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Sebalo I, Sebalo Vňuková M, Anders M, Ptáček R, Páv M. Markers of predicting discharge from forensic psychiatric hospitals in Czechia. Int J Soc Psychiatry 2024; 70:1075-1082. [PMID: 38845176 PMCID: PMC11402263 DOI: 10.1177/00207640241255575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
BACKGROUND Secure forensic hospital treatments are resource-intensive, aiming to rehabilitate offenders and enhance public safety. While these treatments consume significant portions of mental health budgets and show efficacy in some countries, their effectiveness in Czechia remains underexplored. Previous research has highlighted various factors influencing the likelihood of discharge from these institutions. Notably, the role of sociodemographic variables and the length of stay (LoS) in the context of forensic treatments has presented inconsistent findings across studies. METHODS The study, part of the 'Deinstitutionalization project' in Czechia, collected data from all inpatient forensic care hospitals. A total of 793 patients (711 male, 79 female and 3 unknown) were included. Data collection spanned 6 months, with tools like HoNOS, HoNOS-Secure, MOAS, HCR-20V3 and AQoL-8D employed to assess various aspects of patient health, behaviour, risk and quality of life. RESULTS The study revealed several determinants influencing patient discharge from forensic hospitals. Key assessment tools, such as HoNOS secure scores and the HCR-20 clinical subscale, showed that higher scores equated to lower chances of release. Furthermore, specific diagnoses like substance use disorder increased discharge odds, while a mental retardation diagnosis significantly reduced it. The type of index offense showed no influence on discharge decisions. CONCLUSION Factors like reduced risk behaviours, absence of mental retardation diagnosis, social support and secure post-release housing plans played significant roles. The results underscored the importance of using standardized assessment tools over clinical judgement. A standout insight was the unique challenges faced by patients diagnosed with mental retardation, emphasizing a need for specialized care units or tailored programmes.
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Affiliation(s)
- Ivan Sebalo
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Martina Sebalo Vňuková
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Martin Anders
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Radek Ptáček
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Marek Páv
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
- Psychiatric Hospital Bohnice, Prague, Czechia
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Yan WJ, Zhao JH, Chen L. Gender-Specific Pathways in Violent Crime: Investigating the Role of Demographic and Mental Health Factors Using Mixed Graphical Models and Bayesian Networks. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:3446-3463. [PMID: 39056325 DOI: 10.1177/08862605241234658] [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: 07/28/2024]
Abstract
This research aims to uncover gender-specific relationships and pathways that contribute to the perpetration of violent crimes, using sophisticated analytical tools to analyze the complex interactions between various factors. Employing Mixed Graphical Models and Bayesian networks, the study analyzes a sample of 1,254 prisoners (61.64% males and 38.36% females) to investigate the relationships among demographic factors, mental health issues, and violent crime. The study utilizes comprehensive measures, including the Beck Depression Inventory, Beck Anxiety Inventory, and Childhood Trauma Questionnaire, to assess participants' mental health status.Key findings reveal significant gender differences in the pathways to violent crime. For males, incomplete parental marriages strongly correlate with criminal behavior severity, while marriage status emerges as a significant factor, with married males less likely to commit violent crimes. In contrast, these relationships are not significant for females. Bayesian network analysis indicates that living in urban areas differently influences education and emotional expression across genders, emphasizing the importance of contextual factors. The study highlights the need for gender-specific considerations in criminal justice policies and interventions. It underscores the complex interplay of demographic and mental health factors in influencing violent crime pathways, providing insights for developing more effective prevention strategies. Despite its cross-sectional design and reliance on self-reported data, the research significantly contributes to understanding the gendered dimensions of criminal behavior.
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Affiliation(s)
- Wen-Jing Yan
- School of Mental Health, Wenzhou Medical University, China
- Zhejiang Provincial Clinical Research Centre for Mental Illness, Affiliated Kangning Hospital, Wenzhou Medical University, China
| | - Jun-Hao Zhao
- School of Mental Health, Wenzhou Medical University, China
- School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Li Chen
- School of Mental Health, Wenzhou Medical University, China
- Zhejiang Provincial Clinical Research Centre for Mental Illness, Affiliated Kangning Hospital, Wenzhou Medical University, China
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Fisker Christensen L, Sørensen L, Johansen KK. Staff experiences with videoconferences during the COVID-19 pandemic in forensic psychiatry outpatients. Nord J Psychiatry 2024; 78:370-375. [PMID: 38546409 DOI: 10.1080/08039488.2024.2331209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/12/2024] [Indexed: 05/14/2024]
Abstract
AIM To describe staff experiences with the use of videoconferences with forensic psychiatric outpatients during the COVID-19 pandemic. METHOD Semi-structured interviews with staff at forensic community services in the Region of Southern Denmark. RESULTS Nine semi-structured staff interviews were conducted. Two main themes were identified through thematic analysis: Challenges due to technical uncertainty and the Use of videoconferences as support in clinical assessment and treatment. The second main theme also included a number of subthemes: Lack of opportunity for observation of a patient's overall situation; Compromise of nurses' professionalism; Limitation of disturbing stimuli means more focus on the conversation; Telephone contact vs. video contact-pros and cons; Expectations reflect attitudes; and Will professionalism be changed based on organizational and political perspectives? CONCLUSION Staff opinions on use of videoconferences in psychiatric patients differed. The nurses in particular were concerned about whether professionalism could be maintained. Others experienced patients focusing more on the conversation when it took place via video because there were fewer disturbing elements. In general, expectations seem to influence attitudes toward using videoconferences.
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Affiliation(s)
- Lone Fisker Christensen
- Forensic Mental Health Research Unit Middelfart, Mental Health Services in the Region of Southern Denmark/Institute of Regional Health Research, Middelfart, Denmark
| | - Line Sørensen
- Department of Psychiatry Odense, Region of Southern Denmark, Odense, Denmark
| | - Kirsten Kjær Johansen
- Forensic Mental Health Research Unit Middelfart, Mental Health Services in the Region of Southern Denmark/Institute of Regional Health Research, Middelfart, Denmark
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Noland E, Klötz Logan F, Sjöström S, Strandh M. What happens after forensic psychiatric care? A latent class analysis of dimensions of welfare for former forensic psychiatric patients. BMC Psychiatry 2023; 23:937. [PMID: 38087234 PMCID: PMC10714544 DOI: 10.1186/s12888-023-05428-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Mentally disordered offenders are a heterogenous group regarding psychopathology as well as background factors, which makes it likely that more than one stereotypical life situation will apply to all forensic psychiatric patients following discharge. Knowledge about typical life situations would be valuable for optimising support for improving the overall life situation of these individuals. This paper investigates life situations from the perspective of level of living research and resources in terms of different welfare dimensions. METHODS Included were all all individuals (n = 1146) who had been discharged from forensic psychiatric care in Sweden during 2009-2018 and were included in the Swedish National Forensic Psychiatric Register. Follow-up time varied from 4 to 3644 days, (m = 1697, Md = 1685). Register data from several different registers was combined. Data was analysed using latent class analysis, and multinominal logistic regression analysis investigated what background factors were associated with class membership. RESULTS The results show that there are four subgroups of post-discharge life situations: the high support group, the general psychiatric needs group, the working group, and the family group. The high support group was the largest, representing 54% of the entire sample. There are background factors associated with group membership, including both age at discharge, length of stay in forensic psychiatric care and pre-index crime historical factors. CONCLUSIONS This study contributes to the understanding of the post-discharge lives of former forensic psychiatric patients and shows that for several subgroups, negative outcomes are rare. Knowledge about these subgroups could be drawn upon to make informed decisions about in- and outpatient forensic psychiatric care, discharge from forensic psychiatric services, and what support is offered to former forensic psychiatric patients.
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Affiliation(s)
- Ebba Noland
- Department of Social Work, Umeå University, Umeå, 901 87, Sweden.
- Sundsvall Forensic Psychiatric Centre, Region Västernorrland, Box 880, Sundsvall, 851 24, Sweden.
| | - Fia Klötz Logan
- Sundsvall Forensic Psychiatric Centre, Region Västernorrland, Box 880, Sundsvall, 851 24, Sweden
| | - Stefan Sjöström
- Department of Sociology, Center for social work, Uppsala University, Box 624, Uppsala, Sweden
| | - Mattias Strandh
- Department of Social Work, Umeå University, Umeå, 901 87, Sweden
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Smothers M, Hill C, Lawrence D, Bagshaw R, Watt A. Predictors of recovery in a medium secure service: Influence of the Welsh Government's Mental Health (2010) Measure. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 91:101935. [PMID: 37717488 DOI: 10.1016/j.ijlp.2023.101935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Research to date has failed to examine the effectiveness of MSUs in facilitating recovery, or the influence that mental health policy may have on this process. Examining predictors of short-term clinical outcomes during inpatient admission and the effects of policy changes may inform future policy, treatment planning and may improve service user outcomes. AIMS To examine whether service user admission characteristics and length of stay predicted recovery status at discharge from medium secure care and whether a recovery-focused change in policy (introduction of the Mental Health (Wales) Measure (2010)) impacted either on recovery or the relationship between service user characteristics and recovery. METHODS The study adopted a retrospective analysis of quantitative data obtained from healthcare records from a Welsh MSU between 2007 and 2017 (n = 198). The DUNDUM-4 scale assessed recovery whilst DUNDRUM-2 assessed security need at admission. Service user admission characteristics included HCR-20 subscale scores, previous security-level transitions, adverse childhood experiences, substance misuse histories. RESULTS Shorter inpatient stays and higher scores on the dynamic HCR-20 clinical subscale were associated with poorer recovery outcomes. The relationship between admission characteristics and recovery endured despite changes in policy. Implementation of recovery focused legislation was associated with improved recovery. CONCLUSIONS The findings suggest that treatment should focus on dynamic risk factors to improve service user outcomes and highlights the need for long-term medium-secure provision for some. Further research is needed to evaluate the success of MSUs and the validity of the DUNDRUM-4 across UK secure services.
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Affiliation(s)
- Marie Smothers
- Department of Applied Psychology, Cardiff Metropolitan University, Western Avenue, Cardiff, UK
| | - Charlotte Hill
- Department of Applied Psychology, Cardiff Metropolitan University, Western Avenue, Cardiff, UK; South Wales Forensic Psychiatry Service, Swansea Bay University Health Board, Pen-Y-Fai, Bridgend, UK
| | - Daniel Lawrence
- Department of Applied Psychology, Cardiff Metropolitan University, Western Avenue, Cardiff, UK; Psychology Department, Priory Healthcare, Llanarth Court, Monmouthshire, UK.
| | - Ruth Bagshaw
- Department of Applied Psychology, Cardiff Metropolitan University, Western Avenue, Cardiff, UK; South Wales Forensic Psychiatry Service, Swansea Bay University Health Board, Pen-Y-Fai, Bridgend, UK
| | - Andrew Watt
- Department of Applied Psychology, Cardiff Metropolitan University, Western Avenue, Cardiff, UK
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Frowijn I, Masthoff E, Bogaerts S. Predictive validity on clinical item-level of the HKT-R divided into clinical patient classes. BMC Psychiatry 2023; 23:502. [PMID: 37438815 DOI: 10.1186/s12888-023-04994-4] [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: 02/13/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Because of the heterogeneity of forensic groups, latent class analysis (LCA) can allow for the formation of stronger homogeneous patient classes, which can improve the predictive validity of forensic risk assessment tools, such as the Historical Clinical Future - Revised (HKT-R), which was used in this study. In particular, dynamic clinical risk and protective items are important in treatment and are obligatory assessed annually for every forensic patient with a TBS measure in the Netherlands. Therefore, this study investigated the predictive validity of the HKT-R at clinical item-level per patient class. METHOD A cohort of 332 forensic patients, who were discharged from highly secured Forensic Psychiatric Centers/Clinics (FPCs) in the Netherlands between 2004 and 2008, was followed. LCA was performed to cluster this group of patients based on psychopathology and criminal offenses. The predictive validity of the HKT-R clinical items by class was assessed with official reconviction data two and five years after discharge as outcome measure. RESULTS Four classes were identified. The predictive validity of the HKT-R clinical items showed differences between and within classes on admission or discharge, and for predicting violent reoffending after two or five years after discharge. DISCUSSION Different risk/protective factors of the HKT-R may play a role for different subgroups of patients. Therefore, this heterogeneity should be considered for any measure or intervention.
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Affiliation(s)
- Iris Frowijn
- Department of Developmental Psychology, Tilburg University, Tilburg, the Netherlands.
- Fivoor Science and Treatment Innovation (FARID), Rotterdam, the Netherlands.
| | - Erik Masthoff
- Department of Developmental Psychology, Tilburg University, Tilburg, the Netherlands
- Fivoor Science and Treatment Innovation (FARID), Rotterdam, the Netherlands
| | - Stefan Bogaerts
- Department of Developmental Psychology, Tilburg University, Tilburg, the Netherlands
- Fivoor Science and Treatment Innovation (FARID), Rotterdam, the Netherlands
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Knapp M, Wong G. Economic evaluations of mental health interventions in criminal justice. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2023; 33:139-148. [PMID: 36929519 DOI: 10.1002/cbm.2286] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/04/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Mental health interventions targeting crime perpetrators are available. An overview of the current scenario of their economic benefits will help policy decisions. AIM To provide an update on economic evidence for mental health interventions in criminal justice, and to identify challenges and responses in using economic evidence to inform policy. METHOD Narrative review with an analysis frame that organises evidence around four points on the criminal justice system pathway: (a) point of contact; (b) post-arrest; (c) incarceration/punishment and (d) post-incarceration. RESULTS There is a paucity of high-quality economic evidence, especially from cost-benefit analyses. However, there is some evidence of cost-effectiveness in support of interventions at the point of incarceration, such as cognitive behavioural therapy, multisystemic therapy for juvenile delinquents, therapeutic communities, electronic monitoring and telepsychiatry in forensic psychiatry settings. There is also evidence that post-incarceration interventions such as assertive community treatment can be cost-effective. CONCLUSION There remain large evidence gaps. There are also challenges in turning economic evidence on mental health interventions in criminal justice into policy changes and improved practice, such as hidden costs, silo budgeting and delayed pay-off. Research incorporating multi-sectoral costs and benefits recommended by health economics and health technology assessment groups should be prioritised to support difficult resource allocation decisions faced by policy makers.
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Affiliation(s)
- Martin Knapp
- London School of Economics and Political Science, London, UK
| | - Gloria Wong
- The University of Hong Kong, Hong Kong, Hong Kong
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Sivak L, Forsman J, Masterman T. Duration of forensic psychiatric care and subsequent criminal recidivism in individuals sentenced in Sweden between 2009 and 2019. Front Psychiatry 2023; 14:1129993. [PMID: 37009123 PMCID: PMC10053040 DOI: 10.3389/fpsyt.2023.1129993] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/22/2023] [Indexed: 03/17/2023] Open
Abstract
BackgroundThe duration of forensic psychiatric care is in Sweden not determined at the time of sentencing; instead, offenders are regularly evaluated, often with regard to risk of criminal recidivism. The length and justifiability of such a sanction have been greatly debated; however, previous estimates of treatment duration based on datasets delimited to discharged patients—have provided an uncertain groundwork for these deliberations. The aim of this study was to use a more suitable approach to calculate average duration of forensic psychiatric care and to examine the relationship between length of treatment and subsequent recidivism after discharge.MethodsThis retrospective cohort study focused on offenders sentenced to forensic psychiatric care in Sweden between 2009 and 2019 and registered in the Swedish National Forensic Psychiatric Register (n = 2064), with a follow-up period until May 2020. We used Kaplan–Meier estimator to calculate and visualize treatment duration including analyses comparing levels of relevant variables, and then evaluated criminal recidivism in patients discharged from treatment between 2009 and 2019 (n = 640), after stratification for the same variables and dichotomization by treatment duration.ResultsThe median duration of forensic psychiatric care was estimated to 89.7 months (95% CI 83.2–95.8). Treatment was longer in offenders who committed violent crimes, suffered from psychosis, or had a history of substance use disorder, and in offenders whose sentences included special court supervision. The cumulative incidence of recidivism in patients discharged from treatment was estimated to 13.5% at 12 months (95% CI 10.6–16.2) and 19.5% at 24 months (95% CI 16.0–22.8). Corresponding cumulative incidence of violent crime post discharge was 6.3% at 12 months (95% CI 4.3–8.3) and 9.9% at 24 months (95% CI 7.3–12.4). Among other findings, in patients without a history of substance use disorder and patients whose sentences did not include special court supervision, recidivism was significantly higher in those with a shorter treatment duration.ConclusionUsing the entirety of a suitable, contemporary, prospectively enrolled cohort of mentally ill offenders, we were able to estimate—with greater accuracy than previous studies—the average duration of Swedish forensic psychiatric care and rate of subsequent criminal recidivism.
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Affiliation(s)
- Lenka Sivak
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Forensic Psychiatry, National Board of Forensic Medicine, Huddinge, Sweden
| | - Jonas Forsman
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Forensic Psychiatry, National Board of Forensic Medicine, Huddinge, Sweden
- *Correspondence: Jonas Forsman,
| | - Thomas Masterman
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Forensic Psychiatry, National Board of Forensic Medicine, Huddinge, Sweden
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Forsman J, Cornish R, Fazel S. Integrating static and modifiable risk factors in violence risk assessment for forensic psychiatric patients: a feasibility study of FoVOx. Nord J Psychiatry 2022; 77:240-246. [PMID: 35697296 PMCID: PMC10108825 DOI: 10.1080/08039488.2022.2084158] [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: 10/18/2022]
Abstract
INTRODUCTION Risk assessment is integral to forensic psychiatry. Previous work has highlighted the benefits of using scalable and evidence-based actuarial risk tools developed within forensic populations, such as the online Forensic Psychiatry and Violence Oxford (FoVOx) violence risk assessment tool. We examined the feasibility of using FoVOx in a Swedish forensic cohort and tested whether adding modifiable (dynamic) factors would increase its useability to clinicians. METHODS We completed FoVOx assessments on all patients discharged from forensic psychiatric hospitals in Stockholm County, Sweden, between 2012 and 2017 and investigated recidivism rates. In addition, interviews were conducted with the clinicians responsible for each patient on the perceived accuracy, usefulness, and impact of FoVOx, which was examined using thematic analysis. RESULTS Ninety-five discharges from forensic psychiatric hospitals were followed up. The median FoVOx score was a 7% likelihood of violent reoffending in two years after discharge. Six discharged patients (6%) were confirmed as violent recidivists using official records with a similar distribution of FoVOx risk categories as the rest of the sample. FoVOx was considered accurate by clinicians in more than half of cases, who suggested that modifiable risk factors could be added to increase acceptability. All clinicians thought that FoVOx was useful, and in 20% of discharges, it would have materially altered patient care. Overall, FoVOx was thought to impact decision-making and risk management, was practical to use, and could be completed without reference to written case material. CONCLUSION Completing FoVOx in forensic psychiatric hospitals can complement current approaches to clinical decision-making on violence risk assessment and management.
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Affiliation(s)
- Jonas Forsman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Robert Cornish
- The Oxford Clinic, Littlemore Hospital, Oxford Health NHS Foundation Trust, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Seena Fazel
- The Oxford Clinic, Littlemore Hospital, Oxford Health NHS Foundation Trust, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
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Noland E, Strandh M, Klötz Logan F. The reconvictions of mentally disordered offenders-how, when, and where? BMC Psychiatry 2022; 22:264. [PMID: 35418045 PMCID: PMC9008909 DOI: 10.1186/s12888-022-03912-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/04/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about the recidivism of mentally disordered offenders after discharge from forensic psychiatric services. This is problematic because such knowledge could (i) help professionals who encounter this group to better plan interventions to prevent recidivism, (ii) clarify the rates of recidivism post-discharge from forensic psychiatric care and (iii) further develop instruments for specific risk assessment. The aim of this study was to investigate the new crimes of mentally disordered offenders who had been reconvicted after discharge from forensic psychiatric care. METHODS Included in this study were all individuals (n = 1142) who had been discharged from forensic psychiatric care in Sweden during 2009-2018, were included in the Swedish National Forensic Psychiatric Register, and had been reconvicted in a criminal court within the follow-up period of 2009-2018 (n = 157, 14% of the population). The follow-up times of the discharged patients within the period varied from 4 to 3644 days, (m = 1697, Md = 1685). Retrospective registry data along with coded data from criminal court judgments (n = 210) were used to create a database. Kaplan-Meier survival analysis and descriptive statistical analysis was performed. RESULTS 75% of included individuals were reconvicted for at least one violent crime, but only 9 individuals were reconvicted for a serious violent crime, which can be compared to the 44 individuals with serious violent index crimes. The most common crime was "Other violent". The most common sentence was probation. The offender's most common relationship to the victim was having no known relationship, followed by the victim being a person of authority. The most common circumstance of the crime leading to the reconviction was that it occurred without apparent provocation; other common circumstances were related to the exercise of public authority. The most common crime scene was a public place. CONCLUSIONS Even though the reconvictions of this group included many violent crimes, there were very few serious violent crimes. The findings that the victims of the crimes of mentally disordered offenders are most commonly either unknown to the perpetrator or persons of authority, and that the crimes are often perpetrated without apparent provocation or reason, are important information for all professionals who encounter this group and should be taken into consideration to assess risk more accurately.
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Affiliation(s)
- Ebba Noland
- Department of Social Work, Umeå University, 901 87, Umeå, Sweden. .,Sundsvall Forensic Psychiatric Centre, Region Västernorrland, Box 880, 851 24, Sundsvall, Sweden.
| | - Mattias Strandh
- grid.12650.300000 0001 1034 3451Department of Social Work, Umeå University, 901 87 Umeå, Sweden
| | - Fia Klötz Logan
- Sundsvall Forensic Psychiatric Centre, Region Västernorrland, Box 880, 851 24 Sundsvall, Sweden
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Charles M, Akram H, Rogalewski M, Mokrysz C, Wood N, Curran HV. An Exploration of the Nature and Prevalence of Substance Use in a Forensic Population and an Evaluation of Its Role in Recall to Hospital. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00809-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Lutz M, Zani D, Fritz M, Dudeck M, Franke I. A review and comparative analysis of the risk-needs-responsivity, good lives, and recovery models in forensic psychiatric treatment. Front Psychiatry 2022; 13:988905. [PMID: 36386990 PMCID: PMC9659584 DOI: 10.3389/fpsyt.2022.988905] [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: 07/07/2022] [Accepted: 10/10/2022] [Indexed: 11/04/2022] Open
Abstract
Forensic mental health care primarily focuses on aspects of safety. Treatment is involuntary, and personal rights are highly restricted. Both direct and indirect coercion and significant power imbalances can impede not only the psychological state of inpatients but also their treatment motivation and the therapeutic process in general. However, successful treatment is essential to enable patients to regain their freedom. Therefore, the question arises whether and how health professionals, without disregarding the potential risks, can enable forensic psychiatric patients to experience meaningfulness and self-efficacy in their lives. In offender rehabilitation, the Risk-Need-Responsivity (RNR) model and Good Lives Model (GLM) are widely established theories. The RNR model focuses not only on the risk of recidivism but also on those needs of a person that provoke or prevent criminal behavior and the individual's ability to respond to various kinds of interventions. In contrast, the GLM aims to reduce the risk of re-offending by enabling an individual to live a "good life," i.e., a meaningful and fulfilling life. Originally developed in correctional services, i.e., for offenders without severe mental disorders, both the RNR model and the GLM have also been tested in forensic psychiatric treatment contexts. The Recovery Model is based on the concept of personal recovery in mental health care and is understood as the development of a sense of purpose and mastery in one's own life during the process of coping with the sequelae of a mental disorder. It is a central element of rehabilitation in general, but is also being increasingly applied in forensic psychiatric treatment settings. This review aims to compare the central concepts of the three models, in particular regarding personal development, and the current evidence for their efficacy in mentally disordered offenders.
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Affiliation(s)
- Maximilian Lutz
- Department of Forensic Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Davide Zani
- Department of Forensic Psychiatry, Psychiatric Services Grisons, Chur, Switzerland
| | - Michael Fritz
- Department of Forensic Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Manuela Dudeck
- Department of Forensic Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Irina Franke
- Department of Forensic Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany.,Department of Forensic Psychiatry, Psychiatric Services Grisons, Chur, Switzerland
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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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14
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Noland E, Strandh M. Historical, clinical and situational risk factors for post-discharge recidivism in forensic psychiatric patients - A Swedish registry study. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2021; 79:101749. [PMID: 34768026 DOI: 10.1016/j.ijlp.2021.101749] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/22/2021] [Accepted: 10/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate which factors, known at the time of discharge, correlate with post-discharge recidivism in forensic psychiatric patients in Sweden. SUBJECTS AND METHODS A database was constructed based on registry data taken from the Swedish National Forensic Psychiatric Register, as well as data on post-discharge convictions sourced from the National Council of Crime Prevention and demographic data from Statistics Sweden. The sample consisted of all individuals discharged from forensic psychiatric services in Sweden during 2009-2018 (n = 1150), and the follow-up period was 2009-2018. Survival analyses were used to investigate predictors of an increased likelihood for recidivism using both bivariate comparisons and multivariate Cox regression analyses. RESULTS The Cox regression analyses showed that out of the demographic background factors, higher age at discharge was significantly associated with a lower likelihood of recidivism within the follow-up period. The two discrete historical factors of having a history of substance abuse and having been sentenced before the index crime, and the clinical factor of presence of personality disorder without the presence of psychosis were associated with an increase in the likelihood of recidivism. The situational factors of having a trustee or limited guardian and main living accommodation being supported living were associated with a decrease in the likelihood of recidivism. The results support previous research regarding historical and pre-treatment factors, but also show that situational factors related to increased support and supervision in everyday life are associated with a decreased likelihood of recidivism. This knowledge may help the administrative courts and forensic psychiatric services to prevent future recidivism.
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Affiliation(s)
- Ebba Noland
- Department of Social Work, Umeå University, Sweden; Sundsvall Forensic Psychiatric Centre, Sundsvall, Sweden.
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15
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Willoughby M, Young JT, Spittal MJ, Borschmann R, Janca E, Kinner PSA. Violence-related deaths among people released from incarceration: systematic review and meta-analysis of cohort studies. EClinicalMedicine 2021; 41:101162. [PMID: 34746721 PMCID: PMC8551597 DOI: 10.1016/j.eclinm.2021.101162] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND People released from incarceration have an increased risk of violence-related death. As deaths from violence are a rare event, meta-analysis is needed to calculate reliable estimates of this risk. We examined the crude mortality rates (CMRs), standardised mortality ratios (SMRs), and predictive factors for violence-related deaths among people released from incarceration. METHODS In this systematic review and meta-analysis, we searched MEDLINE, PubMed, PsycINFO, Scopus, Web of Science, CINCH, and Criminal Justice Abstracts from inception to 14 September 2020 for cohort studies published in English that examined violence-related deaths occurring in the community following release from adult or youth incarceration. We used the Methodological Standard for Epidemiological Research (MASTER) scale to assess the quality of included studies. We conducted a random-effects meta-analysis to calculate pooled estimates of the CMRs and SMRs. Heterogeneity was assessed using univariable meta-regression. This review was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42020209422). FINDINGS Our search identified 2,489 records, from which 11 studies met the eligibility criteria. The pooled CMR for violence-related deaths after release from incarceration was 78·7 per 100,000 person-years (95%CI 58·0-99·5). The pooled SMR was 7·6 (95%CI 2·4-12·8). The estimate of heterogeneity was high (I2≥99%) and the Cochran's Q test was significant (p<0·001) for the pooled CMR and SMR. Study design (prospective vs. retrospective; p=0·001) and type of incarceration facility (youth detention vs. prison; p=0·006) were identified as possible sources of heterogeneity for CMRs. Risk factors for violence-related death after release were reported in only five studies. These included being male (n=3), Black or Hispanic in the United States (n=3), and younger age at release from incarceration (n=2). INTERPRETATION People released from incarceration are almost eight times more likely to die from violence than the general population. Violence-related deaths are preventable, and the high rate at which they occur after release from incarceration represents an important public health issue requiring targeted, evidence-based response. FUNDING None.
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Affiliation(s)
- Melissa Willoughby
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria, 3053, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia
- Corresponding author: Melissa Willoughby, Justice Health Unit, Level 4, 207 Bouverie Street, Carlton, The University of Melbourne, Victoria, 3053, Australia. ORCID ID: 0000-0002-4360-2605
| | - Jesse T. Young
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria, 3053, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
- National Drug Research Institute, Curtin University, 7 Parker Place, Bentley, Western Australia, 6102, Australia
| | - Matthew J. Spittal
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria, 3053, Australia
| | - Rohan Borschmann
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria, 3053, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, Camberwell, London SE5 8AF, United Kingdom
- Melbourne School of Psychological Sciences, The University of Melbourne, Grattan Street, Parkville, Victoria, Australia
| | - Emilia Janca
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria, 3053, Australia
| | - Prof Stuart A. Kinner
- Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Victoria, 3053, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia
- Mater Research Institute-UQ, University of Queensland, Mater Hospital, Raymond Terrace, South Brisbane, Queensland, 4101, Australia
- Griffith Criminology Institute, Griffith University, 176 Messines Ridge Road, Mount Gravatt, Queensland, 4122, Australia
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
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16
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The Safe pilot study: A prospective naturalistic study with repeated measures design to test the psychosis - violence link in and after discharge from forensic facilities. Psychiatry Res 2021; 298:113793. [PMID: 33582528 DOI: 10.1016/j.psychres.2021.113793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/03/2021] [Indexed: 11/24/2022]
Abstract
The research evidence is very strong for high recidivism rates of violence after discharge from forensic facilities. Big data research has found that a substantial proportion of the forensic population with relapse into violence has a psychosis diagnosis and a criminal record. However, more research on the association between psychotic symptoms and violence may inform and enhance risk assessment, prevention, and treatment. We conducted a prospective naturalistic study with a repeated measures design in a sample of 22 psychotic patients during follow-up after discharge from forensic mental health facilities. We had three aims: to test the predictive validity of three psychotic symptom scales for violence, to analyze main and interaction effects between psychotic symptoms and previous criminal conviction, and to explore the feasibility and potential benefit of the repeated measures design for prospective follow-up research. Interpreted within the limitation of the small sample size, the results were promising for all scales, particularly for adjusted effects without interaction. Two scales remained significant when their interaction with criminal conviction was adjusted. This indicates that risk judgment of psychotic patients with criminal conviction can be improved by adding measurement of fluctuations in psychotic symptoms. The repeated measures design was instrumental in this research.
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17
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Akram F, Rosales M, Chaudhuri S, Mansouripour SM, Sharif U, Maqsood A, Wadhawan A, Mohyuddin F, Mukhtar F. Predictors of civil and forensic inpatient psychiatric readmissions at a Public Mental Health Hospital. Psychiatry Res 2020; 293:113447. [PMID: 32977046 DOI: 10.1016/j.psychres.2020.113447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/07/2020] [Indexed: 11/26/2022]
Abstract
Inpatient psychiatric readmissions are increasingly prevalent and associated with worse prognostic outcomes and high economic costs, regardless of the medicolegal ramifications that necessitate them. Unlike most general medical readmissions, psychiatric readmissions are commonly warranted for both medical and legal purposes. However, studies focusing on analyzing the predictors of inpatient psychiatric readmission and their relationship to civil versus forensic readmission are limited. The purpose of this study was to examine the predictors of psychiatric readmission among civil and forensic patients admitted to a psychiatric hospital. In this retrospective chart review, we extrapolated data from medical records of 741 patients admitted from 2012 to 2017 with follow up until 2019. Analyses involved chi-square tests for comparing the distribution of demographic and clinical variables between forensic and civil readmission, and Cox regression to determine predictors of time to first readmission. Our results show that race, diagnosis, restraint/seclusion, type of admission, and disposition are significantly associated with an increased risk of psychiatric readmission. This study has important implications for healthcare providers and policy makers in revising mental health policies and improving systems-based practices for the mental health system. Future efforts in improving community psychiatric services and enhancing inpatient therapeutic environment may reduce psychiatric readmissions.
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Affiliation(s)
- Faisal Akram
- Saint Elizabeths Hospital, DC Department of Behavioral Health, Washington, DC, United States; Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Marianela Rosales
- Department of Psychiatry, Temple University, Philadelphia, PA, United States
| | - Sanjay Chaudhuri
- Department of Psychiatry, Penn State University, Hershey, PA, United States
| | - Seyed M Mansouripour
- Saint Elizabeths Hospital, DC Department of Behavioral Health, Washington, DC, United States
| | - Usman Sharif
- Department of Psychiatry, Berkshire Medical Center, Pittsfield, MA, United States
| | - Anum Maqsood
- Department of Internal Medicine, Howard University Hospital, Washington DC, United States
| | - Abhishek Wadhawan
- Saint Elizabeths Hospital, DC Department of Behavioral Health, Washington, DC, United States
| | - Farooq Mohyuddin
- Saint Elizabeths Hospital, DC Department of Behavioral Health, Washington, DC, United States
| | - Fahad Mukhtar
- Saint Elizabeths Hospital, DC Department of Behavioral Health, Washington, DC, United States.
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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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19
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Uhrskov Sørensen L, Bengtson S, Lund J, Ibsen M, Långström N. Mortality among male forensic and non-forensic psychiatric patients: matched cohort study of rates, predictors and causes-of-death. Nord J Psychiatry 2020; 74:489-496. [PMID: 32248726 DOI: 10.1080/08039488.2020.1743753] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: The mortality of forensic psychiatric (FP) patients compared to non-forensic psychiatric (non-FP) patients has been sparsely examined.Methods: We conducted a matched cohort study and compared Danish male FP patients (n = 490) who underwent pre-trial forensic psychiatric assessment (FPA) 1980-1992 and were subsequently sentenced to psychiatric treatment with matched (on year of birth, marital status, and municipality of residence) male non-FP patients (n = 490) and male general population controls (n = 1716). FP and non-FP patients were also matched on major psychiatric diagnostic categories. To determine mortality and identify potential predictors of mortality, we linked nationwide register data (demographics, education, employment, psychiatric admission pattern and diagnoses, cause of death) to study cohorts. Average follow-up time was 19 years from FPA assessment/sampling until death/censoring or 31 December 2010 and risk factors were studied/controlled with Cox proportional hazard analysis.Results: Overall, psychiatric patients had significantly higher mortality compared to matched general population controls (medium to large effects). Among patients, 44% (213) of FP vs. 36% (178) of matched non-FP patients died during follow-up (p = 0.02). When we used Cox regression modeling to control for potential risk factors; age, education, immigrant background, employed/studying at index, length of psychiatric inpatient stay/year, and ever being diagnosed with substance use disorder (SUD), FP patient status was no longer significantly associated with increased mortality, whereas SUD and longer inpatient time per year were independently associated with increased mortality.Discussion: This study suggests that SUD and longer inpatient time per year are independent risk factors for increased mortality in psychiatric patients.
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Affiliation(s)
- Lisbeth Uhrskov Sørensen
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Denmark.,Faculty of Health, Department of Clinical Medicine, Aarhus University, Denmark
| | - Susanne Bengtson
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Denmark.,Sexological Clinic, Psychiatric Centre Copenhagen, Denmark
| | - Jens Lund
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Denmark
| | | | - Niklas Långström
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Denmark.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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20
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Rees C, Thomson L. Exploration of morbidity, suicide and all-cause mortality in a Scottish forensic cohort over 20 years. BJPsych Open 2020; 6:e62. [PMID: 32552922 PMCID: PMC7345667 DOI: 10.1192/bjo.2020.40] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Premature mortality among patients experiencing forensic care is high. This paper examines the morbidity and mortality of all Scottish high secure patients in 1992/1993 and followed up 20 years later through the context of recovery. AIMS To explore morbidity and delineate which patients are at greatest risk of premature mortality. To assess the extent of suicide and unnatural deaths. To establish which factors, if any, appear protective. METHOD Health and mortality data were extracted from national data-sets and death categorised as premature or post-expected age. Standardised mortality ratios were calculated to explore natural, unnatural and suicide deaths with Cox regression conducted to explore baseline demographics and premature death. RESULTS During a mean follow-up of 21.1 years, 36.9% (n = 89) died, at an average age of 55.6 years. Of these, 70.8% (n = 63) died prematurely. Men lost on average 14.9 years and women 24.1 years of potential life. Five lives (5.6%) were lost by suicide and three (3.4%) by unnatural means. CONCLUSIONS In contrast to other mainstream and forensic cohorts, high rates of suicide and accidental deaths were not apparent. Risk of premature mortality is high. A greater focus upon physical health by community and in-patient services is essential.
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Affiliation(s)
- Cheryl Rees
- Division of Psychiatry, University of Edinburgh, UK
| | - Lindsay Thomson
- Forensic Psychiatry, University of Edinburgh; The State Hospital, Scotland; and The Forensic Mental Health Managed Care Network, Scotland, UK
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21
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Howner K, Andiné P, Engberg G, Ekström EH, Lindström E, Nilsson M, Radovic S, Hultcrantz M. Pharmacological Treatment in Forensic Psychiatry-A Systematic Review. Front Psychiatry 2020; 10:963. [PMID: 32009993 PMCID: PMC6976536 DOI: 10.3389/fpsyt.2019.00963] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/05/2019] [Indexed: 12/01/2022] Open
Abstract
Background: Pharmacological treatment is of great importance in forensic psychiatry, and the vast majority of patients are treated with antipsychotic agents. There are several systematic differences between general and forensic psychiatric patients, e.g. severe violent behavior, the amount of comorbidity, such as personality disorders and/or substance abuse. Based on that, it is reasonable to suspect that effects of pharmacological treatments also may differ. The objective of this systematic review was to investigate the effects of pharmacological interventions for patients within forensic psychiatry. Methods: The systematic review protocol was pre-registered in PROSPERO (CRD42017075308). Six databases were used for literature search on January 11, 2018. Controlled trials from forensic psychiatric care reporting on the effects of antipsychotic agents, mood stabilizers, benzodiazepines, antidepressants, as well as pharmacological agents used for the treatment of addiction or ADHD, were included. Two authors independently reviewed the studies, evaluated risk of bias and assessed certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: The literature search resulted in 1783 records (titles and abstracts) out of which 10 studies were included. Most of the studies included were retrospective and non-randomized. Five of them focused on treatment with clozapine and the remaining five on other antipsychotics or mood stabilizers. Five studies with a high risk of bias indicated positive effects of clozapine on time from treatment start to discharge, crime-free time, time from discharge to readmission, improved clinical functioning, and reduction in aggressive behavior. Psychotic symptoms after treatment were more pronounced in the clozapine group. Mainly due to the high risk of bias the reliability of the evidence for all outcomes was assessed as very low. Conclusion: This systematic review highlights the shortage of knowledge on the effectiveness of pharmacological treatment within forensic psychiatry. Due to very few studies being available in this setting, as well as limitations in their execution and reporting, it is challenging to overview the outcomes of pharmacological interventions in this context. The frequent use of antipsychotics, sometimes in combination with other pharmacological agents, in this complex and heterogeneous patient group, calls for high-quality studies performed in this specific setting.
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Affiliation(s)
- Katarina Howner
- Department of Clinical Neuroscience, Centre of Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Department for Forensic Psychiatry, National Board of Forensic Medicine, Stockholm, Sweden
| | - Peter Andiné
- Department for Forensic Psychiatry, National Board of Forensic Medicine, Gothenburg, Sweden
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Engberg
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Emin Hoxha Ekström
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden
| | - Eva Lindström
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Mikael Nilsson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden
| | - Susanna Radovic
- Department of Philosophy, Linguistics, Theory of Science, University of Gothenburg, Gothenburg, Sweden
| | - Monica Hultcrantz
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden
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Takeda K, Sugawara N, Matsuda T, Shimada A, Nagata T, Kashiwagi H, Hirabayashi N, Okada T. Mortality and suicide rates in patients discharged from forensic psychiatric wards in Japan. Compr Psychiatry 2019; 95:152131. [PMID: 31669788 DOI: 10.1016/j.comppsych.2019.152131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/11/2019] [Accepted: 09/17/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Japanese forensic mental health services for patients with psychiatric disorders under the Medical Treatment and Supervision Act was initiated in 2005; however, the prognosis of those patients is not well-known, particularly regarding mortality and suicide. This study aimed to evaluate the all-cause mortality and suicide rate in forensic psychiatric outpatients who had been discharged from forensic psychiatric wards in Japan. METHODS Participants included 966 patients who had been discharged from forensic psychiatric wards. Data were collected from July 15, 2005 to July 15, 2018 at 29 of the 33 forensic psychiatric wards in Japan. Only the patients who provided written informed consent were included. We and collaborators at each forensic psychiatric ward identified demographic data of participants from the medical records for the inpatient treatment period. The reintegration coordinators, who belonged to the Ministry of Justice, investigated the prognosis of the participants during the outpatient treatment order period. We then connected demographic data and participants' prognosis for analysis. The crude rates (CRs) and standardized mortality ratios (SMRs) were calculated to analyze all-cause mortality and suicide rates. Univariate analysis was performed to examine the factors associated with all-cause mortality and suicide rates using the Cox proportional hazards ratio model. RESULTS The participants included 3.3 times as many men (n=739) compared to women (n=227), and their combined mean age was 47.3 (SD=12.9). The most common primary psychiatric diagnosis was psychotic disorders (81.3%). The mean follow-up period was 790.2 days (SD=369.6). The total observation period was 2091.2 person-years. The CR for all-cause death was 812.9 per 100,000 person-years (95% CI [426.5, 1199.4]), while the SMR for all-cause death was 2.2 (95% CI [1.3, 3.5]). The CR for completed suicide was 478.2 per 100,000 person-years (95% CI [181.8, 774.6]). The suicide SMR was 17.9 (95% CI [8.6, 32.9]) overall, 7.7 (95% CI [2.5, 18.0]) for men, and 79.4 (95% CI [25.8, 185.2]) for women. Univariate analysis showed that women had higher completed suicide risk than men (hazard ratio=3.599, 95% CI [1.041, 12.445]). CONCLUSION The all-cause mortality and completed suicide rates were higher in participants than observed in the general population consistent with the results of previous international studies.
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Affiliation(s)
- Koji Takeda
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan; Section of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Norio Sugawara
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, 4-2-2, Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan
| | - Taro Matsuda
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan
| | - Akihiro Shimada
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan
| | - Takako Nagata
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan
| | - Hiroko Kashiwagi
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan
| | - Naotsugu Hirabayashi
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8551, Japan
| | - Takayuki Okada
- Section of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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Kennedy HG, Simpson A, Haque Q. Perspective On Excellence in Forensic Mental Health Services: What We Can Learn From Oncology and Other Medical Services. Front Psychiatry 2019; 10:733. [PMID: 31681042 PMCID: PMC6813277 DOI: 10.3389/fpsyt.2019.00733] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/12/2019] [Indexed: 12/11/2022] Open
Abstract
We propose that excellence in forensic and other mental health services can be recognized by the abilities necessary to conduct randomized controlled trials (RCTs) and equivalent forms of rigorous quantitative research to continuously improve the outcomes of treatment as usual (TAU). Forensic mental health services (FMHSs) are growing, are high cost, and increasingly provide the main access route to more intensive, organized, and sustained pathways through care and treatment. A patient newly diagnosed with a cancer can expect to be enrolled in RCTs comparing innovations with the current best TAU. The same should be provided for patients newly diagnosed with severe mental illnesses and particularly those detained and at risk of prolonged periods in a secure hospital. We describe FMHSs in four levels 1 to 4, basic to excellent, according to seven domains: values or qualities, clinical organization, consistency, timescale, specialization, routine outcome measures, and research. Excellence is not elitism. Not all centers need to achieve excellence, though all should be of high quality. Services can provide each population with a network of centers with access to one center of excellence. Excellence is the standard needed to drive the virtuous circle of research and development that is necessary for teaching, training, and the pursuit of new knowledge and better outcomes. Substantial advances in treatment of severe mental disorders require a drive at a national and international level to create services that meet these standards of excellence and are focused, active, and productive to drive better functional outcomes for service users.
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Affiliation(s)
- Harry G. Kennedy
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Alexander Simpson
- Division for Forensic Psychiatry—University of Toronto Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Quazi Haque
- Elysium Healthcare, London, United Kingdom
- Division for Forensic Psychiatry—University of Toronto Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health—University of Toronto, Toronto, ON, Canada
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Bengtson S, Lund J, Ibsen M, Långström N. Long-Term Violent Reoffending Following Forensic Psychiatric Treatment: Comparing Forensic Psychiatric Examinees and General Offender Controls. Front Psychiatry 2019; 10:715. [PMID: 31681032 PMCID: PMC6806391 DOI: 10.3389/fpsyt.2019.00715] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/05/2019] [Indexed: 11/24/2022] Open
Abstract
Background: Long-term violent re-offending in forensic psychiatric (FP) patients vs. non-FP offenders is largely unknown. Methods: We studied rates and facets of long-term violent reoffending among 1,062 violent forensic psychiatric examinees (FPE) consecutively undergoing pre-trial, forensic psychiatric examination (FPE) in Denmark during 1980-1992. Altogether, 392 were sentenced to FP treatment (FPE+T); the remaining 670 examinees received ordinary non-FP sanctions (FPE-T). FPE+T were compared to 392 contemporary matched violent general offenders (GEN) without FPE or other psychiatric contacts and sentenced to ordinary non-FP sanctions. FPE data were linked to population-based registers with sociodemographic, psychiatric, and crime information, and we estimated relative risks controlling for birth year, sex, educational and marital status, and previous violent crime. Results: During follow-up (mean = 18.0-19.5 years), FPE+T and GEN had any violent recidivism rates of 43% vs. 29% [adjusted hazard ratio (aHR) = 1.5; 95% CI, 1.1-1.9], respectively. Corresponding findings for severe violence (21% vs. 14%; aHR = 1.3; 95% CI, 0.9-1.9) and recurrent violence (3+ violent convictions; 16% vs. 6%; adjusted odds ratio [aOR] = 2.5; 95% CI, 1.5-4.4) also suggested weakly to moderately increased risks in FPE+T, albeit non-significantly for the former. Comparing FPE+T to FPE-T suggested decreased risk of any violence (43% vs. 51%; aHR = 0.8; 95% CI, 0.6-1.1), severe (21% vs. 34%; aHR = 0.6; 95% CI, 0.4-0.8), and recurrent violence [16% vs. 22%; adjusted odds ratio (aOR) = 0.7; 95% CI, 0.5-1.0] in FP patients, though non-significantly for any violence and recurrent violence. Among all FPE examinees, violent reoffending was independently predicted by male sex, younger age, pre-index violent crime, personality disorder (vs. schizophrenia spectrum and other psychiatric disorder), substance use disorder, and 5+ hospital admissions. Conclusion: FPE examinees, untreated followed by treated, reoffend violently more often than GENs. Similar trends are suggested also for severe and recurrent violence suggesting a need for continua of services for FPE examinees, independently of medico-legal status (i.e., sentencing to treatment or not).
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Affiliation(s)
- Susanne Bengtson
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Sexological Clinic, Psychiatric Centre Copenhagen, Copenhagen, Denmark
| | - Jens Lund
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | | | - Niklas Långström
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Quinn C, Ryan J, Fullam R, McKenna B. The Use of Restrictive Practices on Males Released from Prison and Entering Acute Mental Health Services: A Retrospective Cross-sectional Comparative Study. Issues Ment Health Nurs 2019; 40:626-631. [PMID: 31050565 DOI: 10.1080/01612840.2019.1572845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Little is understood about restrictive practices (seclusion, physical restraint, mechanical restraint) for those admitted to mental health services from prison. This study aimed to determine restrictive practices use on males admitted involuntarily from prison compared to those admitted from the community. A retrospective cross-sectional, comparative research design was used. Those admitted from prison were no more likely to experience restrictive practices; but were more likely to have a co-existing diagnosis of alcohol/substance use or personality disorder, in addition to a primary diagnosis of psychotic illness. The proportionate use of restrictive practices despite such complex presentations is potentially indicative of the clinical use of effective alternative management strategies.
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Affiliation(s)
- Chris Quinn
- a Forensicare, Victorian Institute of Forensic Mental Health , Fairfield , Australia.,b Centre for Forensic Behavioural Science, Swinburne University of Technology , Melbourne , Australia
| | - Jo Ryan
- a Forensicare, Victorian Institute of Forensic Mental Health , Fairfield , Australia.,b Centre for Forensic Behavioural Science, Swinburne University of Technology , Melbourne , Australia
| | - Rachael Fullam
- a Forensicare, Victorian Institute of Forensic Mental Health , Fairfield , Australia.,b Centre for Forensic Behavioural Science, Swinburne University of Technology , Melbourne , Australia
| | - Brian McKenna
- c School of Clinical Sciences, Auckland University of Technology , Auckland , New Zealand.,d Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board , Auckland , New Zealand
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Ojansuu I, Putkonen H, Lähteenvuo M, Tiihonen J. Substance Abuse and Excessive Mortality Among Forensic Psychiatric Patients: A Finnish Nationwide Cohort Study. Front Psychiatry 2019; 10:678. [PMID: 31572247 PMCID: PMC6754090 DOI: 10.3389/fpsyt.2019.00678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/22/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Forensic psychiatric patients are known to have reduced life expectancy. The aim of this study was to explore to what extent substance abuse disorders account for this increased mortality. Methods: Data up to December 31, 2016 for mortality (causes of death register) and substance abuse (forensic psychiatric examinations) were collected for all of the 950 patients committed to involuntary forensic psychiatric hospital care in Finland during 1980-2009 and discharged no later than December 31, 2016. Patients were then classified as suffering or not suffering from substance abuse disorders and their causes of death were examined. The standardized mortality ratio was then calculated for these groups on the basis of sex-, age-, and calendar-period-specific mortality rates for the general Finnish population. Results: During the follow-up time (mean 13.4 years), 354 (320 men, 34 women) patients died, resulting in a standardized mortality ratio of 3.5. The standardized mortality ratio for the patients with a history of substance abuse disorders was 4.1 compared to 2.8 for those with no such history. Among men, but not women, the age-adjusted proportion of death was significantly higher for those with a history of substance abuse disorders. In addition, in patients with a history of substance abuse disorders, the male age-adjusted competing risk of mortality was higher for unnatural causes, but not natural causes. Furthermore, a prominent proportion (16%) of all deaths and a majority of the accidental deaths (64%) occurred under the influence of some substance. Conclusions: Substance abuse is a major factor causing excessive mortality among forensic psychiatric patients. The management of substance abuse problems should be one cornerstone of the treatment of patients with both severe mental disorders and substance abuse disorders during their time in hospital and this should be extended to outpatient care.
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Affiliation(s)
- Ilkka Ojansuu
- Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland
| | - Hanna Putkonen
- Addiction Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markku Lähteenvuo
- Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland.,Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Jari Tiihonen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland.,Department of Clinical Neuroscience and Center for Psychiatry Research, Karolinska Institutet, Stockholm City Council, Stockholm, Sweden.,Department of Forensic Psychiatry, University of Eastern Finland, Kuopio, Finland
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Kuo CJ, Chen WY, Tsai SY, Chen PH, Ko KT, Chen CC. Excessive mortality and causes of death among patients with personality disorder with comorbid psychiatric disorders. Soc Psychiatry Psychiatr Epidemiol 2019; 54:121-130. [PMID: 30151650 DOI: 10.1007/s00127-018-1587-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 08/20/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE Excessive mortality has been seen in patients with personality disorder (PD), but it has not been well-studied when patients also have other psychiatric comorbidities. This study investigated the mortality rates and causes of death in an Asian cohort with PD. METHOD We enrolled patients ≥ 18 years of age with PD as defined by DSM-IV criteria (N = 1172), who had been admitted to a psychiatric service center in northern Taiwan between 1985 and 2008. By linking with the national mortality database (1985-2008), cases of mortality (n = 156, 13.3%) were obtained. We calculated the standardized mortality ratios (SMRs) to estimate the mortality gap between patients with PD and the general population. Stratified analyses of mortality rates by Axis I psychiatric comorbidity and sex were performed. RESULTS Borderline PD (n = 391, 33.4%) was the dominant disorder among the subjects. The SMRs for all-cause mortality of PD alone, PD comorbid with non-substance use disorder(non-SUD), and PD comorbid with SUD were 4.46 (95% CI 1.94-6.98), 7.42 (5.99-8.85), and 15.96 (11.07-20.85), respectively. Among the causes of death, the SMR for suicide was the highest (46.92, 95% CI 34.29-59.56). The SMR for suicide in PD patients with comorbid SUD was unusually high (74.23, 95% CI 33.88-114.58). Women had a significant increase in suicide with an SMR of 59.00 (95% CI 37.89-80.11). Men had significant increase in SMRs for cardiovascular disease and gastrointestinal disease. CONCLUSIONS We found significant synergistic effects of PD and SUD on mortality risk. A personality assessment should be mandatory in all clinical settings to prevent premature death and detect SUD early.
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Affiliation(s)
- Chian-Jue Kuo
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan, Republic of China.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.,Department and Graduate Institute of Forensic Medicine, National Taiwan University School of Medicine, Taipei, Taiwan
| | - Wen-Yin Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan, Republic of China.,Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Pao-Huan Chen
- Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Kai-Ting Ko
- Department of Psychiatry, Mackay Memorial Hospital and Taipei Medical University, 92 Section II, Chung-Shang North Road, 104, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan. .,Department and Graduate Institute of Forensic Medicine, National Taiwan University School of Medicine, Taipei, Taiwan. .,Department of Psychiatry, Mackay Memorial Hospital and Taipei Medical University, 92 Section II, Chung-Shang North Road, 104, Taipei, Taiwan.
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Cornish R, Lewis A, Parry OC, Ciobanasu O, Mallett S, Fazel S. A Clinical Feasibility Study of the Forensic Psychiatry and Violence Oxford (FoVOx) Tool. Front Psychiatry 2019; 10:901. [PMID: 31920751 PMCID: PMC6928566 DOI: 10.3389/fpsyt.2019.00901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/14/2019] [Indexed: 12/01/2022] Open
Abstract
Background: Risk assessment informs decisions around admission to and discharge from secure psychiatric hospital and contributes to treatment and supervision. There are advantages to using brief, scalable, free online tools with similar accuracy to instruments currently used. We undertook a study of one such risk assessment, the Forensic Psychiatry and Violence Oxford (FoVOx) tool, examining its acceptability, feasibility, and practicality. Methods: We completed the FoVOx tool on all discharges from six secure psychiatric hospitals in one region in England over two years. We interviewed 11 senior forensic psychiatrists regarding each discharge using a standardized questionnaire. Their patient's FoVOx score was compared to clinical risk assessment, and the senior clinicians were asked if they considered FoVOx scores accurate and useful. A modified thematic analysis was conducted, and clinicians were surveyed about current risk assessment practice on discharge. Results: Of 90 consecutive discharges, 84 were included in the final analysis. The median FoVOx probability score was 11% risk of violent recidivism in two years after discharge. We estimated that 12 (14%) individuals reoffended since discharge; all were in the medium or high risk FoVOx categories. Clinical assessment of risk agreed with the FoVOx categories in around half the cases. Clinicians were more likely to provide lower risk categories compared with FoVOx ones. FoVOx was considered to be an accurate representation of risk in 67% of cases; clinicians revised their view on some patient's risk assessment after being informed of their FoVOx scores. Completing FoVOx was reported to be helpful in the majority of cases. Reasons included improved communication with other agencies, reassurance to clinical teams, and identifying additional factors not fully considered. 10 of the 11 respondents reported that FoVOx was practical, and seven of 11 reported that they would use it in the future, highlighting its brevity and speed of use compared to existing risk assessment tools. Conclusions: Senior clinicians in this regional forensic psychiatric service found the FoVOx risk assessment tool feasible, practical, and easy to use. Its use addressed a lack of consistency around risk assessment at the point of discharge and, if used routinely, could assist in clinical decision-making.
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Affiliation(s)
- Robert Cornish
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Thames Valley Forensic Mental Health Service, Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Alexandra Lewis
- Broadmoor Hospital, West London NHS Trust, Southall, United Kingdom
| | - Owen Curwell Parry
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Thames Valley Forensic Mental Health Service, Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Oana Ciobanasu
- Thames Valley Forensic Mental Health Service, Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Susan Mallett
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Wolf A, Whiting D, Fazel S. Violence prevention in psychiatry: an umbrella review of interventions in general and forensic psychiatry. THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY 2017; 28:659-673. [PMID: 30828267 PMCID: PMC6396870 DOI: 10.1080/14789949.2017.1284886] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Relative risks of violence in psychiatric patients are high compared to the general population and existing evidence in non-psychiatric populations may not translate to reductions in violence in psychiatric populations. We searched 10 databases including Medline, EMBASE, CINAHL and Scopus, from inception until August 2015 for systematic reviews and meta-analyses of violence prevention interventions in psychiatry. Reviews were included if they used a hard outcome measure (i.e. police or hospital recorded violence, or reincarceration) and contained randomized or non-randomized controlled studies. Five reviews met our inclusion criteria (n = 8876 patients in total), of which four received a GRADE rating of 'low' or 'very low'. Three randomized studies (n = 636) reported that therapeutic community interventions may reduce reincarceration in drug-using offenders with co-occurring mental illness ('moderate' GRADE rating). The lack of intervention research in violence prevention in general and forensic psychiatry suggests that interventions from non-psychiatric populations may need to be relied upon.
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Affiliation(s)
- Achim Wolf
- Department of Psychiatry, University of Oxford, UK
| | | | - Seena Fazel
- Department of Psychiatry, University of Oxford, UK
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Fazel S, Wolf A, Fimińska Z, Larsson H. Correction: Mortality, Rehospitalisation and Violent Crime in Forensic Psychiatric Patients Discharged from Hospital: Rates and Risk Factors. PLoS One 2016; 11:e0159020. [PMID: 27379701 PMCID: PMC4933332 DOI: 10.1371/journal.pone.0159020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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