Integrated substance use rehabilitation in a secure forensic facility
| Published date | 31 January 2019 |
| Pages | 50-60 |
| DOI | https://doi.org/10.1108/JFP-09-2018-0037 |
| Date | 31 January 2019 |
| Author | Kerri Eagle,Trevor Ma,Barbara Sinclair |
| Subject Matter | Health & social care |
Integrated substance use rehabilitation
in a secure forensic facility
Kerri Eagle, Trevor Ma and Barbara Sinclair
Abstract
Purpose –The purpose of this paper is to inform the development of an evidence-based and effective
rehabilitation programme to address substance use disorders in a population of patients with severe mental
illness and mentaldisorders detained in a secure forensic psychiatric facility. A clinical review identified a high
prevalenceof substance use disordersin the patient population at a secureforensic facility in Sydney,Australia
with only a limited number of patientsbeing assessed and offered interventions for substance use problems.
Design/methodology/approach –A literature review was undertaken specifically looking at articles
between 2009 and 2017 that considered models of care or approaches to substance use rehabilitation in
patients with co-morbid psychiatric disorders. Articles were considered based on their relevance to the
purpose and the environment of a secure forensic facility.
Findings –The literature review emphasised the need for a cohesive model of care integrating substance
use rehabilitation with mental health care. Comprehensive assessment and individualised approaches that
incorporated patient choice and stages of change were considered essential components to any dual
diagnosis rehabilitation programme.
Practical implications –The literature regarding rehabilitation approaches for those with severe mental
illness and co-morbid substance use disorders was reasonably consistent with the models of care used in
relation to criminal offenders and mental illness generally. Integrated and individualised rehabilitation
approaches for dual diagnosis patients could play a significant role in forensic settings.
Originality/value –Limitedrobust evidence for substanceuse rehabilitation has beenpublished. The authors
considerthe existing evidencebase and the underlyingtheory behind substanceuse rehabilitationto propose a
model for rehabilitation in secureforensic settings. This is the firstknown review of substance use rehabilitation
involvingmentally ill offenders with dualdiagnoses in secure forensicsettings. This paper is the originalwork of
the authors.
Keywords Rehabilitation, Mental illness, Dual diagnosis, Substance use, Models of care,
Secure forensic rehabilitation
Paper type Literature review
Introduction
Substance use has been identified as a significant risk factor in relation to violent reoffending in
forensic populations (Fazel et al., 2009; Elbogen and Johnson, 2009). Violent offenders have
high rates of substance use disorders (Fazel et al., 2009). Persons with psychiatric disorders
have been found to have significantly higher rates of substance use disorders than the general
population (Toftdahl et al., 2016).
In forensic populations, individuals who completed interventions targeting substance abuse have
been found to have a significantly reduced risk of committing any new crime as well as any new
violent crime compared to a group who did not have any interventions targeting substance
abuse (Gumpert et al., 2010).
Secure forensic hospital, New South Wales (NSW)
A high secure forensic hospital facility at Malabar, NSW, A ustralia has 125 inpatients with severe
mental illnesses or disorders that are all involuntarily detained under mental health legislation.
Received 27 September 2018
Revised 21 January 2019
Accepted 22 January 2019
The authors wish to acknowledge
Justice Health and Forensic Mental
Health Network for their support in
the conduct of this research.
Kerri Eagle is based at the
University of New South Wales,
Sydney, Australia.
Trevor Ma and Barbara Sinclair
are both based at Forensic
Hospital, Justice and Forensic
Mental Health Network,
Malabar, Australia.
PAG E 50
j
JOURNAL OF FORENSIC PRACTICE
j
VOL. 21 NO. 1 2019, pp. 50-60, © Emerald Publishing Limited, ISSN 2050-8794 DOI 10.1108/JFP-09-2018-0037
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