The influence of therapy alliance and treatment motivation in patients with Cluster B personality disorders on incidents in forensic hospitals

2021 ◽  
Vol 23 (3) ◽  
pp. 272-284
Author(s):  
Maartje Clercx ◽  
Vivienne de Vogel ◽  
Marike Lancel ◽  
Marije Keulen-de Vos
Keyword(s):  
Personality Disorders ◽  
Psychiatric Patients ◽  
Therapy Outcome ◽  
Treatment Motivation ◽  
Content Type ◽  
Forensic Psychiatric Patients ◽  
Cluster B Personality Disorders ◽  
Nonspecific Factors ◽  
Therapy Alliance ◽  
Forensic Psychiatric

Purpose Nonspecific factors such as therapy alliance and treatment motivation have been shown to be predictive of therapy outcome. However, research investigating these factors among patients with personality disorders, or studies in the context of mandated treatment showed mixed results. A new theory furthermore speculates there may be differences between early formed therapeutic alliance (trait-like) versus alliance formed on the longer term (state-like). This paper aims to investigate the effects of therapy alliance and treatment motivation in 103 Dutch male forensic psychiatric patients with Cluster B personality disorders. Design/methodology/approach The authors used incidents as a measure of treatment outcome. They studied the effect of nonspecific factors on incidents in two phases, namely, 0 – 18 months and 18 – 36 months, along with known predictors of incidents (age, Historical items of the HCR-20 and psychopathy) as covariates. Findings Regression models predicting incidents in the first 18 months of treatment were nonsignificant. Incidents in the second 18 months were significantly predicted by models including alliance and motivation measured at the start of treatment, but not measures at 18 months and covariates. Predictors, except for age, were all nonsignificant. Practical implications These findings lend tentative support for the trait-like vs state-like theory of change through nonspecific factors. However, it may also be that other factors are more important in predicting therapy outcome in forensic psychiatric patients with Cluster B personality disorders. Originality/value The current study represents the first effort to study the effects of non-specific factors on therapeutic discourse in hospitalized offenders with Cluster B personality disorders.

The InReach project: from penitentiary to forensic hospital

2014 ◽  
Vol 35 (3) ◽  
pp. 119-126 ◽  
Author(s):  
Wouter Stassen ◽  
Petra Habets ◽  
Astrid Mertens ◽  
Jan De laender ◽  
Inge Jeandarme
Keyword(s):  
Human Rights ◽  
Psychiatric Hospital ◽  
Psychiatric Patients ◽  
Vulnerable Groups ◽  
Content Type ◽  
Forensic Hospital ◽  
Forensic Psychiatric Patients ◽  
Treatment Facilities ◽  
Current Article ◽  
Forensic Psychiatric

Purpose – In Belgium approximately a quarter of forensic psychiatric patients reside within penitentiaries instead of treatment facilities. This situation has yielded the Belgian government several convictions from the Human Rights Court in Strasbourg. In an attempt to facilitate admissions from penitentiary to psychiatric hospital, the Forensic Department of the psychiatric hospital in Rekem (OPZC Rekem), has piloted the InReach project. The paper aims to discuss these issues. Design/methodology/approach – The objective of this project is to engage a psychiatric nurse on the ward in pretherapeutic and motivational activities on a regular basis in the penitentiary for vulnerable groups of forensic psychiatric patients, forming a bridge between penitentiary and hospital. The InReach project even considers patients who have no desire to leave the penitentiary (e.g. due to their psychiatric profile). A motivational approach is used to support these patients in making the transition from penitentiary to hospital. Findings – The current article describes the focus of the InReach project (procedures and InReach candidate profiles) together with the first impressions of the progress that has been made by the InReach project. In addition two case studies of InReach patients are presented. The InReach project is clearly needed in Belgium and because of its success it has been extended to another penitentiary. It is probable the two other medium-security wards will also be included in the project in the near future. Originality/value – The Belgian government has received several convictions from the Human Rights Court in Strasbourg because a substantial number of forensic psychiatric patients reside within penitentiaries instead of treatment facilities. The InReach project presented in this paper is clearly needed in Belgium and was implemented to initiate and facilitate the transition from penitentiaries to treatment facilities. The need for this type of project is reflected in the number of forensic psychiatric patients that reside within a penitentiary and that are not able or willing to make the transition to a treatment facility because of their psychiatric profile.

A medico-judicial framework for the rehabilitation of forensic psychiatric patients in Zimbabwe

2015 ◽  
Vol 17 (2) ◽  
pp. 134-148 ◽  
Author(s):  
VIRGININIA DUBE-MAWEREWERE
Keyword(s):  
Social Workers ◽  
Psychiatric Patients ◽  
Public Attitudes ◽  
Psychiatric Rehabilitation ◽  
Future Research ◽  
Content Type ◽  
The Public ◽  
Forensic Psychiatric Patients ◽  
Service Staff ◽  
Forensic Psychiatric

Purpose – The purpose of this paper is to develop a medico-judicial framework for rehabilitation of forensic psychiatric patients in Zimbabwe. Design/methodology/approach – Grounded theory of the Charmaz (2006, 2014) persuasion was used. An exploratory qualitative design was utilised. The theoretical framework that was used as a point of departure was Pierre Bourdieu’s conceptual canon. Participants were purposefully and theoretically sampled. These included the judiciary, patients, patients’ family, psychiatrists, nurses, social workers, experts in forensic psychiatric practice. They were 32 in total. Findings – The findings reflected a need to realign the dislocation and dissonance between and within the fields of the prison system, medical system, and the judiciary. The realignment was done by co-constructing a therapeutic jurisprudent medico-judicial framework for rehabilitation of forensic psychiatric patients in Zimbabwe with participants who were stakeholders in forensic psychiatric rehabilitation. Research limitations/implications – The study was focused on male forensic psychiatric patients rehabilitation and not on female forensic psychiatric patients because there were important variables in the two groups that were not homogenous. However, it is possible that including females in the study could have added perspective to the study. This also limits the generalisation of findings beyond the male forensic psychiatric participants. Services beyond the experience of participants translate to the notion that findings cannot be generalised beyond the parameters of the study. Future research and service evaluation and audit need to be considered. The study findings focused on the “psychiatric” aspect and did not emphasise the “forensic” aspect of the service delivery service. Future research may need to feature physical provisions and progression pathways with reference to “forensic” risk reduction as a parallel goal. Practical implications – The study calls for the following: Transformation of the medico-judicial system, adjusting legislation and restructuring of the public service; changing of public attitudes to enable implementation of the medico-judicial framework; there is need for a step by step process in the implementation of the framework in which training needs of service staff, social workers, community leaders and key stakeholders will need to be addressed; the proposed changes presented by the model will require cultural, financial and infrastructural shifts. Social implications – There is need for policy makers to re-enfranchise or rebrand forensic psychiatric rehabilitation services in Zimbabwe. This could positively involve the marketing of forensic psychiatric rehabilitation to the stakeholders and to the public. This is projected to counter the stigma, disinterest and disillusionment that run through both professionals and public alike. This will foster a therapeutic jurisprudence that upholds the dignity and rights of forensic psychiatric patients. Originality/value – This work is an original contribution to forensic psychiatry in Zimbabwe. Research in that area is prohibitive because of the complexity of processes that are followed. This research is therefore ground breaking.

Inpatient aggression in forensic psychiatric patients with autism spectrum disorder: the role of risk and protective factors

2020 ◽  
Vol 11 (2) ◽  
pp. 93-100
Author(s):  
Rianne Bosch ◽  
Farid Chakhssi ◽  
Ko Hummelen
Keyword(s):  
Protective Factors ◽  
Physical Aggression ◽  
Psychiatric Patients ◽  
Risk And Protective Factors ◽  
Autism Spectrum ◽  
Assessment Instruments ◽  
Short Term ◽  
Content Type ◽  
Forensic Psychiatric Patients ◽  
Forensic Psychiatric

Purpose Patients with autism spectrum disorder (ASD) are overrepresented in forensic samples. However, research on risk assessment in forensic patients with ASD is scarce. The purpose of this paper was to examine the prevalence of short-term inpatient aggression and explore the risk and protective factors for aggression in forensic psychiatric patients with ASD (N = 32). Design/methodology/approach The association between two commonly used violence risk assessment instruments (HKT-R and SAPROF) and physical aggression during ten weeks of inpatient stay was examined in a Dutch forensic psychiatric hospital. Findings Results showed no significant association between HKT-R and SAPROF and incidents of physical aggression. This suggests that the commonly used assessment instruments may be of limited use for assessing the risk of short-term inpatient aggression in patients with ASD. Research limitations/implications Limitations to the current study include the relatively small sample size and the lack of information on index offenses. Further research with a larger, more homogeneous sample and longer follow-up is indicated to confirm the results of this study. Future research should also include the possible association between aggressive behavior of people with ASD and other factors that might be relevant, such as social cognition deficits, cognitive and sensory impairments, deficient empathy and emotion regulation problems. Originality/value To the authors’ knowledge, this is the first study to directly examine the prevalence of inpatient aggression of forensic psychiatric patients with ASD and its association with risk and protective factors.

Infrahumanisation: the nurse versus the guard phenomenon in forensic psychiatric practice in Zimbabwe

2015 ◽  
Vol 17 (2) ◽  
pp. 149-164
Author(s):  
VIRGININIA DUBE-MAWEREWERE
Keyword(s):  
Research Study ◽  
Psychiatric Patients ◽  
Prison System ◽  
Theory Approach ◽  
Content Type ◽  
Psychiatric Setting ◽  
Major Revision ◽  
Forensic Psychiatric Patients ◽  
Forensic Psychiatric

Purpose – The purpose of this paper is to explicate the lived experiences of nurses involved in rehabilitation of forensic psychiatric patients in special institutions in Zimbabwe. Design/methodology/approach – The study used the grounded theory approach utilising a mixed sequential dominant status design (QUAL/Quant). Pierre Bourdieu’s conceptual canon of field, habitus and capital was used as a theoretical point of departure by the research study. Confirmatory retrospective document review of 119 patients’ files was also done to substantiate the nurses’ experiences. Theoretical sampling of relatives was also done. Findings – Findings and results revealed that nurses seemed to experience infrahumanisation, a subtler form of dehumanisation. The infrahumanisation was embodied in the unpleasant context in which nurses were expected to perform their mandate of championing rehabilitation of forensic psychiatric patients. The guards who represented the prison system seemed to possess all forms of capital in the prison system (where special institutions are housed): the prison cultural capital, social capital and economic capital. This capital seemed to represent symbolic power over the disillusioned and voiceless nurses. Guards attended to and discussed patients and relatives issues instead of nurses. This form of misrecognition of the nurses culminated in dominance and reproduction of the interests of the prison system which underlined the established order of realities in the rehabilitation of forensic psychiatric patients in special institutions at the time of the study. The nurses’ lived experience was confirmed by theoretically sampled by relatives of forensic psychiatric patients who also participated in the research study. Nurses’ powerlessness was also reflected in the patients’ files in which in which care was largely not documented. Research limitations/implications – The study focused on the nurses experiences related to rehabilitation of male forensic psychiatric patients and not on female forensic psychiatric patients because there were important variables in the two groups that were not homogenous. For the little documentation that was done, there was also a tendency nurses to document negative rather than positive events and trends. The documents/files of patients had therefore a negative bias which was a major limitation to this study. Practical implications – There is a need for major revision of the revision of the role of the nurse in the forensic psychiatric setting. Collaboration as academia, practice, professional organisations and regulatory bodies would foster a nurse led therapeutic jurisprudence in the future of rehabilitation of forensic psychiatric patients in Zimbabwe. Social implications – There is a need for major revision of the revision of the role of the nurse in the forensic psychiatric setting. Originality/value – This is the first description of the position of nurses’ seconded to special institutions in Zimbabwe and will go a long way in realigning conflictual policy documents guiding care of forensic psychiatric patients in special institutions.

Self-injurious behaviour in forensic mental health care: a study into the prevalence and characteristics of incidents of self-injury

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Vivienne de Vogel ◽  
Nienke Verstegen
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Suicide Attempts ◽  
Psychiatric Patients ◽  
Forensic Mental Health ◽  
Content Type ◽  
Self Injury ◽  
Forensic Psychiatric ◽  
The Impact

Purpose Incidents of self-injury by forensic psychiatric patients often have a deleterious impact on all those involved. Moreover, self-injurious behaviour is an important predictor for violence towards others during treatment. The aim of this study is to analyse methods and severity of incidents of self-injury of patients admitted to forensic psychiatry, as well as the diagnoses of self-injuring patients. Design/methodology/approach All incidents of self-injury during treatment in a forensic psychiatric centre recorded between 2008 and 2019 were analysed and the severity was coded with the modified observed aggression scale+ (MOAS+). Findings In this period, 299 incidents of self-injury were recorded, displayed by 106 patients. Most of these incidents (87.6%) were classified as non-suicidal. Methods most often used were skin cutting with glass, broken plates, a razor or knife and swallowing dangerous objects or liquids. Ten patients died by suicide, almost all by suffocation with a rope or belt. The majority of the incidents was coded as severe or extreme with the MOAS+. Female patients were overrepresented and they caused on average three times more incidents than male patients. Practical implications More attention is warranted for self-injurious behaviour during forensic treatment considering the distressing consequences for both patients themselves, supervisors and witnesses. Adequate screening for risk of self-injurious behaviour could help to prevent this behaviour. Further research is needed in different forensic settings into predictors of self-injurious behaviour, more specifically, if there are distinct predictors for aggression to others versus to the self. Originality/value Incidents of self-injury occur with some regularity in forensic mental health care and are usually classified as severe. The impact of suicide (attempts) and incidents of self-injurious behaviour on all those involved can be enormous. More research is needed into the impact on all those involved, motivations, precipitants and functions of self-injurious behaviour and effective treatment of it.

The role of psychosocial treatment in decreasing of future violence behavior risk in forensicly treated psychiatric patients

2011 ◽  
Vol 26 (S2) ◽  
pp. 783-783
Author(s):  
S. Jonovska ◽  
V.Š. Jengić ◽  
L. Safner ◽  
G. Bošković ◽  
S. Zudenigo
Keyword(s):  
Psychiatric Patients ◽  
Violent Behavior ◽  
Psychosocial Treatment ◽  
Violence Risk ◽  
Forensic Psychiatric Patients ◽  
Forensic Treatment ◽  
Aggression Questionnaire ◽  
Schizophrenic Group ◽  
Forensic Psychiatric ◽  
In The Beginning

The main aim of this study was to establish to what extent psychosocial treatment as a part of complex, multicomponent forensic treatment has an influence on decreasing of the future violence behavior risk in population of forensic psychiatric patients. We examinated 13 patients treated on Department of Forensic Psychiatry of Psychiatric Hospital Rab in Rab, Croatia. 9 of them were males and 4 of them females, 25–60 years of age, all of them were compulsory hospitalized because of committed criminal act connected with violent behavior. All of them have diagnosis of schizophrenic group of diseases with different duration of forensic treatment (from few months to few years). During 2010. all of them participated in psychosocial programe workshops once a week, for 6 months.MethodsViolence Risk Screening-10 (V-RISK-10), subjective measure of the programme chairmen performed in the beginning and in the end of the programme. The Aggression Questionnaire and Daily Spiritual Experience Scale as self-assesment scales were performed in the end of the programme. Results point on decreasing of V-RISK-10 results in the end of the programe in all participants. Interested observation was that mentioned results and those on self-assesment scales were not always been correlated positively. We also proved negative correlation between aggressivity and spirituality. As a conclusion, we have indications to believe that is real to expect that comining psychosocial treatment with targeted psuchopharmacological interventions could leed to decreasing the risk of future violent bihevior in forensicly treated psuchiatric patients.

Forensic Psychiatric Patients’ Perspectives on Their Care: A Narrative View

2016 ◽  
Vol 54 (1) ◽  
pp. 64-73 ◽  
Author(s):  
Riitta Askola ◽  
Merja Nikkonen ◽  
Eija Paavilainen ◽  
Päivi Soininen ◽  
Hanna Putkonen ◽  
...  
Keyword(s):  
Psychiatric Patients ◽  
Forensic Psychiatric Patients ◽  
Forensic Psychiatric
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