S11.02 - From general to forensic psychiatry and back

Abstract

Problem:

As in other European countries, in the German State of Hessen during the last two decades the number of forensic beds has dramatically increased. From General to Forensic Psychiatry: This increase is a response to violent behaviour by male patients with severe mental illness who previously had been treated in general psychiatry. In Hessen, during the period 1990 to 2005 the number of admissions to forensic hospitals of patients suffering from functional psychoses increased by 118% while the number of patients suffering from other disorders rose by only 18%. Forensic Psychiatric Treatment: Patients with functional psychoses who are admitted to forensic hospitals present antisocial personality traits, long standing mental health and substance misuse problems, and a history of both violent and non-violent criminal activities. In order to meet the complex treatment needs of these patients treatment components which address each of their multiple problems have been implemented. From Forensic Psychiatry back to the community: A forensic mental health service that uses state-of-the-art methods in assessing and managing their patients is able to cope with an increased burden: In Hessen, the average length of inpatient care for patients with functional psychoses has decreased by one year, while the number of discharges increased by 122%. In order to maintain treatment successes it is necessary to discharge these patients into pro-social environments. Furthermore, legal powers to ensure compliance with all aspects of treatment once the patient is discharged into the community have proven to be a key factor in reducing re-offending.