Long Term Forensic Psychiatric Care in Belgium...DegrauweS. LTFPC in Belgium History Long Term...

Long Term Forensic Psychiatric Care in Belgium

First Experiences in Flanders

Steven Degrauwe

U.P.C. Sint-Kamillus, Bierbeek

IAFMHS 2018

History Long Term Forensic Psychiatric Care

Research

Degrauwe S. LTFPC in Belgium

Table of Contents

History

Long Term Forensic Psychiatric Care

Quality of Life

Protection

Research


Research


Short History: Belgium and Forensic Psychiatric Care

1930: Progressive law for offenders with psychiatric

problems/mental disabilities

Not guilty by reason of insanity (NGRI)

But: The progressive law stayed theory

Since mid-80’s: 23 convictions from the European Court of Human

Rights

Peak: 10% of prison-population NGRI (>1.100)


Research


Forensic Psychiatric Care for NGRI: 1998 – 2016

1998 Start specialized teams for sexual delinquents. Also for, but

no specific focus on, sexual delinquents NGRI

2001 3 Medium Security Facilities and 3 units for people with

mental retardation

2014 Extra capacity in Non-Forensic Psychiatric Care

2015 First High-Security Forensic Psychiatric Center

2016 Unit Long Term Forensic Psychiatric Care.



Research

Quality of Life Protection

Table of Contents

History


Quality of Life

Protection

Research



Research


Academic Psychiatric Center Sint-Kamillus, Bierbeek

Medium Security Forensic Psychiatry since 2001

E 3 units Medium Security treatment

Schizophrenia and Personality Disorders

E 2 units Medium Security treatment (longer term) and Long

Term ’Medium Security’ Care

Schizophrenia and Personality Disorders

E 1 team for Outreachment

Forensic FACT

E 1 unit Medium Security Treatment (since April 2018)

Intellectual Disability

E 1 unit Long Term Forensic Psychiatric Care (LFP)



Research


LFP


High Security

Capacity: 30 men

April 2016



Research


Goals

E Quality of Life

E Protection



Research


Challenges. . .

E No experiences in Belgium with this population

E No expertise

E Neighbors and colleagues: stereotype ideas about the

population

E Limited infrastructural space


Research



Challenges. . .

E No experiences in Belgium with this population

E No expertise

E Neighbors and colleagues: stereotype ideas about the

population

E Limited infrastructural space


Research



. . . And Coping I No experiences in Belgium with this population

No Expertise

E Program of LTFPC, Pompestichting in The Netherlands

E No Treatment, but what then?

E Ideas from recovery oriented practice E Respectful person-centered relationships E Giving responsibility to the person and the group

E Culture of hope and personal empowerment E Opportunity for people to express their goals E Meaning of life


Research



. . . And Coping II

No experiences in Belgium with this population

Neighbors and colleagues: stereotype ideas about the population

E Info sessions for neighbors and colleagues

E Lots of visitors

E Positive imaging via press

After two years: still stereotypes


Research



. . . And Coping III Limited infrastructural space

E Challenge to offer meaningful activities for 30 in a limited

space

E Work and Play with the same people on the same x square

feet

E Annexed activities center, gym, space for creative expression,

garden!!!


Research



QoL: Evaluation

FQL-SV


Research



Security Measures

Infrastructure and Procedures

E 4m fence

E Camera-system

E Training of staff members

E Alarm-system

Responsibilities

E Giving Responsibilities to patients = core of our

security-measures

E No drugs/alcohol

E No violence


Research



High Security?

Somewhere in between High and Medium Security?

HCR-20V 3

E Total scores do not reflect a High-risk population

E In fact. . . None of the scores do

E ⇒ No acute risk. Risk expected to increase in less-structured situations

Mean HCR-20V 3

Mean SVR-20


Possible Explanations

E Lack of (treatment) possibilities for NGRI

E Most of the populations: happy with the situation

R-items: future plans: LFP

E Not a high risk population?


Research




Research

Table of Contents

History


Quality of Life

Protection

Research



Research

Research

Risk Assessment?

Current instruments: treatment perspective

Few (?) instruments: evaluation of risk in the current setting,

without future perspectives taken into account

Limitations: not in psychiatric context



Research

Goal

To develop and validate a

E contextualized assessment

E Daily indicators of transgressive behavior

E Self-perspective

E Relevance of Personality Pathology



Research

Progress

E Construction of the instrument

E Extensive literature review

E Pilot study

E Initial psychometric properties and validation study

Interesting connections between our instrument and the AMPD

(DSM-5)



Research

Short Term Planning

E Cross validation across a larger forensic sample

E Further exploration of the contribution of the AMPD to risk

assessment



Research

Questions?

Steven Degrauwe

U.P.C. Sint-Kamillus

Krijkelberg 1

3360 Bierbeek

+32 16/45.27.92

[email protected]

www.kamillus.be

www.vopspsy.ugent.be/en/personality-psychology.html

www.researchgate.net/profile/Steven Degrauwe

mailto:[email protected]

http://www.kamillus.be/

http://www.vopspsy.ugent.be/en/personality-psychology.html

http://www.researchgate.net/profile/Steven

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