This research investigates the intricate interplay between the moral emotions of shame and guilt, within justice-involved populations, with a special focus on those deemed Not Criminally Responsible (NCR) due to Mental Disorder. Recognizing the pivotal role of offense-related shame and guilt in motivating behavior and influencing psychological functioning, we conducted an extensive investigation to underscore the significance of acknowledging moral injury (MI) and its symptoms within this context. By synthesizing two comprehensive studies, our objective was twofold: to shed light on the prevalence and effects of shame and guilt, and to introduce the concept of moral injury as a fundamental lens for understanding their impact. In the first study, we examined the influence of shame and guilt on motivating behavior and psychological well-being among offending populations. We found that shame consistently relates to adverse outcomes, including defensive behaviors, self-loathing, and externalizing behaviors such as blame-shifting. Contrary to our predictions, guilt was associated with constructive responses, such as self-forgiveness, empathic concern, and assuming responsibility for one's actions. However, both shame and guilt contributed to the risk of recidivism among certain offenders. This study illuminates the intricate dynamics between moral emotions, psychopathology, and recidivism, underscoring the need to acknowledge the differential influences of the moral emotions, shame, and guilt. In the second study, we developed and validated the Moral Injury Screener in the Offending Population NCR (MIO-NCR), a self-report measure that assesses MI in justice-involved individuals, particularly NCR individuals. Through rigorous psychometric analysis, the MIO-NCR demonstrated promising criterion and construct validity. Our findings emphasized the centrality of guilt and betrayal in MI experienced by NCR individuals, aligning with contemporary syndromal definitions. The MIO-NCR, an invaluable tool, enables promising identification of MI within the NCR population. By consolidating these studies, we found that shame and guilt manifest profoundly withinthe justice-involved population, underscoring the value of MI and its core symptoms. The current thesis not only reaffirms the importance of understanding moral emotions but also advances knowledge on MI within this unique context. Our research provides a framework for developing a comprehensive approach to intervention and rehabilitation that recognizes the intricate relations between moral emotions, psychopathology, and recidivism, ultimately fostering healthier outcomes for justice-involved individuals. / Thesis / Master of Science (MSc) / This study delves into moral injury experienced by individuals labelled non-criminally responsible (NCR) due to mental health issues within the criminal justice system. Moral injury captures the emotional turmoil, including guilt and shame, arising from engaging in morally conflicting actions or facing betrayal. Our research explores the influence of moral emotions like shame and guilt on those involved in criminal activities. We discovered shame often leads to negative behaviors and self-disapproval, while guilt promotes self-forgiveness and empathy. Both emotions impact the likelihood of reoffending. We also designed and validated a new tool, the Moral Injury Screener, to grasp moral distress in NCR individuals. This tool revealed that guilt and perceived betrayal are central to their moral struggles. Recognizing these feelings is vital for understanding and addressing moral injury within the criminal justice system.

Thesis (MCur)--Stellenbosch University, 2003. / ENGLISH ABSTRACT: No clear description exists in S.A. of the role and functions of a forensic psychiatric nurse. The researcher conducted a research project based on more than 20 years of practice experience to define and describe the role and functions of the forensic nurse practitioner. A non-experimental descriptive study was done. Questionnaires and checklists were compiled to determine the perceptions of forensic psychiatric patients/clients (n =24) and nursing staff (n = 15) .The nursing activities in a selected forensic psychiatric unit was evaluated through nonparticipative observation. Results indicated that: • Patients experienced their environment as isolated and has a need for better support by the nursing staff; • Nursing staff indicated their need for more specific training in forensic psychiatric nursing; and • A need exists for specific protocols and procedures to guide his/her practice. The recommendations are made that: • A special training program for forensic psychiatric nursing needs to be planned and implemented; and • Procedures and guidelines must be established to guide the practice of the nurse practitioner. / AFRIKAANSE OPSOMMING: Daar bestaan in S.A. geen duidelike omskrywing van die rol en funksies van die forensiese psigiatriese verpleegkundige nie. Die navorser het gegrond op meer as 20 jaar praktykervaring 'n navorsingsprojek gedoen om die rol en funksies van die verpleegpraktisyn te definieer en te omskryf. 'n Nie-eksperimentele, beskrywende studie is gedoen. Vraelyste en kontrolelyste is opgestel om die persepsies van forensiese psigiatriese pasiënte/kliënte (n=24) en verpleegpersoneel (n=15) te bepaal. Die verpleegaktiwiteite in 'n geselekteerde forensiese psigiatriese eenheid is deur nie-deelnemende observasie geëvalueer. Resultate het daarop gedui dat: • Pasiënte hulle omgewing as geïsoleerd ervaar en het 'n behoefte aan beter ondersteuning deur die verpleegpersoneel; • Verpleegpersoneel het aangedui dat hulle 'n behoefte het aan spesifieke opleiding in forensiese psigiatriese verpJeging;en • Daar 'n behoefte is aan spesifieke protokolle en prosedures om sy/haar praktyk te rig . Die aanbevelings word gemaak dat: • 'n Spesiale opleidingsprogram vir forensiese psigiatriese verpleging beplan en geïmplementeer word; en • Prosedures en riglyne daargestel moet word om die praktyk van die verpleegpraktisyn te rig.

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.

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.

Die vorliegende Publikationspromotion setzt sich mit dem forensisch-psychiatrischen Werk und Schaffen des ersten abendländischen Lehrstuhlinhabers für Psychiatrie und Begründers der Leipziger Universitätspsychiatrie Johann Christian August Heinroth (1773-1843) zu Beginn des 19. Jahrhunderts auseinander. Die Schwerpunkte dabei sind dessen eigene Gutachtertätigkeit und sein Konzept der Zurechnungsfähigkeit. Anhand ausgewählter Schriften wurde eine textnahe Lektüre durchgeführt, um Heinroth losgelöst von Kontexten und Kategorien direkt verstehen zu können. Es ließ sich rekonstruieren, dass Heinroth durch philosophisches Denken und ganzheitliche Problemlösungsstrategien nicht nur der in seiner Zeit verbreiteten Exkulpationsneigung und der Instrumentalisierung psychischer Erkrankungen entschieden entgegen tritt, sondern auch, wenngleich er dieselben nicht überwindet, dennoch konstruktive Lösungsansätze für forensisch-psychiatrische Debatten findet und damit eine Bereicherung auch für aktuelle neurowissenschaftliche Diskussionen darstellt. Durch die Tiefendarstellung eines Zeitgenossen wird so ein Beitrag zur Vervollständigung der Geschichte der Forensischen Psychiatrie geleistet.