| 1. |
- Andreasson, Helena, et al.
(författare)
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Predictors of length of stay in forensic psychiatry: The influence of perceived risk of violence
- 2014
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527. ; 37:6, s. 635-642
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Tidskriftsartikel (refereegranskat)abstract
- This study describes the prevalence of adverse events and length of stay in forensic psychiatric patients with and without a restriction order. Detailed clinical and administrative information from medical records and written court decisions was gathered retrospectively from admission until discharge for a Swedish population-based, consecutive cohort of forensic psychiatric patients (n = 125). The median length of stay for the whole cohort was 951 days, but patients with a restriction order stayed in hospital almost five times as long as patients without. Restriction orders were related to convictions for violent crime, but not for any other differences in demographic or clinical variables. The majority of the patients (60%) were involved in adverse events (violence, threats, substance abuse, or absconding) at some time during their treatment. Patients with restriction orders were overrepresented in violent and threat events. Previous contact with child and adolescence psychiatric services, current violent index crime, psychotic disorders, a history of substance, and absconding during treatment predicted longer length of stay. Being a parent, high current Global Assessment of Functioning scores, and mood disorders were all significantly related to earlier discharge. In a stepwise Cox regression analysis current violent index crime and absconding remained risk factors for a longer hospital stay, while a diagnosis of mood disorder was significantly related to a shorter length of stay.
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| 2. |
- Krona, Hedvig, et al.
(författare)
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Mentally disordered offenders in Sweden : differentiating recidivists fromnon-recidivists in a 10-year follow-up study
- 2017
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 71:2, s. 102-109
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Tidskriftsartikel (refereegranskat)abstract
- Background: Forensic psychiatric patients present a challenge as they manifest severe mental disorders together with criminal behaviour. There are well-known risk factors for criminal behaviour in the general population, yet knowledge of what predicts reconviction in the Swedish forensic population in the long-term perspective is still insufficient. Aims: The study aims to (1) describe background and clinical characteristics of forensic psychiatric patients in a 10-year follow-up, (2) analyse risk factors associated with recidivism, and (3) test the predictive validity of risk factors for general and violent criminality. Methods: Detailed information on all offenders from the Malmö University Hospital catchment area sentenced to forensic psychiatric in-patient treatment from 1999–2005 (n = 125) was collected. Court decisions were collected up until the end of 2008 (median follow-up time = 6.2 years, range = 0.6–9.7 years). Results: Relapse in general crime (n = 30) was predicted by low educational attainment, mental disorder in a first degree relative, and low age at first sentenced crime. Relapse in violent crime (n = 16) was predicted by low educational attainment and low GAF scores. Patients with a restriction order were less likely to relapse in both crime categories. Conclusions: Signs of childhood adversities together with early debut in criminality appeared as important risk factors for general and violent recidivism. Forensic psychiatric treatment combined with a restriction order was demonstrated as a protective factor against recidivism, suggesting that the risk of recidivism is strongly related to the level of supervision. Although the low number of recidivism cases is highly desirable, it unfortunately reduces the power of the analyses in this paper.
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| 3. |
- Nyman, Marielle, et al.
(författare)
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Mental Health Nurses' Experiences of Risk Assessments for Care Planning in Forensic Psychiatry
- 2020
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Ingår i: International Journal of Forensic Mental Health. - : Informa UK Limited. - 1499-9013 .- 1932-9903. ; 19:2, s. 103-13
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Tidskriftsartikel (refereegranskat)abstract
- The risk of patients committing violence implies major challenges throughout the care process in forensic psychiatry and brings risk assessments to the fore. The aim was to explore nurses' experiences of risk assessments for their care planning and risk management in forensic psychiatry. Data were collected through focus groups with 15 nurses. The qualitative content analysis followed a deductive approach guided by the person-centered philosophy. When exploring nurses' reasoning on risk assessment, units related to person-centered principles were identified. The findings showed that nurses made great efforts to confirm the unique person behind the patient, even when challenged by patients' life histories of violence. They also regarded therapeutic alliance as crucial, although this needed to be balanced between caring and restricting actions. A fruitful strategy to preserve therapeutic alliance may be to increase the use of a structured focus on protective factors in treatment plans towards promoting recovery-oriented policies and practices.
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| 4. |
- Nyman, Marielle
(författare)
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Risk Assessments in Forensic Psychiatry: Consequences and Experiences for Patients and Nurses
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In forensic psychiatry, risk assessment of future violence poses a great challenge to mental health care professionals. Forensic psychiatric patients are particularly vulnerable due to their complex mental health needs in combination with criminal behavior. The overall aim was to evaluate the importance and validity of risk assessments in forensic psychiatric care, and the related experiences of patients and nurses. The methods used were, (I) statistical analyses of file register data, (II) focus group interviews with nurses, (III) semi-structured interviews with inpatients, and (IV) quantitative analyses of assessments based on forensic psychiatric investigations. Findings: From a cohort of 125 forensic psychiatric inpatients, the findings showed a median length of stay of slightly more than two and a half years, predicted by previous contact with child- and adolescent psychiatry, violent index crime, psychotic disorders, history of substance use, and absconding during treatment. Treatment with special court supervision resulted in an almost five times longer length of stay compared to treatment without such supervision. Sixty percent were involved in at least one adverse event during their treatment. Elements of person-centered care were identified when nurses’ views were explored. Great efforts were made to confirm the unique person behind the patient, even when challenged by patients’ previous violence. Relationships with patients were considered crucial for successful risk management, this needed to be balanced against caring and restricting actions. The patients’ experiences of risk assessments could be summarized in three categories; taking responsibility for one’s own situation, taking charge of the present, and being involved and having impact. To evaluate the utility of the SAPROF (Structured Assessment of Protective Factors for violence risk), predictive validity was compared to three risk- and strength-based instruments: SAPROF, HCR-20 (Historical Clinical Risk Management-20), and LHA (Life History of Aggression). Only the SAPROF subscale ‘internal factors’ and the LHA total score, showed a significant, but weak, predictive ability of the occurrence of violent incidents. Conclusion: Perceived risk of future violence, as determined by the court, determined length of stay in forensic psychiatric care much more than clinical needs. However, structured instrument for risk assessments, currently used by clinician, showed poor ability to predict violence during inpatient care. Nurses in forensic psychiatric care found that risk assessments offered opportunities to confirm the patient as a person and to establish a trusting relationship. The findings point to the importance of promoting agency and active participation in the patients’ own care processes, highlighting the most important conditions for autonomy and well-being.
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| 5. |
- Nyman, Marielle, et al.
(författare)
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“You Should Just Keep Your Mouth Shut and Do As We Say”: Forensic Psychiatric Inpatients’ Experiences of Risk Assessments
- 2022
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Ingår i: Issues in Mental Health Nursing. - : Informa UK Limited. - 1096-4673 .- 0161-2840. ; 43:2, s. 137-145
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Tidskriftsartikel (refereegranskat)abstract
- This study presents findings of forensic inpatients’ experiences of their role in the risk assessment process. Eleven patients, recruited from two forensic psychiatric clinics in Sweden, participated in semi-structured interviews which were analyzed using qualitative content analysis. The analysis of their experiences resulted in the information of three categories: Taking responsibility for one’s own situation, in terms of taking responsibility for aspects of one’s care, taking charge of the present, emphasizing potential challenges in grasping reality, and being involved and having impact, which concerns feelings of being involved in discussions related to one’s care and treatment versus feelings of being an outsider.
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