ABSTRACTJonasson Anna (2015). Educational background in forensic psychiatric patients – judged according to the LRV and LRV: sup. School Improvement and Leadership, Master, Learning and Society, Malmö University.The intention of the research in forensic psychiatry and special education is an improvement of psychiatric care, but also to contribute knowledge to prevention work in the community that lead to benefits for individuals` health and by extension economic gains. The aim of this study was to investigate forensic psychiatric patients´ needs of special education. The first question was how forensic psychiatric patients’ preschool and school background looked like. The second question was, wherein sessions of information, which would give possibilities to increase the patients´ information comprehension by special education during their treatment process. The theoretical base is socio-cultural perspective. By using a qualitative approach two qualitative studies were developed. In the first study a content analysis was conducted regarding pre-school and school background on 102 forensic psychiatric examinations. In the second study, the reader can follow a fictional patient through the forensic psychiatric treament process. The results show that 50 % of patients documented to have family-related problems. The most common measures were contact with BUP, Swedish child and adolescent psychiatry, and measures among the Care of Young Persons. 65 % attended at least 9 years of school and half of the patients have, received some form of grades. The enrollment, change of ward, distributing folders are some of the sessions of information, which would give possibilities to increase the patients´ information comprehension by using special education during the treatment process. Special education support involves consideration of the literacy level. The importance of the patients to have a realistic self-image regarding their cognitive abilities is emphasized. Tailor-made training programs in information literacy are proposed, also the importance of training non-cognitive abilities are recognized. Access to illustrative pictures and follow-up discussions at information sessions are also proposed as special education support.

Bakgrund: Begreppet personcentrerad har internationellt blivit vedertaget inom omvårdnadsvetenskap och används för att beskriva en vårdform där vården utgår från ett partnerskap med patienten. Engagemang, trygghet, tillit, att vara delaktig i planeringen av vården och en vårdande relation upplevs vara viktiga komponenter som främjar delaktigheten. För att öka förståelsen om delaktighetens och personcentreringens syfte inom den rättspsykiatriska vårdkontexten krävs studier som beskriver de mångfacetterade begreppen ur vårdarens och patientens perspektiv. Syfte: Att förstå upplevelser av delaktighet och personcentrerad vård hos patienter och personal på en rättspsykiatrisk avdelning och diskutera hur delaktighet kan möjliggöras. Design: Studien är en kulturanalys och ansatsen är hermeneutisk. Metod: Enskilda halvstrukturerade intervjuer med fyra vårdare och fyra patienter på en rättspsykiatrisk avdelning i Mellansverige genomfördes. Intervjuerna har bearbetats utifrån en kulturanalytisk hermeneutisk arbetsmodell i sju faser. Interna dokument från sjukhuset analyserades avseende delaktighet. Resultat: Oklarheter gällande vårdprocessen och rättspsykiatrins strukturer som är inte fullkomligt tydliga inverkar på upplevelsen av delaktighet. Konklusion: Personal och patienter har olika uppfattningar om strukturernas funktion. Personalen anser att patienternas delaktighet är en förutsättning för vårdprocessen. Patienter uttrycker osäkerhet kring vad som förväntas av dem. Identitet och tolkning av den egna rollen kan påverka delaktigheten hos patienter inom rättspsykiatri. / Background: The concept of person-centered care is internationally accepted in nursing science and describes a form of care with an active patient included in all aspects of care. Commitment, trust, and involvement in the planning of care and a caring relationship are perceived to promote participation. To increase understanding person-centering in the forensic psychiatric care context, studies on the multifaceted concepts from carers’ and patients’ perspectives are required. Aim: To understand experiences of participation and person-centered care among patients and staff in a forensic psychiatric ward and discuss how participation can be promoted. Method: Individual semi-structured interviews with four carers and four patients in a forensic psychiatric hospital in Central Sweden were conducted. A seven-phase cultural analysis model was used. Internal documents were analyzed for statements about participation. Design: The study is a cultural analysis with a hermeneutic approach. Result: Unclear care process and structures of forensic care affect the experience of participation. Conclusion: The perceptions of the function of the structures differ. Staff believe that patient participation is a prerequisite for the care process. Patients express uncertainty about what is expected of them. Identity and interpretation of one's own role can influence the participation of patients in forensic psychiatry.

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.

Background: It is now well established that there are core cognitive impairments associated with a diagnosis of schizophrenia. In parallel with our increased understanding of these core deficits, our awareness that mentally ill offenders (MIOs) are at additional risk of cognitive impairment due to an increased rate of traumatic brain injury and substance abuse has also grown. Absent from the literature is evidence of whether these cognitive impairments change over longer periods of time in MIO’s and whether these changes, or baseline abilities, impact an individual’s risk of violence. Furthermore, the negative impact head injury has on an individuals’ cognitive, behavioural and psychological functioning is well documented. These changes can lead to an increased likelihood of violence and crime, yet there is currently a scarcity of knowledge regarding the prevalence of head injury within mentally ill offenders in Scotland and its association with risk-related outcomes. Aims: The aims of the present thesis were to; (a) Examine the course of cognition in N=49 mentally ill offenders who underwent neuropsychological assessment while in the State Hospital, Scotland in 2004-5, and assess whether baseline or change in cognition predicts violent incidents or risk at follow-up, and; (b) Examine the cross-sectional association between head injury, substance abuse and risk-related outcomes of all individuals within the forensic network in Scotland for whom data could be extracted (N=428). Hypotheses: (a) We hypothesized that processing speed, verbal comprehension, working memory, delayed verbal memory, delayed non-verbal memory, impulsivity, inattention and problem-solving would decline over a 10-year period, and that deficits in impulsivity, emotion recognition, working memory and delayed memory would predict patients’ risk-related outcomes in a sample of mentally ill offenders. (b) It was also hypothesized that the presence of head injury and/or substance abuse within patients would predict worse risk-related outcomes, namely: quantity of violent offences, risk of harm to self, risk of harm to others and severity of violent offences. Analysis: We conducted a series of repeated measures MANOVAs, MANCOVAs and hierarchical linear regressions in SPSS Statistics to test our hypotheses. Individuals with a primary or secondary diagnosis of a learning disability were excluded. Results: (a) Our results propose that cognitive abilities significantly change over time (F(1.51, 30.1) = 5.98, p = .011), but direction of change is ability dependent. We found that impulsivity (Effect Size (ES) = .253), inattention (ES = .233), working memory (ES = .288) and auditory delayed memory (ES= .268) worsen over time. Measures of impulsivity and working memory significantly predicted some, but not all, risk-related outcomes, however these effects became diluted once additional variables with shared variance were added into the predictive models. We did not find that traumatic brain injury, substance misuse or alcohol misuse significantly mediated change in cognition over time. (b) In the national cohort study, results suggested that head injury had a significant effect on HCR total scores, F(1,259) = 6.679, p = .010 (partial eta square = .025), violence during admission (χ2 = 5.545, p = .022) and violent offences at a .1 p-value only, F(1,259) = 3.495, p = .063 (partial eta square = .013). Drug misuse only had a significant impact on total violent offences, F(1,259) = 8.933, p = .003 (partial eta square = .033) and nothing else. Furthermore, the interaction between alcohol misuse and schizophrenia also only had impact on total violent offences, F(1, 259) = 7.516, p = .007 (partial eta square = .028). Head injury was not significantly associated with either historical or current self-harm, however alcohol misuse, drug misuse and schizophrenia were. Conclusions: Our results highlight the unstable nature of cognition in mentally ill offenders and the impact that head injury has on violence-related outcomes, over and above substance misuse and a diagnosis of schizophrenia. This has potentially renovating implications for clinical practice regarding risk management, assessment, and treatment planning.

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.

Aboriginal youth are overrepresented at Vancouver Island’s Youth Forensic Psychiatric Services (YFPS) clinics. Despite this, research on Aboriginal young offenders is very limited. Information of the unique needs of Aboriginal young offenders is needed to enhance culturally appropriate forensic services. The goal of this study was to identify psychosocial characteristics associated with delinquent behaviour that distinguish Aboriginal young offenders from non-Aboriginal young offenders. Utilizing data of 638 reports (168 Aboriginal young offenders and 470 non-Aboriginal young offenders) from the YFPS databank, logistic regression models were used to predict being an Aboriginal young offender, from 24 psychosocial characteristics. Aboriginal young offenders were differentiated based on 12 significant factors. Key findings were: Aboriginal youth were almost 5 times more likely to report alcohol use, 3 times more likely to be incarcerated and 3 times more likely to have lived with a step-parent, a non-parent and to be removed from their families for 1-2 months, than non-Aboriginal youth. The results are preliminary; significant amounts of unknown data was found for both ethnic groups in the YFPS databank. This study is an important first step in laying the foundation for empirical research on Aboriginal young offenders necessary for culturally appropriate treatment services. / Graduate

Background. Research shows that 91.2% of inpatients at forensic psychiatric wards have a history of drug use and a third of those patients use drugs frequently. To be able to confront and address patients with substance abuse on the ward, the working staff needs to have adequate competence concerning the ability to understand who the patients are. Aim. The aim of this study was to explore how the working staff use their competence when interacting with patients who are influenced by drugs on forensic psychiatric wards. Method. The study was conducted in the western parts of Sweden and at three forensic psychiatric wards. The study was designed after a qualitative design and based on an empirical approach with interviews. The data was collected by interviewing a total of six informants through semi-structured interviews. The interviews were analysed using a qualitative content analysis. Results. The result ended up in eight themes, showing that informants in this study used their competence to recognize substance abuse, to help the patients navigating around potential dangers and create a caring relation. Further they trusted their experience, but all informants requested further education. Conclusion. The informants in this study expressed that they had good strategies in terms of supporting and rehabilitating patients with substance abuse. All informants requested further education about preventing relapse, knowledge about drug abuse and knowing how to work after a relapse.

Abstract Purpose: The study aims to establish a summary of the main characteristics of gender, age, types of crimes and previous criminal records of the offenders sentenced to forensic-psychiatric care in the time period 1995 to 2018 in Sweden and to compare them with offenders sentenced to imprisonment for the same types of crime types in the same time period in Sweden as well as to link different types of crimes to mental illness. Furthermore, the study attempts to find correlations between the group sentenced to forensic-psychiatric care and different types of crimes. Method: Using official statistical data from BRÅ, serious crimes, age, gender and criminal records for all individuals sentenced to forensic-psychiatric care during 1995 to 2018 are described together. This group was compared to all individuals which were convicted to prison in the same period. Furthermore, correlations between types of crimes and the group of individuals sentenced to forensic-psychiatric care were examined in order to find any statistical difference between the two groups. Result: A few differences between the groups were found. The individuals in the forensic-psychiatric care group did not differentiate much in age, and also had similar criminal records, unlike the prison- group. Additionally, a meaningfully higher amount of women was prevalent in the forensic psychiatric care-group compared to the prison-group. A small correlation between individuals sentenced to forensic psychiatric treatment and arson were confirmed as well as stronger correlations with offenders sentenced to FPT and crimes of theft, vehicle theft, arson and homicide were found. Conclusion: These findings provide data for future research as well as potential support for courts to identify more suitable treatment for offenders with a mental illness. Additionally, the findings in this paper presents the health care system and social services with opportunities to analyse and prevent trajectories into more serious offending in particular regards to individuals who are young and/or have a mental disorder.

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.

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