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Down syndrome is one of the common genetic causes of intellectual disability. Adult with Down syndrome may have many psychiatric comorbidities. Therefore, their mental health status should be considered in legal proceedings such as criminal responsibility and legal capacity where they are involved. This study aims to highlight that individuals with Down syndrome are often referred directly to forensic psychiatry without undergoing an interview, despite the fact that this is a group with varied mental statuses.

This study analysed the socio-demographic, clinical and forensic characteristics of eight adult individuals with Down syndrome for whom the Council of Forensic Medicine (CFM) requested an opinion on criminal liability and other legal situations between 2018 and 2022. The CFM is an authoritative institution to which cases from all areas of Türkiye are referred.

The mean age of the individuals with Down syndrome for whom a forensic psychiatric opinion was requested was 24.63 (±7.95) and the mean IQ level was 54.13 (±13.38). All cases were male, 6 / 8 were referred for assessment of criminal responsibility and 4 / 6 of those referred for assessment of criminal responsibility were referred for sexual offences. It was found that 5 / 8 of the cases had moderate intellectual disability and 3 / 8 of the cases had mild intellectual disability.

Regarding the limitations of this study, the first one is the small sample size. Nevertheless, due to the low prevalence of people with Down syndrome in society, it is plausible that their stigmatization may not be reflected in the judicial system, even in cases involving violent behaviour. The second limitation is that the reports lack all psychiatric medical documents, including forensic psychiatric evaluations of individuals with Down syndrome. Additionally, additional diseases were recorded based on familial anamnesis. The third limitation is that this study is the first publication to investigate Down syndrome from a forensic psychiatric perspective. Thus, there is a lack of literature to make direct comparisons and references in the discussion section.

This is the first study about forensic psychiatric aspects for people with Down syndrome. The aim of this study was to examine the forensic psychiatric approach in Down syndrome, one of the most common genetic causes of intellectual disability, the situations in which forensic psychiatric assessment is required and the issues that might be considered important in this regard. Although there are various publications in the literature on the psychiatric conditions of individuals with Down syndrome, to our knowledge, this is the first study to evaluate individuals with Down syndrome in terms of forensic psychiatric evaluation. People with Down syndrome are known to have varying degrees of intellectual disability and different types of psychiatric comorbidity.

People with Down syndrome are a heterogeneous group in terms of intellectual disability. The criminal responsibility and legal capacity of individuals may vary according to the legal situation. When requesting forensic psychiatric evaluation of these patients with psychiatric co-morbidity, patients should not be prejudged in terms of their level of mental competence and each case should be assessed individually.

The purpose of this paper is to explicate the lived experiences of nurses involved in rehabilitation of forensic psychiatric patients in special institutions in Zimbabwe.

The study used the grounded theory approach utilising a mixed sequential dominant status design (QUAL/Quant). Pierre Bourdieu’s conceptual canon of field, habitus and capital was used as a theoretical point of departure by the research study. Confirmatory retrospective document review of 119 patients’ files was also done to substantiate the nurses’ experiences. Theoretical sampling of relatives was also done.

Findings and results revealed that nurses seemed to experience infrahumanisation, a subtler form of dehumanisation. The infrahumanisation was embodied in the unpleasant context in which nurses were expected to perform their mandate of championing rehabilitation of forensic psychiatric patients. The guards who represented the prison system seemed to possess all forms of capital in the prison system (where special institutions are housed): the prison cultural capital, social capital and economic capital. This capital seemed to represent symbolic power over the disillusioned and voiceless nurses. Guards attended to and discussed patients and relatives issues instead of nurses. This form of misrecognition of the nurses culminated in dominance and reproduction of the interests of the prison system which underlined the established order of realities in the rehabilitation of forensic psychiatric patients in special institutions at the time of the study. The nurses’ lived experience was confirmed by theoretically sampled by relatives of forensic psychiatric patients who also participated in the research study. Nurses’ powerlessness was also reflected in the patients’ files in which in which care was largely not documented.

The study focused on the nurses experiences related to rehabilitation of male forensic psychiatric patients and not on female forensic psychiatric patients because there were important variables in the two groups that were not homogenous. For the little documentation that was done, there was also a tendency nurses to document negative rather than positive events and trends. The documents/files of patients had therefore a negative bias which was a major limitation to this study.

There is a need for major revision of the revision of the role of the nurse in the forensic psychiatric setting. Collaboration as academia, practice, professional organisations and regulatory bodies would foster a nurse led therapeutic jurisprudence in the future of rehabilitation of forensic psychiatric patients in Zimbabwe.

There is a need for major revision of the revision of the role of the nurse in the forensic psychiatric setting.

This is the first description of the position of nurses’ seconded to special institutions in Zimbabwe and will go a long way in realigning conflictual policy documents guiding care of forensic psychiatric patients in special institutions.

Mental health is an inevitable and vital dimension when it comes to providing a global definition for the appropriate health status. This highlights the importance of investigating factors influencing utilization and out-of-pocket payments (OOP) for mental health services. Thus, the purpose of this paper is to assess the determinants of the utilization and OOP for psychiatric healthcare in Iran.

A total of 39,864 households were included in this cross-sectional study. Data on the utilization and OOP for psychiatric healthcare as well as all their determinants (e.g. wealth index of households, geographical area, household size, etc.) were extracted from the Household Income and Expenditure Survey (HIES). The HIES was conducted by the Statistical Center of Iran in 2016. A zero-inflated Tobit model was used to identify the main factors affecting utilization and OOP for psychiatric healthcare utilization.

The average of utilization and OOP for psychiatric services was found to be 14.67 times per 1,000 households and $7.783 per month for service users, respectively. There were significant positive relationships between income and utilization (p=0.0002) and OOP (p<0.0001) for psychiatric services. Significant negative associations were found between the number of illiterate people in the household and OOP (coefficient=−1.56) and utilization (coefficient=−0.2002) for psychiatric services. Utilization and OOP for psychiatric services were statistically significantly higher among households with higher wealth status.

Despite the higher rate of mental disorders, the utilization of psychiatric services in Iran is very low. Due to financial barriers and insufficient insurance coverage, high socioeconomic status (SES) households utilize more psychiatric services than low-SES households. Thus, the integration of mental health services in public health programs is required to improve the utilization of psychiatric services in Iran.

The purpose of this paper is to explore newly graduated nurses’ experiences of their preparation for psychiatric nursing practice in Malawi. Knowledge of how basic or undergraduate nursing training programs prepare nurses for mental health services will inform educators to maximize the teaching and learning processes. Students are a key stakeholder in professional training hence an understanding of their experiences of training programs is critical.

A qualitative exploratory study was undertaken. In total, 16 newly graduated nurses with six months work experience at three psychiatric hospitals in Malawi were purposively sampled and recruited into the study. One to one interviews which lasted almost 45 minutes were conducted. Data were analyzed using content analysis.

Findings show that training programs fall short in preparing students for psychiatric nursing practice. Participants reported little attention to the specialty as compared to other specialties by educators. Inadequate academic support during practice sessions was highlighted by the majority of participants.

The study needed to compare the findings with experiences of students who have been allocated to other nursing specialties.

Psychiatric nursing specialty remains the least preferred career choice for many nursing students. However, preservice nursing education programs are expected to socialize, motivate and prepare students for psychiatric practice as well. It is therefore critical to understand gaps that exist in student preparation for psychiatric nursing services in order to improve mental health training.

In Belgium approximately a quarter of forensic psychiatric patients reside within penitentiaries instead of treatment facilities. This situation has yielded the Belgian government several convictions from the Human Rights Court in Strasbourg. In an attempt to facilitate admissions from penitentiary to psychiatric hospital, the Forensic Department of the psychiatric hospital in Rekem (OPZC Rekem), has piloted the InReach project. The paper aims to discuss these issues.

The objective of this project is to engage a psychiatric nurse on the ward in pretherapeutic and motivational activities on a regular basis in the penitentiary for vulnerable groups of forensic psychiatric patients, forming a bridge between penitentiary and hospital. The InReach project even considers patients who have no desire to leave the penitentiary (e.g. due to their psychiatric profile). A motivational approach is used to support these patients in making the transition from penitentiary to hospital.

The current article describes the focus of the InReach project (procedures and InReach candidate profiles) together with the first impressions of the progress that has been made by the InReach project. In addition two case studies of InReach patients are presented. The InReach project is clearly needed in Belgium and because of its success it has been extended to another penitentiary. It is probable the two other medium-security wards will also be included in the project in the near future.

The Belgian government has received several convictions from the Human Rights Court in Strasbourg because a substantial number of forensic psychiatric patients reside within penitentiaries instead of treatment facilities. The InReach project presented in this paper is clearly needed in Belgium and was implemented to initiate and facilitate the transition from penitentiaries to treatment facilities. The need for this type of project is reflected in the number of forensic psychiatric patients that reside within a penitentiary and that are not able or willing to make the transition to a treatment facility because of their psychiatric profile.

The purpose of this paper is to explore the association between economic factors (consumer price index, real gross domestic product per capita, base discount rate, and rate of unemployment) and numbers of hospital psychiatric beds.

Time series analytical techniques (unit root and cointegration tests) were applied to two regional data sets from the nineteenth century (North Carolina, USA; Berkshire, UK) and three national data sets in the twentieth century (US; UK; Italy) to test the hypothesis of a relationship.

All data sets suggest a long‐run relationship between economic factors and psychiatric bed numbers. Increase of consumer price predicted a decrease of hospital beds (and vice versa) in all data sets and was the strongest predictor of changes in psychiatric bed numbers. Hence, economic factors appear to be an important driver for the supply of hospital beds.

Cointegration tests are not true causality tests as they only measure the ability to forecast the value of an X variable knowing the value of N other variables. Therefore, one cannot rule out that the relationship between economic factors and psychiatric hospital beds is an indirect one, caused by another unidentified factor. Also, this study alone does not provide evidence to decide whether economic factors mainly influence demand or supply, although various findings suggest the latter.

CPI is of particular significance for changes in psychiatric bed provision, and co‐integration tests are a useful method to explore such association.

This study is the first one to apply time series analytical techniques to explore the role of economic factors in the processes of psychiatric institutionalisation and deinstitutionalisation.

The purpose of this paper is to examine two competing pharmacological models that have been used to understand how psychiatric drugs work: the disease-centred model and the drug-centred model. In addition, it explores the implications of these two models for mental health service users and the degree to which they are meaningfully involved in decisions about the use of psychiatric drugs.

The approach is a conceptual review and critical comparison of two pharmacological models used to understand the mode of action of psychiatric drugs. On the basis of this analysis, the paper also provides a critical examination, supported by the available literature, of the implications of these two models for service user involvement in mental health care.

The disease-centred model is associated with a tendency to view the use of psychiatric drugs as a technical matter that is to be determined by mental health professionals. In contrast, the drug-centred model emphasises the centrality of the individual experience of taking a psychiatric drug and implies a more equitable relationship between practitioners and mental health service users.

Although infrequently articulated, assumptions about how psychiatric drugs work have important consequences for service user involvement in mental health care. Critical consideration of these assumptions is an important aspect of seeking to maximise service user involvement in decisions about the use of psychiatric drugs as a response to their experience of mental distress.

Life expectancy is 15–20 years shorter for individuals with than for people without mental illness. Assuming that undiagnosed and undertreated somatic conditions are significant causes, the Central Denmark Region set out to implement joint psychiatric and somatic emergency departments (EDs) to support integrated psychiatric/somatic care as an effort to prolong the lifetime of individuals with mental illness. Through the lens of Normalization Process Theory, the authors examine healthcare frontline staff’s perceptions of and work with the implementation of integrated psychiatric/somatic care in the first joint-specialty ED in Denmark.

A single-case mixed-methods study using Normalization Process Theory (NPT) as an analytic framework to evaluate implementation of psychiatric/somatic integrated care (IC) in a joint-specialty emergency department. Data were generated from observations, qualitative interviews and questionnaires distributed to the frontline staff.

Implementation was characterized by a diffuse normalization leading to an adaption of the IC in a fuzzy alignment with existing practice. Especially, confusion among the staff regarding how somatic examination in the ED would ensure prolonged lifetime for people with mental illness was a barrier to sense-making and development of coherence among the staff. The staff questioned the accuracy of IC in the ED even though they recognized the need for better somatic care for individuals with mental illness.

This study highlights that a focus on outcomes (prolonging lifetime for people with mental illness and reducing stigmatization) can be counterproductive. Replacing the outcome focus with an output focus, in terms of how to develop and implement psychiatric/somatic IC with the patient perspective at the center, would probably be more productive.

In 2020, the Danish Health Authorities published new whole-system recommendations for emergency medicine (EM) highlighting the need for intensifying integrated intra and interorganizational care including psychiatric/somatic IC (ref). Even though this study is not conclusive, it points to subjects that can help to identify resources needed to implement psychiatric/somatic IC and to pitfalls. The authors argue that the outcome focus, prolonging the lifetime for individuals with mental illness by identifying somatic illness, was counterproductive. In accordance with the recommendations of contemporary implementation studies, the authors recommend a shift in focus from outcome to output focus; how to develop and implement psychiatric/somatic IC.

The purpose of this paper is to compare the effects of two types of community-based, residential treatment programs among justice involved persons with dual diagnoses.

A randomized clinical trial examined treatment conditions among justice involved persons with substance use disorders who reported high baseline levels of psychiatric severity indicative of diagnosable psychiatric comorbidity. Participants (n=39) were randomly assigned to one of three treatment conditions upon discharge from inpatient treatment for substance use disorders: a professionally staffed, integrated residential treatment setting (therapeutic community), a self-run residential setting (Oxford House), or a treatment-specific aftercare referral (usual care). Levels of psychiatric severity, a global estimate of current psychopathological problem severity, were measured at two years as the outcome.

Participants randomly assigned to residential conditions reported significant reductions in psychiatric severity whereas those assigned to the usual care condition reported significant increases. There were no significant differences in psychiatric severity levels between residential conditions.

Findings suggest that cost-effective, self-run residential settings such as Oxford Houses provide benefits comparable to professionally run residential integrated treatments for justice involved persons who have dual diagnoses.

Results support the utilization of low-cost, community-based treatments for a highly marginalized population.

Little is known about residential treatments that reduce psychiatric severity for this population. Results extend the body of knowledge regarding the effects of community-based, residential integrated treatment and the Oxford House model.

Mental health assessment in people with learning disability can be a challenging process for clinicians. The more severe the cognitive impairment and level of learning disability, the less likely it is that the clinician can reliably confirm the diagnosis of a psychiatric disorder. Coordinated, multi‐modal interdisciplinary team assessment is the way forward, as it draws together the bio‐psychosocial model of interviewing and mental health care planning. In this article we go through the psychiatric assessment structure and highlight the differences in assessing people with learning disability compared with their peers in the general population. We give special consideration to mental health assessments in emergency settings, and to people with challenging behaviour.