Denna studie handlar om den rättspsykiatriska personalens erfarenheter av patienternas återhämtningsprocesser. Studien syftar till att försöka belysa de erfarenheter som personalen besitter, med fokus på återhämtning. Studien bygger på en kvalitativ metod och består av intervjuer som gjorts med personal som arbetar inom en av Sveriges rättspsykiatriska vårdkliniker. Resultatet visar att personalen har erfarenheter av att det finns både gynnsamma och hindrande faktorer som påverkar patienternas återhämtning. Resultatet visar även att relationerna mellan personalen och patienten är en viktig förutsättning för patienternas återhämtning. / This study is about the forensic psychiatry staff experiences of patients ' recovery processes. The study aims to highlight the experience staff possesses. The study is based on a qualitative approach and consists of interviews conducted with staff who works in one of the forensic psychiatric care clinics. The study is based on a qualitative approach and consists of interviews conducted with personnel working in one of the forensic psychiatric care clinics. The results show that the staffs have experience of both beneficial and hindering factors that influence patients ' recovery. The result also shows that relations between staff and patient are essential for patients ' recovery.

Bakgrund: Att utvecklas professionellt som sjuksköterska är en kontinuerlig, individuell och lång process som startar med utbildning och som fortsätter hela arbetslivet. Det kan vara svårt att finna sin roll och få den säkerhet och trygghet som krävs för att man ska kunna vidareutvecklas inom sin profession. Sjuksköterskans utveckling och självkännedom kring sin kompetensnivå är nödvändig för att uppehålla en hög standard av omvårdnad och möjliggöra att bemöta och uppfölja nya krav som ställs på omvårdnaden allteftersom utveckling fortskrider. Syftet med denna studie var att belysa sjuksköterskors upplevelser av sin professionella utveckling i sitt arbete inom den rättspsykiatriska vården. Metoden som användes för att belysa sjuksköterskornas upplevelser var av kvalitativ art med induktiv ansats och byggde på en innehållsanalys av halvstrukturerade intervjuer. Åtta legitimerade sjuksköterskor med minst två års yrkeserfarenhet inom rättspsykiatrisk vård intervjuades. Resultatet presenterades under fyra kategorier; erhållbar kunskap, formell kunskap,förtrogenhetskunskap, motverkan av stagnerad kunskap. Studien visade att via kontinuerlig handledning, utbildning och erfarenhet skedde en vidareutveckling av sjuksköterskans profession.Omvårdnaden förhindrades att stagnera i och med att sjuksköterskorna utvecklades och fördjupades i sin kompetens. Slutsatsen blev att då sjuksköterskan utvecklades inom professionen så ledde det i sin tur till att förutsättningar skapades för att omvårdnaden utvecklades och gick framåt. / Background: To develop professional as a nurse is a continuous,individual and long process that starts with education and continues throughout working life. It can be difficult to find one’s role and getthe certainty and assureness needed for further development within the profession. The nurses` development and self-awareness about their level of competence is necessary to maintain a high standard of caring and making it possible to cope with and fulfilling new demands placed on nursing care as a development progress. The purpose of this study was to illuminate nurses` experiences of their professional development in their work in the forensic psychiatry care. The method used to illuminate nurses` experiences was of aqualitative nature with an inductive approach and was based on a content analysis of semi-structured interviews. Eight registered nurses with at least two years professional experiences in forensic psychiatry care were interviewed. The result was presented under four categories; receivable knowledge, formal knowledge, familiarity knowledge, countering of stagnate knowledge. The study showed that through continuous coaching, education and experience, there was a further development of the nurses’ profession. Nursing care was prevented to stagnate as the nurses developed and deepened in their level of competence. The conclusion was that when the nurse developed within the profession, new conditions were made to develop the nursing care further.

Background: Forensic psychiatric care is a non-voluntary care form for people with severe mental disorders and criminal backgrounds. These patients have a restricted autonomy based on predetermined guidelines regulating this careform. The legislation governing forensic psychiatry confines the patient's power to influence the decision making concerning their treatment plan. Enabling patient involvement in this non-voluntary careform can be challenging for healthcare staff. Aim:To identify how patient involvement can be encouraged within forensic psychiatry. Method: A literature overview proceeding from eleven scientific qualitative articles that were analysed using thematic analysis method. Result: The patients stated that they wanted a greater influence over their care form. Furthermore, they lifted the importance of being informed about their treatment plan and medications by the caregivers to increase their involvement. Patients and healthcare staff relations are characterized by honesty and constitute a central role in patient involvement encouragement. Conclusion: Based on the literature study’s result the authors identified two key factors that affect the patients' experience of their involvement negatively, these factors were lack of information and exclusion from treatment conferences. Further research through qualitative studies should be carried out focusing on the working and non-working methods regarding the promotion of forensic psychiatric patients' involvement. / Bakgrund: Rättspsykiatrisk vård är en ofrivillig vårdform som personer med en allvarlig psykiatrisk störning som begår ett brott kan dömas till. Patienter inom rättspsykiatrisk vård har en begränsad autonomi vilket grundar sig i förutbestämda riktlinjer som styr denna vårdform. Att möjliggöra patientens delaktighet inom rättspsykiatrisk vård kan vara en utmaning för vårdpersonalen då vården inte utgår från samtycke. Syfte: Att identifiera hur patienters delaktighet kan främjas inom den rättspsykiatriska vården. Metod: En litteraturöversikt som utgick från elva vetenskapliga artiklar med kvalitativ ansats. Artiklarna som inkluderades analyserades med tematisk innehållsanalys. Resultat: Patienterna uppgav att de ville ha större inflytande över den vård de erhöll. Vidare lyfte de vikten av att vårdpersonal gav dem information kring deras behandling och medicinering för att främja deras delaktighet i vården. Vårdrelationen mellan patienter och vårdpersonal präglas av ärlighet och utgör en central roll vid främjande av patienters delaktighet. Slutsats: Utifrån litteraturstudiens resultat identifierade författarparet att två nyckelfaktorer som visades påverka patienternas upplevelse av delaktighet negativt var brist på information och exkludering från behandlingskonferenser. Fortsatt forskning genom kvalitativa studier bör utföras med fokus på de arbetsmetoder som fungerat och inte fungerat gällande främjandet av rättspsykiatriska patienters delaktighet.

Bakgrund: Det finns tidigare forskning inom området vårdande relation. Dock är den begränsad inom rättspsykiatrisk vård. I synnerhet forskning som integrerar patienter och sjuksköterskors erfarenheter av det undersökta fenomenet. Syfte: Att beskriva patienter och sjuksköterskors erfarenheter om vad som möjliggör respektive försvårar en vårdande relation inom rättspsykiatrisk vård. Metod: Studiens resultat bygger på intervjuer av fem patienter som är inneliggande på en rättspsykiatrisk klinik respektive fem sjuksköterskor som arbetar på samma klinik. Studien genomfördes med en induktiv ansats. Insamlade data analyserades utifrån en kvalitativ innehållsanalys. Resultat: Studiens resultat visar att patienterna upplever det viktigt att de blir sedda som människor, att vårdare gör det lilla extra och att vårdare samt patient drar åt samma håll för att vårdande relation ska kunna etableras. Sjuksköterskorna tyckte det var viktigt att sätta sig in i patienten, att ha en fungerande arbetsgrupp, att göra något utöver det vanliga och får förtroende att samspela. Slutsatser: Resultatet svarar an till studiens syfte. Såväl patienterna som sjuksköterskorna ansåg att vårdarna hade det yttersta ansvaret för att en vårdande relation skulle kunna etableras. I båda grupperna sågs flera gemensamma nämnare såsom tidsaspekt, närvaro och att vårdaren har ett genuint intresse.      NYCKELORD:, bemötande, erfarenheter, patientperspektiv, rättspsykiatrisk vård, sjuksköterskeperspektiv, vårdande relation / Background: Previous research in the field caring relationship is available. However, it is limited in forensic psychiatric care. Especially studies that integrate patients and nurses experiences of the investigated phenomenon. Aim: The aim of this study was to describe patients and nurses experiences of what enables and aggravate a caring relationship in forensic psychiatry care. Methods: The results of the study are based on interviews of five patient in a forensic clinic and five nurses who works on the clinic. The study was performed with an inductive approach. Data were analyzed based on a qualitative content analysis. Results: In order for a caring relationship to be established the results indicates that the patients find it important to be seen as humans, that the carers do ”that little extra” and that the carers and patients works at the same direction. The nurses found it important to familiarize themselves in the patient, to have a stabilized work with the team, to do “the little extra” and get the trust to cooperate. Conclusion: The results corresponds to the aim of the study. Both patients and nurses agreed that the nurse had the responsibility of the caring relationship. A similarity were shown between both of the groups such as time aspect, presence and a genuin interest from the carrier. Keywords: caring relationship, encounter, experiences, forensic psychiatric care, nurse, patient.

Bakgrund: Det finns tidigare forskning inom området vårdande relation. Dock är den begränsad inom rättspsykiatrisk vård. I synnerhet forskning som integrerar patienter och sjuksköterskors erfarenheter av det undersökta fenomenet. Syfte: Att beskriva patienter och sjuksköterskors erfarenheter om vad som möjliggör respektive försvårar en vårdande relation inom rättspsykiatrisk vård. Metod: Studiens resultat bygger på intervjuer av fem patienter som är inneliggande på en rättspsykiatrisk klinik respektive fem sjuksköterskor som arbetar på samma klinik. Studien genomfördes med en induktiv ansats. Insamlade data analyserades utifrån en kvalitativ innehållsanalys. Resultat: Studiens resultat visar att patienterna upplever det viktigt att de blir sedda som människor, att vårdare gör det lilla extra och att vårdare samt patient drar åt samma håll för att vårdande relation ska kunna etableras. Sjuksköterskorna tyckte det var viktigt att sätta sig in i patienten, att ha en fungerande arbetsgrupp, att göra något utöver det vanliga och får förtroende att samspela. Slutsatser: Resultatet svarar an till studiens syfte. Såväl patienterna som sjuksköterskorna ansåg att vårdarna hade det yttersta ansvaret för att en vårdande relation skulle kunna etableras. I båda grupperna sågs flera gemensamma nämnare såsom tidsaspekt, närvaro och att vårdaren har ett genuint intresse. / Background: Previous research in the field caring relationship is available. However, it is limited in forensic psychiatric care. Especially studies that integrate patients and nurses experiences of the investigated phenomenon. Aim: The aim of this study was to describe patients and nurses experiences of what enables and aggravate a caring relationship in forensic psychiatry care. Methods: The results of the study are based on interviews of five patient in a forensic clinic and five nurses who works on the clinic. The study was performed with an inductive approach. Data were analyzed based on a qualitative content analysis. Results: In order for a caring relationship to be established the results indicates that the patients find it important to be seen as humans, that the carers do "that little extra" and that the carers and patients works at the same direction. The nurses found it important to familiarize themselves in the patient, to have a stabilized work with the team, to do "the little extra" and get the trust to cooperate. Conclusion: The results corresponds to the aim of the study. Both patients and nurses agreed that the nurse had the responsibility of the caring relationship. A similarity were shown between both of the groups such as time aspect, presence and a genuin interest from the carrier. Keywords: caring relationship, encounter, experiences, forensic psychiatric care, nurse, patient.

Background: A person with a serious mental disorder who commits a crime can be sentenced to forensic psychiatric care. Forensic psychiatric care is permeated by a high sense of security, while patients are expected to follow a predetermined treatment plan. This restrictive environment, where patients are forcibly cared for during indeterminate time leads to a complex ethical dilemma. Patients are treated for their mental illness whilst the restrictive nature of the care environment deprives them of the opportunity for full autonomy, which can affect their overall experience of the care period. Aim: The aim was to describe patients' experience of their care in forensic psychiatry. Method: A general literature review based on ten scientific articles with a qualitative approach that were analyzed with a content analysis. Results: Three main categories were identified: Being locked up and supervised, The importance of interpersonal encounters and Rehabilitation process in forensic psychiatry. Mentioned main categories were divided into six subcategories. Conclusion: The strict requirements of the forensic psychiatric care form require an adaptation of the admitted patients. Patients' experience the lack of meaningful activities and autonomy. Central are the relationships between care recipients and care providers to evoke a sense of safety and meaningfulness for the patients. A therapeutic approach is important and seeing the human behind the crime. Suggestions for further research: The results show the absence of therapeutic roles in forensic psychiatry. The need for guidelines regarding the therapeutic treatment of forensic psychiatric patients should thus be considered to be developed. This to create a safe and empathetic existence that contributes to a health-promoting environment for forensic psychiatric patients. / Bakgrund: Personer med en allvarlig psykisk störning som begår ett brott kan dömas till rättspsykiatrisk vård. Rättspsykiatrisk slutenvård genomsyras av strikta riktlinjer kring säkerhet samtidigt som patienterna förväntas följa en förutbestämd behandlingsplan. Denna restriktiva miljö där patienterna tvångsvårdas under en obestämd tid bidrar till ett komplext etiskt dilemma, då personer behandlas för sin psykiska ohälsa samtidigt som vårdmiljöns restriktiva natur fråntar deras möjlighet till full autonomi, vilket kan påverka deras helhetsupplevelse av vårdtiden. Syfte: Syftet var att beskriva patienters upplevelse av vården inom rättspsykiatrin. Metod: En allmän litteraturöversikt baserat på tio vetenskapliga artiklar med kvalitativ ansats som analyserades med en innehållsanalys. Resultat: Tre huvudkategorier identifierades: Att vara inlåst och övervakad, Betydelsen av mellanmänskliga möten och Rehabiliteringsprocessen inom rättspsykiatrin. Nämnda huvudkategorier delades in i sex underkategorier. Slutsats: Den rättspsykiatriska vårdformens strikta krav kräver en anpassning av de inlagda patienterna. Patienterna upplever avsaknad av meningsfulla aktiviteter och autonomi. Centralt är relationerna mellan vårdtagare och vårdgivare för att framkalla en känsla av trygghet samt meningsfullhet hos patienterna. Terapeutiska förhållningssätt identifieras som viktiga samt att se människan bakom brottet. Förslag på fortsatt forskning: Resultatet visar frånvaron av terapeutiska roller inom rättspsykiatrin. Behovet av riktlinjer kring terapeutiskt bemötandet av rättspsykiatriska patienter anses således behöva utvecklas. Detta för att skapa en trygg och empatisk tillvaro som bidrar till en hälsofrämjande miljö för rättspsykiatriska patienter.

Background: It is part of the nurse's professional responsibility to involve patients indecisions concerning their care. Previous studies show that patients wish to be activeparticipants in care and to be seen and heard. Nurses also express a desire for patients toparticipate. However, there are obstacles linked to the forensic psychiatric care context thatcan make this difficult. Purpose: To describe patients' experiences of participation inSwedish forensic psychiatric care. Method: Data collection was carried out through semistructured interviews with ten participants who were patients at a forensic psychiatrichospital in Central Sweden. To analyze the material, a qualitative content analysis with aninductive approach was used. Results: Through the analysis, three categories emerged,which were The importance of being active yourself, The meaning of being treated as anactive participant and The meaning of feeling powerless. These categories had six associatedsubcategories that describe how participation can be promoted or hindered in different ways.The results showed the importance of the patient feeling seen, but also the importance of thepatient contributing. Conclusion: Participation is influenced by one's own ability andwillingness to actively contribute as well as the commitment and the competence of the staff.Obstructive factors that emerged were feeling vulnerable linked to the forensic psychiatriccare context and experiencing a lack of treatment.Keywords: Forensic psychiatric care, Interview study, Participation, Qualitative, The TidalModel / Bakgrund: Det ingår i sjuksköterskans yrkesansvar att göra patienter delaktiga i beslut somrör deras vård. Tidigare studier visar att patienter önskar ses som aktiva deltagare i vårdensamt bli sedda och hörda. Även sjuksköterskor uttrycker en önskan om att patienter ska varadelaktiga i vården. Dock framkommer hinder kopplat till den rättspsykiatriska vårdkontextensom kan försvåra detta. Syfte: Att beskriva patienters erfarenheter av delaktighet inom denrättspsykiatriska vården. Metod: Datainsamlingen genomfördes med semistruktureradeintervjuer med tio deltagare som vårdades på ett rättspsykiatriskt sjukhus i Mellansverige.För att analysera materialet användes en kvalitativ innehållsanalys med induktiv ansats.Resultat: Genom analysen framträdde tre kategorier, vilka var Betydelsen av att själv varaaktiv, Betydelsen av att bli bemött som en aktiv deltagare samt Betydelsen av att känna sigmaktlös. Dessa kategorier presenterades i sex subkategorier som beskrev hur delaktighetkunde främjas respektive försvåras på olika sätt. Resultatet visade att det var viktigt förpatienter att känna sig sedda men också betydelsen av att själva bidra. Slutsats: Delaktighetpåverkas av den egna förmågan och viljan att aktivt bidra samt vårdpersonalens engagemangoch kompetens. Hindrande faktorer som framkom var att känna sig utsatt kopplat till denrättspsykiatriska vårdkontexten och att erfara ett bristande bemötande.Nyckelord: Delaktighet, Intervjustudie, Kvalitativ, Rättspsykiatrisk vård,Tidvattenmodellen

O presente trabalho foca a questão da implementação da Reforma Psiquiátrica nos Hospitais de Custódia e Tratamento Psiquiátrico, objetivando delinear os limites, desafios e possibilidades da referida Reforma no Estado de São Paulo. O trabalho, do ponto de vista metodológico, partiu da técnica de análise do discurso de entrevistas realizadas com pessoas chave no processo de discussão e implementação das diretrizes da Reforma Psiquiátrica nos Hospitais de Custódia e Tratamento Psiquiátrico Paulistas, além da revisão de literatura, subsídio a dados estatísticos e pesquisa jurisprudencial. Os principais limites e desafios para a implementação da Reforma Psiquiátrica nos Hospitais de Custódia e Tratamento Psiquiátrico no Estado de São Paulo são comuns a outros Estados da Federação. Em seu funcionamento, os HCTPs apresentam a predominância do aspecto custodial sobre o terapêutico, sendo que a contenção química e a física continuam a representar o agir institucional. As principais questões legais envolvidas e questionadas pelos entrevistados referem-se à não aplicação da Lei 10.216/01 na seara das medidas de segurança e a questão da presunção da periculosidade legal, reservada ao considerado louco infrator. A desinstitucionalização, vista como processo complexo, ainda apresenta grandes desafios nas dimensões técnico-assistencial, consistente na ampliação da rede de serviços substitutivos, bem como o acesso da população confinada nos HCTPs a essa rede e na dimensão sócio-cultural, uma vez que as pessoas com transtorno mental em conflito com a lei enfrentam uma tripla exclusão e estigmatização: vistos como loucos e criminosos e apresentando, antes mesmo da internação, um quadro de vulnerabilidade social. O Estado de São Paulo possui a maior população de internos, considerados números absolutos, e em seus três HCTPs criou-se uma espécie de regime de cumprimento de medida de segurança mais ou menos rigorosa, analogicamente ao existente em relação ao cumprimento de pena. Dentro dessa dinâmica, a existência do Programa de Desinternação Progressiva realizado em Franco da Rocha é indicado como uma possibilidade de aplicação das diretrizes da Reforma Psiquiátrica. O SAIPEMS Sistema de Atenção Integral às Pessoas em Medida de Segurança visto como uma forma de implantar, no Estado de São Paulo, um programa semelhante ao PAILI e PAI-PJ, desde 2009, aguarda um encaminhamento por parte dos entes governamentais. A questão do transtorno de personalidade e a possibilidade de responsabilização dos chamados sociopatas merecem estudos mais aprofundados, assim como a questão da mudança do perfil tradicional dos internos dos HCTPs, que são cada vez mais jovens e com questões relacionadas ao uso de drogas. Os Programas exitosos existentes no País que utilizam os paradigmas da Reforma Psiquiátrica no cumprimento das Medidas de Segurança apontam a questão da intersetorialidade como ponto central para o sucesso de tais programas, assim como assinalam o necessário debate para a questão da responsabilização das pessoas com transtorno mental em conflito com a lei. / This paper addresses the issue of implementation of the Psychiatric Reform in Hospitals of forensic psychiatric care, aiming at outlining the boundaries, challenges and possibilities of that reform in the State of São Paulo. The work, the methodological point of view, came from technical analysis of interviews conducted with people \"key\" in the discussion and implementation of guidelines in Psychiatric Hospitals Reform of forensic psychiatric care Paulistas, besides the literature review, subsidy statistical and jurisprudential research. The main limitations and challenges to the implementation of the Psychiatric Reform in Hospitals forensic psychiatric care in the State of São Paulo are common to other states. In operation, the present HCTPs the prevalence of custodial aspect of the therapy, and the \"chemical restraint\" and continue to represent the physical act institucional.As main legal issues involved and questioned by the respondents refer to the non-application of Law 10,216 / 01 harvest in security measures and the issue of the presumption of dangerousness cool, reserved for offenders considered insane. The deinstitutionalization process as complex, still presents major challenges in the dimensions and technical assistance, namely the expansion of the network of alternative services, as well as the population\'s access in confined HCTPs to this network and the socio-cultural dimension, since the people with mental disorders in conflict with the law face a triple exclusion and stigmatization: visitos like madmen and criminals and presenting, even before the hospitalization, a framework of social vulnerability. The State of São Paulo has the mairo among inmates, considered absolute numbers and in its three HCTPs created a kind of compliance regime security measure more or less strict analogy with that in relation to the execution of a sentence. Within this dynamic, the existence of the program be discharged Progressive performed in Franco da Rocha is mentioned as a possible application of the guidelines of the Psychiatric Reform. The SAIPEMS-System of Integral Attention to People in Security Measure - seen as a way to deploy, in the State of São Paulo, a program similar to PAILI and PAI-PJ, since 2009, awaiting a referral by the government agencies. The issue of personality disorder and the possibility of accountability called sociopaths deserve further study, as well as the issue of changing the traditional profile of the internal HCTPs, who are increasingly younger and issues related to drug use. The existing successful programs in the country that use the paradigms of Psychiatric Reform in compliance with the security measures point to the issue of intersectionality as a central point for the success of such programs, as well as point out the need to debate the issue of accountability of people with mental disorder in conflict with the law.

O presente trabalho foca a questão da implementação da Reforma Psiquiátrica nos Hospitais de Custódia e Tratamento Psiquiátrico, objetivando delinear os limites, desafios e possibilidades da referida Reforma no Estado de São Paulo. O trabalho, do ponto de vista metodológico, partiu da técnica de análise do discurso de entrevistas realizadas com pessoas chave no processo de discussão e implementação das diretrizes da Reforma Psiquiátrica nos Hospitais de Custódia e Tratamento Psiquiátrico Paulistas, além da revisão de literatura, subsídio a dados estatísticos e pesquisa jurisprudencial. Os principais limites e desafios para a implementação da Reforma Psiquiátrica nos Hospitais de Custódia e Tratamento Psiquiátrico no Estado de São Paulo são comuns a outros Estados da Federação. Em seu funcionamento, os HCTPs apresentam a predominância do aspecto custodial sobre o terapêutico, sendo que a contenção química e a física continuam a representar o agir institucional. As principais questões legais envolvidas e questionadas pelos entrevistados referem-se à não aplicação da Lei 10.216/01 na seara das medidas de segurança e a questão da presunção da periculosidade legal, reservada ao considerado louco infrator. A desinstitucionalização, vista como processo complexo, ainda apresenta grandes desafios nas dimensões técnico-assistencial, consistente na ampliação da rede de serviços substitutivos, bem como o acesso da população confinada nos HCTPs a essa rede e na dimensão sócio-cultural, uma vez que as pessoas com transtorno mental em conflito com a lei enfrentam uma tripla exclusão e estigmatização: vistos como loucos e criminosos e apresentando, antes mesmo da internação, um quadro de vulnerabilidade social. O Estado de São Paulo possui a maior população de internos, considerados números absolutos, e em seus três HCTPs criou-se uma espécie de regime de cumprimento de medida de segurança mais ou menos rigorosa, analogicamente ao existente em relação ao cumprimento de pena. Dentro dessa dinâmica, a existência do Programa de Desinternação Progressiva realizado em Franco da Rocha é indicado como uma possibilidade de aplicação das diretrizes da Reforma Psiquiátrica. O SAIPEMS Sistema de Atenção Integral às Pessoas em Medida de Segurança visto como uma forma de implantar, no Estado de São Paulo, um programa semelhante ao PAILI e PAI-PJ, desde 2009, aguarda um encaminhamento por parte dos entes governamentais. A questão do transtorno de personalidade e a possibilidade de responsabilização dos chamados sociopatas merecem estudos mais aprofundados, assim como a questão da mudança do perfil tradicional dos internos dos HCTPs, que são cada vez mais jovens e com questões relacionadas ao uso de drogas. Os Programas exitosos existentes no País que utilizam os paradigmas da Reforma Psiquiátrica no cumprimento das Medidas de Segurança apontam a questão da intersetorialidade como ponto central para o sucesso de tais programas, assim como assinalam o necessário debate para a questão da responsabilização das pessoas com transtorno mental em conflito com a lei. / This paper addresses the issue of implementation of the Psychiatric Reform in Hospitals of forensic psychiatric care, aiming at outlining the boundaries, challenges and possibilities of that reform in the State of São Paulo. The work, the methodological point of view, came from technical analysis of interviews conducted with people \"key\" in the discussion and implementation of guidelines in Psychiatric Hospitals Reform of forensic psychiatric care Paulistas, besides the literature review, subsidy statistical and jurisprudential research. The main limitations and challenges to the implementation of the Psychiatric Reform in Hospitals forensic psychiatric care in the State of São Paulo are common to other states. In operation, the present HCTPs the prevalence of custodial aspect of the therapy, and the \"chemical restraint\" and continue to represent the physical act institucional.As main legal issues involved and questioned by the respondents refer to the non-application of Law 10,216 / 01 harvest in security measures and the issue of the presumption of dangerousness cool, reserved for offenders considered insane. The deinstitutionalization process as complex, still presents major challenges in the dimensions and technical assistance, namely the expansion of the network of alternative services, as well as the population\'s access in confined HCTPs to this network and the socio-cultural dimension, since the people with mental disorders in conflict with the law face a triple exclusion and stigmatization: visitos like madmen and criminals and presenting, even before the hospitalization, a framework of social vulnerability. The State of São Paulo has the mairo among inmates, considered absolute numbers and in its three HCTPs created a kind of compliance regime security measure more or less strict analogy with that in relation to the execution of a sentence. Within this dynamic, the existence of the program be discharged Progressive performed in Franco da Rocha is mentioned as a possible application of the guidelines of the Psychiatric Reform. The SAIPEMS-System of Integral Attention to People in Security Measure - seen as a way to deploy, in the State of São Paulo, a program similar to PAILI and PAI-PJ, since 2009, awaiting a referral by the government agencies. The issue of personality disorder and the possibility of accountability called sociopaths deserve further study, as well as the issue of changing the traditional profile of the internal HCTPs, who are increasingly younger and issues related to drug use. The existing successful programs in the country that use the paradigms of Psychiatric Reform in compliance with the security measures point to the issue of intersectionality as a central point for the success of such programs, as well as point out the need to debate the issue of accountability of people with mental disorder in conflict with the law.

Bakgrund: Studier visar att hundar har en positiv effekt på den fysiska hälsan. De kan också öka det sociala samspelet, minska depression, öka självförtroende och självbestämmande samt reducera ångest genom hundassisterad aktivitet eller hundassisterad intervention. Syfte: Syftet med denna studie är att undersöka om hundar inom ramen för omvårdnad på en rättspsykiatrisk avdelning kan påverka patienternas välbefinnande. Metod: För att undersöka patienternas upplevelser användes en kvalitativ studiedesign. För att besvara syfte och frågeställningar gjordes semistukturerade intervjuer som analyserades med en kvalitativ innehållsanalys.   Resultat: Hundar på avdelningen upplevdes både positivt och negativt. De inverkade på välbefinnandet genom att de genererade glädje och välmående men också irritation och ilska. De gav också en känsla av att bli sedd som människa, ökade den fysiska aktiviteten, förbättrade sömnen och påverkade självkänslan och självförtroendet. Vårdmiljön påverkades också genom ett förbättrat klimat på avdelningen. De gav en meningsfullhet i vardagen, en möjlighet till närhet, en känsla av mindre kontrollerande miljö samt att de hade en inverkan på hur patienterna rörde sig på avdelningen. Det identifierades en ståndpunkt för hundar på avdelningen, men också en emot att ha hundar på avdelningen. Slutsats: Resultaten tyder på att det positiva överväger det negativa då majoriteten av resultatet belyser aspekter som ökar välbefinnandet hos patienterna. Hundar inom vården anses därför vara en bra komplementär omvårdnadsform för att som sjuksköterska på en rättspsykiatrisk avdelning. Detta för att kunna utföra god omvårdnad, främja välbefinnande och upprätthålla ett samhällsskydd och samtidigt reducera känslan hos patienten av att vara underordnad och kontrollerad. Det är dock viktigt att beakta olika individers åsikter för att hitta en form som passar. / Background: Studies have shown that dogs have a positive effect on humans physical health. They may also increase social interactions, decrease depression, increase peoples selfconfidence and autonomy and reduce anxiety trough animal-assisted interventions. Aim: The aim of this studie is to investigate if dogs can effect well-being in patients within forensic psychiatric care. Method: To investigate the patients experiences a qalitative reserch method were used. Semi-structured interviews were used to answer to the aim of the studie, and analysed with a content analysis. Result: The patients had both positive and negative experiences regarding the presence of the dogs at the unit. The dogs had an impact on the patients well-being by generating joy as well as anger and irritation. They gave a sense of being perceived as an individual, they increased physical activity, improved quality of sleep and had an inpact on self-esteem and self-confidence. The dogs also had an impact on the health facility environment trough an inprovement of the atmosphere at the unit. The dogs gave sense of mening in the everday life, an opportunity for intimacy, a sense of a less controlling environment and they also had an impact on how the patients moved at the unit. Some where proponents and some opponents to the impementation of dogs at the unit. Conclusion: The results shows that the positive experiences tops the negative because the majority of the results shows aspects of improved well-being. Dogs within healthcare facilities are therefore concidered to be a good complementary form of care for nurses working in forensic psychiatric care. This to perform good nursing care, promote well-being and maintain the civil protection and at the same time reduce feelings of being inferior, subordinated and controlled. It is however important to pay regards to the different idividual opinions and find a resolution that suits best.