Querengässer Jan, Reinhardt Isabelle, Zielasek Jürgen, Hufnagel Sylvia, Gouzoulis-Mayfrank Euphrosyne
LVR-Institut für Versorgungsforschung, LVR-Institut für Forschung und Bildung, Köln, Germany.
Fakultät für Psychologie, FernUniversität in Hagen, Hagen, Germany.
Gesundheitswesen. 2024 Oct;86(10):640-646. doi: 10.1055/a-2230-8618. Epub 2024 Mar 11.
In forensic psychiatric clinics, patients who have committed a criminal offense on the basis of intellectual disability are also treated in according to Sect. 63 of the German Criminal Code. This group of patients has above-average lengths of stay and specific difficulties in treatment and in transition to aftercare systems are reported from practice. The present study is based on a content-analytical evaluation of ten structured interviews with practitioners of different professions who are familiar with the treatment of this patient group in forensic psychiatry. The aim was to identify treatment experiences and challenges of inpatient forensic care for this group as well as needs for change and suggestions for improvement. Respondents confirmed the specific treatment needs and person- and diagnosis-related challenges known from other studies, which were considered to be causally related to prolonged hospital stay and problems at discharge. Numerous structural and systemic barriers were also identified that impede the shortest possible forensic inpatient care and seamless transition to the non-forensic aftercare system. At the structural level, these included the need for human resources (both quantitative and qualitative) and adapted treatment concepts. Professional aftercare was considered very important for this group of patients. In this regard, the non-availability of suitable institutions, long waiting lists and reservations on the part of these institutions towards former forensic patients were identified as problems. The fact that patients with intellectual disability were less able to make their needs known than other patients and thus often received less attention from the treatment providers can be described as a systemic obstacle. This also applies to the rather high demands that the forensic system, with its goal of "improvement" through treatment, also places on people with intellectual disability. The findings of this study can contribute to improvement of the forensic inpatient care of people with intellectual disability at systemic and structural levels.
在法医精神病诊所，根据德国刑法典第63条，对因智力残疾而实施犯罪行为的患者也进行治疗。这类患者的住院时间高于平均水平，且据实践报告，他们在治疗以及向后续照护系统过渡方面存在特殊困难。本研究基于对十次结构化访谈的内容分析评估，这些访谈的对象是熟悉法医精神病学中该患者群体治疗的不同职业从业者。目的是确定该群体住院法医护理的治疗经验和挑战，以及变革需求和改进建议。受访者证实了其他研究中已知的特殊治疗需求以及与个人和诊断相关的挑战，这些被认为与住院时间延长和出院问题存在因果关系。还发现了许多结构性和系统性障碍，这些障碍阻碍了尽可能短的法医住院护理以及向非法医后续照护系统的无缝过渡。在结构层面，这些包括对人力资源（数量和质量）的需求以及适应性治疗理念。专业的后续照护对这类患者非常重要。在这方面，合适机构的缺乏、长长的等候名单以及这些机构对前科患者的保留态度被确定为问题。智力残疾患者比其他患者更难以表达自己的需求，因此往往较少受到治疗提供者的关注，这一事实可被描述为一种系统性障碍。这也适用于法医系统对智力残疾者提出的相当高的要求，法医系统的目标是通过治疗实现“改善”。本研究的结果有助于在系统和结构层面改善对智力残疾者的住院法医护理。
