European Psychiatric Association (EPA) guidance on forensic psychiatry: evidence based assessment and treatment of mentally disordered offenders

TLDR: It is found that the evidence base for forensic-psychiatric practice is weak though there is some evidence to suggest that psychiatric care produces better outcomes than criminal justice detention only.

About: This article is published in European Psychiatry.The article was published on 2018-06-01 and is currently open access. It has received 71 citations till now. The article focuses on the topics: Forensic psychiatry & Expert witness.

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Table 1 Search strategies.

Frequently asked questions

Q1. What contributions have the authors mentioned in the paper "European psychiatric association (epa) guidance on forensic psychiatry : evidence based assessment and treatment of mentally disordered offenders" ?

Inthis guidance paper the authors first present an overview of the field of forensic psychiatry from a European perspective. The authors then present a review of the literature summarising the evidence on the assessment and treatment of MDOs under the following headings: The authors undertook a rapid review of the literature with search terms related to: forensic psychiatry, review articles, randomised controlled trials and best practice. The authors presentthe findingsof the scientific literature as well as recommendations for best practice drawing additionally from the guidance documents identified. The authors found that the evidence basefor forensic-psychiatricpractice isweak thoughthere is some evidence to suggest that psychiatric care produces better outcomes than criminal justice detention only. 

Q2. What databases were used as search terms?

Both textword and MeSH categories were used as search terms in the following databases: Medline,Embase, PsycINFO, and the Cochrane library. 

Q3. What is the common form of assessment requiring forensic expertise?

The determination of criminal responsibility is in many countries the most usual form of assessment requiring forensic expertise. 

Q4. What is the importance of obtaining the consent of the examinee before working on the report?

Prior to working on the report, the expert should obtain the agreement of the examinee, based on informed consent, including informing them of the consequences of cooperating or not cooperating. 

Q5. What is the need to be cautious in the use of risk assessment instruments for individual clinical decisions?

The need to be cautious in the use of risk assessment instruments for individual clinical decisions is compounded by the low and varying base rates for violent recidivism in the local population of which the assessed person is a member and the assessed person is compared with [71]. 

Q6. Why should practitioners be aware of the limitations of the tools available?

Due to their, at best, moderate performance in risk prediction, practitioners should be aware of the limitation of the tools available and not use them as sole determinant of decision making. 

Q7. What are the exclusion criteria for detention in a psychiatric hospital?

A number of national laws within Europe provide exclusion criteria for detention in a psychiatric, including forensic-psychiatric hospital, e. g. personality disorders, substance use disorders or sexual deviancy. 

Q8. In what countries did a pilot service for people with personality disorders be developed?

In England and Wales a pilot service was developed in the early 2000s for individuals with so-called Dangerous and Severe Personality Disorders, established partly in prison and partly in high secure hospitals [100]. 

Q9. What was the average follow-up period for sex offenders?

The follow-up periods were generally short particularly given that sex offenders have low rates of reconviction and need to be followed up for sufficient time. 

Q10. What is the recent review of surveys on the use of violence risk assessment tools?

A review of surveys on the use of violent risk assessment tools, published between 2000 and 2013, identified nine surveys, mostly from the US and the UK [65]. 

Q11. In what countries has the forensic-psychiatric population increased by 45% between 1996?

In England and Wales, e.g., the forensic-psychiatric population has increased by 45% between 1996 and 2006 and the length of stay has also risen.