long term forensic psychiatric care in belgium...degrauwes. ltfpc in belgium history long term...
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Long Term Forensic Psychiatric Care in Belgium
First Experiences in Flanders
Steven Degrauwe
U.P.C. Sint-Kamillus, Bierbeek
IAFMHS 2018
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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
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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
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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)
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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.
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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
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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)
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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
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Degrauwe S. LTFPC in Belgium
History Long Term Forensic Psychiatric Care
Research
Quality of Life Protection
Goals
E Quality of Life
E Protection
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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
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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
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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
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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
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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!!!
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History Long Term Forensic Psychiatric Care
Research
Quality of Life Protection
Degrauwe S. LTFPC in Belgium
QoL: Evaluation
FQL-SV
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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
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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
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Mean HCR-20V 3
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Mean SVR-20
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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
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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
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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
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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
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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)
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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
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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
www.kamillus.be
www.vopspsy.ugent.be/en/personality-psychology.html
www.researchgate.net/profile/Steven Degrauwe