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.