Training School 2017 – Patient and Carer Involvement and Participation in Long Term Forensic Care

What is the training school about?

The next upcoming training school for the IS1302 COST Action will primarily focus on patient and carer participation and involvement in long term forensic psychiatric care and how this can be realized without compromising risk factors.

In almost every country, long term forensic care is a necessary pathway. It is well understood that rehabilitating forensic patients is a process that takes time. The danger on the other hand is that forensic patients can get stuck in the system. Several causes of this ‘side effect’ can be determined: patient characteristics, quality of treatment or even the quality and availability of facilities with a lower level of security and/or aftercare, lack of patient involvement, etc. This is wat COST Action IS1302 focuses on.

Establishing the Risk Needs Responsivity principles is a must in forensic psychiatry. In Long Term Forensic Care, where the Risk and Needs can be countered in part by context, responsivity becomes fundamentally important. With a focus on Quality of Life, patient and carer participation and involvement should take into account responsivity factors. The focus of this training school will be patient participation, involvement of patients in long term care and how this can be realized without compromising risk factors.

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Client Service Centre – Ex-User Involvement at the “Woenselse Poort” in the Netherlands

The process of recovery is often more difficult for forensic psychiatric clients than for people who are treated within the ‘regular’ mental healthcare system. Within a secure facility such as De Woenselse Poort (‘the Woensel Gateway’), the Client Service Centre was set up with a view to offering clients more support and opportunities. Very soon after admission, the Client Service Centre can be called upon to help clients to help themselves and develop their skills and acquire general knowledge, separate from their treatment program and hospital ward. In this way, the Client Service Centre tries to assist clients in their recovery process.

The complete article – written by Toon Walravens – about the Client Service Centre and ex-User Involvement can be read here.

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STSM: Franco Scarpa will visit De Woenselse Poort in the Netherlands

Cost Action IS 1302 “Towards a network of Forensic Psychiatric System in Europe” has the aim of finding out and sharing the best practices in treatment of forensic patients. One of the goals of the Action is the improvement in the quality of life and involvement of the users in active participation to their treatment. The final goal is the well-being of the users, the reduction of lenght of the institutional treatment and their recovery to the social life. Franco´s goal is to coordinate the users involvement in Action’s projects regarding their interests and life. The visit of the De Woenselse Clinic in Eindhoven allowed him to acquire knowledge and experience regarding the participation of ex-clients in the activity of the Clinic.

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STSM: Ian Callaghan visits the Pompefoundation in the Netherlands

His aim is to investigate service user involvement in forensic services in The Netherlands and explore the similarities and differences with that found in forensic services in England. And investigate the recovery orientation of forensic services in The Netherlands and contrast this with the increasing focus on recovery and social inclusion in forensic services in England.

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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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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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