Annual Conference – Innovation and New Developments in Forensic Psychiatry

“Innovation and New Developments in Forensic Psychiatry”

will be the theme of the third Annual Conference of the COST Action IS1302

and will be organised in cooperation with USL Centro Toscana in Florence, Italy.


The first confirmed key note speakers are:

Prof. Dr. Robbert-Jan Verkes, MD, PhD, Radboud University Nijmegen (NL)

Dr. Angelo Fioritti, Director of the Department of Mental Health Bologna (IT)

Mr. Mark Kelly, Irish Human Rights & Equality Commission (IHREC) and Committee for Prevention of Torture (CPT) (IE)

Prof. Dr. Birgit Völlm, MD, PhD, University of Nottingham (UK)

Mr. Toon Walravens, De Woenselse Poort (NL)

Ms. Ellen Vorstenbosch (MSc), Sant Joan de Deu Foundation (ES)


FlorencePhoto credit: Ghost of Kuji via Remodel / CC BY


Also, the following working groups will present their latest achievements:

“Determination of Patient Characteristics” – Prof. Dr. Harry Kennedy, University of Dublin (IE)
“Towards Best Practice in Long-term Forensic Psychiatric Care” – Dr. Vivek Furtado, University of Warwick (UK)
“Meeting Patient Needs and Optimizing Quality of Life” – Ms. Gemma Escuder-Romeva, Sant Joan de Deu Hospital (ES)
“Recent EU Developments on Patient and Caregiver/Family Involvement” – Prof. Dr. Franco Scarpa (IT)


The complete program and information about the venue can be found here.

To register please send an email to:

Registration deadline is October, 20th 2016

Please note that your registration is not official till you received a confirmation of the organisers.


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Training School 2016 – Modern forensic in-patient facility design standards

The next upcoming training school for the IS1302 COST Action will primarily focus on how to develop modern forensic in-patient facilities. How society defines its basic ethical principles changes in time, and it is a matter of continual ethical, clinical and legal debate where the line between security and therapy is drawn at any given time. By entering into an open, international discussion with clinicians, architects, policy-makers and medico-legal authorities this training school aims to develop our services to a better standard by focusing on how modern forensic facilities should be designed.

Experts from EU countries will share their experiences of developing (long-stay) forensic units and the challenges associated with it. The three day training school will be held between 21-23 September 2016 and participants can choose to soak into the Finnish culture over the following weekend.


 Photo credit: Miguel Virkkunen Carvalho via Source / CC BY

The programme involves lectures, videos, discussions anddebates in small groups. The speakers are international experts in the field of forensic psychiatry and mental health and bring with them a wealth of experience (speakers list). The training school will cover basic, internationally applicable standards for forensic psychiatric facilities and how to integrate concepts of therapy and security.

Please find here a time-table for the 3 day programme.

For further information and application please click here.

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Training School 2016 – Modern forensic in-patient facility design standards

What is the training school about?

Forensic psychiatric care is aimed at improving mental health and reducing the risk of recidivism of mentally disordered offenders, within the least restrictive setting possible and with a view to community reintegration, whilst simultaneously maintaining a secure treatment environment. However, the way the services are defined and governed across Europe differ significantly: some countries have issued detailed criteria for different levels of secure care, whereas in other countries security is much more loosely defined and has essentially developed over time along with clinical practices. Also, different historical factors have dictated that in some countries there are secure units that operate in densely populated urban areas, whereas in some countries forensic facilities have been placed further from the surrounding communities.

The rationale behind developing urban forensic services is that this can provide various forms of rehabilitative stimuli not as easily accessible in a more rural environment. However, issues concerning the safety of both the patients themselves and their environment merit particular planning in a more centrally placed location. Drugs, alcohol and antisocial interaction are all factors to take into consideration. A sensitive balance between providing care and security is vital for a well-functioning urban forensic service. Buildings must be used to facilitate the treatment model and care pathway, and to promote community engagement and recovery. Maintaining a high standard in building materials and continually improving the design of the environment will help to improve outcomes for patients. The building should help to ensure comfortable, secure surroundings for patients many of whom are detained for prolonged periods of time.


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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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STSM: Ellen Vorstenbosch will visit OPGs and REMS in Italy

In April 2008, the Italian government approved a major reform of mental health care for mentally ill offenders. Up until then the six Ospedales Psichiatrici Giudiziari (OPG; Forensic Psychiatric Hospitals) fell completely under the responsibility of the Ministry of Justice and policy, regulations, staff management, careers, budget, etc. were completely organised at a national level. A census on 31 January 2012 showed that 1.264 mentally ill offenders resided in the six OPGs (Reggio Emilia, Montelupo Fiorentino, Naples, Aversa, Castiglione delle Stiviere and Barcellona Pozzo di Gotto). Apart from Castiglione delle Stiviere, the OPGs are described as obsolete 19th-century institutions, with heavy use of custodial staff. Many user associations, psychiatric societies, associations of psychiatrists working in OPGs, and also political parties demanded radical reform of the sector. However, it was not until 2006, when the Italian government received a warning of the council of Europe for violation of human rights because of the poor quality of care and living conditions, that an Italian Parliamentary Commission unanimously recommended that (except Castiglione delle Stiviere) these OPGs should be rapidly closed down.

In 2008 all resources and responsibilities for general and mental health care both in prisons and OPGs was transferred to the National Health Service (NHS), to be delivered by Regional Health Systems (RHSs). In 2012, as a consequence of another Law (9/2012), which aimed to reduce the number of prison inmates, extra financial support was given for a rapid closure of the OPGs. These changes occurred without any changes in the Criminal Code, simply stipulating that security measures be set up in ordinary psychiatric NHS settings or in newly established Residenze per la Esecuzione della Misura di Sicurezza (REMS; high-security small-size residential facilities). The REMS have been developed to better meet the needs of providing intensive and high quality mental healthcare under proper secure conditions. The REMS (for no more than 20 patients) are intended to replace admissions to OPGs. The implementation of the laws has been unsatisfactory, and in May 2014 Law 81/2014 set deadlines and operational procedures2 . Although the deadline for the final dismantlement of the OPGs was March 2015 in many regions the forensic services are currently still in the transformation phase.

As stated above the REMS are (being) developed to offer better high secure mental health care. A concept that is increasingly being used to assess (the outcome of) mental health care is quality of life (QoL). Although there is a lack of consensus about the exact definition, QoL as whole refers to an overall “sense of well-being and satisfaction experienced by people under their current life conditions”. QoL or better said the optimization of QoL could also be considered as a facilitator for forensic psychiatric treatment, as it might influence the patient’s readiness for treatment and the patient’s preparation for reintegration into society (Good Lives Model4 ). Besides, QoL also serves to monitor if patient’s basic human rights of good quality of care and living conditions are being met with the creation of new facilities.

To conceptualize QoL different approaches can be used. A first approach would be a generic conceptualization of QoL; based on research in the general population the most determining aspects of QoL are being assessed. Some of these aspects are not necessarily directly affected by the fact that patients are receiving mental health care e.g. functional status, access to resources and opportunities. These instruments are especially of value to compare QoL between different populations. A second approach is a disease-specific conceptualization of QoL; the main focus is on the aspects that are being affected by the (mental) health condition. These instruments are especially valuable when evaluating pharmaceutical interventions; e.g. medication might reduce symptoms but the side effects of the medication might actually worsen QoL.

The choice for the approach or conceptualization of QoL should be guided by the goals of the evaluation or the topic of interest that is being studied. QoL-assessment can be useful in determining needs, developing intervention strategies, and evaluating the outcomes of interventions at both the service and the individual patient level. At service level, QoL can provide an ongoing feedback from service users about the outcomes of services and thus influence further development of service and resource allocation. At the individual patient level, QoL assessment can be used to determine needs and to monitor the impact treatment interventions and services. Besides, QoL assessment can be used to guide treatment planning in (newly developed) forensic psychiatric services.

Based on the above, the Italian forensic services would be served by a more generic QoL approach in order to compare QoL in different facilities. A well-known generic QoL instrument is the World Health Organisation Quality of Life assessment and its´ abbreviated version the WHOQoL-Bref. Although the WHOQoL is health related, it is not sufficiently disease-specific and assesses a broad range of aspects related with QoL. However, what is lacking in the WHOQoL is to take into account liberty deprivation and a restrictive context, as is the case in forensic mental health services. In forensic services QoL is being influenced by generic, disease-specific and context-specific aspects. These three aspects come together in the Forensic Psychiatric inpatient Quality of Life questionnaire (FQL) and its abbreviated version the FQL-SV. The FQL has been developed as a tool for every day practice, containing life domains that can be of guidance for (individual) treatment in forensic psychiatric services. Therefore, also the FQL could be of additional value in the reorganisation of forensic psychiatric services in Italy.

The first aim of the STSM was to gain insight in the conceptualization of QoL for assessment in forensic psychiatric services in Europe. This was done by further exploring the concept of QoL against the background of newly developed forensic psychiatric services in Italy.

A secondary aim was to increase the knowledge of QoL as an outcome measure for service evaluation and (individual) treatment planning in the host institutions of the STSM. This was among others done by providing a seminar for staff about QoL within a forensic psychiatric context.

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STSM: Jack Tomlin will visit the Pompestichting and the EFP in the Netherlands

The concept of ‘restrictiveness’ in the forensic psychiatric care setting is often vague. When brought up in conversation, it is not unusual for speakers to inquire further as to what it exactly means. One key aim of this STSM is to visit the Netherlands to ask different interested groups what they thought ‘restrictiveness’ means. Does it refer to the physical confines within which patients reside? The limitations imposed upon them as regards hobbies, personal affects, relationships etc. These questions will be asked of similar individuals in the UK, to further conceptualize ‘restrictiveness’, and to see how or if definitions differ.

A second key aim of this STSM is to better understand the legal framework that surrounds the forensic psychiatric care setting in the Netherlands – again, to compare with the UK. Most of this information was received during my trip to the Expertisecentrum Forensische Psychiatrie.

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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.



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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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We´d like to show you the trailer of a Belgian documentary made by Ellen Vermeulen on Forensic Psychiatry in Belgium.


Wilfried refers to himself as ‘king one-eye in the land of the blind’. This land lays in Merksplas’ prison in Belgium and the blind are the internees who reside in the prison without treatment. Mentally ill criminals in Belgium are not held responsible for their actions but become separated from society. There criminal acts range from murder to stabbing fire of a bike. Due to the lack of places in psychiatric hospitals they end up in prison without any possibility for therapy nor end date. Their files mention as date of release: 31/12/9999.

9999 intertwines five different stories of these ‘blind.’ These men are waiting; for comfort, for hope, for freedom, for change. The time between their prison bars is altogether different from the time outside the prison walls. Time is annihilated. The only thing that remains is an eternal confrontation; a confrontation with their deeds and with their illness. There is nothing else. In this film we disappear, together with the characters in need of treatment, behind the inexorable closed doors. We wait side by side.

For more information, please visit the movie´s website.

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