Impact of Legal Traditions on Forensic Mental Health Treatment Worldwide

Beis, Pavlos; Graf, Marc; Hachtel, Henning

doi:10.3389/fpsyt.2022.876619

Cited by 8 publications

(14 citation statements)

References 52 publications

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“…Criminal offenders who are deemed to suffer from a severe mental disorder are subject to exemption under the law in most countries, albeit the corresponding definition of mental disorder and specifics of legal treatment vary (1)(2)(3)(4)(5)(6). The Swedish judicial system is relatively unique in this respect, as practically all offenders are considered to be accountable for their crimes regardless of their mental status.…”

Section: Introductionmentioning

confidence: 99%

Duration of forensic psychiatric care and subsequent criminal recidivism in individuals sentenced in Sweden between 2009 and 2019

2023

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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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Section: Introductionmentioning

confidence: 99%

Duration of forensic psychiatric care and subsequent criminal recidivism in individuals sentenced in Sweden between 2009 and 2019

2023

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“…While psychotic illnesses such as schizophrenia represent a main diagnosis in most inpatient care forensic services, the place of personality disorders in mental disorder defense is by far more ambiguous ( 1 ). For instance, personality disorders were not considered in this context in France.…”

Section: Discussionmentioning

confidence: 99%

“…Forensic psychiatric treatment of mentally disordered offenders (MDO) has been thought to be a pragmatic and successful way of reducing criminal recidivism ( 1 ). Some European countries, such as England and Finland, regulate inpatient treatment of MDO by their mental health acts, while in other countries such as Austria, Belgium and Switzerland, the judicial framework focuses on the possibility to provide a complete panel of psychiatric care interventions in prisons ( 1–5 ).…”

Section: Introductionmentioning

confidence: 99%

“…Legal frameworks governing detention vary across European countries so that the characteristics of COT are not easily comparable ( 1 , 2 , 4 ). Over the last 20 years, detailed description of inpatient COT was provided in Austria ( 17 ), Belgium ( 18 ), France ( 8 , 19 ), Germany ( 20 ), Netherlands ( 21 ), and United Kingdom ( 22 ).…”

Section: Introductionmentioning

confidence: 99%

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Court-ordered inpatient psychiatric care in Switzerland: determinants of length of stay and treatment outcome

Weber,

Morier,

Lesaffre

et al. 2023

Front. Psychiatry

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IntroductionIn several European countries, offenders with decreased or abolished responsibility and high risk of recidivism due to long-lasting mental disorders are compulsory admitted for court-ordered treatments (COT) that take place in high and medium-security hospitals. As a rule, length of stay in these structures is very long implying major restrictions for the inmate and high societal cost. Despite intensive research, the predictors of length of stay and treatment outcome in long stay forensic services is still matter of debate.MethodsWe report here a detailed analysis of the demographic, psychiatric and offense predictors of length of stay and discharge locations of 204 mentally disordered offenders convicted to COT in a new medium-security forensic psychiatry clinic in Geneva, Switzerland. Kaplan-Meier survival estimates were performed to determine time to release. Length of stay was predicted by Cox regressions, and discharge locations were predicted by multinomial logistic regressions.ResultsThe typical inpatient was a 35-age single male re-offender, submitted to COT after a conviction for physical violence (78.9%) or property violation (64.2%), with drug trafficking (52.9%), in relation to psychotic (67.2%), antisocial or borderline personality disorder (35.8%) with comorbid substance use disorders (60.3%). Sex offenses were found in 24.5% of cases and were associated with Cluster B personality disorders. The median length of stay was of 2.5 years and was independent of demographic variables, severity of crime recidivism and psychiatric diagnosis. Longer COT at admission, and type of offense (in particular drug traffic and sexual violence) predicted longer stays. At discharge, 32.8% of cases were transferred to sheltered educational housing, 23.1% to open low-security wards, while 30.6% returned to regular prisons and 9.7% to their country of origin.DiscussionYounger age and conviction for property violation rather than physical violence increased the chances to be discharged to sheltered educational housing. Longer COT at admission, personality disorders, and conviction for sexual offense increased the risk to return to prison. These data suggest that sex offenses determine not only longer stays under COT but also drastically decreases the chance of freedom for inmates with Cluster B personality disorders.

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“…Forensic psychiatry services are important because people with mental disorders commit conflicts against the law of their country and these people require mental health services [61]. However, evidence shows that more studies are needed regarding differences in legal tradition of each country and forensic mental health treatment standards on an international level [62]. Psychiatric outpatient services are also vital to be available because they provide appropriate setting for assessment, brief psychological interventions, initial monitoring of the effectiveness of prescribed medications, and referral to more appropriate mental health facilities [63], particularly beneficial to expatriate workers in the Arab Gulf region who comprise almost half (48%) of the population and have greater risk for mental health morbidity than the nationals or citizens in the region [10].…”

Section: Discussionmentioning

confidence: 99%

The Nature and Availability of Mental Health Services in Arab Gulf Countries: A Scoping Review

Alanazi,

McKenna,

Buck

2023

Saudi J Health Syst Res

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Introduction: Given that mental health services are developing across Gulf Cooperation Council (GCC) or Arab Gulf countries, there is a need to examine the nature of these services to explore how they are developing, expanding, or evolving. This study aimed to explore what is known about the scope and nature of available mental health services for adult populations in Arab Gulf countries. Methods: This scoping review was informed by the 2005 methodological framework of Arksey and O’Malley. The databases MEDLINE, PsycINFO, CINAHL, ProQuest Central, EMBASE, Web of Science/Scopus, DOAJ, and Saudi Digital Library were searched for studies published between 2011 and 2021. Studies were included if they focused on reported scope and nature of available mental health services for adult populations in Arab Gulf countries, excluding those related to drug and alcohol, intellectual disability, and behavioural problems. Results: The search identified 8,884 articles, from which a total of 28 were included in the final review. The majority of studies were from the Kingdom of Saudi Arabia, with fewer studies from other Arab Gulf countries, and only one conducted in Bahrain. Mental health services described were primarily referral services, psychotherapy and cognitive behavioural therapy, telepsychiatry and mobile health services, screening, early detection and management of depression and anxiety, and other mental health services. Conclusion: This review revealed that the most available and utilised mental health services in Arab Gulf countries for treating adult mental disorders are psychotherapy and cognitive behavioural therapy, telepsychiatry and mobile health services, especially during the COVID-19 pandemic.

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Impact of Legal Traditions on Forensic Mental Health Treatment Worldwide

Cited by 8 publications

References 52 publications

Duration of forensic psychiatric care and subsequent criminal recidivism in individuals sentenced in Sweden between 2009 and 2019

Duration of forensic psychiatric care and subsequent criminal recidivism in individuals sentenced in Sweden between 2009 and 2019

Court-ordered inpatient psychiatric care in Switzerland: determinants of length of stay and treatment outcome

The Nature and Availability of Mental Health Services in Arab Gulf Countries: A Scoping Review

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