Guidelines for Improving Forensic Mental Health in Inpatient Psychiatric Settings

Authored by: Tonia L. Nicholls , Ilvy Goossens

Handbook of Forensic Mental Health Services

Print publication date:  May  2017
Online publication date:  May  2017

Print ISBN: 9781138645943
eBook ISBN: 9781315627823
Adobe ISBN:

10.4324/9781315627823.ch17

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Abstract

Forensic mental health care has often been characterized as having been left behind when it comes to developing, implementing, and evaluating evidencebased practice (Grubin, 2001; Howells, Day, & Thomas-Peter, 2004; Keune, de Vogel, & van Marle, 2016). Experts agree that there is an absence of evidencebased practice guidelines and standardized assessment and treatment models in forensic mental health settings (Crocker, Nicholls, Seto, Roy et al., 2015), making theoretical conceptualizations (Barnao & Ward, 2015; Mullen, 2000) and further rigorous research imperative (Morgan et al., 2012). For instance, Barnao and Ward (2015) recently described our field as “Sailing unchartered seas without a compass,” noting the lack of a comprehensive rehabilitation model. Further, the International Journal of Forensic Mental Health recently published an article that detailed the absence of productive daily activities and treatment opportunities in the daily lives of forensic patients (Sturidsson, Turtell, Tengström, Lekander, & Levander, 2007). Sturidsson and colleagues (2007) mapped the 24-hour activities of patients into 15-minute time segments. The findings demonstrated that patients spent 18 hours each day sleeping, sitting idly, and watching television; comparatively, patients spent just 1.60 hours per day in structured activities and 0.31 hours in treatment. What is perhaps particularly troubling about the Sturidsson and colleagues’ (2007) results is that the authors also found no difference in the amount of time in treatment for individuals assessed as high risk versus those identified as low risk for violence. The findings are tantamount to demonstrating that in some circumstances we are doing little more than ‘warehousing’ a very high needs, high-risk population.

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