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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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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