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首页> 外文期刊>European psychiatry: the journal of the Association of European Psychiatrists >Dangerous or merely difficult? The new population of forensic mental hospitals.
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Dangerous or merely difficult? The new population of forensic mental hospitals.

机译：危险还是困难？法医精神病医院的新人口。

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BACKGROUND: During recent decades, there has been a substantial increase in admissions to forensic mental hospitals in several European countries. It is not known if reforms implemented in mental health policies and practices are responsible for this development. OBJECTIVE: Our study examined the development of mental health care in Austria and the incidence and prevalence of mentally disordered offenders judged not guilty by reason of insanity (NGRI). METHODS: We analysed data on service provision and data from criminal statistics between 1970 and 2008 from several national sources. RESULTS: During the first decade when reforms to mental health practice were implemented, the incidence and prevalence of offenders judged NGRI remained unchanged, despite a reduction of mental hospital beds by nearly 50% and little outpatient care. Surprisingly, the enormous increase in admissions to forensic inpatient treatment began in Austria only after community mental health services were rolled out across the country in the 1990s. This increase was primarily due to admissions of patients who had committed less severe offences, while rates of those who had committed homicide remained unchanged. CONCLUSION: Our results cannot be explained by details of the reforms such as the downsizing of mental hospitals or a lack of outpatient facilities, nor by changes to criminal sentencing. Rather, the results provide evidence of an increasingly inadequate provision of comprehensive care for difficult community. This may result from the attitudes of mental health professionals who have become less inclined to integrate aggressive behaviour into their understanding of psychosis. As a consequence, increasing numbers of "difficult" patients end up in forensic psychiatric institutions. This development, which can be observed in nearly all European countries, raises concerns with regard to efforts to destigmatize both patients and psychiatry.
机译：背景：在最近几十年中，欧洲几个国家的法医精神病院的入院人数大幅增加。尚不清楚在精神卫生政策和实践中进行的改革是否对这一发展负责。目的：我们的研究调查了奥地利精神卫生保健的发展以及因精神错乱而被判定无罪的精神错乱罪犯的发生率和患病率（NGRI）。方法：我们分析了1970年至2008年间来自几个国家的服务提供数据和刑事统计数据。结果：在实施精神卫生实践改革的第一个十年中，尽管减少了近50％的精神病床位和很少的门诊治疗，但由NGRI判定的罪犯的发病率和患病率保持不变。出乎意料的是，只有在1990年代在全国范围内推出社区精神卫生服务之后，奥地利的法医住院治疗才开始大幅度增加。这一增加主要是由于犯下了较轻罪行的患者的入院率，而犯有凶杀罪的患者的比率保持不变。结论：我们的结果不能通过改革的细节来解释，例如减少精神病院的规模或缺少门诊设施，也不能通过改变刑事判决来解释。相反，这些结果提供了越来越多的证据表明，为困难社区提供的全面护理日益不足。这可能是由于精神卫生专业人员的态度降低了，他们不愿意将攻击性行为纳入他们对精神病的理解中。结果，越来越多的“困难”患者最终进入法医精神病学机构。在几乎所有欧洲国家都可以观察到的这种发展趋势，引起了人们对患者和精神病患者污名化的关注。

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