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 mental disorders detained in a secure forensic psychiatric facility. A clinical review identified a high prevalence of substance use disorders in the patient population at a secure forensic facility in Sydney, Australia with only a limited number of patients being assessed and offered interventions for substance use problems.,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.,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.,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.,Limited robust evidence for substance use rehabilitation has been published. The authors consider the existing evidence base and the underlying theory behind substance use rehabilitation to propose a model for rehabilitation in secure forensic settings. This is the first known review of substance use rehabilitation involving mentally ill offenders with dual diagnoses in secure forensic settings. This paper is the original work of the authors.

中文翻译：

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在安全的法医设施中进行综合的物质使用康复

本文的目的是为制定基于证据的有效康复计划提供信息，以解决严重精神疾病和被安全司法精神病院拘留的精神障碍患者群体中的物质使用障碍。一项临床审查发现在澳大利亚悉尼的一个安全的法医机构中，患者人群中药物滥用的患病率很高，仅对少数患者进行了评估，并提供了针对药物滥用问题的干预措施。在2009年至2017年之间的文章中，研究了合并病态精神病患者的护理模型或药物滥用康复方法。文章是根据其与安全法医设施的目的和环境的相关性来考虑的。文献综述强调了一种将药物使用康复与精神卫生护理相结合的整体护理模式的必要性。综合评估和结合患者选择和改变阶段的个体化方法被认为是任何双重诊断康复计划的必要组成部分。有关重度精神疾病和合并病的物质使用障碍者的康复方法的文献与以下模型基本一致通常用于犯罪分子和精神疾病的护理。双重诊断患者的综合和个性化康复方法可能在法医环境中发挥重要作用。关于药物滥用康复的有限可靠证据已经发表。作者考虑了物质使用康复背后的现有证据基础和基础理论，提出了在安全的法医环境中进行康复的模型。这是关于药物滥用康复的第一个已知综述，涉及在安全的法医环境中进行双重诊断的精神病患者。本文是作者的原创作品。