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Forensic psychiatry Rekem (Belgium). Medium security units: 2007. “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” Historical background Hospital Contract Organisation

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medium security units 2007
Medium security units: 2007

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

  • Historical background
  • Hospital
  • Contract
  • Organisation
  • Challenges

Forensic psychiatry Rekem

slide3
Historical background
    • New law 1964: psychiatric disordered offendersreceive treatment (intention !!!!)
    • Increasing domestic criticism
    • European Committee for the Prevention of Torture
    • Case Dutroux 1996
    • Case Ait Oud 2006

Forensic psychiatry Rekem

slide4
Historical background

19th C psychiatric institutions belong to the department of justice

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

1995 forensic department tradition – familiar low risk patients OPZC Rekem // U.P.C. Bierbeek, P.C. Zelzate

 historical background

Forensic psychiatry Rekem

slide5
Historical background
  • Problems: complexity– multiple handicaps offer >> capacity re-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 Care n = 40 T-beds + support MIN Antwerpen

Forensic psychiatry Rekem

hospital
Hospital

Serious Minor

Psychopathology

Risk of relapse

Escape risk

Offence/act

+ alcohol

substance abuse

sexual deviancy

Forensic psychiatry Rekem

slide7
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

…..

  • Hospital
  • Target group: specific features

Forensic psychiatry Rekem

hospital care network

C.P.S.

Nesessity of residential treatment

Prison

Mid Security/Care

Low Security/Care

Halfway House

Nursing home

Home care

Ambulatory follow up

Impulscontrol

HospitalCare network

Forensic psychiatry Rekem

contract
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) places MIN Antwerpen
  • Support for the network MIN Antwerp

Forensic psychiatry Rekem

contract modular structure
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

Forensic psychiatry Rekem

contract1
Contract
  • Therapeutic project
  • Cross-sectional consultation

Forensic psychiatry Rekem

contract forensic care network 2007
ContractForensic care network: 2007

Forensic psychiatry Rekem

organisation
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 Hospitals10% of 51,2 FTE: not assigned to a specific department

  • Working budget: max. 3,95% /budget

Forensic psychiatry Rekem

organisation1
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 CommunityPartially outside regularprogramme recognition sui generis?
  • Specific supplementary security measures

Forensic psychiatry Rekem

challenges
Challenges
  • Medium risk + intensive treatment-> low risk ?Therapeutically naive (?) optimismPrognoses : silt up psychiatric nursing home ,limited ability to learn patientsLimited 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

Forensic psychiatry Rekem

challenges1
Challenges
  • Joint staffing policyNeed for a joint management: Hospital, Psychiatric Nursing Home, Halfway HousePublic servants versus private contracts Medical responsabilityNot 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

Forensic psychiatry Rekem

challenges2
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?

Forensic psychiatry Rekem

challenges3
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

Forensic psychiatry Rekem

challenges4
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 methodDefining medium risk: multidimentionalForeign experiences: good practices
  • Knowledge centre 2008-2009

Forensic psychiatry Rekem