This book provides an overview of forensic psychiatry, focusing on the provision of care in Europe as well as the legal and ethical challenges posed by long-term stays in forensic settings. Forensic psychiatric services provide care and treatment for mentally disordered offenders (MDOs) in secure in-patient facilities as well as in the community. These services are high-cost/low-volume services; they pose significant restrictions on patients and hence raise considerable ethical challenges. There is no agreed-upon standard for length of stay (LoS) in secure settings and patients’ detainment periods vary considerably across countries and even within the same jurisdiction. Thus far, little research has been conducted to identify factors associated with length of stay; consequently, it remains unclear how services should be configured to meet the needs of this patient group. This volume fills some of those gaps. Furthermore, it presents new research on factors associated with length of stay, both patient-related and organisational. Various approaches to the provision of care for long-term patients in different countries are explored, including a few best practise examples in this specific area of psychiatry. The book also addresses the perspective of those working in forensic care by reviewing quality-of-life research and interviews with patients. The authors of this volume come from a range of professional backgrounds, ensuring a certain breadth and depth in the topic discussion, and even includes patients themselves as (co-)authors.

This book presents the legal context and describes the ethical and practical challenges when using coercive measures in forensic psychiatric settings. A wide range of aspects relevant to the use of such measures, including environmental, patient-related, and staff-related factors, are explored, and the experience of coercive interventions is described from the staff and the patient perspective. Differences in jurisdictions and examples of good practice are highlighted. The authors are from a range of professional backgrounds, ensuring breadth as well as depth in discussion of the topic. The use of coercive measures, in particular restraint, seclusion, and involuntary medication, for the control of aggression in psychiatry remains controversial. Forensic mental health care deals with individuals who pose a risk to others and often present with significant management problems within institutions. The care of patients in these settings gives rise to debates about the balance between care and safety, and between the interests of the patients and those of the wider society to be protected. Despite these tensions, limited research has been conducted specifically on the use of coercive measures in forensic mental health care. This volume aims to fill the gap and will be of value to all professionals working in forensic psychiatric settings as well as to those working in general psychiatric and custodial settings, law professionals, and patients.

This book explores the ways in which diversity and experiences of marginalisation are present in forensic mental health care settings around the globe and suggests ways of moving forward. Forensic mental health services provide care for a group of patients who are marginalised in several respects. Many have experienced childhood adversity and abuse, substance use, serious and chronic mental disorders, poor healthcare education or treatment, inadequate educational opportunities, social isolation, and pervasive forms of stigmatization. On top of these individual experiences of marginalisation, wide diversity exists across patients’ socio-demographic, cultural, and clinical characteristics. Chapters in this book discuss these crucial and often sensitive problems, such as working with transgender prisoners, the impact of incarceration for children from non-white backgrounds, cultural and linguistic diversity in forensic settings, and more. Combining global perspectives, current evidence and case studies, this book will be of interest to patients, carers, practitioners, researchers, and students of forensic mental health.

The first comprehensive account of forensic nursing and its role within the wider professional team, the aim of this book is to provide a multidisciplinary perspective on the training needed to work with mentally disordered patients, as well as to examine the key characteristics of the forensic nursing role. An international group of contributors, from a wide range of disciplines, provides a well-rounded, comparative view of the forensic nursing profession. The chapters are a rich contribution of cross-cultural thinking on the many dilemmas and challenges facing nurses, psychiatrists, psychologists and other health care practitioners, working with specific client groups. Each contributor has utilised empirical data to analyse relevant issues, such as: professional standards; effectiveness of preparation for nurses working within secure environments; day to day and long term challenges facing nurses; clinical effectiveness; the dilemma of security versus practice; how forensic nursing differs from other kinds of nursing; and what forensic nurses can contribute to other mental health care disciplines. Examples of how research findings may be integrated into practice, will be of interest not only to forensic nurses, but also to significant sectors of the mental health care field.

Mentally disordered offenders (MDOs) have dominatd the recent political agenda for mental health care emphasised by cases such as those of Christopher Clunis and Michael Stone. Yet successive governments have constrained the development of all health and social services by the requirement that they must be demonstrated as capable of benefiting those to whom they are applied. This book analyses the development of government policy for services for MDOs since the important Butler report in 1975 and provides a theoretical framework for adjudging research which purports to demonstrate a need and outcome. Finally, it emphasises the subjective and value-laden nature of all needs assessments and their interpretation and poses the crucial questions of whose need it is that we address through MDO services, those of the patient or of society. This book will be valuable to clinicians and researchers working in mental health services, policy-makers, service commissioners and managers. Features: An analysis of the history of the MDO policy in relation to needs assessment pre and post the important Reed Report. A methodological framework for needs assessment of MDOs. Critical appraisal of alternative definitions of needs and of related concepts. Critical analysis of the application of needs assessment methods. A review of research relevant to needs assessment for MDOs. Needs in relation to outcome. An analysis of recent policy development related to MDO services.

Updated core text, addressing safe and effective psychiatric practice in prisons, courts, community clinics, and secure hospitals.

Geriatric Forensic Psychiatry: Principles and Practice is one of the first texts to provide a comprehensive review of important topics in the intersection of geriatric psychiatry, medicine, clinical neuroscience, forensic psychiatry, and law. It will speak to a broad audience among varied fields, including clinical and forensic psychiatry and mental health professionals, geriatricians and internists, attorneys and courts, regulators, and other professionals working with the older population. Topics addressed in this text, applied to the geriatric population, include clinical forensic evaluation, regulations and laws, civil commitment, different forms of capacity, guardianship, patient rights, medical-legal issues related to treatment, long term care and telemedicine, risk management, patient safety and error reduction, elder driving, sociopathy and aggression, offenders and the adjudication process, criminal evaluations, corrections, ethics, culture, cognitive impairment, substance abuse, trauma, older professionals, high risk behavior, and forensic mental health training and research. Understanding the relationship between clinical issues, laws and regulations, and managing risk and improving safety, will help to serve the growing older population.

Ethical medical practice and treatment in psychiatry are based on the concept of first do no harm. However, this cannot, and does not, apply to forensic cases where there is no doctor–patient relationship and the forensic psychiatrist may indeed cause harm to the examinee. In this book, Robert Sadoff analyzes the ethical issues affecting forensic psychiatric practice, especially those promulgated by the American Academy of Psychiatry and the Law. Within those guidelines, he looks at individual bias, vulnerability of the examinee, and potential harm to the mental health professional. The book discusses each of the procedures of the forensic expert separately with respect to minimizing harm. It has been written with an international audience in mind and features chapters reviewing the European and UK perspectives, by Emanuele Valenti and John Baird, respectively. Robert Sadoff addresses the long-term harm that can be either avoided or minimized through careful planning and application of ethical principles. He is not advocating that the harm can be totally eliminated, because that is impossible in the adversarial system in which forensic psychiatrists work. However, there are means by which harm may be minimized if care is taken during the assessment, the report writing, and the testimony phase of the proceedings. The book develops the scope of forensic psychiatry from the standpoint of administrative, civil and criminal cases. It presents the practical issues involved in conducting forensic psychiatric assessments under various conditions plus special considerations, such as bias, minimizing harm, developing a therapeutic approach, and elaborating on various vulnerable individuals who are frequently examined in forensic cases. These include juveniles, mentally retarded, autistic, sexual assault victims, the elderly, the organically damaged, the psychotic, and mentally disabled prisoners. Immigrants are covered in a chapter by Solange Margery Bertoglia. The ethical issues in conducting forensic psychiatric examinations and presenting psychiatric testimony in court are examined and discussed. Cases illustrating the difficulties involved punctuate the presentation. The book closes with a fascinating account of the legal perspective by Donna Vanderpool. In summary, this book illustrates the ethical and practical issues that affect forensic psychiatric practice. The question is not what we do, but how we do it, and which standards, ethical guidelines and personal values contribute to the total picture. Despite the fact that we cannot always adhere to the doctrine of "primum non nocere," we can minimize the harm caused inherently by the adversarial system in which we participate. Praise for Ethical Issues in Forensic Psychiatry "One of the founding giants of the forensic psychiatric field has written here far more than a "mere" ethics textbook. Instead, this compendium serves multiple purposes: it is a valuable primer on forensic techniques of examination and testimony, a model of best forensic practices, and an instruction on the most appropriately civilized way in which to conduct oneself as a forensic psychiatrist. The success of these multiple accomplishments clearly derives from characteristics of the author. In both sage advice to practitioners and in many revealing case examples, Dr. Sadoff displays the tact, good manners and sensitivity of a consummate gentleman – a term not always associated with the hurly-burly of courtroom work. The book's primary focus on avoiding harm to all the parties involved in the work places it on the moral high ground of the legal system in which participating clinicians must find a place." Thomas G. Gutheil, MD, Professor of Psychiatry and Co-Founder, Program in Psychiatry and the Law, Beth Israel Deaconess Medical Center, Harvard Medical School