Abstract
We propose that excellence in forensic and other mental health services can be recognized by the abilities necessary to conduct randomized controlled trials (RCTs) and equivalent forms of rigorous quantitative research to continuously improve the outcomes of treatment as usual (TAU). Forensic mental health services (FMHSs) are growing, are high cost, and increasingly provide the main access route to more intensive, organized, and sustained pathways through care and treatment. A patient newly diagnosed with a cancer can expect to be enrolled in RCTs comparing innovations with the current best TAU. The same should be provided for patients newly diagnosed with severe mental illnesses and particularly those detained and at risk of prolonged periods in a secure hospital. We describe FMHSs in four levels 1 to 4, basic to excellent, according to seven domains: values or qualities, clinical organization, consistency, timescale, specialization, routine outcome measures, and research. Excellence is not elitism. Not all centers need to achieve excellence, though all should be of high quality. Services can provide each population with a network of centers with access to one center of excellence. Excellence is the standard needed to drive the virtuous circle of research and development that is necessary for teaching, training, and the pursuit of new knowledge and better outcomes. Substantial advances in treatment of severe mental disorders require a drive at a national and international level to create services that meet these standards of excellence and are focused, active, and productive to drive better functional outcomes for service users.
Highlights
Forensic mental health services (FMHSs) provide treatment for persons with severe and disabling mental disorders in conditions of therapeutic safety and security
This paper describes how excellence can be recognized from the ability to conduct randomized controlled trials (RCTs) [7] and information-driven research paradigms which may be “hypothesis free” [8] or mix quantitative and qualitative methods so as to continuously improve treatment as usual (TAU)
The most cogent criticisms of FMHSs are not debates about the ethics of compulsion but criticisms of effectiveness, and these are based on the absence of RCT studies relevant to the field [14]
Summary
Forensic mental health services (FMHSs) provide treatment for persons with severe and disabling mental disorders in conditions of therapeutic safety and security. This paper describes how excellence can be recognized from the ability to conduct randomized controlled trials (RCTs) [7] and information-driven research paradigms which may be “hypothesis free” [8] or mix quantitative and qualitative methods so as to continuously improve TAU This is set out with particular reference to FMHS for persons presenting serious risk to others [9], since FMHSs increasingly provide the main access route to more intensive, more organized, and more sustained pathways through care and treatment [10]. FMHS can be structured in a population-based and tiered way to ensure high quality of care through coordinated, robust TAU and continuously improving outcomes through academic leadership of services that promote excellence through research, evaluation, and dissemination of improving clinical standards. We will describe an organizing framework based on excellence, to advance these ends
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