Mapping Offender-Patient Pathways
Previous reviews have described services for offenders with mental disorder in several European countries, but we wanted to understand how these might apply in an individual case. We used process mapping to record pathways taken through the legal process and other services by offenders suspected of having committed a homicide in four EU countries—Austria, Finland, the Netherlands and the UK. All have the facility to meet some urgent mental health needs at any point in the criminal justice pathway, but countries differ in when evidence on the relevance of mental disorder to the offence may be introduced into the legal process. All countries provide some sort of specialist health service, but the nature of its administration and its placement differs. Austria’s specialist inpatient services are provided entirely within the prison system, the Netherlands in either the Joint Departments of Health and Justice TBS system or prison hospital units. In Finland and the UK, inpatient services are all health service based and clinical input to prisons by health service employees only. Development of offender pathway maps is likely to assist mutual understanding of services. They could be used to inform patients, relatives and victims about what they may expect of the months and years which follow first involvement with the criminal justice system. They may help us to learn from each other’s similarities and differences what works best.
We would like to acknowledge the following clinicians for the original interview data and for patient guidance in subsequent drafts: Dr. Alexander Dvorak, Consultant Psychiatrist, Ministry Of Justice Justizanstalt Göllersdorf, Austria; Dr. Allan Seppanen, Consultant Forensic Psychiatrist and Clinical Director, Helsinki University Hospital, Finland; and Dr. Ellen van Lier and Dr. Hans Hulsbos, Consultant Forensic Psychiatrists, Penitentiary Institution Vught, the Netherlands.
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