A Comparison of English and Dutch Long-Stay Patients in Forensic Psychiatric Care.

Dhanuja Senn,Birgit Völlm,Erik Bulten,Jack Tomlin

doi:10.3389/fpsyt.2020.574247

Abstract

Background: A significant proportion of forensic patients in England are long-stayers. This can be problematic as individuals are kept in restrictive environments at potentially inappropriate levels of security for many years, sometimes decades. Improvements to the current English forensic mental health system to meet the needs of long-stay forensic patients more effectively might be informed by the Dutch service for long-stay forensic patients.Aims: To compare the characteristics of representative samples of long-stay patients in England and in the Netherlands in an attempt to draw conclusions on the degree to which the Dutch service model might be relevant to England.Method: This cross-sectional study explores the relevance of the Dutch service model by comparing the characteristics of representative samples of long-stay patients in England (n = 401) and the Netherlands (n = 102). Descriptive statistics and analyses of differences between groups are presented. The Risk-Need-Responsivity model was used to guide the selection of the study variables and structure the interpretation of the findings.Results: Compared to their English counterparts, the long-stay Dutch patients were less likely to be diagnosed with schizophrenia, but more likely to have personality disorder and have committed sex offences. The English group were younger at first conviction and at first custodial sentence. The total number of offences and the proportion of violent offenders were similar, but the Dutch HCR-20 scores indicated a significantly higher risk of violence.Conclusions: Whilst there may be barriers to adopting the Dutch service model in England, the differences in the characteristics of the two groups studied here do not necessarily preclude this approach.

Highlights

In England, forensic care is provided at three levels of security with most facilities providing services at a single security level
The current service model is based on a medical approach with emphasis on the mental health and security needs of the offender [1]; inpatient treatment is focused on ameliorating symptoms, lowering risk and facilitating reintegration into society [2]
(3) We have previously shown that there are more similarities than differences between the high and medium secure groups even in our United Kingdom (UK) sample of long-stay patients who appear to constitute a unique group not defined by level of security [28]

Summary

Introduction

In England, forensic care is provided at three levels of security (high, medium and low) with most facilities providing services at a single security level. The current service model is based on a medical approach with emphasis on the mental health and security needs of the offender [1]; inpatient treatment is focused on ameliorating symptoms, lowering risk and facilitating reintegration into society [2]. The duration of such hospitalization is not fixed, and a significant number of patients remain in forensic care for lengthy periods. A significant proportion of forensic patients in England are long-stayers This can be problematic as individuals are kept in restrictive environments at potentially inappropriate levels of security for many years, sometimes decades. Improvements to the current English forensic mental health system to meet the needs of long-stay forensic patients more effectively might be informed by the Dutch service for long-stay forensic patients

Methods

Results

Conclusion