Involving Forensic Patients in Treatment Planning Increases Cooperation and May Reduce Violence Risk

[摘要] Risk assessment in a forensic hospital is a complex process. Decisions made about individuals and their lives cannot be made lightly and must include relevant information from as many sources as possible. The forensic hospital and the greater legal system that oversees forensic treatment have an obligation to protect the safety of the community. Thus, any decision about a forensic patient's progress from high to low security or eventual transition and discharge into the community must be thoughtful and balanced, and must include input from the patients themselves. Eliciting and providing for patients to articulate how they perceive their own risk and potential stressors and triggers can be potentially helpful in managing their day-to-day progress, safety, and eventual transition out of the hospital. One of the greatest challenges in a forensic hospital is assessing patients' risk for immediate or future violence, particularly with respect to their progression to less restrictive environments and eventual release to the community. In the treatment of forensic patients who have already been dangerous (or just nearly so), assessing, predicting, and managing potential dangerousness is an important part of ongoing treatment and discharge planning. Although treatment itself is designed to help individuals to manage the symptoms and behaviors related to their mental illness, it is also provided to assess and mitigate risk so that forensic patients can make clinical progress and move to less secure environments. Whether we like to admit it or not, there is truth to the statistic that an individual who once was violent may be likely to become violent again, depending, of course, on past and future circumstances. ¹ However, there are specific treatments that can work to identify, assess, and mitigate future risk of dangerousness once the underlying vulnerabilities of the forensic patient are identified. Forensic assessment of risk is a complicated process in a complex system that tries to balance the need for security and the safety of the community with some measure of patient autonomy. Ray and Simpson ² are correct when they argue for greater involvement of the forensic patient in the assessment of the patient's risk. I also agree that patients' understanding of their own risk is important to their successful rehabilitation. The philosophy of the recovery movement is that patients' involvement in guiding treatment can be helpful for their sense of autonomy, which can result in better cooperation with treatment plans, and a sense of ownership of the treatment-planning process. Patients' general improvement may in turn lead to decreased risk of future violence, in the hospital or after discharge, because of greater insight. In my view, Schaufenbil et al. ³ go too far when they argue that forensic treatment plans should include only matters directly related to the “legal reasons for admission and discharge […] based on the commitment specific statutory language …” (Ref. 3 , p 2), essentially rejecting completely the role of the patient, broad clinical progress, and the role and philosophy of the recovery movement.

[学科分类] 儿科学