Suchergebnisse

"Was haben MedizinerInnen, TiermedizinerInnen und BiologInnen gemeinsam? Zum Beispiel, daß sie während ihres Studiums einen Frosch dekapitiert haben, um anschließend an dessen Organen physiologische Experimente durchzuführen. Hätten sie dies nicht getan, wären sie wahrscheinlich nicht MedizinerIn, TiermedizinerIn oder Biologe/in geworden, da die Teilnahme an Tierversuchen in den entsprechenden Studiengängen traditionell Pflichtbestandteil der Ausbildung ist." (Autorenreferat)

Background: The recent UK Government strategy on high-risk offenders with personality disorders (PD) proposes improved identification of this group, assessment of their treatment needs through case formulation (CF) and the subsequent provision of treatment pathways. Little is known about service user and carer views on this strategy. Aims/Hypotheses: This study sought to identify the views of personality-disordered (PD) offenders and carers on the proposed role of Probation staff in CF. Methods: Three focus groups were carried out, two with service users and one with carers, with a total of 10 participants overall. Results: Five themes emerged: 'power', 'conflicting roles', 'trust', 'building a relationship through consistency of care' and 'hope and possibility'. Conclusions/Practical implications: Offenders and carers were sceptical regarding the proposed role of Offender Manager (OMs) in CF and this could pose a potential barrier to the successful implementation of the strategy.

We conducted a systematic review of studies reporting on the effectiveness of Circles of Support and Accountability (Circles). Circles use volunteers to provide support for sex offenders living in the community. We searched 10 databases up to the end of 2013 and identified 3 relevant outcome studies. An additional 12 papers or reports were identified by searching reference lists, Google, and contacting key authors and Circles providers to obtain unpublished data. These 15 studies comprised one randomized controlled trial, three retrospective cohorts with matched controls, and 11 case series. The majority reported measures of recidivism, particularly reconviction. The 4 studies with controls generally reported that participation in Circles was associated with lower recidivism although there were few statistically significant differences. Few studies examined changes in risk or psychosocial outcomes. A number of methodological issues are discussed. Longer term, prospective follow-up studies with control groups are required to address these issues.

This book covers models as well as ethical issues in psychiatric healthcare in prisons in several countries. It comes as recent surveys demonstrate the rising prevalence of mental disorders among prisoners, and suggests models for good practice in the field.

The general public has been shown to hold negative attitudes toward sexual offenders, sex offender treatment, and the rehabilitation of sexual offenders. It appears pertinent to the success of sex offender management strategies that utilise volunteers that selected volunteers do not share these attitudes. Here, volunteers for Circles of Support and Accountability (CoSA), a community-based initiative supporting the reintegration of sex offenders, completed three validated psychometric measures assessing attitudes toward sex offenders in general and toward their treatment and rehabilitation. Responses were compared with a U.K. general public sample. The results showed that volunteers held more positive attitudes toward sex offenders, sex offender treatment, and sex offender rehabilitation than the U.K. general public sample. The significance of these findings is discussed alongside directions for future research.

Background: Academic literature and government initiatives have emphasised the importance of work as a means of improving health and reducing reoffending among offenders with mental disorders. Whilst a number of work skills programmes have shown promise for offenders more generally, evaluation of evidence for their effectiveness for those with a mental disorder is lacking, particularly in relation to improving employment outcomes.Aims: To assess the evidence on the effectiveness of work skills programmes for mentally disordered offenders. Method: A systematic review of the literature was conducted by searching the following databases: PsycINFO, CINAHL, Cochrane Library (Trials Register), Embase and Medline, using search terms which included Work Skills Programme*, Offend* and Mental*. Any empirical comparison study of work skills programmes was included in this review. The primary outcome was employment. Secondary outcomes included employment outcomes, reoffending, education, mental state, substance misuse, global functioning, quality of life, acceptability, leaving the study early and cost effectiveness or other economic outcomes.Results: Six articles met the inclusion criteria. Collectively they provided limited evidence that work skills programmes increase the likelihood of people with mental disorder who are offenders obtaining employment in the short term, but there are insufficient studies to determine the long-term impact of work skills programmes. Conclusions: There is modest evidence to support inclusion of specific work skills programmes in the treatment of offenders with mental disorder. Future studies should be of theoretically driven programmes, such as Individual Placement Support (IPS), use a standard set of relevant outcome measures and long enough follow-up for testing the effectiveness of any programme on engagement in competitive, paid employment as, even if skilled, offenders with mental disorder must constitute a hard to place group.

The objective of this study was to explore current provisions within forensic mental health inpatient services for people who require longer-term care within Europe. We used a structured questionnaire and follow-up semi-structured interviews with experts in forensic psychiatry in 18 European countries. All experts interviewed acknowledged the issue of 'long-stay' in forensic psychiatry with patient characteristics including chronic mental disorder, treatment-resistance and violent behavior. Formal and informal definitions of 'long-stay' varied widely between countries. Eight experts stated that long-stay services are currently available in their country. Of the countries without long-stay services, five experts expressed a need develop them. Improved quality of life and promotion of wellbeing were emphasized as the fundamental treatment philosophy. Even without an agreed definition of 'long-stay', it is clear that a proportion of mentally disordered offenders (MDOs) are 'stuck' in 'the system'. Experts shared common concerns in terms of political pressures to contain dangerous MDOs for ensuring public safety as well as ethical debates regarding long-term forensic mental health care. Further research is required to promote dialogue between and within countries to address the balance of patient' rights and public safety, and to produce longitudinal and economic analyses of existing long-stay forensic service provisions.

In England and Wales, prisoners with mental disorder of such severity as to warrant inpatient treatment may be transferred to hospital under the Mental Health Act. UK Government guidance recommends that this process should be completed within 14 days; however, evidence suggests that in many cases it can take much longer. This retrospective service evaluation of 64 male prisoners, who were transferred under Section 47 or Section 48, aimed to evaluate transfer durations. The mean time from referral to admission was 76 days. Prisoners with a psychotic disorder were admitted more quickly. Remand prisoners were admitted more quickly than sentenced prisoners. Findings suggest that, in the UK the transfer time of prisoners under Sections 47 and 48 of the Mental Health Act continues to far exceed the 14-day target which raises concern about equivalence of care for prisoners. Our findings support arguments for fundamental amendments to the admissions process.

Die Arbeit stellt die Entstehung der forensischen Psychiatrie in Deutschland sowie die Etablierung von Eingangskriterien in das deutsche Strafrecht als Exkulpationsgrundlage bei psychischen Erkrankungen dar. Diese Entwicklungen werden anhand des Gelehrtenstreits der Medizinier A. Henke und J. Conradi um das historische Krankheitsbild der Mania sine delirio nachvollzogen. Im Fokus steht die Innovationskraft der Mania sine delirio in verschiedenen Wissenschaftsbereichen.

Die Arbeit stellt die Entstehung der forensischen Psychiatrie in Deutschland sowie die Etablierung von Eingangskriterien in das deutsche Strafrecht als Exkulpationsgrundlage bei psychischen Erkrankungen dar. Diese Entwicklungen werden anhand des Gelehrtenstreits der Medizinier A. Henke und J. Conradi um das historische Krankheitsbild der Mania sine delirio nachvollzogen. Im Fokus steht die Innovationskraft der Mania sine delirio in verschiedenen Wissenschaftsbereichen.

Purpose. While the number of forensic beds and the duration of psychiatric forensic psychiatric treatment have increased in several European Union (EU) states, this is not observed in others. Patient demographics, average lengths of stay and legal frameworks also differ substantially. The lack of basic epidemiological information on forensic patients and of shared indicators on forensic care within Europe is an obstacle to comparative research. The reasons for such variation are not well understood. Methods. Experts from seventeen EU states submitted data on forensic bed prevalence rates, gender distributions and average length of stay in forensic in-patient facilities. Average length of stay and bed prevalence rates were examined for associations with country-level variables including Gross Domestic Product (GDP), expenditure on healthcare, prison population, general psychiatric bed prevalence rates and democracy index scores. Results. The data demonstrated substantial differences between states. Average length of stay was approximately ten times greater in the Netherlands than Slovenia. In England and Wales, 18% of patients were female compared to 5% in Slovenia. There was a 17-fold difference in forensic bed rates per 100,000 between the Netherlands and Spain. Exploratory analyses suggested average length of stay was associated with GDP, expenditure on healthcare and democracy index scores. Conclusion. The data presented in this study represent the most recent overview of key epidemiological data in forensic services across seventeen EU states. However, systematically collected epidemiological data of good quality remain elusive in forensic psychiatry. States need to develop common definitions and recording practices and contribute to a publicly available database of such epidemiological indicators.

PURPOSE: While the number of forensic beds and the duration of psychiatric forensic psychiatric treatment have increased in several European Union (EU) states, this is not observed in others. Patient demographics, average lengths of stay and legal frameworks also differ substantially. The lack of basic epidemiological information on forensic patients and of shared indicators on forensic care within Europe is an obstacle to comparative research. The reasons for such variation are not well understood. METHODS: Experts from seventeen EU states submitted data on forensic bed prevalence rates, gender distributions and average length of stay in forensic in-patient facilities. Average length of stay and bed prevalence rates were examined for associations with country-level variables including Gross Domestic Product (GDP), expenditure on healthcare, prison population, general psychiatric bed prevalence rates and democracy index scores. RESULTS: The data demonstrated substantial differences between states. Average length of stay was approximately ten times greater in the Netherlands than Slovenia. In England and Wales, 18% of patients were female compared to 5% in Slovenia. There was a 17-fold difference in forensic bed rates per 100,000 between the Netherlands and Spain. Exploratory analyses suggested average length of stay was associated with GDP, expenditure on healthcare and democracy index scores. CONCLUSION: The data presented in this study represent the most recent overview of key epidemiological data in forensic services across seventeen EU states. However, systematically collected epidemiological data of good quality remain elusive in forensic psychiatry. States need to develop common definitions and recording practices and contribute to a publicly available database of such epidemiological indicators. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00127-020-01909-6) contains supplementary material, which is available to authorized users.