Silver S B, Tellefsen C
Department of Health and Mental Hygiene, Baltimore, MD 21201.
J Ment Health Adm. 1991 Fall;18(3):242-52. doi: 10.1007/BF02518595.
This paper discusses issues in the community-based management of forensic patients. Community acceptance and safety demand a careful system of follow-up treatment for insanity acquittees. Many studies have examined the recidivism of this population, but few have dealt with administrative strategies to manage their care as outpatients. In this paper, we discuss our experiences in developing systems for follow-up care of insanity acquittees in the state of Maryland. Central to this work is the balancing of clinical, judicial and community concerns. The decision for outpatient care or movement of the patient to a non-forensic (regional) hospital is a significant turning point in the forensic patient's care. One of the major challenges faced by forensic mental health services is to develop consistency of practice throughout a state. A centralized system is easier to manage, but costly. A system embedded in community mental health centers is less duplicative, but requires major and ongoing educational support. A private practice model is flexible, but administratively challenging. The authors believe Maryland possesses well-developed approaches for the evaluation, treatment and conditional release of insanity acquittees. The state continues to study and redesign its systems toward increased effectiveness and efficiency.
本文讨论了法医鉴定患者社区管理中的问题。社区接纳和安全要求为被判定精神错乱无罪者建立一个谨慎的后续治疗体系。许多研究考察了这一人群的再犯情况，但很少有研究涉及将他们作为门诊患者进行管理的行政策略。在本文中，我们讨论了在马里兰州为被判定精神错乱无罪者建立后续护理系统的经验。这项工作的核心是平衡临床、司法和社区方面的关切。决定对患者进行门诊护理或将其转至非法医（地区）医院是法医鉴定患者护理中的一个重要转折点。法医精神健康服务面临的主要挑战之一是在全州范围内形成一致的做法。集中化系统易于管理，但成本高昂。嵌入社区精神健康中心的系统重复性较低，但需要大量且持续的教育支持。私人执业模式灵活，但在行政管理方面具有挑战性。作者认为马里兰州在对被判定精神错乱无罪者的评估、治疗和有条件释放方面拥有完善的方法。该州继续研究并重新设计其系统，以提高有效性和效率。
