Forensic psychiatry Rekem Belgium

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Forensic psychiatry Rekem(Belgium)
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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
• Challenges

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

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• 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

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• Historical background
• Problems complexity multiple handicaps offer
  gtgt 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

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Hospital

• Serious Minor
• Psychopathology
• Risk of relapse
• Escape risk
• Offence/act
• alcohol
• substance abuse
• sexual deviancy

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• Hospital
• Target group specific features

• Cross-border and disturbed autonomy
• Lack of practical skills
• Crimes
• Traumas
• Lack of social skills
• ..

• Disturbed perception
• Destructive aggression
• Impulsivity
• Disturbed conscience
• Disturbed expression of emotions and empathy
• High emotional tension

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HospitalCare network
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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

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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

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Contract

• Therapeutic project
• Cross-sectional consultation

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ContractForensic care network 2007
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Organisation

• Staff 110 FTEs / 214 patients -gt 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

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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 regular programme
  recognition sui generis?
• Specific supplementary security measures

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Challenges

• Medium risk intensive treatment-gt 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

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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

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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?

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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 gt fragmentation

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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
  multidimentional Foreign experiences good
  practices
• Knowledge centre 2008-2009