Abstract
In several European countries, the number of forensic psychiatric hospital beds has increased in recent years. This is in contrast to the decrease in general psychiatric hospital beds in Europe. Although caution is required when interpreting the data, in most European countries the increasing number of forensic psychiatric beds is associated with an increase in the average duration of stay within high-security forensic hospitals. What does this growing demand for inpatient forensic psychiatric capacity in some countries and increasing length of stay mean? The debate on the increasing length of stay in forensic psychiatry differs in the various European countries but revolves around ethical issues, legal aspects such as proportionality and economic considerations within countries. What can we learn from the comparison of different countries? Comparing countries, and trying to find underlying mechanisms, which factors should be taken into account? This chapter aims to address these questions and will argue that a systemic approach is necessary. Changes and developments in one part of the total mental health system (including forensic mental health and prison mental health) affect the other parts. Implications for current and future policy in forensic psychiatry can only be understood within such a systemic understanding of the interdependency of those parts.
