Post on 30-Jun-2020
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
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
History Long Term Forensic Psychiatric Care
Research
Degrauwe S. LTFPC in Belgium
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)
History Long Term Forensic Psychiatric Care
Research
Degrauwe S. LTFPC in Belgium
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.
Degrauwe S. LTFPC in Belgium
History Long Term Forensic Psychiatric Care
Research
Quality of Life Protection
Table of Contents
History
Long Term Forensic Psychiatric Care
Quality of Life
Protection
Research
Degrauwe S. LTFPC in Belgium
History Long Term Forensic Psychiatric Care
Research
Quality of Life Protection
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)
Degrauwe S. LTFPC in Belgium
History Long Term Forensic Psychiatric Care
Research
Quality of Life Protection
LFP
Long Term Forensic Psychiatric Care
High Security
Capacity: 30 men
April 2016
Degrauwe S. LTFPC in Belgium
History Long Term Forensic Psychiatric Care
Research
Quality of Life Protection
Goals
E Quality of Life
E Protection
Degrauwe S. LTFPC in Belgium
History Long Term Forensic Psychiatric Care
Research
Quality of Life Protection
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
History Long Term Forensic Psychiatric Care
Research
Quality of Life Protection
Degrauwe S. LTFPC in Belgium
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
History Long Term Forensic Psychiatric Care
Research
Quality of Life Protection
Degrauwe S. LTFPC in Belgium
. . . 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
History Long Term Forensic Psychiatric Care
Research
Quality of Life Protection
Degrauwe S. LTFPC in Belgium
. . . 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
History Long Term Forensic Psychiatric Care
Research
Quality of Life Protection
Degrauwe S. LTFPC in Belgium
. . . 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!!!
History Long Term Forensic Psychiatric Care
Research
Quality of Life Protection
Degrauwe S. LTFPC in Belgium
QoL: Evaluation
FQL-SV
History Long Term Forensic Psychiatric Care
Research
Quality of Life Protection
Degrauwe S. LTFPC in Belgium
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
History Long Term Forensic Psychiatric Care
Research
Quality of Life Protection
Degrauwe S. LTFPC in Belgium
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
Degrauwe S. LTFPC in Belgium
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?
History Long Term Forensic Psychiatric Care
Research
Quality of Life Protection
Degrauwe S. LTFPC in Belgium
History Long Term Forensic Psychiatric Care
Research
Table of Contents
History
Long Term Forensic Psychiatric Care
Quality of Life
Protection
Research
Degrauwe S. LTFPC in Belgium
History Long Term Forensic Psychiatric Care
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
Degrauwe S. LTFPC in Belgium
History Long Term Forensic Psychiatric Care
Research
Goal
To develop and validate a
E contextualized assessment
E Daily indicators of transgressive behavior
E Self-perspective
E Relevance of Personality Pathology
Degrauwe S. LTFPC in Belgium
History Long Term Forensic Psychiatric Care
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)
Degrauwe S. LTFPC in Belgium
History Long Term Forensic Psychiatric Care
Research
Short Term Planning
E Cross validation across a larger forensic sample
E Further exploration of the contribution of the AMPD to risk
assessment
Degrauwe S. LTFPC in Belgium
History Long Term Forensic Psychiatric Care
Research
Questions?
Steven Degrauwe
U.P.C. Sint-Kamillus
Krijkelberg 1
3360 Bierbeek
+32 16/45.27.92
steven.degrauwe@fracarita.org
www.kamillus.be
www.vopspsy.ugent.be/en/personality-psychology.html
www.researchgate.net/profile/Steven Degrauwe