Written by Ana Cristina Neves (Forensic Psychology Assistant Professor at Instituto Superior de Ciências da Saúde Egas Moniz, Portugal) and Valentina Campani (Psychology Master Student, trainee at Reggio Emilia Forensic Unit, Italy)
The Training School (TS) was focused on the concepts of quality of life (QoL) and needs within a long-term forensic psychiatric context, how to assess them and how to improve conditions of long-term patients while meeting their needs. As one of the aims of the TS was the interaction between participants, we were just 18, what allowed the experience of a friendly and functional environment. Treatment realities vary substantially within Europe according to different legal frameworks and resources, so group work and discussion was actively stimulated by the trainers. They also provided valuable advises on how to integrate both concepts into everyday practice.
During the TS we had the chance to learn several definitions of QoL and realize how difficult it can be to find a consensual one. According to the World Health Organization (WHO, 1997, p.1), it can be defined as “individuals perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns”. It thus should be understood as a sense of well-being that is necessarily subjective and that exists in all individuals, mentally disordered people not excluded. WHO definition goes on to say that QoL “is a broad ranging concept affected in a complex way by the person’s physical health, psychological state, level of independence, social relationships, personal beliefs and their relationship to salient features of their environment”. Thus QoL and needs are intimately related concepts in the sense that QoL is dependent on how needs are perceived to be met or not. And just as QoL is subjective, so are needs specific to each individual. As such, to improve the perceived quality of life one has to attend to the specific needs of each patient. This led us to conclude how difficult it must be to manage service provision in institutional settings, especially of forensic nature – while it is desirable to tailor interventions, legal rules, as well as security and technical procedures, shall apply to everyone.
Our training included getting acquainted with QoL and needs assessment tools. Both assessments can be performed with instruments developed for the general population, such as the WHO Quality of Life (WHOQOL; WHO, 1997) or the Camberwell Assessment of Needs (CAN; Slade et al., 1999), but several authors advise the use of tools adapted to forensic psychiatric settings (e.g., Oliver et al., 1996). In the TS we trained the use of the Forensic Inpatient Quality of Life Questionnaire – Short Version (FQL-SV; Schel et al., 2015) and the Camberwell Assessment of Needs Forensic scale version (CANFOR; Thomas et al., 2003) and had the opportunity to practice how important these tools can be for intervention planning and evaluation (Romeva et al., 2010).
The contribution of occupational therapy to QoL was also a topic developed during the TS. We experienced how important it can play an important role in the rehabilitation of forensic psychiatric patients as well as on their QoL. We also recognized that patients in institutional settings can be particularly prone to “occupational deprivation” (i.e., a state in which people are precluded from opportunities to engage in occupations of meaning due to factors outside their control; Whiteford, 2000) with serious detrimental effects, so such state should be actively avoided.
The TS raised our awareness to the importance of respecting the carers’ perspective and rights. We role played the feelings that carers can experience and understood how important it is to validate them, as well as promote involvement in treatment decisions. In short, carers should be allowed to participate in the care of their loved ones at all times.
“Long-term” is a heterogeneous concept, so it is difficult to find a “one size fits all” approach, both inside a single country and in EU context. Some countries in Europe do not have plans for life-long patients. But others do, as is the case of the Netherlands. We had the opportunity to get into their system by seeing the documentary “Longstay”. We recommend taking the time to see it to have a deep understanding of how a long-term facility can work and to see the Netherland’s point of view on QoL and needs.
As the Training School was a melting pot of representatives from many EU countries, we could benefit from the comparisons between different systems and perspectives. We had the chance to visit a Slovenian Forensic Unit in Maribor, where we had a look at the facility and talked with the staff and patients. This field experience was very enriching.
Since the principal aims of long-term forensic psychiatric treatment should not only be psychiatric/medical care, but also improving quality of life, the importance of research in this area is undeniable. Nevertheless, the QoL of such patients is still a recent concern in research and practice. The TS also gave us the opportunity to learn the challenges that the forensic psychiatric context can pose for research and some guidelines on how to overcome them.
As a concluding remark, we like to thank Cost Action IS1302 and the trainers for the all the acquisitions they have allowed us to gain during the TS. We would also like to show our gratitude to our Slovenian colleagues for the amazing hospitality during all the time we spent in their beautiful country!
Oliver, J., Huxley, P., Bridges, K. & Mohamad, H. (1996). Quality of life and mental health services. London/New York: Routledge.
Romeva, G.E., Rubio, L.G.G., Guerrem S.O., Miravet, M.J.R., Cáceres, A.G., & Thomas, S.D.M. (2010). Clinical validation of the CANFOR scale (Camberwell Assessment of Need-Forensic version) for the needs assessment of people with mental health problems in the forensic services. Actas Esp Psiquiatr, 38 (3), 129-137.
Schel, S.H.H., Bouman, Y.H.A., Vortenbosch, E.C.W, & Bulten, E. (2015). Quality of Life Questionnaire (Short Version) for patients on long-term forensic care. Nijmegen: Pompestichting.
Slade, M., Thornicroft, G., Loftus, L., Phelan, M., & Wykes, T. (1999). CAN: Camberwell Assessment of Need – A comprehensive needs assessment tool for people with severe mental illness. London: Gaskell.
Thomas, S., Harty, M.A., Parrott, J., McCrone, P., Slade, M., & Thornicroft, G. (2003). CANFOR: Camberwell Assessment of Need – Forensic Version. London: The Royal College of Psychiatrists.
Whiteford, G. (2000). Occupational deprivation: Global challenge in the new millennium. The British Journal of Occupational Therapy, 63(5), 2000-204. DOI: 10.1177/030802260006300503
World Health Organization (1997). WHOQOL: Measuring quality of life. Available at http://www.who.int/mental_health/media/68.pdf