Background: The mortality of forensic psychiatric (FP) patients compared to non-forensic psychiatric (non-FP) patients has been sparsely examined. Methods: We conducted a matched cohort study and compared Danish male FP patients (n = 490) who underwent pre-trial forensic psychiatric assessment (FPA) 1980–1992 and were subsequently sentenced to psychiatric treatment with matched (on year of birth, marital status, and municipality of residence) male non-FP patients (n = 490) and male general population controls (n = 1716). FP and non-FP patients were also matched on major psychiatric diagnostic categories. To determine mortality and identify potential predictors of mortality, we linked nationwide register data (demographics, education, employment, psychiatric admission pattern and diagnoses, cause of death) to study cohorts. Average follow-up time was 19 years from FPA assessment/sampling until death/censoring or 31 December 2010 and risk factors were studied/controlled with Cox proportional hazard analysis. Results: Overall, psychiatric patients had significantly higher mortality compared to matched general population controls (medium to large effects). Among patients, 44% (213) of FP vs. 36% (178) of matched non-FP patients died during follow-up (p = 0.02). When we used Cox regression modeling to control for potential risk factors; age, education, immigrant background, employed/studying at index, length of psychiatric inpatient stay/year, and ever being diagnosed with substance use disorder (SUD), FP patient status was no longer significantly associated with increased mortality, whereas SUD and longer inpatient time per year were independently associated with increased mortality. Discussion: This study suggests that SUD and longer inpatient time per year are independent risk factors for increased mortality in psychiatric patients.

This nationwide cross-sectional study of the lifetime prevalence and determinants of suicide attempts includes 90% of Greenlandic forensic psychiatric patients. Retrospective data were collected from electronic patient files, court documents, and forensic psychiatric assessments using a coding form from a similar study. We used unpaired t-tests and chi² or Fisher’s exact test. The lifetime prevalence of suicide attempts was 36% (n = 32), and no difference in prevalence was found between male and female patients (p = 0.95). Patients having attempted suicide had a higher rate of physical abuse in childhood (p = 0.04), family history of substance misuse (p = 0.007), and criminal convictions among family members (p = 0.03) than patients who had never attempted suicide. Women primarily used self-poisoning in their latest suicide attempts (67%), whereas men more often used sharp objects or a firearm (42%). Over a third of Greenlandic forensic patients have attempted suicide at some point in their life, and patients with traumatic childhood experiences are at higher risk of suicidal behaviour. It is not possible to conclude whether the lifetime prevalence of suicide attempts among Greenlandic forensic patients is comparable to that of other high-risk groups in other Arctic regions due to methodological differences among the very few other comparable studies.

Excellence is that quality that drives continuously improving outcomes for patients. Excellence must be measurable. We set out to measure excellence in forensic mental health services according to four levels of organisation and complexity (basic, standard, progressive and excellent) across seven domains: values and rights; clinical organisation; consistency; timescale; specialisation; routine outcome measures; research and development. To validate the psychometric properties of a measurement scale to test which objective features of forensic services might relate to excellence: for example, university linkages, service size and integrated patient pathways across levels of therapeutic security. A survey instrument was devised by a modified Delphi process. Forensic leads, either clinical or academic, in 48 forensic services across 5 jurisdictions completed the questionnaire. Regression analysis found that the number of security levels, linked patient pathways, number of in-patient teams and joint university appointments predicted total excellence score. Larger services organised according to stratified therapeutic security and with strong university and research links scored higher on this measure of excellence. A weakness is that these were self-ratings. Reliability could be improved with peer review and with objective measures such as quality and quantity of research output. For the future, studies are needed of the determinants of other objective measures of better outcomes for patients, including shorter lengths of stay, reduced recidivism and readmission, and improved physical and mental health and quality of life.

Accessible summary: What is known on the subject?: Frontline forensic mental health staff often face challenges when providing recovery‐orientated care, as they must balance between caring for the forensic psychiatric patient and at the same time ensuring safety and security for all other patients and staff at the ward. Research shows that balancing between care and custody in everyday clinical practice is possible, but more practical nursing studies showing ways of balancing power relations are needed to guide clinical practice. Online video games are increasingly recognized as promising new tools to promote social relations, establish competencies and re‐articulate power relations in therapeutic environments. What the paper adds to existing knowledge?: This paper provides insights into how using online video gaming interventions may influence the establishment of social power relations of staff and forensic psychiatric patients. It adds to existing research by providing a conceptual way to study and understand how mental health nurses may balance between care and custody, delivering care to accommodate patients' needs without compromising safety and security at the ward. This study answers a call in current research by providing qualified knowledge regarding the use of online video gaming to build and sustain therapeutic relations in mental health care. What are the implications for practice?: Our paper suggests that balancing between care and custody is possible by using online video gaming interventions in forensic psychiatry. It moreover provides practice‐close knowledge that may inspire and guide clinical mental health nurses to further develop online video gaming interventions in mental health care for the benefit of their patients. Introduction: In recovery‐oriented care, forensic psychiatric nurses must engage in care relationships with forensic psychiatric patients (FPs) whilst focussing on ward security. Online video games (OVGs) may provide a platform for negotiating power and social relations. Studies showing how OVG interventions may influence power balances in forensic psychiatric care are needed to guide clinical practice.Aim: Our aim was to study how power relations were articulated between FPs and staff in an OVG intervention in a Danish forensic psychiatric ward.Method: Data consist of three months of observational data and interviews with three staff members and six patients. We used sociologist Pierre Bourdieu's framework of field, power and capital to analyze data.Results: The OVG intervention consisted of two power fields, “in‐game” and “over‐game.” In‐game concerned the practice of gaming. Over‐game described the organization of the gaming intervention. Specific logics, skills and symbolic capitals drove power in each field.Discussion: Power in‐game was open to FPs and staff, leading to symmetric power relations. Power over‐game was open to staff only, resulting in asymmetrical power relations.Implications for practice: Online video game interventions may facilitate power balancing in forensic psychiatry. These insights may guide the development of new OVG interventions for patients and nurses in mental health care.

Medical consultations depend on a shared linguistic understanding between the patient and physician. When language concordance is not possible, interpretation is required. Prior studies have revealed that professional in-person interpretation (PIPI) results in patients reporting higher satisfaction and a better understanding of things the physician explained. Despite this, language-discordance often results in using family and/or friends for ad hoc interpretation. This systematic review examines the linguistic aspect of medical interpretation by assessing the number of linguistic errors made and their relation to professional in-person interpretation (PIPI) or in-person ad hoc interpretation (IPAHI). PIPI was defined as people employed as interpreters, but with no specific requirements for education or experience. This systematic review examines studies comparing the number of errors when using PIPI and IPAHI. We performed a PICO-criteria-based search in five scientific databases. We screened English and Danish studies published between 1995 and October 2024. Furthermore, we screened references from, and citations of the included articles. We used the appropriate Cochrane Tool for risk of bias assessment. We identified six studies using a PICO search and one additional study by snowballing. The included studies revealed critical methodological differences, and consequently a statistical synthesis of results was not conducted. We found indications that the number of interpreting errors was significantly lower when using PIPI than family members for IPAHI. Interpreting error rates were not significantly lower when comparing PIPI to the use of medical staff without interpretation training for IPAHI. Generally, we found that the difference between PIPI and IPAHI tended to be more prominent when dealing with more severe diagnoses, e.g., incurable cancer. The methodological differences between included studies and the risk of bias within included studies limit the conclusions drawn in this review. Also, no other kinds of interpretation than PIPI and IPAHI were considered, and the recommendations are solely based on accuracy. Considering these limitations and the fact that no other systematic reviews within this highly specific topic exist, this review resulted in the following recommendations: 1) Professional in-person interpretation should be the first choice in language-discordant medical consultations. 2) If professional interpretation is not possible, using medical staff without interpretation training should be chosen before interpretation by family or friends. 3) All consultation participants should keep sentences short and straightforward, as this is related to a lower risk of omissions in interpretation.