Dutch Forensic Flexible Assertive Community Treatment: Operating on the Interface Between General Mental Health Care and Forensic Psychiatric Care.

Berend H. Bulten,Fedde Sappelli,Meike G. de Vries,Marjam V. Smeekens

doi:10.3389/fpsyg.2021.708722

Abstract

In the Netherlands, Forensic Flexible Assertive Community Treatment (ForFACT) is used as a specialized form of outpatient intensive treatment. This outreaching type of treatment is aimed at patients with severe and long lasting psychiatric problems that are at risk of engaging in criminal behavior. In addition, these patients often suffer from addiction and experience problems in different areas of their life (e.g., financial debt, unemployment, or lack of daytime activities). The aim of this exploratory study was to gain more insight into the characteristics of the ForFACT patient population. More knowledge about these patients may enhance the effectiveness of ForFACT and therefore (further) reduce the risk of recidivism. Data on 132 ForFACT patients were gathered by studying electronic patient records, criminal records, and by conducting semi-structured interviews with practitioners and patients. Additionally, as part of a cognitive screening, two screening instruments were conducted to gain insight into intelligence and possible mild cognitive impairments. This article gives a broad description of the ForFACT patient population, including demographic data and context variables, diagnostics, recidivism risk and offense history, and aspects related to care. Furthermore, several recommendations are given to further improve ForFACT. Based on the results it can be concluded that the ForFACT patient population shows a high degree of diversity in complex care needs and responsivity issues. Therefore, this article highlights the necessity for ForFACT to collaborate with other mental health institutions, as well as probation officers, and forensic or criminal justice institutions. Moreover, it is important to continually check the inclusion and exclusion criteria when admitting patients to ForFACT, and to examine whether ForFACT is still the most adequate care for patients or if they need to be referred. In addition, the results emphasize the importance of cognitive screening for forensic outpatients. Finally, this study zooms in on the interface between forensic psychiatric care and general mental health care.

Highlights

In the last 60 years, the focus of psychiatric care in Western countries transitioned from conventional institutional settings to community-based services (Novella, 2008)
In the Netherlands, there is a policy stating that Forensic Flexible Assertive Community Treatment (ForFACT) may treat patients who are expected to show an elevated risk of criminal behavior if no forensic treatment would be offered, for instance for patients with serious socially disruptive behavior
The Dutch ForFACT teams partly operate in a preventive manner, since patients can be referred to ForFACT without a current conviction

Summary

Introduction

In the last 60 years, the focus of psychiatric care in Western countries transitioned from conventional institutional settings to community-based services (Novella, 2008). This process of deinstitutionalization led to the closure of many psychiatric hospitals, causing patients with severe mental health problems to be discharged. In the Netherlands, an adaptation of the ACT model was developed, called flexible ACT (Van Veldhuizen, 2007). This Dutch treatment model focuses on supporting and treating a broader group of patients with a prolonged need of mental health care. Flexible ACT teams ensure the continuity of care through their ability to (temporarily) (de)intensify treatment

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Results

Conclusion