Challenges in Comparing Health-Care Systems Across Different Countries

Abstract

Only limited international research has been conducted on the complex issue of the placement and treatment of mentally ill offenders (Blaauw et al., Mentally disordered offenders. International perspective on assessment and treatment. Elsevier, The Hague, 2002). Despite a few analyses from recent years, standardized descriptions or comparisons of legal instruments regulating the disposal of mentally ill offenders and/or the different pathways into the various penal or health-care systems are missing. Indicators reflecting how far the scientific progress in forensic psychiatry is depicted by the various national psychiatric, forensic or judicial systems are not implemented internationally. This is in contrast to the controversies the placement and treatment of mentally ill offenders raise worldwide within the criminal justice or health-care systems and the wider public. The need of societies to balance public safety interests with basic human rights principles in penal, forensic and mental health-care practices---which often are contradictory rather than complementary values---requires extensive research on judicial and psychiatric concepts, trial procedures, practice models and their effectiveness. However, due to lacking evaluation standards, effective practices or models are hard to identify and to describe. As a consequence, there is no evidence base available for decision-making, planning or improving forensic psychiatric services or systems, both on a national or international level.