This book provides an overview of forensic psychiatry, focusing on the provision of care in Europe as well as the legal and ethical challenges posed by long-term stays in forensic settings. Forensic psychiatric services provide care and treatment for mentally disordered offenders (MDOs) in secure in-patient facilities as well as in the community. These services are high-cost/low-volume services; they pose significant restrictions on patients and hence raise considerable ethical challenges. There is no agreed-upon standard for length of stay (LoS) in secure settings and patients' detainment periods vary considerably across countries and even within the same jurisdiction. Thus far, little research has been conducted to identify factors associated with length of stay; consequently, it remains unclear how services should be configured to meet the needs of this patient group. This volume fills some of those gaps. Furthermore, it presents new research on factors associated with length ofstay, both patient-related and organisational. Various approaches to the provision of care for long-term patients in different countries are explored, including a few best practise examples in this specific area of psychiatry. The book also addresses the perspective of those working in forensic care by reviewing quality-of-life research and interviews with patients. The authors of this volume come from a range of professional backgrounds, ensuring a certain breadth and depth in the topic discussion, and even includes patients themselves as (co-)authors.

Preface.-Introduction

Part I - The context: Asylums and deinstitutionalization: The Penrose hypothesis in the 21st century.-Challenges in comparing healthcare systems across different countries
Long-term in forensic care in Europe
Characteristic and needs of long-term patients in the UK
Challenges in the provision of forensic services in Eastern Europe
Ethical and human rights aspects of long-term
Part II - Clinical aspects of long-term: What works for long-term forensic patients
How to measure progress in forensic care
Enhancing protective factors in the management of violence risk in long-term stay patients
Challenges in the treatment of sex offenders
Occupational therapy with long-term service users
The importance of ward climate
Quality of life in forensic settings
Patient experiences of long-term
A service user perspective
Involving carers in forensic settings
Part III - Alternative provision
The closure of forensic-psychiatric institutions inItaly
The Dutch model of long stay
German long-term services in forensic settings
Complementary model of long-term service as the result of reform of forensic psychiatry system after political transformation
Attitudinal and organizational barriers to the introduction of long-term services.