Women admitted to forensic psychiatry in Flanders (Belgium): who are they?

Abstract

Purpose Despite the rising number of females in forensic psychiatry, research about their characteristics remains limited and is currently lacking in Belgium. Optimizing knowledge about the characteristics of these women will lead to a better understanding of this specific group. Therefore, the aim of the study was to gain insight into the characteristics of female forensic psychiatric patients in Flanders, Belgium. Design/methodology/approach A case file study was carried out in the forensic psychiatric hospital Sint-Jan-Baptist in Zelzate, Belgium. The files of female patients admitted in the period 2006–2017 were analysed (N = 82) based on a checklist including sociodemographic, mental health care and offence-related characteristics as well as historical risk factors. Findings The study revealed that female patients have been confronted with a large number of adverse experiences during both childhood and adulthood, were frequently diagnosed with borderline personality disorder and usually had an extensive mental health treatment history with many drop-outs. The majority of the female patients had committed violent offences towards relatives. Practical implications These findings are similar to those of other jurisdictions and highlight the importance of a gender-responsive treatment. This kind of treatment should include trauma-informed care, gender-sensitive risk-assessment and adapted versions of dialectical behavioural therapy and schema-focussed therapy. Additionally, treatment should focus on breaking the intergenerational transmission of violence and mental health problems by targeting parenting skills. Originality/value To the best of the authors’ knowledge, this is the first study that scientifically scrutinized the detailed characteristics of female forensic psychiatric patients in Flanders, Belgium. Recommendations for gender-responsive treatment and directions for future research are discussed.

Systematic Aggression Registration in Forensic Psychiatric Care: A Qualitative Study on Preconditions for Successful Implementation

“…Since the interviews and the focus group addressed some of the same themes (e.g., relevance, monitoring function, and preconditions for implementation), the same thematic structure was used for both types of data, and the focus group data were seen as a further elaboration of the interview data. When discussing this thematic tree structure, a similarity with the preconditions for introducing routine outcome monitoring in clinical practice came to the fore (Boswell et al, 2015;De Varé et al, 2017). Therefore, the decision was taken to reorganize the thematic structure of the interviews and focus group data in these three preconditions: (1) creating the most appropriate context for introduction, (2) choosing a relevant instrument, and (3) perpetuating the use in clinical practice.…”

“…The first referred to installing a registration culture supported by the hospital management. In order to achieve this, it is important to have stakeholders who "carry out" this registration culture and boost it from time to time by training courses for both new and experienced staff members (De Varé et al, 2017). These stakeholders should be attentive for resistance or a diminishing drive to register these incidents.…”

“…Crucial aspects in promoting the time-efficiency are limiting the time needed for registration, connecting the different registration tasks and providing quick access to the data and their graphical representation. Thus-despite inevitable costs-a good and smoothly working IT-system for electronic patient files and for data visualization should be strived for (De Varé et al, 2017;Vess, 2001).…”

“…Insight into these preconditions can help to further introduce systematic aggression registration in other (forensic) psychiatric units, resulting in tailored-made aggression, and future risk management plans. The framework of Boswell et al (2015) includes three crucial processes that help to clearly discuss preconditions of a good implementation of Routine Outcome Monitoring (ROM) instruments for measuring treatment progress (De Varé et al, 2017;Vess, 2001), that is, (1) creating the most appropriate context for introduction, (2) choosing a relevant instrument, and (3) perpetuating the use in clinical practice. The first process refers to recognizing and overcoming institutional and practical (e.g., infrastructural, financial, and time-related) barriers.…”