[Forensic preventive assertive community treatment : Pilot project to prevent violent crimes in the context of...

Since 2012, a forensic preventive outpatient clinic has been established at Ansbach District Hospital to fill a gap in general psychiatric care for patients with schizophrenia or severe personality disorders and having a high risk for violent behavior. An interdisciplinary team drawing on forensic psychiatric knowledge applies instruments for forensic risk prognosis and treatment or interventions to prevent violent crimes and to protect potential victims. Admissions depend on certain criteria, e.g., increased risk potential for violent crimes against the background of schizophrenia or severe personality disorders.

How can a forensic psychiatric preventive treatment be organized, which helps to avoid detention in a forensic commitment and is complementary to general psychiatric treatment structures? Can such a model project reach the target group?

In forensic preventive outpatient care the treatment is based on violence prevention (e.g., psychoeducation, group training, individual treatment on violence risk co-management). Data are collected using general psychiatric and forensic instruments on, e.g., risk of violence (HCR-20), global functional level (GAF), violent behavior (SDAS-9) on a regular basis. The values with respect to these instruments on admission were compared to published key factors from population samples with general and forensic psychiatric patients.

A total of 146 patients between the ages of 18 and 79 years have so far been treated. About 4,000,000 EUR could be saved during the duration of the project because of preventing involuntary admission to a forensic hospital apart from preventing violent crimes. In contrast 3,000,000 EUR had to be spent for the new outpatient service.

Indications for the efficacy of a forensic preventive care for patients with schizophrenia and severe personality disorders with a risk for violence are confirmed. Therefore, an institutionalization and a statewide implementation of forensic preventive care in terms of the forensic preventive out-patient clinic are recommended.