Assessment of everyday functioning in Swedish forensic mental health services

Abstract

Individuals in forensic mental health services (FMHS) commonly exhibit greater cognitive deficits and unmet health needs than those in general psychiatric care. Despite the central role of functional disability in FMHS treatment objectives, the assessment in this domain remains underexplored. This study examines current practices of functional assessment in Swedish FMHS through the combination of a survey and analysis of register data. The survey covered the presence and content of procedure manuals regarding functional assessment and the clinical use of assessment results. Frequency of assessment and relation to individual factors (age, gender, place of birth, psychiatric diagnosis, and history of addiction) and contextual factors (FMHS site, size and security level at the site, and administrated risk assessment) were investigated through statistical analysis of register data. Results indicate significant variability in functional assessment practices across different FMHS sites. Contextual factors such as site and the use of risk assessment instruments demonstrate a positive association with assessment frequency. Functional assessments were primarily used with in-patients, raising concerns about applicability beyond hospital settings and preparation for community re-entry. Despite professionals’ belief in the potential benefits of functional assessment for tailoring interventions, its impact on individual treatment plans was limited. The study underscores the need for improved assessment accuracy and ongoing monitoring of functioning, particularly considering the disparate practices observed across FMHS sites. Moreover, there is a call for national coordination and evidence-based guidelines to enhance functional assessment practices in Swedish FMHS.