The purpose of this study was to develop a medico-judicial framework for the rehabilitation of forensic psychiatric patients in Zimbabwe. The study used the grounded theory approach utilising a mixed sequential dominant status design. Purposive sampling of key stakeholders was the primary method and theoretical sampling became necessary as the study evolved in the qualitative phase. A confirmatory retrospective document review of 119 files of patients was done in the quantitative phase. Pierre Bourdieu’s conceptual canon of field, habitus and capital was utilised as the theoretical point of departure for the study. Findings and results showed dislocation and dissonance between and within the habitus of social fields the judiciary, health (medical) and the prison systems with an ensuing hysteretic effect that negatively affected the outcome of forensic psychiatric rehabilitation in special institutions in Zimbabwe. Forensic psychiatric patients were caught up in a double bind situation of aligning to both of the contradictory functions of the medical and the prison systems. The result of this hysteretic scenario seemed to breed some kind of rehabilitative schizophrenia. The developed medico-judicial framework is projected to transform the libido dominandi of the present into a widened scope of therapeutic jurisprudence. The medico-judicial framework is forwarding the forensic psychiatric practitioner to a new address since it has changed its residence from the special institution to the forensic psychiatric hospital. It is inviting the person involved with forensic psychiatric rehabilitation to begin again, inciting him or her to be open to the possibilities of mapping a path through the tangled growth of current realities into an increased width and depth of comprehensive forensic psychiatric practice that follows an empowering legislative prescript / Health Studies / D. Litt. et Phil. (Health Studies)

Considerable attention has focussed on identifying individual factors associated with, or predictive of, sexual offending (e.g., Efta-Breitbach & Freeman, 2004). In light of these individual factors, clinicians and researchers have developed standardized instruments for assessing the risk posed by sexually offending youth. Two such instruments are the Juvenile Sex Offender Assessment Protocol-II (J-SOAP-II; Prentky & Righthand, 2003) and the Estimate of Risk of Adolescent Sexual Offence Recidivism Version 2.0 (ERASOR-II; Worling & Curwen, 2001). In addition to individual factors, research on crime has demonstrated that structural factors within the community may be important determinants of sexual and non-sexual offending (e.g., McCarthy, 1991; Ouimet, 1999; Shaw & McKay, 1942; Wirth, 1938). Therefore, the purpose of this study was twofold: (a) to compare the psychometric properties of two newly developed risk assessment instruments (i.e., J-SOAP-II and ERASOR-II) and (b) to use the better instrument to compare the levels of risk posed by sexually offending youth in 3 neighbouring, but diverse communities. Using file information, the J-SOAP-II and ERASOR-II were scored on 84 adolescent males between the ages of 11 and 20 years who had committed a sexual offence and received treatment at Youth Forensic Psychiatric Services (YFPS) in the Greater Vancouver Area (GVA; n = 30), Central Okanagan (CO; n = 26), and Thompson Nicola region (TN; n = 28). Calculations of interrater reliability and item-total correlations indicated that the J-SOAP-II was a better assessment instrument for this sample of offenders. Consequently, further regional analysis of risk was conducted using the J-SOAP-II data. Results indicated that although there were no regional differences among the severity and history of sexual offending, TN youth generally had a greater number of risk factors than did youth in CO and GVA. Specifically, youth in TN were found to be higher risk in the areas of intervention, general problem behaviour, iii and family/environment dynamics. These results suggest that to better understand youth who commit sexual offences and to provide appropriate prevention and intervention strategies for individual offenders and their communities, youth should not be evaluated in isolation from their social and community context. Recommendations for practice are discussed.

Considerable attention has focussed on identifying individual factors associated with, or predictive of, sexual offending (e.g., Efta-Breitbach & Freeman, 2004). In light of these individual factors, clinicians and researchers have developed standardized instruments for assessing the risk posed by sexually offending youth. Two such instruments are the Juvenile Sex Offender Assessment Protocol-II (J-SOAP-II; Prentky & Righthand, 2003) and the Estimate of Risk of Adolescent Sexual Offence Recidivism Version 2.0 (ERASOR-II; Worling & Curwen, 2001). In addition to individual factors, research on crime has demonstrated that structural factors within the community may be important determinants of sexual and non-sexual offending (e.g., McCarthy, 1991; Ouimet, 1999; Shaw & McKay, 1942; Wirth, 1938). Therefore, the purpose of this study was twofold: (a) to compare the psychometric properties of two newly developed risk assessment instruments (i.e., J-SOAP-II and ERASOR-II) and (b) to use the better instrument to compare the levels of risk posed by sexually offending youth in 3 neighbouring, but diverse communities. Using file information, the J-SOAP-II and ERASOR-II were scored on 84 adolescent males between the ages of 11 and 20 years who had committed a sexual offence and received treatment at Youth Forensic Psychiatric Services (YFPS) in the Greater Vancouver Area (GVA; n = 30), Central Okanagan (CO; n = 26), and Thompson Nicola region (TN; n = 28). Calculations of interrater reliability and item-total correlations indicated that the J-SOAP-II was a better assessment instrument for this sample of offenders. Consequently, further regional analysis of risk was conducted using the J-SOAP-II data. Results indicated that although there were no regional differences among the severity and history of sexual offending, TN youth generally had a greater number of risk factors than did youth in CO and GVA. Specifically, youth in TN were found to be higher risk in the areas of intervention, general problem behaviour, iii and family/environment dynamics. These results suggest that to better understand youth who commit sexual offences and to provide appropriate prevention and intervention strategies for individual offenders and their communities, youth should not be evaluated in isolation from their social and community context. Recommendations for practice are discussed.

Considerable attention has focussed on identifying individual factors associated with, or predictive of, sexual offending (e.g., Efta-Breitbach & Freeman, 2004). In light of these individual factors, clinicians and researchers have developed standardized instruments for assessing the risk posed by sexually offending youth. Two such instruments are the Juvenile Sex Offender Assessment Protocol-II (J-SOAP-II; Prentky & Righthand, 2003) and the Estimate of Risk of Adolescent Sexual Offence Recidivism Version 2.0 (ERASOR-II; Worling & Curwen, 2001). In addition to individual factors, research on crime has demonstrated that structural factors within the community may be important determinants of sexual and non-sexual offending (e.g., McCarthy, 1991; Ouimet, 1999; Shaw & McKay, 1942; Wirth, 1938). Therefore, the purpose of this study was twofold: (a) to compare the psychometric properties of two newly developed risk assessment instruments (i.e., J-SOAP-II and ERASOR-II) and (b) to use the better instrument to compare the levels of risk posed by sexually offending youth in 3 neighbouring, but diverse communities. Using file information, the J-SOAP-II and ERASOR-II were scored on 84 adolescent males between the ages of 11 and 20 years who had committed a sexual offence and received treatment at Youth Forensic Psychiatric Services (YFPS) in the Greater Vancouver Area (GVA; n = 30), Central Okanagan (CO; n = 26), and Thompson Nicola region (TN; n = 28). Calculations of interrater reliability and item-total correlations indicated that the J-SOAP-II was a better assessment instrument for this sample of offenders. Consequently, further regional analysis of risk was conducted using the J-SOAP-II data. Results indicated that although there were no regional differences among the severity and history of sexual offending, TN youth generally had a greater number of risk factors than did youth in CO and GVA. Specifically, youth in TN were found to be higher risk in the areas of intervention, general problem behaviour, iii and family/environment dynamics. These results suggest that to better understand youth who commit sexual offences and to provide appropriate prevention and intervention strategies for individual offenders and their communities, youth should not be evaluated in isolation from their social and community context. Recommendations for practice are discussed. / Graduate Studies, College of (Okanagan) / Graduate

Bakgrund: Forskning visar att ökad delaktighet leder till en högre vårdkvalitet, men studier visar på brister i patientdelaktigheten. Syfte: Syftet med denna studie var att beskriva patienters upplevelse av delaktighet inom rättspsykiatrisk heldygnsvård. Metod: Examensarbetet har en kvalitativ metod med induktiv ansats och analyserades utifrån en kvalitativ innehållsanalys. Sju patienter med erfarenheter av att vårdas inom rättspsykiatrisk heldygnsvård intervjuades genom semistrukturerade intervjuer. Resultat: Analysen resulterade i tre slutkategorier; ”Att ingen lyssnar och informerar”, ”Att vara fast i en miljö styrd av lagar och regler”, ”Att tillitsfulla relationer ger styrka”. Det som hindrar delaktighet beskrivs av deltagarna som att inte känna sig lyssnad på, inte bli bemötta utifrån den person de är och att vara fast i en miljö som styrs av lagar och regler. De känner sig begränsade i vården och tycker det är svårt att ta sig framåt. Det som underlättar delaktighet upplevs kopplat till tillitsfulla relationer som avgörande för att kunna känna att man har kontroll och makt över sitt liv. Slutsats: Resultatet bidrar med en fördjupad förståelse av betydelsen av delaktighet i rättspsykiatrisk vård, och vad som kan hindra och underlätta den. Delaktighet är något som patienterna inte tar för givet och vården behöver utveckla förståelse för relationens betydelse som är helt avgörande för vilka möjligheter patienten får till delaktighet och återhämtning. Den rättspsykiatriska vården skulle kunna utvecklas i en riktning mot ökad delaktighet med hjälp av personcentrerad vård.

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.

Background: Forensic psychiatric care means restricted freedom during a long period of care. The restriction leads among other things to a loss of independent decision-making in relation to physical health in terms of time outdoors, diet and exercise. Previous research highlights how deteriorating physical health seems to go hand in hand with mental illness. In addition, nurses experience health promoting and disease prevention work within forensic psychiatric inpatient care as a challenge. Aim: To describe patients' experiences of maintaining physical health in forensic psychiatric inpatient care. Method: The study has a qualitative design with an inductive approach. Semi-structured interviews were conducted with ten patients from two forensic psychiatric clinics in central Sweden. Data was analyzed using qualitative content analysis. Results: The patients' experiences are illuminated through four categories: to feel restricted, to be able to adapt to a new situation, to utilize healthcare resources and to have access to support which were further clarified by six subcategories. This led to the overarching theme of reclaiming physical health through support and adaptation in a new environment. Conclusions: The person-centered approach needs to be given even greater space within forensic psychiatric inpatient care. Consequently, nurses need to take advantage of patients' experiences to a greater extent in order to, along with the patient, find the way forward in the maintenance of physical health during the period of care. Keywords: Forensic psychiatric inpatient care, patients' experiences, physical health, qualitative content analysis, semi-structured interviews, Tidal model