, 68159, Mannheim, Deutschland
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Heitzman J, Gosek P. Polish Experiences of Safety Measures Involving Forensic Psychiatric Inpatients Implemented During the SARS-CoV-2 Pandemic. Front Psychiatry 2021; 11:576703. [PMID: 33519542 PMCID: PMC7843567 DOI: 10.3389/fpsyt.2020.576703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/18/2020] [Indexed: 11/19/2022] Open
Abstract
The SARS-CoV-2 pandemic has made it necessary for us to adapt our healthcare systems to a very different sort of reality. This clearly also applies to psychiatric services. The restrictions and safeguards associated with the pandemic particularly concern adherence to social distancing and medical treatment safety procedures. The implementation of these procedures is generally complicated by conditions of forensic psychiatry where, in line with demands made by courts, the treatment and isolation of mentally unwell offenders must be carefully managed. In most countries, forensic psychiatric treatment is an inpatient service where patients are kept in restricted and cramped spaces, making social distancing difficult to implement as patients participate in compulsory group therapeutic activities. As a result, it is necessary to introduce unique recommendations relating to patient safety and treatment adapted to the realities of forensic psychiatry. All this requires the implementation of additional restrictions, over and above those arising from the essential aspects of forensic psychiatry. In this paper, we present and discuss the Polish guidelines for forensic psychiatric care during the SARS-CoV-2 pandemic, developed as a result of discussions on essential measures introduced to reduce the spread of the virus and the unique needs of the forensic patient population.
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Affiliation(s)
| | - Paweł Gosek
- Department of Forensic Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
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12
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Basrak N, Mulcrone N, Sharifuddin S, Ghumman Z, Bechan N, Mohamed E, Murray M, Rajendran H, Gunnigle S, Nolan M, Quane T, Terao M, Hoare T, Kirrane K, Kennedy HG, Davoren M. Risk of adverse outcome of COVID-19 among patients in secure psychiatric services: observational cohort study. BJPsych Open 2021; 7:e31. [PMID: 33427191 PMCID: PMC7804071 DOI: 10.1192/bjo.2020.169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/16/2020] [Accepted: 12/22/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Secure forensic mental health services treat patients with high rates of treatment-resistant psychoses. High rates of obesity and medical comorbidities are common. Population-based studies have identified high-risk groups in the event of SARS-CoV-2 infection, including those with problems such as obesity, lung disease and immune-compromising conditions. Structured assessment tools exist to ascertain the risk of adverse outcome in the event of SARS-CoV-2 infection. AIMS To assess risk of adverse outcome in the event of SARS-CoV-2 infection in a complete population of forensic psychiatry patients using structured assessment tools. METHOD All patients of a national forensic mental health service (n = 141) were rated for risk of adverse outcome in the event of SARS-CoV-2 infection, using two structured tools, the COVID-Age tool and the COVID-Risk tool. RESULTS We found high rates of relevant physical comorbidities. Mean chronological age was 45.5 years (s.d. = 11.4, median 44.1), mean score on the COVID-Age tool was 59.1 years (s.d. = 19.4, median 58.0), mean difference was 13.6 years (s.d. = 15.6), paired t = 10.9, d.f. = 140, P < 0.001. Three patients (2.1%) were chronologically over 70 years of age, compared with 43 (30.5%) with a COVID-Age over 70 (χ2 = 6.99, d.f. = 1, P = 0.008, Fisher's exact test P = 0.027). CONCLUSIONS Patients in secure forensic psychiatric services represent a high-risk group for adverse outcomes in the event of SARS-COV-2 infection. Population-based guidance on self-isolation and other precautions based on chronological age may not be sufficient. There is an urgent need for better physical health research and treatment in this group.
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Affiliation(s)
- Natasa Basrak
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Naoise Mulcrone
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Sue Sharifuddin
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Zeshan Ghumman
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Nirvana Bechan
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Enas Mohamed
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Michael Murray
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Hariharan Rajendran
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Sean Gunnigle
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Mark Nolan
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland; and DUNDRUM Centre for Forensic Excellence, Trinity College Dublin, Ireland
| | - Tim Quane
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Masashi Terao
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Tracey Hoare
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Kevin Kirrane
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Harry G. Kennedy
- National Forensic Mental Health Service, Central Mental Hospital, Dublin; and DUNDRUM Centre for Forensic Excellence, Trinity College Dublin, Ireland
| | - Mary Davoren
- National Forensic Mental Health Service, Central Mental Hospital, Dublin; and DUNDRUM Centre for Forensic Excellence, Trinity College Dublin, Ireland
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Bogaerts S, van Woerkom M, Erbaş Y, De Caluwé E, Garofalo C, Frowijn I, Jeandarme I, Masthoff E, Janković M. Associations Between Resilience, Psychological Well-Being, Work-Related Stress and Covid-19 Fear in Forensic Healthcare Workers Using a Network Analysis. Front Psychiatry 2021; 12:678895. [PMID: 34177662 PMCID: PMC8226029 DOI: 10.3389/fpsyt.2021.678895] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
Forensic healthcare workers deal with patients with severe psychiatric and behavioral problems that put them at an increased risk of developing work-related stress and burnout. Working with this target group of patients during the Coronavirus disease 2019 (Covid-19) pandemic with far-reaching restrictive measures can negatively affect the psychological well-being of forensic workers. Research suggests that resilience can buffer workplace stress and contribute positively to psychological well-being. However, research on resilience, psychological well-being and work-related stress among forensic healthcare workers is still lacking. Therefore, in this study, we investigated the interrelations between psychological well-being and resilience on the one hand and work-related stress and Covid-19 fear-related symptoms on the other hand. Self-report data were obtained from 318 healthcare workers (73.9% women) working in three Forensic Psychiatric Centers (M age = 44.20, SD = 14.31) and are in direct contact with forensic patients. The data were analyzed using network analysis. Consistent with previous research, the results showed that workplace stress and fear associated with the Covid-19 pandemic can be detrimental to workers' psychological well-being, while resilience can serve as a protective factor against being personally attacked or threatened by patients at the workplace. Last but not least, we identified highly central symptoms, namely tremors due to the fear of the coronavirus and anxiety when other people coughing, which would be the best candidates for future treatment targets. This knowledge can help clinicians optimize interventions to reduce workplace stress and fear due to the pandemic. Future studies should aim to replicate our findings in a larger and more representative sample of forensic healthcare workers.
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Affiliation(s)
- Stefan Bogaerts
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands.,Fivoor Academy of Research, Innovation and Development (FARID), Rotterdam, Netherlands
| | - Marianne van Woerkom
- Department of Human Resource Studies, Tilburg University, Tilburg, Netherlands.,Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Yasemin Erbaş
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands
| | - Elien De Caluwé
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands
| | - Carlo Garofalo
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands
| | - Iris Frowijn
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands
| | - Ingeborg Jeandarme
- Department of Criminal Law and Criminology, Katholieke Universiteit Leuven, Leuven, Belgium.,Knowledge Center Forensic Psychiatric Care, Openbaar Psychiatrisch Zorgcentrum Rekem, Rekem, Belgium
| | - Erik Masthoff
- Fivoor Academy of Research, Innovation and Development (FARID), Rotterdam, Netherlands
| | - Marija Janković
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands.,Fivoor Academy of Research, Innovation and Development (FARID), Rotterdam, Netherlands
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Puzzo I, Aldridge-Waddon L, Stokes N, Rainbird J, Kumari V. The Impact of the COVID-19 Pandemic on Forensic Mental Health Services and Clinical Outcomes: A Longitudinal Study. Front Psychiatry 2021; 12:780236. [PMID: 35115963 PMCID: PMC8803909 DOI: 10.3389/fpsyt.2021.780236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a substantial impact on forensic mental health service provision and implementation. This study aimed to provide an analysis of the impact of COVID-19 related restrictions on routine outcomes within a large forensic mental health service in London, UK. METHOD We conducted a longitudinal cohort study using data collected routinely prior to the COVID-19 pandemic (April 2018-March 2020) and then stages thereafter (March 2020-March 2021; analyzed as March-May 2020, June-September 2020, October-December 2020, January-March 2021). We used causal impact models (Bayesian structural time-series) to examine the effect of COVID-19 related changes on routine outcomes related to service provision and implementation. RESULTS There was an overall increase in long-term segregation (LTS) hours during the pandemic; 140%, (95% Cl 107, 171%) during Lockdown 1; 113%, (159% Cl 127, 192%) during post-Lockdown 1; 45% (95% Cl 23, 68%) during Lockdown 2 and, finally, 90% (95% Cl 63, 113%) during Lockdown 3. The most negative outcomes were evident during Lockdown 3. Incidents of violence were significantly more frequent during Lockdown 3 than would have been predicted based on pre-pandemic data, including physical assaults to service users (206%, 95% CI 57%, 346%), non-physical assaults to service users (206%, 95% CI 53%, 339%), and self-harm (71%, 95% CI 0.4%, 135%). Use of enforced medication also increased during Lockdown 3 (317%, 95% CI 175%, 456%). CONCLUSION The pandemic and its related restrictions negatively affected some service outcomes. This resulted in increased incidents of violence and increased use of restrictive interventions, beyond what would have been expected had the pandemic not occurred.
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Affiliation(s)
- Ignazio Puzzo
- Department of Life Sciences, Centre for Cognitive Neuroscience, Brunel University London, Uxbridge, United Kingdom
| | - Luke Aldridge-Waddon
- Department of Life Sciences, Centre for Cognitive Neuroscience, Brunel University London, Uxbridge, United Kingdom
| | - Nicholas Stokes
- West London Forensic Service, West London National Health Service (NHS) Trust, Southall, United Kingdom
| | - Jordan Rainbird
- West London Forensic Service, West London National Health Service (NHS) Trust, Southall, United Kingdom
| | - Veena Kumari
- Department of Life Sciences, Centre for Cognitive Neuroscience, Brunel University London, Uxbridge, United Kingdom
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French forensic mental health system during the COVID-19 pandemic. ACTA ACUST UNITED AC 2020; 1:100034. [PMID: 34173562 PMCID: PMC7521870 DOI: 10.1016/j.fsiml.2020.100034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 01/03/2023]
Abstract
Many facilities involved in caring people diagnosed with mental health disorders who committed crime had to adapt to COVID-19 pandemic in France. Particularly, the impact of the COVID-19 pandemic on incarcerated people was the subject of many concerns. The COVID-19 pandemic also posed major challenges in secure psychiatric hospitals and for psychiatrist experts. Rapid changes in working practices occurred. Finally, the lockdown period was associated with an increase in domestic violence, especially gender-based violence and child abuse and neglect. Overall, the COVID-19 pandemic emphasized the well-known limitations of the French mental health system to manage people diagnosed with mental health disorders who committed crime and the urgent need for better recognition of forensic psychiatry in France.
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