Systematic Aggression Registration in Forensic Psychiatric Care: A Qualitative Study on Preconditions for Successful Implementation.

Available research emphasizes the importance of getting a systematic overview of inpatient aggression in forensic psychiatric care. However, the same research does not focus on how systematic aggression registration should be introduced in clinical practice. To facilitate the use of systematic aggression registration instruments, it is very relevant to gain insight into the perspective of staff members on the introduction of these instruments in daily clinical practice. Additionally, preconditions for achieving a successful implementation can be considered. Therefore, this study aims to gain insight into the perspective of the staff members on the implementation of a systematic aggression registration instrument-that is, the MOAS-in a forensic psychiatric unit. Interviews (n = 8) and a focus group with staff members were carried out. Three main themes: (1) creating the most appropriate context for introduction, (2) choice for the MOAS as relevant instrument, and (3) perpetuating the use of the MOAS in clinical practice are scrutinized. The mentioned preconditions can be used as guidelines when implementing systematic aggression registration in clinical practice. We hope that this paper can inspire other forensic psychiatric facilities to introduce systematic registration of aggressive incidents.

Who decides? The decision-making process of juvenile judges concerning minors with mental disorders.

Previous research on juvenile judges' decision-making process has neglected the role of the different actors involved in judicial procedures. The decision can be considered as a result of information exchange between the different actors involved. The process of making a decision is equally important as the decision itself, especially when the decision considers minors with mental disorders. The presence and the type of interaction determine the information available to the juvenile judges to make their final decision. The overall aim of this study is to gain insight into the role of all actors, including the juvenile judge, in the juvenile judge's decision-making process in cases relating to minors with mental disorders. Semi-structured interviews were carried out with professional actors (n=32), minors (n=31) and parents (n=17). The findings indicated that the judge's decision is overall the result of an interaction between the juvenile judge, the social services investigator and the youth psychiatrist. The other professional actors, the minors and the parents had only a limited role in the decision-making process. The research concludes that the judge's decision-making process should be based on dialogue, and requires enhanced collaboration between the juvenile court and youth psychiatrists from mental health services. Future decision-making research should pay more attention to the interactions of the actors that guide a juvenile judge's decision.

The blurred vision of Lady Justice for minors with mental disorders: records of the juvenile court in Belgium.

PURPOSE: This study examined (1) the information present in juvenile court records in Belgium (Flanders) and (2) whether there are differences in information between records that mention a mental disorder and those that do not. METHOD: The file study sample included 107 court records, and we used a Pearson's chi-square test and a t-test to analyze the information within those records. RESULTS: Information in juvenile court records varied considerably. This variability was evident when we compared juvenile court records with and without mention of a mental disorder. Significantly more information about school-related problems, the functioning of the minor, and the occurrence of domestic violence was included in records that mentioned a mental disorder compared with records that did not. CONCLUSION: The content of the juvenile court records varied, particularly with regard to the mental health status of the minor in question. We suggest guidelines to standardize the information contained in juvenile court records.

Mental health in juvenile judges' decision-making: review of literature.

OBJECTIVE: The purpose of this study is to provide an overview of the (strength of the) association between mental health aspects in juvenile offenders and the decision-making process of the juvenile judge. In particular, the presence of a mental disorder in the juvenile offender, the presence of a mental health report, and the mental health orientation of the juvenile judge were studied. METHODS: A literature review was performed in order to identify relevant studies on the basis of three selection criteria: (i) the decision-making process of the juvenile judge concerning juvenile offenders, (ii) the use of quantitative methodology and (iii) the focus on the three mental health aspects. RESULTS: Eight studies were found to meet the criteria (n=4318). The association between a mental disorder in the juvenile offender, a mental health report, and the decision of the juvenile judge was rather strong. There was no evidence of an association between mental health orientation of the juvenile judge and his/her decision. DISCUSSION: Mental health aspects seem to be associated with the decision-making process of the juvenile judge. Future research should further examine the association between these aspects and the decision of the juvenile judge, particularly in the subgroup of juvenile offenders with mental disorders.