Guest Editorial: How Treatable Are Untreatable Forensic Psychiatric Patients?

Abstract

The untreatable patient has been the subject of discussion for many years. Some professionals believe that following unsuccessful long-lasting forensic psychiat ric treatment—some suggest after 7 to 10 years of treatment—or in the case of serious reoffending, forensic patients should be regarded as untreatable and should be admitted to special institutions that have only a minimum of treatment facilities. In doing so, it appears that these mentally disordered patients are being punished for a lack of treatment success. In all probability, they will remain dan gerous because they will be deprived of further treatment. They will be kept forever in these special institutions, and this is the equivalent of a life sentence. Is it ethical, correct, and wise to consider such forensic patients as untreatable and place them in such special institutions without further assessing their treatability, their motivation for treatment, and their own possible responsibility for treatment failure? Although these questions are relevant, actually essential, they remain unanswered. Is the untreatable patient always the sole party responsible for his or her untreatability? I do not believe this to be the case (Martens, in press-b). In my opinion, in some cases the therapist, the hospital staff, and even at times the cost-cutting measures of the government that affect the quality of treatment negatively also may be responsible for therapeutic failure. The therapists and staff of forensic psychiatric hospitals may show ∞ a lack of patience and therapeutic creativity; ∞ the inability to imagine themselves in or to assess the mental and emotional condition of the patient; ∞ the use of the wrong therapeutic strategy, method, or approach; ∞ a fear of extremely intelligent and dangerous patients (mostly psychopaths); and ∞ rigid therapeutic regimes and policies in forensic psychiatric hospitals.