Syftet med studien är att undersöka hur samverkan ser ut mellan kommun och landsting vad avser personer som vårdas enligt lag (1991:1129) om rättspsykiatrisk vård (LRV) och skall permitteras till hemkommunen. Studiens frågeställningar är: (1) Hur sker samverkan mellan kommun och landsting innan permissionen verkställs? (2) Hur sker samverkan mellan kommun och landsting under tiden en person är permitterad? (3) Vilka möjligheter och hinder finns vad avser samverkan mellan kommun och landsting gällande personer som permitterats? Metodvalet är kvalitativt och författarna har genomfört fem intervjuer med nyckelpersoner inom landsting och samverkande kommuner. Den teoretiska utgångspunkten är Danermarks tre primära samverkansbegrepp: organisation, kunskap och regelverk. Resultatet visar att landstinget har ansvar för vård och behandling och att kommunen har ansvar för boende och sysselsättning. Respondenterna inom landstinget upplever att deras samverkan fungerar bra och uttrycker att det är vikigt med en god kommunikation samt att personkännedom underlättar samverkan. I dagsläget saknas det skriftliga samverkansavtal som är förankrade i verksamheterna, det saknas även en klar målsättning för samverkan. Detta är något som studiens tidigare forskning rekommenderar för en förbättrad samverkan. Respondenterna i en av kommunerna upplever att de får för lite bakgrundshistorik om brukarna och anser att viss rädsla kan finnas på grund av detta. De anser även att den handledning de idag får ifrån landstingets personal inte är tillräcklig. En respondent ifrån landstinget tycker dock att de ger lagom mycket information och att rädslan skulle kunna öka bland kommunens personal om de gav mer information. / The aim of this study is to research how the collaboration between municipality and county council works, about persons who are in forensic psychiatric care and are going on community leave. The studied issues are: (1) How does the collaboration work, between the municipality and county council, before the community leave is carried out? (2) How does the collaboration work, between the municipality and county council, during the community leave? (3) Witch possibilities and obstacles can be found in the collaboration between the municipality and county council, about persons who are on community leave? The method in the study is qualitative and the authors have accomplished five interviews with key figures within county council and collaborating municipalities. The theoretical starting point is Danermarks three collaboration concepts: organization, knowledge and rules. The result shows that the county council has the responsibility of medical care and treatment and that the municipality has the responsibility of the housing and occupation. The county council respondents experience that the collaboration is good and they also express that it is important to have an open communication, and that good knowledge of the persons involved facilitates the collaboration. Today there is a lack of written collaboration agreements that have gained approval within the organizations. Also, there is no common aim with the collaboration. A written agreement with a clear aim for the collaboration is something that is recommended by earlier research to improve the collaboration. The respondents in one municipality would like to get more background history about the persons who are on community leave, the lack of information could cause fear among the employees. They would also like some more guidance from the county council staff. One county council employee thinks that more information would cause more fear amongst the municipality staff.

While forensic psychiatric inpatient violence is a serious problem, research on risk assessment for this outcome is limited; the current research investigated the predictive validity of a number of structured risk/forensic instruments for inpatient violence. Research objectives included: 1) observing the profile of dynamic changes in violence risk detected by existing violence risk assessment instruments; 2) assessing whether existing violence risk assessment instruments could be used to assess risk for inpatient violence; 3) evaluating the contribution of dynamic risk measures to the prediction of inpatient violence; and 4) assessing the relationship between dynamic changes in risk and inpatient violence. Instruments included: the Historical Clinical Risk Management 20 - Version 3 (HCR-20V3), the Psychopathy Checklist Revised (PCL-R), the Short-Term Assessment of Risk and Treatability (START), the Revised Violence Risk Appraisal Guide (VRAG-R), and the Violence Risk Scale (VRS). Two studies were conducted on a maximum-security forensic psychiatric unit at Alberta Hospital Edmonton. Study 1 was a pseudo-prospective archival investigation (n = 99), while Study 2 was a prospective investigation (n = 19); all risk assessment scores were based on information available in institutional files. Instruments designed to capture dynamic/clinical risk variables (HCR-20V3, START, VRS) detected dynamic changes in risk in this setting over longer follow-ups (i.e., between admission and discharge), but not over shorter follow-ups (i.e., 28 day periods). Predictive validity analyses indicated that specialized measures designed to capture relevant dynamic/clinical variables were significant predictors of inpatient violence; instruments that were not designed for this purpose (PCL-R and VRAG-R), did not demonstrate predictive validity for inpatient violence. Dynamic measures consistently demonstrated incremental predictive validity for inpatient violence, beyond the static measures. Additionally, change scores demonstrated incremental relationships with decreased inpatient violence, beyond pretreatment scores. Put another way, positive risk change was associated with decreased violence over the course of the patients’ stays in hospital. Reliable and valid risk assessments are a necessary component of effective offender programming (Risk-Need-Responsivity Model) and the current results indicated that valid violence risk assessments for forensic psychiatric inpatient violence are possible. Implications for clinical practice and the reduction/mitigation of inpatient violence are discussed.

Syftet med uppsatsen har varit att undersöka hur anställda inom rättspsykiatrin ser på relationen mellan sig själva och vårdtagarna, samt att studera de olika aspekter som berör relationen i vårdandet, bland annat maktrelationen och vänskapsrelationen. Uppsatsen baseras på en kvalitativ studiemetod med semistrukturerade intervjuer. Nio stycken anställda vårdare (undersköterskor och skötare) från en avdelning inom rättspsykiatrin i Växjö deltar i studien. Resultatet visar att relationen mellan vårdare och vårdtagare är en viktig aspekt inom vården, och att relationen är basen inom vården för att kunna erbjuda bra vård till patienten. Intervjupersonerna menar att: En bra relation mellan vårdare och vårdtagare kännetecknas av att vårdaren ska kunna skapa förtroende, tillit i relationen, samt stödja och tillfredsställa patientens behov med hjälp av relationen. Studien belyser svårigheterna inom relationen mellan vårdare och vårdtagare samt de risker som kan förekomma. Resultatet visar även att en viss synlig och osynlig makt utövas; den makten är svår att definiera, personalen är delvis omedvetna om att de själva utövar makt dagligen. / The purposes of this essay are to examine how employees in a psychiatric ward experience the relationships between them and the caretakers, and to study the different aspects of relationships between them. For instance the power relation and the friend relation. The essay is based on a qualitative method with semi structured interviews from 9 employees, whom are nurses and caregivers at a ward in Växjö psychiatric institution.  The results from this study illuminate that the relationship between caregivers and caretakers is a vital aspect of the care itself. And that this relationship is the foundation for caregiver to be able to offer necessary care. A good relationship between caregiver and caretaker is characterized by the abilities of the caregiver to create trust and confidence in their relationship to the caretaker, as well as supporting and satisfying the caretakers’ needs by help of their relationship.  This study highlights the issues in the relationship between caregivers and caretakers as well as the risk that pertain to this relationship. The results indicate that certain power exertions overt and covert are factors in some relationships. These power exertion are, however, hard to define, the caregivers also seem partly unaware of them.

To be sentenced to care in the forensic psychiatric services can be seen as one of the most comprehensive encroachments society can make on a person's life and being, as it entails a limitation of the individual's freedom but with no time limit. The aim of this dissertation is to describe caring in forensic psychiatry based on how it is experienced by those who perform the caring and by those are cared for in a maximum secure unit. A reflective lifeworld approach, based on phenomenological philosophy, has been applied. The data has been collected in interviews that have been analyzed by use of a meaning analysis searching for the essence of the phenomenon. The results of the research are presented in two empirical studies and a general structure based on the empirical findings. The dissertation also contains an excursus, a philosophical intermediate chapter containing further analysis of the results of the studies. The results show how the forensic psychiatric care is experienced as being non-caring by the patients with only small "pockets" of good care. Caring consists of corrective techniques that are unreflected and contradictory, where the conditions are determined by the caregivers and the ward culture. The correcting takes place through the modification of the patients' behaviour with the aim of the patients having to adapt themselves to the terms of the care provision. This care results in the patients trying, by use of different strategies, to adapt them-selves to the demands of the caregivers in order to gain privileges. At the same time the patients long to get away from the care system and are lacking real, meaningful and close relationships. To be the subject of care entails struggling against an approaching overwhelming sense of resignation and to care entails experiencing both power and powerlessness in performing the care. A destructive power struggle is being waged within forensic psychiatric care that suppresses the caring potential and true caring is thus elusive. The characteristics of forensic psychiatric care, based on the results of the research, are clarified in the dissertation's excursus. These include the corrective and disciplinary nature of forensic psychiatric care, its power and how this is materialized in care situations as well as the influence of tradition on current forensic psychiatric care in the light of the work of the French philosopher Michel Foucault. The dissertation shows that if the caring potential is to be able to be developed and form a caring nucleus for forensic psychiatric care then education levels need to be further developed. A caring culture and caring environment is needed where true caring can gain a foothold. In order for this to become a possibility the current caring culture and environment must be clarified, questioned and examined. The prevalent fundamental ideas in forensic psychiatric care have to be "jeopardized" and challenged by new scientifically based ideas on what constitutes true caring in this context.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Thèse (Ph.D.)--Université de Montréal, 1998. / Comprend des réf. bibliogr.

No description available.

Bakgrund : Sjuksköterskans roll i omvårdnad inom rättspsykiatrin är komplex. Detta på grund av att utöver omvårdnaden, skall även en säker miljö upprätthållas. Tvångsåtgärder kanske också måste utföras, vilket kan påverka sjuksköterskans etiska och moraliska principer. Den mest framträdande uppgiften sjuksköterskan har är dock att genom en sjuksköterska-patient relation skapa hälsa och välbefinnande samt ge patienter en chans till att växa och utveckla sina beteende. Syfte: Syftet med studien var att beskriva aktuell forskning om sjuksköterskans attityder inom den rättspsykiatriska omvårdnaden. Metod: Litteraturöversikt som inkluderar elva kvalitativa studier. Studierna som tagits fram har analyserats och teman identifierats. Databassökningar har genomförts i PubMed, CINAHL, SveMed+ och PsycINFO. Resultat: Tre huvudteman och två subteman identifierades. Första huvudtemat var sjuksköterskans roll med subteman relationens faser och säkerhet och tvångsåtgärder. De andra två huvudteman som identifierades var maskulinitet och copingstrategier. Slutsats : De affektiva attityderna som sjuksköterskan upplever kan styra mycket av de beslut och handlingar som utförs. Detta kan påverka patienters hälsa, välbefinnande och utvecklande. Män ansåg sig själva att genom handlingskomponenten bidra till en trygg och säker miljö. / Background: The nurse has a complex role of nursing care in a forensic care setting. This due to in addition to nursing care, also a safe environment should be preserved. Coercive measures may also have to be carried out, which can affect nurse´s ethical and moral principles. The most prominent task the nurse has are however to create health and wellbeing through nurse-patient relation as well as to offer the patient an opportunity to grow and to develop his behavior. Aim: The aim with this study was to describe current research of the nurse’s attitudes about nursing care in forensic care settings Method: Literature review including eleven qualitative studies. The studies have been analyzed and themes has identified. Database searches are made in PubMed, CINAHL, SveMed+ and PsycINFO. Results: Three main themes and two sub themes were identified. The first main theme was the nurse role with the sub themes the phases of a relationship and safety and coercive measures. The two other main themes that were identified are masculinity and coping strategies. Conclusion: The affective attitudes that the nurse experiences can control much of the decisions and actions that are performed. This can affect patients' health, well-being and development. Men considered themselves to contribute, through the action component, to a safe and secure environment.

This study examines the utility of the MMPI-2 in predicting responsibility in pre-trial forensic patients, using a post hoc sample of 94 offenders from Sterkfontein Psychiatric Hospital in Gauteng. Firstly, the overall characteristics of the pre-trial forensic patients are discussed, following an analysis of demographic, clinical, criminal and MMPI-2 pre-trial data, as well as an overview of the Megargee typological classification of offenders. The sample is classified into Criminally Responsible (CR), Diminished Criminal Responsibility (DCR) and Not Criminally Responsible (NCR), and the CR and DCR groups are collapsed (CR/DCR) for many of the analyses when comparing them to the NCR group. Secondly, the variance of variables with responsibility is discussed, after examining one-way ANOVA’s of demographic, clinical, criminal and MMPI-2 variables, as well as an overview of high point pairs. Thirdly, discriminant analyses were conducted of demographic, clinical and MMPI-2 variables. When comparing the collapsed CR/DCR group to the NCR group, psychiatric diagnosis, presence of psychosis, the MMPI-2 Pa and Es scales, as well as race and substance abuse each had unique predictive power and created a substantial discriminative equation (F (6,70) = 45.732, p <0.0005) with a successful prediction rate of 96%. Using only MMPI-2 variables to predict responsibility showed significant unique contributions for the Pa, Es, MAC-R and Mf scales, with the BIZ scale not quite significant, and a fairly significant overall discriminant equation (F (5,73) = 6.474, p < 0.0005), with an overall successful prediction rate of 82%, with the MMPI-2 variables adding an additional 3% to the predictive power of the demographic and clinical variables. Similarly, when examining the more complex 3 group responsibility classification of CR, DCR and NCR, it was found that the demographic, clinical and MMPI-2 variables of psychiatric diagnosis, psychosis, race, substance abuse, and the Pa, Es and Ma scales all had significant contributions to a powerful discriminant analysis (F (14, 136) = 19.758, p < 0.0005) that was capable of correctly reclassifying almost 95% of the sample, and the MMPI-2 variables providing an increase in predictive power of 8%. Differences in responsible and not responsible pre-trial forensic patients are discussed, as well as the role of the MMPI-2 in assessing these differences, and the fact that it is highly likely that it adds more to the forensic assessment of responsibility than a 3% (CR/DCR versus NCR) or 8% (CR versus DCR versus NCR) increase in predictive power. Limitations of the study are discussed, together with recommendations for future research with the MMPI-2 for assessment of criminal responsibility. The suggestion is made that the MMPI-2 can become a valuable tool in South African forensic settings, not only in the assessment of responsibility and malingering, but also in the placement, management, follow-up and treatment of offenders, to maximize the limited resources in South Africa allocated for the rehabilitation of offenders, and minimize the risk of recidivism or rehospitalization.

The current study addresses the fundamental role of expert evidence advanced in support of the defence of criminal incapacity. It was endeavoured to illustrate that the scientific entities of forensic psychiatry and psychology fulfil an essential and pivotal role in establishing and assessing the defence of criminal incapacity. The study proposed to illustrate the interaction between the professions of law and medicine on the backdrop of the defence of criminal incapacity. Recommendations were provided with the aim of enhancing the dialogue between the professions of law and medicine when the defence of criminal incapacity falls to be assessed. The study was approached from a dual dimensional perspective illustrating both the need for mental health experts as well as the need for adequately trained and experienced mental health experts to provide expert testimony as to an accused’s mental state when the defence of criminal incapacity is raised. The motivation for the current study is enumerated and the concepts of “criminal capacity”, “non-pathological criminal incapacity”, “pathological criminal incapacity” and “expert evidence” are, amongst others, conceptualized. It is indicated that expert evidence plays an essential role not only in cases where pathological criminal incapacity, or put differently, criminal incapacity attributable to mental illness or mental defect is raised, but also in instances where non-pathological criminal incapacity is raised as a defence. The role of the mental health expert is addressed with reference to battered woman syndrome evidence advanced in support of the defence of non-pathological criminal incapacity. It is illustrated that the defence of non-pathological criminal incapacity is in need of reform. It is in addition illustrated that legislative reform is essential to establish the defence of non-pathological criminal incapacity and to create legal certainty. The inconsistent approach in the application of expert evidence to the defence of criminal incapacity is emphasized with specific focus on the semantic distinction between the defences of non-pathological criminal incapacity and pathological criminal incapacity. The role and application of the DSM-IV in the definition and assessment of mental disorders is addressed in conjunction with the various obstacles associated with the application of the DSM-IV to the defence of criminal incapacity. The nature and scope of the basic rules of expert evidence as they would apply to mental health professionals acting as expert witnesses in support of the defence of criminal incapacity are addressed. The assessment of the probative value of expert evidence is addressed and the complexities associated therewith are espoused. The numerous ethical dilemmas faced by mental health experts are illustrated and recommendations are provided aimed at eliminating these dilemmas. A comparative study of selected principles pertaining to expert evidence in the United States of America is embarked upon to illustrate the need for a codification of the rules of expert evidence as well as effective guidelines aimed at enhancing the scientific reliability and validity of expert evidence advanced in support of the defence of criminal incapacity. Finally, conclusions are drawn and motivated recommendations are made. Law reform is proposed in the form of draft proposals for legislative reform in respect of the defence of criminal incapacity as well as a draft ethical code of conduct for mental health experts providing expert testimony in cases where the defence of criminal incapacity is raised. / Thesis (LLD)--University of Pretoria, 2011. / Public Law / unrestricted