Implementation Research: Referrals of people subjected to Forensic services using the DUNDRUM Toolkit

Forensic psychiatric patients are at risk of prolonged hospitalisation and placement at inappropriate security levels, raising concerns about patient rights and inefficient resource use. The DUNDRUM Toolkit is an evidence-based decision-support instrument designed to guide placement according to patients’ therapeutic and security needs. While its psychometric properties are well established, its implementation in clinical practice remains underexplored.

This PhD study investigates the implementation of the DUNDRUM Toolkit in referral processes between general and forensic psychiatry in Region Zealand, Denmark. Using an implementation research approach, the study combines a scoping review, qualitative interviews, and a case study of referral practices. The aim is to identify barriers and facilitators to implementation and generate actionable recommendations. The project seeks to improve decision-making transparency, support appropriate patient placement, and strengthen evidence-based practice in forensic psychiatry.

Some patients in forensic psychiatry stay in hospital longer than needed or are placed in settings that do not match their needs. This can limit their freedom and affect their recovery. The DUNDRUM tool helps professionals decide the right level of care and security for each patient.

This project studies how the tool can be used in everyday practice in Region Zealand. By looking at how staff use it and what helps or hinders its use, the project aims to improve decisions about patient placement. The goal is to support fairer treatment, shorter hospital stays, and better use of healthcare resources.