Mapping Systematic Reviews on Forensic Psychiatric Care: A Systematic Review Identifying Knowledge Gaps

Katarina Howner,Björn Hofvander,Peter Andiné,Göran Bertilsson,Frida Mowafi,Alexandra Snellman,Eva Lindström,Monica Hultcrantz

doi:10.3389/fpsyt.2018.00452

Abstract

Background: Forensic psychiatric care treats mentally disordered offenders who suffer mainly from psychotic disorders, although comorbidities such as personality disorders, neurodevelopmental disorders, and substance abuse are common. A large proportion of these patients have committed violent crimes. Their care is involuntary, and their caregivers' mission is complex: not only to rehabilitate the patient, but also to consider their risk for reoffending and their risk to society. The objective of this overview of systematic reviews is to identify, appraise, and summarize the existing knowledge in forensic psychiatric care and identify knowledge gaps that require further research.Methods: We undertook a systematic literature search for systematic reviews in five defined domains considered important in daily clinical practice within the forensic psychiatric care: (1) diagnostic assessment and risk assessments; (2) pharmacological treatment; (3) psychological interventions; (4) psychosocial interventions, rehabilitation, and habilitation; and (5) restraint interventions. The target population was mentally disordered offenders (forensic psychiatric patients aged >15 years). Each abstract and full text review was assessed by two of the authors. Relevant reviews then were assessed for bias, and those with moderate or low risk of bias were included.Results: Of 38 systematic reviews meeting the inclusion criteria, only four had a moderate risk of bias. Two aimed to incorporate as many aspects of forensic psychiatric care as possible, one investigated non-pharmacological interventions to reduce aggression in forensic psychiatric care, and one focused on women with intellectual disabilities in forensic care. However, most of the primary studies included in these reviews had high risks of bias, and therefore, no conclusions could be drawn. All of our identified domains must be considered knowledge gaps.Conclusion: We could not answer any of our research questions within the five domains because of the high risk of bias in the primary studies in the included systematic reviews. There is an urgent need for more research on forensic psychiatric care since all of our studied domains were considered knowledge gaps.

Highlights

Disordered offenders in most developed countries are treated according to special regulations in the legal system
As always, when a mapping survey is conducted there are systematic reviews that do meet some, but not all, inclusion criteria or quality demands, meaning that potentially important, and interesting published studies many not been included in reviews or in this overview. This overview of systematic reviews provides a systematic description of research activity in practice-relevant fields of forensic psychiatry
Our conclusion is that all our studied domains represent knowledge gaps, and there is an urgent need for more primary studies and systematic reviews in the field of forensic psychiatric care

Summary

Introduction

Disordered offenders in most developed countries are treated according to special regulations in the legal system. The concept of accountability is applied, and if an offender is found to be unaccountable before a verdict has been reached, he or she will be moved out of the criminal justice system and into a compulsory psychiatric care system [1] These offenders are typically treated in secure or forensic psychiatric hospitals, sometimes alongside prisoners who cannot be managed by prison medical services or psychiatric patients who cannot be managed in general wards. Forensic psychiatric care treats mentally disordered offenders who suffer mainly from psychotic disorders, comorbidities such as personality disorders, neurodevelopmental disorders, and substance abuse are common. A large proportion of these patients have committed violent crimes Their care is involuntary, and their caregivers’ mission is complex: to rehabilitate the patient, and to consider their risk for reoffending and their risk to society. The objective of this overview of systematic reviews is to identify, appraise, and summarize the existing knowledge in forensic psychiatric care and identify knowledge gaps that require further research

Objectives

Methods

Results

Discussion

Conclusion