Abstract
Background: Little is known about the opinions of forensic inpatients with psychotic disorders like schizophrenia on factors likely to prevent or decrease future violent behavior.Aims: To understand the perspectives of forensic inpatients with psychotic disorders on protective factors against risk of violent behavior and compare them to factors identified by professional staff.Method: Using the Structured Assessment of Protective Factors (SAPROF) checklist for self-appraisal of violence risk, we conducted semi-structured interviews with 32 inpatients of the Medical Treatment and Supervision Act Ward and compared the results with those of professionals.Results: Inpatients scored higher in the SAPROF total score, the motivational factors of “life goals” and “motivation for treatment,” and the protective level in general. Inpatients scored themselves lower in risk level than professionals. The degree of agreement between service users' and professionals' evaluations was low for all categories except external factors. Inpatients prioritized “life goals,” “self-control,” and “medication” as the top three key strengths currently preventing violent behavior, whereas the professionals selected “life goals” less often. The top three important future goals for preventing future violence selected by inpatients were “work,” “intimate relationships,” and “life goals,” with the former two being selected significantly less often by the professionals.Conclusions: This is the first study to shed light on Japanese forensic inpatients' perspectives about preventing future violent behavior. Despite professionals' underestimation, inpatients viewed themselves as having high motivation for treatment and positive life goals. Inpatients prioritized personal values such as life goals, work, and intimate relationships, whereas professionals prioritized understanding, treating, and observing the disease. Our findings are consistent with past reports on patients' and clinicians' perspectives. Awareness of such gaps in perceptions can help build fruitful therapeutic alliances. We discuss the implications in terms of treatment, how to address the gap therapeutically, and how to design treatment accordingly. Directions for future research are also discussed.
Highlights
In Japan, legislation to provide specialized treatment to forensic service users with mental disorders, along with the Medical Treatment and Supervision Act (MTSA), have been enforced since 2005, symbolizing the beginning of fully fledged forensic psychiatry [1,2,3,4,5]
The Structured Assessment of Protective Factors (SAPROF) is a checklist of 17 protective factors (Table 1), all of which are rated on a 3-point scale (0 = the protective factor is clearly absent or there is no evidence that the protective factor is present; 1 = the protective factor may be present or is present to some extent; 2 = the protective factor is clearly present) reflecting the extent to which they are present for a given service user in a specific situation [12]
The participation of seven service users was rejected by the multi-disciplinary team in charge of the study because their participation would have likely been difficult: three refused treatment or were highly suspicious of the multidisciplinary team and could not establish a cooperative treatment alliance, one showed severely obsessive behavior, and three suffered from significant unrest such as delirium and psychomotor arousal
Summary
In Japan, legislation to provide specialized treatment to forensic service users with mental disorders, along with the Medical Treatment and Supervision Act (MTSA), have been enforced since 2005, symbolizing the beginning of fully fledged forensic psychiatry [1,2,3,4,5]. According to the Medical Treatment and Supervision Act Hospitalization Guidelines, developed by the Ministry of Health, Labor and Welfare, service users are required to seek necessary medical care autonomously and be willing to work proactively on their issues [6]. In risk assessment and management of violent behavior, the Structured Professional Judgment (SPJ) method is of mainstream use worldwide. The importance of involving service users in risk assessment has been noted. In the risk assessment and management of violence, it is important to focus on the experience and perspective of service users [9]. Little is known about the opinions of forensic inpatients with psychotic disorders like schizophrenia on factors likely to prevent or decrease future violent behavior
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