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Contains fulltext : 306746.pdf (Publisher’s version ) (Closed access), Forensic mental health professionals are frequently exposed to inpatient aggression, which may negatively affect their physical and mental health. Current studies offer limited insight into how this may affect staff-patient interactions in the aftermath of aggression. A qualitative study was conducted to explore professionals' experiences with exposure to aggression. Thirteen semi-structured interviews and three focus groups were conducted with 25 professionals working in a high secure forensic mental health unit. A thematic analysis was conducted in consensus among three researchers. Five main themes were generated in the analysis: exposure to different forms of aggression, factors that shape the impact of aggression, emotional reactions, managing emotional reactions, and managing relationships with patients. These themes form a complex interplay. Feelings of anger and fear, intrusive memories, and avoidant or agitated behavior toward patients are frequently reported, affecting both the personal and professional lives of participants. Interpersonal relationships between team members can promote or hinder adequate management of feelings that arise after exposure to aggressive incidents. The tremendous impact that exposure to inpatient aggression may have on professionals, and the way that they care for their patients requires more attention., 21 mei 2024, 12 p.

Item does not contain fulltext, Background: Violent criminal offenders with personality disorders (PD's) can cause immense harm, but are often deemed untreatable. This study aimed to conduct a randomized clinical trial to test the effectiveness of long-term psychotherapy for rehabilitating offenders with PDs. Methods: We compared schema therapy (ST), an evidence-based psychotherapy for PDs, to treatment-as-usual (TAU) at eight high-security forensic hospitals in the Netherlands. Patients in both conditions received multiple treatment modalities and differed only in the individual, study-specific therapy they received. One-hundred-three male offenders with antisocial, narcissistic, borderline, or paranoid PDs, or Cluster B PD-not-otherwise-specified, were assigned to 3 years of ST or TAU and assessed every 6 months. Primary outcomes were rehabilitation, involving gradual reintegration into the community, and PD symptoms. Results: Patients in both conditions showed moderate to large improvements in outcomes. ST was superior to TAU on both primary outcomes - rehabilitation (i.e. attaining supervised and unsupervised leave) and PD symptoms - and six of nine secondary outcomes, with small to moderate advantages over TAU. ST patients moved more rapidly through rehabilitation (supervised leave, treatment*time: F(5308) = 9.40, p < 0.001; unsupervised leave, treatment*time: F(5472) = 3.45, p = 0.004), and showed faster improvements on PD scales (treatment*time: t(1387) = -2.85, p = 0.005). Conclusions: These findings contradict pessimistic views on the treatability of violent offenders with PDs, and support the effectiveness of long-term psychotherapy for rehabilitating these patients, facilitating their re-entry into the community.

This study aimed to examine the unique predictive validity of debt regarding recidivism and what elements are specifically predictive. This was done based on a Dutch sample of 250 people on probation using an explorative research tool, the Finances, Debt, and Offending Scale (FDOS). Cox survival regression and receiver operating characteristics analyses were conducted on the total FDOS and its individual items as predictors and diverse recidivism criteria. The average follow-up duration was 5.41 years. The results show that debt moderately predicts recidivism (adjusted for other predictors). The FDOS significantly predicted recidivism on all three levels of severity, and regarding the type of crime, it predicted recidivism in property and drug-related crime. Earlier debt and probation officers’ indications of whether finances are criminogenic were especially predictive. These insights may help frontline service providers better understand the role of finances in recidivism, measure financial problems in risk assessment, and select interventions.

The probationer–probation officer working alliance plays an important role in the outcome of probation supervision. This study explored the development of the working alliance between probationers and probation officers in the Netherlands, from the perspective of both probationers and probation officers. More specifically, we explored the significance of different aspects of the working alliance at the start of probation supervision and after a three-month period, as well as the role played by critical incidents during the supervisory process and their subsequent effect on the working alliance. Overall, the study showed that clarity over goals and restrictions was initially the most salient issue for both parties, and that after a three-month period the working alliance evolved into a trusting relationship. Several incidents were identified, probationers identified more positive moments and less negative moments than their PO counterparts. If these types of incidents are managed accordingly by the probation officer, then they can ultimately serve to strengthen the relationship.

Item does not contain fulltext, In high security forensic institutions, patients are sometimes placed on small-scale wards to be treated individually if their psychiatric condition and behaviour do not allow for them to live and interact more freely with other patients. On these so-called individual wards, there is little contact between patients and more security measures are in place, such as higher numbers of staff members per patient than on group wards. The present study investigated the experienced safety of staff members (n = 41) and patients (n = 21) of such individual wards, compared to staff members (n = 55) and patients (n = 55) of group wards with the Essen-CES. The mean item score on the scale experienced safety of the Essen-CES for the entire sample was 2.1 (SD = .9) with a range from 0 to 4 and higher scores reflecting a higher experienced safety. Staff on individual wards had a significantly lower experienced safety than patients on both ward types and staff on group wards. It is advised, therefore, to implement additional measures to support professionals who work on these individual wards.

Item does not contain fulltext, Background: Victimization is highly prevalent in individuals with mild intellectual disability (MID) or borderline intellectual functioning (BIF) and is an important risk factor for mental health problems and violent behavior. Not much is known, however, about victimization history in women with MID-BIF admitted to forensic mental health care. Aims: The aim of this multicenter study is to gain insight into victimization histories and mental health problems of female forensic psychiatric patients with MID-BIF. Methods: File data were analyzed of 126 women with MID-BIF who have been admitted to one of five Dutch forensic psychiatric hospitals between 1990 and 2014 and compared to data of 76 female patients with average or above intellectual functioning and to a matched sample of 31 male patients with MID-BIF. Results: All forensic patients had high rates of victimization, but women with MID-BIF showed an even higher prevalence of victimization during both childhood and adulthood and more complex psychopathology compared to female patients without MID-BIF. Compared to male forensic patients with MID-BIF, women with MID-BIF were more often victim of sexual abuse during childhood. During adulthood, the victimization rate in these women was more than three times higher than in men. Conclusions: Victimization is a salient factor in female forensic patients with MID-BIF and more gender-responsive trauma-focused treatment is needed.

Item does not contain fulltext, Verlof is een essentieel onderdeel van de tbs-behandeling. We analyseerden 1313 aanvragen voor begeleid verlof, ingediend tussen 2010-2018 bij het AVT, om patronen in de beoordeling, de duur tot de eerste aanvraag en patiëntkenmerken die daarop van invloed zijn te onderzoeken. De resultaten laten een min of meer constant hoog percentage van positief geadviseerde verlofaanvragen zien. Diagnoses, type delict of HKT-variabelen hangen weliswaar significant, maar zwak samen met het type advies en de duur in maanden tot de eerste begeleid verlofaanvraag. Deze duur neemt in de jaren gestaag af. Het toekennen van begeleid verlof is gebaseerd op de individuele weging van het risicomanagement.

04 april 2022, Item does not contain fulltext, Forensic psychiatric inpatients are frequently exposed to aggression from fellow patients during their treatment, but research on how this impacts patients' well-being and treatment progress is lacking. In this study, we interviewed nine patients on their experiences of victimization during mandatory psychiatric treatment. The interviews were analyzed using a Grounded Theory approach combined with elements from Consensual Qualitative Research and Interpretative Phenomenological Analysis. Three main themes emerged from the data, namely situational descriptives, intrapersonal and interpersonal consequences. Patients were not only exposed to both physical violence and verbal aggression by other patients, but also to a more ubiquitous flow of micro-aggressive comments. Options to escape these situations were limited. This means that victimization processes, which for most patients started much earlier in life, continue during forensic psychiatric treatment. Intrapersonal consequences include fear, hypervigilance, reactive aggression, flashbacks and avoidance and withdrawal. Interpersonal consequences include increased power differences between patients and adverse treatment consequences, such as difficulties with self-esteem. Victimization processes are not always timely noticed in an environment that focuses on risks and treatment of delinquent behavior. A higher level of trauma sensitivity in forensic mental health care is thus required. Recommendations for the implementation of trauma informed care are provided.

Item does not contain fulltext, Insomnia has a negative impact on mental health and is a potential risk factor for impulsive and problematic behavior. This multicenter, cross-sectional study investigated the prevalence of insomnia and underlying and maintaining factors in a group of forensic psychiatric inpatients (N = 281). Insomnia severity, subjective sleep quality, sleep hygiene and erroneous cognitions about sleep were measured with the Insomnia Severity Index, Pittsburgh Sleep Quality Index, Sleep Hygiene questionnaire and Dysfunctional Beliefs and Attitudes about Sleep, respectively. Impulsivity was derived from risk assessment instruments routinely completed by trained professionals. Almost half of the patients (48.7%) appeared to suffer from insomnia. Particularly moderate-severe insomnia (26.7%) was significantly associated with worse sleep quality, poorer sleep hygiene, stronger endorsement of dysfunctional sleep cognitions and higher impulsivity scores. It can be concluded that insomnia is rather common in forensic psychiatric patients. Insomnia appears related to various sleep hygiene behaviors and sleep-related cognitions, and probably also to diverse situational and environmental factors as well as a lack of autonomy. Cognitive behavioral therapy for insomnia, with some adjustments specific for this population, may be an effective intervention, ameliorating sleep problems and possibly also emotional and behavioral dysregulation.

Item does not contain fulltext, Achtergrond: Verlof is een essentieel onderdeel van behandeling in het kader van de tbs-maatregel. Van oudsher leiden deze verloven tot zorgen over de veiligheid. Doel: Onderzoeken hoe vaak tbs-patiënten niet (op tijd) van verlof terugkeren en hoe vaak zij tijdens een ongeoorloofde afwezigheid (OA) een delict plegen. Daarnaast onderzoeken we of patiënt- of delictkenmerken een OA kunnen voorspellen. Methode: Alle OA's van 2009-2020 werden in kaart gebracht. Daarnaast analyseerden we patiëntkenmerken van 11.525 verlofaanvragen tussen 2010 en 2018 afkomstig uit het registratiesysteem van het Adviescollege Verloftoetsing TBS (AVT). Resultaten: Bij 2,5% van de verlofaanvragen in 2009-2020 was er een OA en bij 0,15% een OA met een recidive. Patiënten met een cluster B-persoonlijkheidsstoornis, een aan middelen gebonden stoornis, stemmingsstoornis, aandachtsstoornis, brandstichting of een ernstig geweldsdelict als indexdelict hadden een significant hogere kans op een OA. Deze relaties waren echter zeer zwak. De HKT-risicofactor ‘overtreding voorwaarden’ was tevens een significante, maar zeer zwakke voorspeller voor OA. Conclusie: Een OA is een zeldzame gebeurtenis. Hoewel enkele patiënt- en delictkenmerken gerelateerd waren aan een OA is het verband zwak en het voorspellen van een OA moeilijk.

Item does not contain fulltext, Therapy alliance has been studied largely in voluntary psychotherapy but less is known about its predictive factors for positive alliance and treatment outcome in forensic populations. The aim of this study was to examine the relationship between offenders' emotional states and therapy alliance. Moreover, we were interested in the predictive impact of emotional states early in treatment on alliance at 18 months into treatment. Self-ratings of emotional states and alliance by 103 male offenders, and therapist-ratings for therapy alliance were examined using hierarchical multiple regression analyses. Participants were primarily convicted for violent of sexual offenses, and were diagnosed with antisocial, borderline or narcissistic personality disorders. Healthy emotional states were predictive of mid-treatment agreement on therapy goals and therapist ratings on tasks within the therapy. Unhealthy emotional states were predictive of patient-rated agreement on tasks. Emotional states were not predictive for the reported therapist/patient bond or global alliance ratings. This study emphasizes the importance of healthy emotional states in treatment of offenders with personality disorders.

BACKGROUND: Leave is an essential part of treatment within the framework of the tbs measure (court ordered psychiatric treatment for offenders with a mental disorder). Traditionally, these leaves lead to concerns about safety.AIM: To study how often tbs-patients do not return from leave (on time) and how often they commit a crime during an unauthorized absence (UA). In addition, we investigate whether patient or offence characteristics can predict an UA.METHOD: All UA’s between 2009-2020 were examined. We also analysed the patient characteristics of 11,525 permit applications between 2010 and 2018 from the registration system of the Advisory Board for Permitting Leave TBS (AVT).RESULTS: 2.5% of the applications for leave between 2009 and 2020 involved an UA and 0.15% involved an UA with a recidivism. Patients with a cluster B personality disorder, substance use disorder, mood disorder, attention disorder, arson or a serious violent crime as an index offence had a significantly higher chance of having an UA. However, these associations were very weak. The risk factor violation of conditions (from the Dutch risk assessment tool, the HKT (Historical, Clinical, Future)) was also a significant but very weak predictor of UA.CONCLUSION: UA is a rare event. Despite the fact that some patient and offence characteristics were associated with an UA, this relationship is weak and predicting an UA is difficult.

Although studies point to a relationship between debt and crime, there is a limited understanding of their reciprocal relationship and possible mediating risk factors. Moreover, knowledge about the prevalence and scope of debt among offenders is lacking. Therefore, the present study analyzed 250 client files including risk assessment data from the Dutch probation service on the prevalence of debt and possibly related risk factors. The results show that debt is highly prevalent and complex, which underlines the importance of acquiring more knowledge about debt as a potential risk factor for relapse during supervision. It was found that problems with regard to childhood and living situation, education and work/daytime activities, and mental and physical health may be possible underlying risk factors in the relationship between debt and crime. These insights can help professionals adequately support clients with regard to debt in order to prevent recidivism.

Little research exists on what works in the supervision of offenders with debt problems. This qualitative study aims to provide insight into the barriers probation officers and clients experience during supervision regarding debt and the support that clients need. Interviews were conducted with 33 Dutch probation officers and 16 clients. The results show that debt often negatively influences clients’ lives and hinders their resocialization. Probation officers lack effective methods to support clients with debt problems. To adequately help clients with debt problems, probation officers should obtain more knowledge about effective interventions and collaborate more closely with debt specialists from the probation supervision outset.

15 juni 2021, Item does not contain fulltext, Background: Violent criminal offenders with personality disorders (PD's) can cause immense harm, but are often deemed untreatable. This study aimed to conduct a randomized clinical trial to test the effectiveness of long-term psychotherapy for rehabilitating offenders with PDs. Methods: We compared schema therapy (ST), an evidence-based psychotherapy for PDs, to treatment-as-usual (TAU) at eight high-security forensic hospitals in the Netherlands. Patients in both conditions received multiple treatment modalities and differed only in the individual, study-specific therapy they received. One-hundred-three male offenders with antisocial, narcissistic, borderline, or paranoid PDs, or Cluster B PD-not-otherwise-specified, were assigned to 3 years of ST or TAU and assessed every 6 months. Primary outcomes were rehabilitation, involving gradual reintegration into the community, and PD symptoms. Results: Patients in both conditions showed moderate to large improvements in outcomes. ST was superior to TAU on both primary outcomes - rehabilitation (i.e. attaining supervised and unsupervised leave) and PD symptoms - and six of nine secondary outcomes, with small to moderate advantages over TAU. ST patients moved more rapidly through rehabilitation (supervised leave, treatment*time: F(5308) = 9.40, p < 0.001; unsupervised leave, treatment*time: F(5472) = 3.45, p = 0.004), and showed faster improvements on PD scales (treatment*time: t(1387) = -2.85, p = 0.005). Conclusions: These findings contradict pessimistic views on the treatability of violent offenders with PDs, and support the effectiveness of long-term psychotherapy for rehabilitating these patients, facilitating their re-entry into the community.

Item does not contain fulltext, 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.

Contains fulltext : 219929.pdf (Publisher’s version ) (Closed access), This study explores variables that predict physical violence in 614 (forensic) psychiatric inpatients. All violent incidents that occurred in a Dutch forensic psychiatric hospital between 2014 and 2019 (N = 3,713) were coded with the Modified Overt Aggression Scale+ based on daily hospital reports and patients' medical records. Binary logistic regression analyses examined which patient variables could differentiate between patients with and without physical violence during treatment and between patients with single and multiple incidents of physical violence. Variables included in the analyses were gender, legal status, borderline personality disorder, antisocial personality disorder, schizophrenia spectrum disorder, psychopathy (Psychopathy Checklist-Revised [PCL-R] score), self-harm during treatment, impulsivity, intellectual disability, and length of stay. A clear association was found between self-harm and inpatient physical violence on all outcome measures and in all analyses. Adequate monitoring of self-harm is advised as a strategy to early identify patients with a high risk to threaten ward safety.

Currently, implementation research in the field of forensic risk assessment is limited and consensus on "implementation success" is lacking. This study applies outcomes of success from implementation science to the implementation evaluation of the Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV) in a residential youth care facility in the Netherlands. Staff perceptions on the implementation and the instrument were assessed using 5 implementation outcomes in a longitudinal multimethod design: acceptability, adoption, appropriateness, feasibility, and penetration. As anticipated, the majority of staff perceived START:AV core constructs as useful for treatment (appropriateness). However, satisfaction with the instrument decreased over time (acceptability). This was likely due to an increased workload (feasibility). Despite this dissatisfaction, the completion rate was acceptable (adoption). Lastly, staff reported a lack of integration of the START:AV findings in clinical case conferences (penetration). The implementation outcomes aid in identifying areas for improvement, which in turn can lead to an increased and more consistent uptake of structured risk assessment into routine practice.