法医精神病治疗中患有物质使用障碍(SUD)和并发精神障碍(COD)的患者通常会遭受不良的治疗结果和高的犯罪累犯率,物质使用,和精神问题。这项研究的目的是描述条件,和精神卫生保健人员的经验,实施以SUD为重点的综合临床指南,包括在瑞典的高安全性法医精神卫生服务(FMHS)机构对COD患者进行评估和治疗。
研究人员对在管理新SUD评估和治疗方面有经验的医护人员进行了19次半结构化访谈。该研究进行了主题分析,以描述医护人员对这些指南的经验和改进建议。
大多数参与者报告说,以SUD为重点的临床指南的实施表示赞赏。他们认为以前被忽视的领域,但也指出在评估管理方面需要更实际的指导。参与者报告说,看护者和典狱长的双重角色难以调和,阻碍分裂也存在于医护人员对SUD的态度中。与会者的报告还描述了实施前的不平衡,因此SUD很少被评估,但仍开始治疗。实施一年后,不平衡仍然存在,但反过来:SUD被更频繁地评估,但是治疗很难开始。
尽管有迹象表明工作人员对评估和治疗指南的必要性有些矛盾,许多参与者认为有一个结构化的方法来评估和治疗该患者组的SUD是有帮助的.频繁评估和不频繁治疗之间的不平衡可能是由于患者难以跨越评估和治疗之间的“差距”。为了弥合这个差距,精神卫生服务应努力提高患者对SUD的洞察力,治疗的灵活性,以及与该患者组合作的医护人员的激励技能。与会者认为,关于SUD的共享知识库对于提高治疗质量很重要,并加强不同专业之间以及门诊服务之间的合作。
Patients with substance use disorders (SUD) and co-occurring mental disorders (COD) within forensic psychiatric care often suffer poor treatment outcomes and high rates of criminal recidivism, substance use, and psychiatric problems. This study aimed to describe the conditions for, and mental health care staff\'s experiences with, implementing integrated SUD-focused clinical
guidelines, including assessment and treatment for patients with COD at a high-security forensic mental health services (FMHS) facility in Sweden.
Study staff conducted nineteen semi-structured interviews with health care staff experienced in administering the new SUD assessment and treatment. The study conducted a thematic analysis to describe the health care staff\'s experiences with these
guidelines and suggestions for improvement.
Most participants reported appreciation for the implementation of clinical
guidelines with an SUD focus, an area they considered to have previously been neglected, but also noted the need for more practical guidance in the administration of the assessments. Participants reported the dual roles of caregiver and warden as difficult to reconcile and a similar, hindering division was also present in the health care staff\'s attitudes toward SUD. Participants\' reports also described an imbalance prior to the implementation, whereby SUD was rarely assessed but treatment was still initiated. One year after the implementation, an imbalance still existed, but in reverse: SUD was more frequently assessed, but treatment was difficult to initiate.
Despite indications of some ambivalence among staff regarding the necessity of the assessment and treatment
guidelines, many participants considered it helpful to have a structured way to assess and treat SUD in this patient group. The imbalance between frequent assessment and infrequent treatment may have been due to difficulties transitioning patients across the \"gap\" between assessment and treatment. To bridge this gap, mental health services should make efforts to increase patients\' insight concerning their SUD, flexibility in the administration of treatment, and the motivational skills of the health care staff working with this patient group. Participants considered important for enhancing treatment quality a shared knowledge base regarding SUD, and increased collaboration between different professions and between in- and outpatient services.