Birgit Völlm

University of Rostock · Klinik und Poliklinik für Forensische Psychiatrie

IntroductionPeer Support has become common in psychiatric practice in the past decade. In this article we present findings from the implementation of peer support service into a forensic mental health hospital for offenders with substance use disorders from a patient's perspective.Methods We conducted focus groups and interviews with patients of th...

Background Among people with a diagnosis of borderline personality disorder (BPD) who are engaged in clinical care, prescription rates of psychotropic medications are high, despite the fact that medication use is off‐label as a treatment for BPD. Nevertheless, people with BPD often receive several psychotropic drugs at a time for sustained periods...

In this session I will discuss recent publications that have advanced the field of forensic psychiatry or changed clinical practice. Content will be current so that it is not possible to specify at present. Disclosure No significant relationships.

Introduction A feeling of restrictiveness is often associated with coercive practices, such as seclusion or restraint. In addition to these obvious procedures more subtle practices can also feel restrictive. Its registration and monitoring is of special importance in forensic mental health care since feelings of restrictiveness can lead to adverse...

Introduction Peer Support Work can be an effective way to support patients and their participation also in psychiatric populations. Unlike in general psychiatry there is less experience with peer support work in forensic mental health inpatient settings. Characteristics different from general psychiatry, e.g., regarding safety, might be a reason fo...

This book explores the ways in which diversity and experiences of marginalisation are present in forensic mental health care settings around the globe and suggests ways of moving forward. Forensic mental health services provide care for a group of patients who are marginalised in several respects. Many have experienced childhood adversity and abus...

Background: Older individuals (e.g., 55 years and over) constitute a growing proportion of the forensic mental health patient population. As a group, they are vulnerable to health outcomes similar to other individuals with serious mental disorders of the same age; however, these concerns can be compounded by complex forensic-related care background...

Older forensic mental health patients have complex needs and requirements; service provision is required to address mental health, offending risk and issues associated with aging (geriatric care). This study aimed to identify the systems and processes that enable valued progress (in terms of quality of life, health, wellbeing, recovery and reduced...

Objectives: There is a lack of research informing service delivery for older forensic mental health patients. This study explored service provision in forensic mental health inpatient and community services in England, investigating what is required for progress in terms of quality of life, health, wellbeing, recovery and reduced risk, and the bar...

In Germany, the most frequently used legal section to order forensic mental health treatment is § 63 of the Penal Code (Strafgesetzbuch; StGB). This disposition is primarily aimed at individuals with major mental illnesses who are not fully responsible for a criminal act they committed. Despite evaluation and follow-up studies being conducted withi...

Background: Inpatient violence is a relevant issue in forensic psychiatric settings. Coercive measures are used as a last resort to prevent further harm although they are often regarded as untherapeutic. In order to enable staff to intervene before inpatient violence or other serious incidents occur and thus to avoid coercion, deescalation training...

Background: Older individuals (e.g., 55 years and over) constitute a growing proportion of the forensic mental health patient population. As a group, they are vulnerable to health outcomes similar to other individuals with serious mental disorders of the same age; however, these concerns can be compounded by complex forensic-related care background...

Background A recently updated Cochrane review supports the efficacy of psychotherapy for borderline personality disorder (BPD). Aims To evaluate the effects of standalone and add-on psychotherapeutic treatments more concisely. Method We applied the same methods as the 2020 Cochrane review, but focused on adult samples and comparisons of active tr...

This paper provides an overview of some of the key features of forensic mental health systems around Europe. Forensic mental health systems share in common the aim to assist in the rehabilitation of people diagnosed with a mental disorder and reduce reoffending or risk of harm. How these aims are pursued varies across the continent. We suggest that...

Body Forensic psychiatry is a specialty of psychiatry primarily concerned with individuals who have either offended or present a risk of doing so, and who also suffer from a psychiatric condition. These mentally disordered offenders(MDOs) are often cared for in secure psychiatric environments or prisons. However, the organisation of these services...

Experienced Involvement (also called Peer Support Work, PSW) has existed in mental health care in Germany since 2005 though its implementation lags behind, compared to other countries. Due to the unique challenges of forensic-psychiatric settings, implementation of PSW in these settings is even less developed. We prepared the implementation of a pe...

PurposeWhile the number of forensic beds and the duration of psychiatric forensic psychiatric treatment have increased in several European Union (EU) states, this is not observed in others. Patient demographics, average lengths of stay and legal frameworks also differ substantially. The lack of basic epidemiological information on forensic patients...

Impulsivity is a multi-faceted construct that underpins various mental health disorders. Impulsive behavior exacts a substantial health and economic burden, hence the importance of developing specific interventions to target impulsivity. Two forms of non-invasive brain stimulation, namely transcranial direct current stimulation (tDCS) and repetitiv...

Background: A significant proportion of forensic patients in England are long-stayers. This can be problematic as individuals are kept in restrictive environments at potentially inappropriate levels of security for many years, sometimes decades. Improvements to the current English forensic mental health system to meet the needs of long-stay forensi...

Background: When treating addicted offenders in a forensic psychiatric setting, a primary concern is to decrease antisocial cognitions and behaviors. The cognitive style of offenders is often characterized by impulsiveness, egocentricity, irrational thinking, and rigidity. We examined the relative efficacy of Reasoning and Rehabilitation Program (...

Older people are at a higher risk of becoming the victims of crime than of being the perpetrators of it, given the added vulnerability that comes with aging. This chapter examines crime in relation to old age. The first section presents data around older people as victims of crime, and further discusses different types of abuse against older people...

Older forensic psychiatric patients (defined as aged 50 or over) have complex needs and require specialized treatment to enable recovery and reduce risk. Little is known about what service provision is available for this population, so a scoping literature review was undertaken to establish the extent of service provision and if services are specif...

Background: Antisocial personality disorder (AsPD) is associated with poor mental health, criminality, substance use and relationship difficulties. This review updates Gibbon 2010 (previous version of the review). Objectives: To evaluate the potential benefits and adverse effects of psychological interventions for adults with AsPD. Search metho...

Background: Antisocial personality disorder (AsPD) is associated with rule-breaking, criminality, substance use, unemployment, relationship difficulties, and premature death. Certain types of medication (drugs) may help people with AsPD. This review updates a previous Cochrane review, published in 2010. Objectives: To assess the benefits and adv...

Our social activity is heavily influenced by the process of introspection, with emerging research suggesting a role for the Default Mode Network (DMN) in social cognition. We hypothesize that oxytocin, a neuropeptide with an important role in social behaviour can effectively alter the connectivity of the DMN. We test this hypothesis using a randomi...

Purpose While the number of forensic beds and the duration of psychiatric forensic psychiatric treatment have increased in several European Union (EU) states, this is not observed in others. Patient demographics, average lengths of stay and legal frameworks also differ substantially. The lack of basic epidemiological information on forensic patient...

The management of mentally disordered offenders varies widely across countries. Given the high prevalence of individuals with mental disorders throughout the criminal justice system, it is not always clear why some people receive forensic treatment and others a prison sentence. This project investigated trends in criminal justice sentencing practic...

Forensic psychiatric care settings are intended to be more therapeutic than penal settings. More homely, recovery-oriented, person-centered, and less overtly punitive. However, forensic inpatient hospitals are highly secure, risk averse, and can diminish patient autonomy. A body of research is investigating how patients experience care and how thes...

Background Over the decades, a variety of psychological interventions for borderline personality disorder (BPD) have been developed. This review updates and replaces an earlier review (Stoffers‐Winterling 2012). Objectives To assess the beneficial and harmful effects of psychological therapies for people with BPD. Search methods In March 2019, we...

Background: Some forensic patients in England remain in secure care for long, possibly unnecessarily prolonged, periods, raising significant ethical and resource issues. Research focused on the patients in secure care has examined quality of life and service provision but not the perspectives of patients experiencing long stays. This study explore...

Purpose Patients detained in high-security psychiatric hospitals are particularly vulnerable to excessive restrictions and exploitation. In the UK, the care quality commission (CQC) monitors and regulates forensic healthcare provision. The purpose of this study is to identify key concerns highlighted in CQC inspection reports of the three high-secu...

[This corrects the article DOI: 10.3389/fpsyt.2019.00805.]. In the original article, there was an error. The Forensic Inpatient Quality of Life Questionnaire - Short Version (FQL-SV) was incorrectly called the Forensic Quality of Life Profile - Short Version (FQL-SV). A correction has been made to the Instruments section, subsection Forensic Qual...

Background: In England, forensic psychiatric hospital services are provided at three security levels: high, medium and low. All are publicly funded and similarly regulated, but medium and low secure services are provided in the private and charitable (PCS) sector as well as the National Health Service (NHS). Originally, medium secure hospital serv...

Where safe, forensic mental health systems should provide care in the least restrictive environment possible. Doing so can maximize patient autonomy and empowerment while minimizing unnecessary social disconnection and stigmatization. This study investigated whether patients’ perceptions of restrictiveness were associated with demographic, clinical...

Background. Given the lack of official policies around sexual expression in several countries, members of staff are key in managing patients’ sexuality in forensic psychiatric settings. This study explored staff views on sexual expression in inpatient secure services. Methods. A survey on sexual expression was administered to professionals from t...

Introduction: Forensic psychiatric care is often practiced in closed institutions. These highly regulated, secure, and prescriptive environments arguably reduce patient autonomy, self-expression, and personhood. Taken together these settings are restrictive as patients’ active participation in clinical, organizational, community, and personal life-...

Background: The literature surrounding patient feedback is limited, despite government policy integrating patient feedback into how the care quality of the National Health Service (NHS) is assessed. The aim of the study is to examine the detailed contextualised accounts of patient feedback within forensic and non-forensic settings through qualitati...

Introduction: we aimed to identify the barriers and facilitators to the implementation of a high fidelity IPS service in a community forensic mental health setting. Method: in-depth interviews were conducted with clinical staff (n=11), patients (n=3), and employers (n=5) to examine barriers and facilitators to implementation of a high fidelity IPS...

Background: Sexual behaviour towards another person who does not or cannot consent to it causes serious harm to its victims. Understandable tendencies towards isolating or shaming the offenders, however, may actually increase risks of recidivism and further such harms. Aim: The study aims to consider evidence for the effectiveness of interventio...

Medico-legal psychiatry is the field of forensic psychiatry that consists of reporting to criminal, civil and administrative authorities and testifying in courts of law. As a forensic science, medico-legal psychiatry is based on the principle of impartiality. However, the notion of impartiality is not clearly defined and can be understood in many d...

Purpose: Arrangements for the management of mentally disordered offenders vary widely across countries, as do rates of imprisonment and detention in forensic-psychiatric settings of such individuals. This study aims to quantify the characteristics of offenders detained in forensic-psychiatric settings in Germany over a 15 year period from 1995 and...

Although the number of older patients in forensic psychiatric settings is increasing, there is limited information around their sociodemographic characteristics, needs and cognitive abilities. This cross-sectional study focuses on patients aged ≥ 50 years in three (high, medium and low) secure forensic psychiatric services in England. The study com...

Forensic psychiatric services care for patients who present with a mental disorder as well as a risk to themselves or others, and have usually been convicted of an offence. Their needs are complex and the length of stay (LoS) in forensic settings is long. LoS is affected by patient factors as well as legal and policy issues. Owing to the considerab...

Background A lack of concern for the feelings, needs or suffering of others and lack of remorse after hurting or mistreating others are key characteristics of antisocial personality disorder (ASPD), otherwise identified as dissocial personality disorder (DPD) and suggest that impaired emotion processing and empathy may contribute to antisocial beha...

Forensic care settings are often isolated spaces with high levels of security. Where these settings are overly restrictive, this can affect recovery, autonomy and the therapeutic milieu. It is not clear what phenomena patients themselves identify as restrictive and how, subjectively, they experience these. Semi-structured interviews were conducted...

Forensic psychiatric services provide care for those with mental disorders and offending behaviour. Some patients may stay in such services for excessive periods of time. This causes an economic burden to society and might limit the quality of life of patients. This research therefore aimed to estimate the number of long-stay patients in secure set...

Antisocial personality disorder (ASPD) and psychopathy attempt to represent individuals demonstrating callousness and disregard for others. ASPD has been criticized for capturing a heterogeneous population whilst missing the essence of the diagnosis by neglecting interpersonal/affective deficits which measures of psychopathy include. This heterogen...

Objective: To examine the feasibility of conducting a fully powered randomized controlled trial (RCT) of Individual Placement and Support (IPS). IPS is a form of supported employment which aims to put people into open employment quickly and in accordance with their preferences. It is delivered by employment specialists collocated within clinical te...

Background and aims: Antisocial personality disorder is an enduring mental disorder associated with significant disease burden and treatment difficulties. This is apparent within forensic populations. There is growing evidence to suggest that treatment with oxytocin could have some benefit in treating a range of psychiatric disorders. There are no...

Background: For patients with a mental disorder facing lengthy stays in secure forensic care, the role and experiences of their carers has only recently started to be explored in research. Aims: To explore the experiences of carers of longstay patients in low-to-high- secure forensic care. Methods: This exploratory qualitative study included two fo...

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. T...

Impulsivity and empathy are clinically relevant multi-dimensional concepts. Existing evidence suggests the leftdorsolateral prefrontal cortex (LDLPFC) plays a crucial role in impulsivity and empathy. However, the neuro-modulation effect of excitatory repetitive transcranial magnetic stimulation at the LDLPFC is insufficiently ex-plored in the current...

Zusammenfassung Dieser Beitrag beschreibt den Umgang mit Sexualstraftätern in England. Zunächst werden einige Besonderheiten der britischen Gesellschaft und deren Rechtssystem dargestellt. Sodann werden Fakten zu Sexualstraftaten präsentiert sowie die rechtlichen Grundlagen und praktischen Aspekte der Unterbringung und Behandlung im Strafvollzug so...

Background. Although the prevalence of older patients in forensic psychiatric services is increasing, research around service provision for this population is very limited. We aimed to gather the views of members of staff on how well secure services are meeting the challenges of an ageing population. Methods. Three focus groups were carried out wi...

Background: Impulsivity is a multi-dimensional construct that is regarded as a symptom of many psychiatric disorders. Harm resulting from impulsive behaviour can be substantial for the individuals concerned, people around them and the society they live in. Therefore, the importance of developing therapeutic interventions to target impulsivity is pa...

Objectives. The prevalence of ageing patients in forensic psychiatric settings is increasing. However, limited research has reported around this population. The aim of this scoping review is to synthesise the current evidence around ageing forensic psychiatric patients. Methods. The literature was searched through four databases and Google searche...

Older patients account for around 20% of the population in secure forensic psychiatric services in the UK. However, little qualitative research has investigated the experience of ageing in secure settings. This study aimed to gather the individual views of a sample of patients over 50 years old in three services within the region of one NHS Trust i...

Background: In recent years, concerns have been raised that too many patients stay for too long in forensic psychiatric services and that this is a particular problem in those with an intellectual disability. Aims: To compare the characteristics, needs, and care pathways of long-stay patients with and without intellectual disability within forens...

The British Association for Psychopharmacology and the National Association of Psychiatric Intensive Care and Low Secure Units developed this joint evidence-based consensus guideline for the clinical management of acute disturbance. It includes recommendations for clinical practice and an algorithm to guide treatment by healthcare professionals wit...

The British Association for Psychopharmacology and the National Association of Psychiatric Intensive Care and Low Secure Units developed this joint evidence-based consensus guideline for the clinical management of acute disturbance. It includes recommendations for clinical practice and an algorithm to guide treatment by healthcare professionals wit...

Standards and guidelines of forensic psychiatric care and treatment have not been agreed upon in the European Community respectively, and are only insufficiently established in a small number of European states. The legal situation of forensic care differs between countries, affecting different legal frameworks for care and treatment. Treatment con...

Intro. Older patients constitute around 20% of the population in secure forensic psychiatric services in the UK. However, little qualitative research has investigated the experience of ageing in secure settings. Aims. This study aimed to answer the questions: (i). What is the experience of older patients in forensic psychiatric services? (ii). Ar...

Older people are at a higher risk of becoming the victims of crime than of being the perpetrators of it, given the added vulnerability that comes with aging. This chapter examines crime in relation to old age. The first section presents data around older people as victims of crime, and further discusses different types of abuse against older people...

Background: Many patients experience extended stays within forensic care, but the characteristics of long-stay patients are poorly understood. Aims: To describe the characteristics of long-stay patients in high and medium secure settings in England. Method: Detailed file reviews provided clinical, offending and risk data for a large representative...

PurposeForensic services provide care for mentally disordered offenders. In England this is provided at three levels of security—low, medium and high. Significant number of patients within these settings remain detained for protracted periods of time. This is both very costly and restrictive for individuals. No national studies have been conducted...

Background: Impulsivity is a multi-faceted concept. It is a crucial feature of many neuropsychiatric disorders. Three subtypes of impulsivity have been identified: motor, temporal, and cognitive impulsivity. Existing evidence suggests that the right inferior frontal gyrus (rIFG) plays a crucial role in impulsivity, and such a role has been elucida...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the beneficial and harmful effects of psychological therapies for people with borderline personality disorder (BPD).

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the beneficial and harmful effects of pharmacological treatment for adolescents and adults with borderline personality disorder (BPD).

Mentally disordered offenders may be sent to secure psychiatric hospitals. These settings can resemble carceral spaces, employing high levels of security restricting resident autonomy, expression and social interaction. However, research exploring the restrictiveness of forensic settings is sparse. A systematic review was therefore undertaken to co...

Purpose The purpose of this paper is to describe service users’ perspectives on the difference between high secure long-stay forensic psychiatric services in the Netherlands and high secure forensic psychiatric care in England. These perspectives are relevant in considering the benefits of a similar long-stay service in England. Design/methodology...

Forensic psychiatry in Europe is a specialty primarily concerned with individuals who have either offended or present a risk of doing so, and who also suffer from a psychiatric condition. These mentally disordered offenders (MDOs) are often cared for in secure psychiatric environments or prisons. In this guidance paper we first present on overview...