Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Institute of History, Theory and Ethics in Medicine, University Hospital Düsseldorf, Dusseldorf, Germany.
Front Public Health. 2023 Jan 26;11:1095743. doi: 10.3389/fpubh.2023.1095743. eCollection 2023.
There is wide variation in the processes, structures and treatment models for dealing with mentally disordered offenders across the European Union. There is a serious lack of data on population levels of need, national service capacities, or treatment outcome. This prevents us from comparing the different management and treatment approaches internationally and from identifying models of good practice and indeed what represents financial efficiency, in a sector that is universally needed.
From March 2019 till January 2020 we surveyed forensic psychiatric experts from each European Union Member State on basic concepts, service capacities and indicators for the prevalence and incidence of various forensic psychiatric system components. Each expert completed a detailed questionnaire for their respective country using the best available data.
Finally, 22 EU Member States and Switzerland participated in the survey. Due to the frequent lack of a clear definition of what represented a forensic psychiatric bed, exact numbers on bed availability across specialized forensic hospitals or wards, general psychiatric hospitals or prison medical wards were often unknown or could only be estimated in a number of countries. Population-based rates calculated from the survey data suggested a highly variable pattern of forensic psychiatric provision across Europe, ranging from 0.9 forensic psychiatric beds per 100,000 population in Italy to 23.3 in Belgium. Other key service characteristics were similarly heterogeneous.
Our results show that systems for detaining and treating mentally disordered offenders are highly diverse across European Union Member States. Systems appear to have been designed and reformed with insufficient evidence. Service designers, managers and health care planners in this field lack the most basic of information to describe their systems and analyse their outcomes. As a basic, minimum standardized national reporting systems must be implemented to inform regular EU wide forensic psychiatry reports as a prerequisite to allow the evaluation and comparison of the various systems to identify models of best practice, effectiveness and efficiency.
在欧盟，处理精神障碍罪犯的程序、结构和治疗模式存在广泛差异。在人口需求水平、国家服务能力或治疗结果方面，数据严重缺乏。这使我们无法在国际上比较不同的管理和治疗方法，也无法确定良好实践模式，以及在这个普遍需要的领域中，什么代表着财务效率。
从 2019 年 3 月到 2020 年 1 月，我们调查了来自每个欧盟成员国的法医精神病学专家，了解各种法医精神病学系统组成部分的基本概念、服务能力和流行率及发病率的指标。每位专家都使用最佳可用数据为各自国家填写了详细的问卷。
最终，22 个欧盟成员国和瑞士参与了调查。由于经常缺乏明确界定何为法医精神病学床位，因此在许多国家，专门的法医医院或病房、综合精神病医院或监狱医疗病房的床位可用性的准确数字通常是未知的，或者只能估计。根据调查数据计算的基于人群的比率表明，欧洲各地的法医精神病学服务提供情况存在高度差异，从意大利每 10 万人中有 0.9 个法医精神病学床位到比利时的 23.3 个床位不等。其他关键服务特征也同样存在异质性。
我们的研究结果表明，欧盟成员国中用于拘留和治疗精神障碍罪犯的系统存在很大差异。这些系统似乎是在证据不足的情况下设计和改革的。该领域的服务设计者、管理者和医疗保健规划者缺乏描述系统和分析结果的最基本信息。作为一个基本要求，必须实施标准化的国家报告系统，定期向欧盟报告法医精神病学信息，作为评估和比较各种系统、确定最佳实践、有效性和效率模式的前提。
