Restrictiveness in long-term forensic psychiatric care – report of a STSM in the Netherlands

Written by Jack Tomlin – PhD student at Nottingham University

This STSM was undertaken with the aim of developing over the coming years a tool to measure restrictiveness in (long-term) forensic psychiatric care. In December of 2015, I was fortunate enough to receive COST Action funding to undertake an STSM in the Netherlands and I welcomed gladly the opportunity to visit several Dutch forensic institutions and the Expertisecentrum Forensische Psychiatrie.

The ‘Dutch approach’ seems to have become quite en mode in discussions of forensic psychiatric care in the UK. I recently attended an end of project conference on Long-term forensic psychiatric care (LFPC) wherein comparisons of British and Dutch secure settings provoked fruitful discussion. Typically, the Dutch are seen as being less restrictive, more liberal and QoL-focused in their care approach than the British. This is evidenced most strongly in patients’ rights of sexual expression. In the UK, although not codified in any national policy, sexual relationships between patients are prohibited – in the Netherlands, this is not the case. Indeed, a week prior to my arrival in December, two individuals; one from a secure care ward in Nijmegen, another from the long-stay centre in Zeeland, wed in the latter’s chapel.

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STSM – Training of professionals in forensic systems under renovation

Written by Luca Castelletti (Medical Director, REMS Carlo Poma Mantova, Italy)

The whole Italian forensic sector is undergoing a radical process of renovation, as since 1st of april 2015 the 6 national forensic hospital have been closed down and are going to be replaced by small regional 20 bedded-units named REMS standing for Residencies for the Application of  Security Measures. As the process is delegated to the 20 regional health systems, the institution of the residencies is at different speed of building up. In our contest, in the Lombardy region, with a catchment area of around 10 milion people including Milan area, the project is to refurbish and renovate the “old” Ospedale Psichiatrico Giudiziario (OPGs) into a system of 6 REMS for a total of 120 beds. In the regional and central political plans it’s going to be the main forensic centre serving the Country. At the moment we host around 180 patients, of whom 45 are women, as we supply the momentary lack of ready residencies of some other regions.

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Ward climate and (long term) forensic care

(How and why) should ward climate differ between forensic facilities?

Written by Meike de Vries, Researcher: Pompestichting, The Netherlands

Ward climate is an important factor within the treatment of inpatients in secure settings. Ward climate can be seen as a multifactorial construct including the material, social, and emotional conditions of a given ward and the interaction between these factors (Moos, 1989). In several studies, climate is found to play a role in therapeutic outcomes and regarded as an aspect of program responsivity that enhances treatment effects. Within high secure forensic hospitals establishing and maintaining an optimal climate is an important, but also a very challenging task due to the complex patient population and setting which incorporates both therapeutic- and security goals.

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Strengths and weaknesses in mental health and legal systems in the European Union: An evaluation

Written by Caty Connel (Senior Forensic Occupational Therapist, Birmingham and Solihull Mental Health NHS Foundation Trust, United Kingdom)

This blog summarises the findings from a study to evaluate the strengths and weaknesses of legal and mental health systems in the European Union.

Aim
To identify which external factors impact on length of stay in forensic mental health services.

Method
Representatives with expertise in long-term forensic care from 16 European countries reported the strengths and weaknesses of the mental health and legal systems in their respective countries. Thematic analysis [1] of the data was conducted for strengths and weaknesses independently, then overarching themes were identified by combining these analyses.

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A STSM comparing patients and services in long term forensic psychiatry in Germany (Vitos-Haina) & Ireland (Dundrum, Dublin).

Written by Padraic O’ Flynn (Senior Occupational Therapist, Central Mental Hospital, Dundrum, Ireland).  

This short term scientific mission explored two forensic psychiatric services in Ireland (Central Mental Hospital, Dundrum, NFMHS) and Germany (Vitos Haina) which cater for long term forensic psychiatric patients. The completed report detailed the overall model and design of the two services, the patient characteristics (diagnosis, average length of stay, index offence, “step”, nationality, IQ)  on long stay wards,  procedures in both services for identifying patient need for psychosocial treatment, comparisons of what psychosocial interventions are offered on long stay units/ with long stay patients, and finally comparisons on quality of life from self reported measures on long stay wards in Ireland and Germany. The report also detailed recommendations for future research in this area. Below the points from the main report are summarised with graphs and diagrams included. Further exploration of comparisons of descriptive characteristics, service models etc. are available in the full report.

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TRAINING SCHOOL 2015 – Koper, Slovenia – 14-17th July 2015

Written by Ana Cristina Neves (Forensic Psychology Assistant Professor at Instituto Superior de Ciências da Saúde Egas Moniz, Portugal) and Valentina Campani (Psychology Master Student, trainee at Reggio Emilia Forensic Unit, Italy)

The Training School (TS) was focused on the concepts of quality of life (QoL) and needs within a long-term forensic psychiatric context, how to assess them and how to improve conditions of long-term patients while meeting their needs. As one of the aims of the TS was the interaction between participants, we were just 18, what allowed the experience of a friendly and functional environment. Treatment realities vary substantially within Europe according to different legal frameworks and resources, so group work and discussion was actively stimulated by the trainers. They also provided valuable advises on how to integrate both concepts into everyday practice.

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Long-Term Suicide Risk in Forensic Psychiatric Patients

Based on the article Long-Term Suicide Risk in Forensic Psychiatric Patients by Clarke, M., Davies, S., Clive, H. & Duggan, C. (2011) in Archives of Suicide Research, 15: 1, 16 — 28

It is often said that psychiatric patients are a greater risk to themselves than others; while this may be true for general samples, the risk that patient treated in Forensic Psychiatric Units present to themselves, rather than to others, which by the nature of the sample is high, had not been a focus for study. Clarke et al. (2011) investigated the long-term suicide risk in forensic psychiatric patients. They performed a retrospective study, which considered the mortality outcomes of a cohort of 595 former patients of a medium secure unit in Leicester, England. Patients were admitted during the 20-year period between 1983 and 2003. The study found an increased risk of mortality in former forensic patients, from all causes, and particularly from suicide.

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How do Dutch LFPC-patients experience their quality of life and are their case managers aware of these experiences?

Written by Sandra Schel
Junior Researcher, Pompefoundation, The Netherlands

Quality of life is seen as an important treatment goal in Dutch LFPC. Since 2007 QoL has been measured on a yearly basis at the LFPC-wards of the Dutch Pompefoundation, using the Forensic Inpatient Quality of Life Questionnaire (FQL; Vorstenbosch, Bulten, Bouman, & Braun, 2007). The FQL is a setting- and disease-specific questionnaire for QoL-assessment in long-care forensic psychiatry, which is based on patients’ and forensic psychiatric nurses’ experiences and their perceptions on quality of life (Vorstenbosch, Bulten, Bouman, & Braun, 2010). In Dutch LFPC every member of the forensic psychiatric nursing staff is linked to specific patients. Therefore, additionally, Vorstenbosch and colleagues developed a proxy version of the FQL, which consists of exactly the same questions, but then rephrased as to how the forensic psychiatric nurse assigned to the patient (henceforth: case manager) thinks the patient would answer.

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Attitudes towards sexual expression in professionals in forensic psychiatry in different EU countries

Written by Shaz Majid
Research Assistant, Faculty of Medicine & Health Sciences, University of Nottingham

Sexuality, sexual relationships and sexual functioning are important quality-of-life issues for patients with mental disorders (Assalian, P., Fraser, R., Tempier, R., & Cohen, D., 2000; Dobal & Torkelson 2004). Although sexual interaction is not a specifically protected right, a person’s right to consensual sexual activity, including those persons involuntarily detained under the Mental Health Act 1983 (MHA), is implicitly inferred through Article 8 of the Human Rights Act 1998 (HRA) which upholds one’s right to privacy, personal dignity, autonomy and social interaction. The International Covenant on Economic, Social and Cultural Rights (ICESCR) further supports sexual freedom of mental health patients. Article 12 of ICESCR establishes the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. This includes the right to control one’s health and body, including sexual and reproductive freedom.

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Protective factors for violence risk

Written by Dr. Michiel de Vries Robbé, Senior Researcher at Forensic Psychiatric Hopsital Van der Hoeven Kliniek, the Netherlands.

The Structured Assessment of Protective Factors for violence risk (SAPROF; de Vogel, de Ruiter, Bouman, & de Vries Robbé, 2007; 2012) is a risk assessment tool developed specifically for the structured assessment of protective factors for violence risk. The SAPROF was designed to complement existing structured risk-focused risk assessment tools, such as the HCR-20 / HCR-20V3, the LS/CMI, the Static/Stable and others. The SAPROF aims to contribute to an increasingly accurate and comprehensive risk assessment, and is intended for use in combination with other tools.

SAPROF

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