Characteristics and needs of long stay patients in high and medium
secure care: implications for service ( C.A.N.L.I.S )

Tiwana R, McDonald S, Völlm B (2016): Policies on sexual expression in forensic psychiatric settings in different European countries. International Journal of Mental Health Systems. Published online 3.2.2016


Sexual expression by forensic psychiatric patients is poorly researched.
Forensic experts representing 14 European countries were interviewed to explore the diverse ways in which sexual expression within forensic settings is handled.
No country had a national policy, although many had local policies or shared practices. Progressive approaches to patient sexuality were evident in nine of the countries sampled. The UK appeared the most prohibiting and excluding, its protocols apparently based on risk aversion and lack of emphasis or consideration of patients’ sexual needs.
Uniform national policy supporting patients’ sexual expression would provide significant improvements.


Edworthy R, Sampson S, Völlm BA (2016): Inpatient forensic-psychiatric care: Legal frameworks and service provision in three European countries. International Journal of Law and Psychiatry. Available online 4.4.2016

Submitted to: International Journal of Law and Psychiatry 


Laws governing the detention and treatment of mentally disordered offenders (MDOs) vary widely across Europe, yet little information is available about the features of these laws and their comparative advantages and disadvantages. The purpose of this article is to compare the legal framework governing detention in forensic psychiatric care in three European countries with long-established services for MDOs, England, Germany and the Netherlands. A literature review was conducted alongside consultation with experts from each country. We found that the three countries differ in several areas, including criteria for admission, review of detention, discharge process, the concept of criminal responsibility, service provision and treatment philosophy. Our findings suggest a profound difference in how each country relates to MDOs, with each approach contributing to different pathways and potentially different outcomes for the individual. Hopefully making these comparisons will stimulate debate and knowledge exchange on an international level to aid future research and the development of best practice in managing this population.



Dutton S, Majid S, Völlm B (accepted for publication): Experiences of nursing staff working with long-stay patients in a high secure psychiatric hospital setting


Background and Objective: Forensic psychiatric nursing is a demanding branch of nursing that deals with a
highly complex group of patients who are detained in restrictive environments, often for lengthy periods.
There is little information about the daily experiences of these nurses. This study sought to explore the roles
and relationships of forensic psychiatric nurses with long-stay patients in a high secure hospital in England.
Method and Analysis: The study obtained data via three focus groups, and thematic analysis was carried out
using NVIVO 10 software.
Results: Five prominent themes emerged: First, nurses elaborated on their role with patients and the kinds of
interactions they had with them. The next two themes explored the reasons why some patients are long-stay
patients and the challenges nurses face while working with this group. The fourth theme was the impact of external
support, such as the patient’s families, on length of stay. The final theme covered the changes that the
nurses observed in these patients and in themselves over time.
Conclusion: It was noticeable that those interviewed were committed professionals, eager to provide an optimistic
and hopeful environment for the patients to help them progress through “the system.” The study presents
a number of pertinent issues regarding long-stay patients that provide a basis for further research and to inform
policy, educational reforms, and clinical practice.


Völlm BA, Bartlett P, McDonald R (2016): Ethical issues of long-term forensic psychiatric care. Ethics, Medicine and Public Health 2: 36 - 44


Forensic psychiatry is a subspecialty of clinical psychiatry that operates at the interface between law and psychiatry. It is concerned with patients who have a mental disorder as well as having committed an offence, often serious. Forensic psychiatric institutions are high-cost/low-volume services that impose significant restrictions upon their residents. Patients may be detained in those services against their will for lengthy periods, potentially life-long. The purpose of this detention is seen as two-fold: care and treatment for the patient and protection of the public from harm from the offender. Here we review the ethical issues around such long-term detention. We base our observations on a review of relevant literature and from focus groups with professionals working in forensic psychiatric settings.


pdfEthical issues of long-term forensic psychiatric care