Patient Involvement

Written by Franco Scarpa, Patient Involvement Coordinator of the COST Action and, Psychiatrist and Director of  Unità Operativa Complessa of USL 11 in Tuscany.

A key recommendation of our COST Action is the involvement of patients in the activities of the Action. This involvement may come from patients and their relatives individually, or from patient boards, where such boards exist. The aim of Patient Involvement here is to provide users of long term forensic psychiatric care services a platform for input, where they can express their ideas and opinions on our two objectives, 1) reducing the length of treatment for long term forensic psychiatric patients and 2) improving the in-care life experience for long term forensic psychiatric patients, measured through the use of Quality of Life (QoL) indicators. To begin with, we will be collecting written contributions from patients, their families, industry experts, and others with ties to long term forensic psychiatric patients. This will provide foundations for continued patient involvement.

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Do money and bureaucratism make the world go around?

Written by Erik Bulten, PhD,
Head assessment, research and professional development of Forensic Psychiatric Hospital the Pompefoundation

 

The Dutch forensic psychiatric system is influenced by several different cultural developments. Some of them are positive while some are, perhaps not too helpful for improving quality. Anxiety in society, strong emotions and reactions to repression by isolated incidents, shaming and blaming do also affect forensic psychiatry and the patients who are treated using this line of treatment. We have to deal with such influences. We like to deal with them as forensic psychiatry works for and with the society and is of course part of it.

Variation in budgets is, at all times, directly related to increasing and decreasing the number of beds. We have to deal with these cycles as well; we want to deal with them because forensic psychiatry is part of economic systems, governmental budgets and economical fluctuations.

Guided by mistrust, and perhaps, based on obsessive compulsive attitudes, forensic psychiatry in the Netherlands is forced to produce multiple reviews, involving a lot of paper work and file information and follow intensive procedures, in order to put in place huge amounts of so called benchmark statistic, measures of achievement etc.

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Women in forensic psychiatry

Written by Vivienne de Vogel, PhD,
Head of Research department De Forensische Zorgspecialisten

 

Violence by women

While women still represent a minority of the forensic psychiatric and prison population, worldwide the number of women committing violent crimes has increased steadily over the past two decades. Moreover, some types of violence, such as intimate partner violence, violence towards one’s own children and inpatient violence by psychiatric patients seem to be as common in women as in men. Most of the research in the forensic field, however, is still devoted to male samples and there are growing concerns about whether the theoretical knowledge we have on factors contributing to violence in men is sufficiently valid and useful for women. Research has demonstrated that the nature of violence differ at least to a certain extent between women and men. Overall, compared to male violence female violence is more indirect, more reactive and within social relationships and less instrument or sexual.

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Quality of life according to Dutch Long-term Forensic Psychiatric Patients

Written by Ellen Vorstenbosch,
former researcher of the Pompefoundation, the Netherlands

Over the last decade, the duration of treatment in Dutch clinical forensic psychiatric facilities has increased considerably, leading to an average duration of over nine years. Furthermore, there is a growing group of forensic psychiatric patients who have insufficiently benefited from the offered treatment methods and who are still deemed to pose a high risk for society (De Kogel, Verwers, & den Hartogh, 2005; Dienst Justitiële Inrichting, 2009; Expertisecentrum Forensische Psychiatrie, 2009; see also Salize & Dressing, 2007). A significant proportion of these patients may require long-term, potentially life-long, forensic psychiatric care (Reed, 1997; Harty et al., 2004). In the Netherlands, a patient’s main therapist can advise upon placement in a long-term forensic psychiatric facility if the risk of recidivism did not diminish sufficiently after two serious treatment attempts in two different forensic psychiatric hospitals. Subsequently, an independent committee of multi-disciplinary experts decides if placement in a long-term forensic psychiatric facility is considered adequate. Of the total Dutch forensic psychiatric population, about 10% currently resides in a specialized long-term forensic psychiatric care (LFPC) ward.

Typical for long-term forensic psychiatric patients is a complex psychopathology, non-compliance in therapy and/or poor learning abilities. Instead of treatment aimed towards re-entry into society, the main goal of long-term forensic psychiatry is to offer care in accordance with the rehabilitation principles. In LFPC, these principles entail psychiatric and medical care, acceptance of stay, and optimising quality of life (QoL) within acceptable boundaries for society. The emphasis no longer lays on risk-reduction and therefore on treatment of dynamic risk factors, but on QoL-enhancement. In every day clinical care, there is a need for practical guidance to achieve this.

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Characteristics and needs of long-stay patients in high and medium secure forensic-psychiatric care: Implications for service organization

Written by Prof. Birgit Völlm,
Clinical Professor and Readerin Forensic Psychiatry, Faculty of Medicine & Health Sciences, University of Nottingham

 

This report summarises the research progress we have made on ‘Characteristics and needs of long-stay patients in high and medium secure forensic-psychiatric care: Implications for service organisation’. The National Institute of Health Research (NIHR) UK has funded this 3-year study, which we are two thirds through, as of the recent quarterly meeting – the ‘Project Management Group and Service User Reference Group meeting’ – which took place in mid-January.

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Festival Forensic Care 2015, the Netherlands

Written by Peter Braun,
Manager Long-Term Forensic Psychiatric Care, Pompefoundation, the Netherlands.

 

On the 27th of January ´Festival Forensische Zorg´, a large conference in the Netherlands was organized by the Dutch Ministry of Safety and Justice. The conference attracted a wide audience from Forensic Psychiatric organizations, clinics, detention centres, forensic outdoor-facilities and service-users organizations, volunteers, probation-officers, sheltered living facilities for ex-forensic patients and many more.

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