Forensic psychiatry Rekem(Belgium)

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“contract concerning the partial creation of a care path for mentally-disturbed offenders medium risk within the target group of adults in the region of Antwerp and Limburg”

1. Historical background

2. Hospital

3. Contract

4. Organisation

5. Challenges

Medium security units: 2007

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1. Historical background

New law 1964: psychiatric disordered offenders receive treatment (intention !!!!)

Increasing domestic criticism

European Committee for the Prevention of Torture

Case Dutroux 1996

Case Ait Oud 2006

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1. Historical background

19th C psychiatric institutions belong to the department of justice

20th C psychiatric hospitalsRekem up to 1964 department ‘social defense’

1995 forensic departmenttradition – familiar low risk patients

OPZC Rekem // U.P.C. Bierbeek, P.C. Zelzate

historical background

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1. Historical background

Problems: complexity– multiple handicapsoffer >> capacityre-integration: almost inexisting

Consequence: Psychiatric nursing home Rekem (15/90) Psychiatric nursing home MIN Antwerp: 24 Halfway house MIN Antwerp: 50 Halfway house ‘t Veer Lanaken: 20

2001: projects Department of Justice and Health Caren = 40 T-beds +support MIN Antwerpen

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2. HospitalSerious Minor

Psychopathology

Risk of relapse

Escape risk

Offence/act

+ alcohol

substance abuse

sexual deviancy

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Disturbed perception

Destructive aggression

Impulsivity

Disturbed conscience

Disturbed expression of emotions and empathy

High emotional tension

Cross-border and disturbed

autonomy

Lack of practical skills

Crimes

Traumas

Lack of social skills

…..

2. Hospital

Target group: specific features

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2. Hospital

Care network C.P.S.

Nese

ssit

y o

f re

sidenti

al tr

eatm

ent

Nursing home

Home care

Low Security/Care

Halfway House

Mid Security/Care

Prison

Ambulatory follow up

Impulscontrol

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3. Contract

Hospital: 40 beds

Psychiatric Nursing Home: 60 (4 x 15) beds

Halfway house (rehabilitation): 20 (2 x 10) places‘t Veer Rekem

Halfway house (rehabilitation): 20 (2 x 10) placesMIN Antwerpen

Support for the network MIN Antwerp

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3. Contract: modular structure

Hospital: total stay 2 years

Crisis and relapse: 3 beds; max. 14 days

Observation: 1 – 3 months

Intensive treatment; 6 – 12 months

Continued treatment; 6 – 12 months

Outreaching

Training, advice, coaching

Reporting CPS (committee protection of society – “parole board”

Psychiatric nursing home: rehabilitation (2 years) and care

Halfway house: rehabilitation, e.g. on campus

Joint medical committee

Joint management

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3. Contract

Therapeutic project

Cross-sectional consultation

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3. ContractForensic care network: 2007

H Forensic department psychotic disorders 21

H Forensic department disturbed identity 22

H Drug abuse Klimop 3

NH Forensic Psychiatric Nursing Home Rekem 15

NH Psychiatric nursing home MIN 22

HH Halfway House MIN 60

HH Halfway House ‘t Veer 20

PTZ Psychiatric Homecare 6

TOTAAL 169

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4. Organisation

Staff: 110 FTE’s / 214 patients-> 0,51 FTE / patient

Norm: T, Nursing Home, (HH)

Supplement contract: Hospital, Nursing home (rehabilitation)

network M.I.N.

Stewards: security cf. other Psychiatric Hospitals

10% of 51,2 FTE: not assigned to a specific department

Working budget: max. 3,95% /budget

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4. Organisation

Network: not a legal entity4 seperate managements: Hospital,Psychiatric Nursing Home en 2 non-profit associations3 types of employment contracts

Partially whithin regular programme/ reconversionrecognised by the Flemish Community

Partially outside regular programme recognition sui generis?

Specific supplementary security measures

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5. Challenges

Medium risk + intensive treatment-> low risk ?

Therapeutically naive (?) optimism

Prognoses : silt up psychiatric nursing home ,limited ability to learn

patients

Limited possibility to work towards rehabilitation within the psychiatric

nursing home setting

Both in quantity as in quality weaker staff

Severe pathology: negative selection

Specific problems: mourning, giving meaning to life,

learning to accept oneself, limited

perspectives

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5. Challenges

Joint staffing policyNeed for a joint management: Hospital, Psychiatric Nursing

Home, Halfway House

Public servants versus private contracts

Medical responsability

Not specifically forensic, typically for a network without legal

entity

Financial managementNo unity in accounting

Hospital and psychiatric nursing home analytical

bookkeeping

non-profit organisations not an analytical bookkeeping

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5. Challenges

Implementation new Internment act –max date of coming into operation : 2012 ...

“Court for execution of sentences” allocates patients to an authorized institution; each alteration to the stay requires a new verdict

Care coordinator: Key figure in allocation of new patientsTo be appointed by Federal department of Justice (temporary)Experience in mental health sector

Required administration (reporting, …)

Royal Decree safety standards: Content? Supervision? Finance?

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5. Challenges

Care network is incomplete without high risk facilitiesInstitutions in Gent / Antwerp: Federal department of Justice?Importance of cooperation – owner – structure ?

Mental health care for mentally disturbed offenders: outreach?Hospitals should not become prisons

Expansion of capacity40 beds for treatment is insufficient to provide for the diverse and complex problemsIncrease of financial means:

specialisation > fragmentation

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5. Challenges

Consultation between different departments and ministers :FOD Health, FOD Justice, Communities

Safety Standards

Financing building projects

Administrative requirements new “Internment Act”

Socialization: involving other aspects education, housing, culture, work, ……

Scientific monitoringJoint registration of target group and method

Defining medium risk: multidimentional Foreign experiences: good practices

Knowledge centre 2008-2009