Long-term forensic psychiatric care

Long-term forensic psychiatric care concerns itself with patients who do not profit enough from treatment to return safely to society. For many of these patients return to society is no longer an option. Consequently, treatment is not primarily focused on risk reduction. Rather, the main objective is to offer the patients an optimal quality of life. This demands a specialized approach, which provides a life environment optimally attuned to individual possibilities and needs, as well as tailored psychological, psychiatric and somatic care.

In the Netherlands, LFPC involves forensic psychiatric patients with a long-term risk of reoffending who

  1. got the TBS order (placement under a hospital order) with a so-called long stay indication, or
  2. are chronic psychiatric patients who for a long time have disrupted society, present risks and respond insufficiently to treatment (so called long-care).

 


Special interest group LFPC

At the IAFMHS Conference in Barcelona 2011 a special interest group LFPC (SIG LFPC) was started.

The purpose of this special interest group, which operates under the auspices of IAFMS, is to establish an ongoing forum where issues and best practices regarding Long-term Forensic Psychiatric Care (LFPC) can be discussed and shared.

LFPC concerns itself with patients who do not profit enough from treatment to return safely to society. After years of various treatment attempts, some patients remain too dangerous or disruptive, and are still in need of substantial care. The seriousness and complexity of their problems, the strong societal response they evoke, the ethical considerations about the proportionality between their offences and the length of their custody, as well as the daily issues professionals on LFPC wards have to deal with will be subjects of this forum.

LFPC issues
The group currently concentrates on the following tracks:

1. System characteristics. Criteria of LFPC inclusion/exclusion concerning reasons why patients cannot leave the forensic psychiatric system and where in the system their progress stagnates.
2. Patient characteristics of the population which cannot leave the system.
3. An overview of ongoing or planned research on the population of chronic (forensic) psychiatric patients

Steering committee (1st year 2011-2012)

  • Peter Braun
  • Gopi Krishan
  • Ton Verbeet
  • Laurie Guidry
  • Helen Olsson
  • Iva Embley/Denise van Eeden

Target group
Anybody involved with LFPC patients: psychologists, psychiatrists, nurses, social workers, managers, administrators, lawyers, judges and other professionals.

Next meeting

Date: Sunday, April 22, 2012
Time: 17:30 – 18:30
Place: Eden Roc Renaissance Hotel (IAFMHS)
Room: TBA

The purpose of the meeting is to discuss joint LFPC projects that took place in the last year, learn from each other, and determine a strategy for future collaborations.

LFPC Care Program

EFP has developed in collaboration with LFPC facilities in the Netherlands (FPC Pompe Foundation, FPC Veldzicht, De Woenselse Poort, and the Ministry of Justice) a care program (CP),  which describes the status quo in the long-term forensic psychiatric care in the Netherlands, as well as ideas for further development of coherence, transparency, goal-directedness, quality, and evaluation of LFPC in order to realize a learning practice. The CP is certainly not a static instrument or a strict protocol, but more a first initiative to a guideline.

You can download the summary here.

 

International Knowledge Exchange Activities

Until now two international knowledge exchange meetings were organized in the Netherlands, and two LFPC symposia were presented at the 10th IAFMHS Conference in Vancouver as well at the 11th IAFMHS Conference in Barcelona.

 

11th IAFHMS Conference, Barcelona, June 29 - July 1, 2011

In June the EFP participated in the IAFMHS Conference in Barcelona by organizing two symposia about LFPC. The title of these symposia was: Challenges in Long-term Forensic Psychiatric Care (LFPC): from Preventing Integration to Integral Prevention.

To see the presentations that were held, click beneath:

 

10th IAFHMS Conference, Vancouver, May 25-27, 2010
In the right place at the right time: Conceptual and practical considerations about long-term forensic psychiatric care. Read an impression of the conference here.

Presentations:

 

2nd International Long stay Knowledge Exchange
The 2nd International Long stay Knowledge Exchange  was organized at the occasion of the opening of the new LFPC facility of the Pompe Foundation in Zeeland, the Netherlands,  on June 11, 2009 . At the same time,  the Dutch   LFPC care program was presented.

Presentations:

 

1st International Long stay Knowledge Exchange

The 1st International Long stay Knowledge Exchange was held on October 6 & 7, 2008 in Nijmegen, the Netherlands. The purpose of the meeting was to lay a foundation for further collaboration of practitioners and managers responsible for forensic psychiatric wards for long stay patients.

During the meeting were discussed the intricacies of the various national legal systems, the characteristics of patients who are hospitalized for extended time periods (typically six years or longer), the paths that lead to long stay wards, as well as the major issues and challenges relevant for these wards (see presentations of the participating countries beneath). Moreover, the participants of the meeting visited three long stay locations: The 'Kempehuis', PI Vught,  and 'Corridor', all under the management of the Pompestichting.

Presentations of participating countries:
- England - Rampton Hospital
- England - Frankland Prison
- Germany - Forensic Psychiatric Hospital Haina
- Sweden - Sundsvall Forensic Psychiatric Hospital
- Belgium - Forensic Psychiatry Rekem
- The Netherlands - Pompestichting

Conclusions of the meeting:
o Long stay wards are dealing with very much the same issues, regardless of the  - quite different - national legal systems. Thus the legal differences do not stand in a way of further international collaboration at the ward and patient level.
o Jeremy Resnick - Rampton Hospital:  "Forensic psychiatry could learn a lesson from the somatic medicine, which already long time ago accepted that certain illnesses are untreatable with the current state-of-the-art. Palliative care aimed at improving the quality of life of people facing serious, complex illnesses is then more in place than senseless attempts to cure these patients".
o Manipulation of the living environment plays a significant therapeutic role, especially so on long stay wards. This issue deserves further research!

Do you have experience with long stay patients? Please, share your experiences, concerns, and ideas with us: secretariaat@efp.nl