Improving continuity of forensic mental health care

DOIhttps://doi.org/10.1108/JFP-04-2019-0012
Published date12 August 2019
Date12 August 2019
Pages180-189
AuthorVivienne de Vogel,Petra Schaftenaar,Maartje Clercx
Subject MatterHealth & social care
Improving continuity of forensic mental
health care
Vivienne de Vogel, Petra Schaftenaar and Maartje Clercx
Abstract
Purpose Continuity of forensic mental health care is important in building protective structures around a
patient and has been shown to decrease risks of relapse. Realising continuity can be complicated due to
restrictions from finances or legislation and difficulties in collaboration between settings. In the Netherlands,
several programs have been developed to improve continuity of forensic care. It is unknown whether
professionals and clients are sufficiently aware of these programs. The paper aims to discuss this issue.
Design/methodology/approach The experienced difficulties and needs of professionals and patients
regarding continuity of forensic care were explored by means of an online survey and focus groups. The
survey was completed by 318 professionals. Two focus groups with professionals (15 participants), one
focus group and one interview with patients (six participants) were conducted.
Findings The overall majority (85.6 percent) reported to experience problems in continuity on a frequent
basis. The three main problems are: first, limited capacity for discharge from inpatient to outpatient or
sheltered living; second, collaboration between forensic and regular mental health care; and, third, limited
capacity for long-term inpatient care. Only a quarter of the participants knew the existing programs. Actual
implementation of these programs was even lower (3.9 percent). The top three of professionalsneeds are:
better collaboration; higher capacity; more knowledge about rules and regulation. Participants of the focus
groups emphasized the importance of transparent communication, timely discharge planning and education.
Practical implications Gathering best practices about regional collaboration networks and developing a
blueprintbased on the best practices couldbe helpful in improving collaborationbetween setting in theforensic
field. In addition,more use of systematic discharge planningis needed to improve continuityin forensic mental
health care.It is important to communicate in an honest,transparent way to clients about their forensicmental
health trajectories, even if there aresetbacks or delays. More emphasis needsto be placed on communicating
and implementingpolicy programs in dailypractice and more education aboutlegislation is needed Structured
evaluations of programs aiming to improvecontinuity of forensic mental health care arehighly needed.
Originality/value Policy programs hardly reach professionals. Professionals see improvements in
collaboration as top priority. Patients emphasize the human approach and transparent communication.
Keywords Collaboration, Discharge planning, Continuity of care, Forensic treatment, Resocialisation,
Sheltered living
Paper type Research paper
Improving continuity of forensic mental health care
Forensic psychiatric patients form a specific group within psychiatric services with complex
needs (Skipworth and Humberstone, 2002). They frequently have severe psychopathology,
including comorbid substance use disorders, are not always intrinsically motivated for treatment
and their offending histories demand frequent risk assessments. The problems of many forensic
psychiatric patients are multidimensional and long-term supervision or enduring sheltered living
is often required to prevent recidivism. Fragmentation in care and frequent changes in
supervisors may be confusing and highly demotivating for these patients (Haggerty et al., 2003).
Disruptions in the mental health care trajectories of forensic patients can have deleterious
consequences, such as relapse in violent or criminal behavior and psychiatric instability (James
et al., 2013; Schaftenaar et al., 2018). More generally, providing continuity in mental health has
been identified as a focal point by the World Health Organization (World Health Organization,
2001). The importance of continuity in forensic mental health care to prevent recidivism is also in
Received 12 April 2019
Revised 11 June 2019
Accepted 17 June 2019
No potential conflict of interest is
reported by the authors. The
authors would like to thank all
professionals and patients who
participated in this study. This
study was funded by Grant KFZ
2018-79 from the Dutch program
Kwaliteit Forensische Zorg (Quality
of Forensic Care). The principles
outlined in the Declaration of
Helsinki were followed in
this study.
Vivienne de Vogel is based at
the Department of Research,
De Forensische
Zorgspecialisten, Utrecht,
The Netherlands and University
of Applied Sciences Utrecht,
Utrecht, The Netherlands.
Petra Schaftenaar is based at
Metis Zorg, Utrecht,
The Netherlands.
Maartje Clercx is based at FPC
de Rooyse Wissel, Oostrum,
The Netherlands.
PAGE180
j
JOURNAL OF FORENSIC PRACTICE
j
VOL. 21 NO. 3 2019, pp. 180-189, © Emerald Publishing Limited, ISSN 2050-8794 DOI 10.1108/JFP-04-2019-0012

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