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The Trinitarian model of therapeutic security is used to organize forensic mental health care in Ireland, England and Scotland. However, it remains unclear whether this model captures all significant factors for the organization of forensic mental health care delivery. In this case study, the Trinitarian model is applied to and tested on Belgian forensic mental health services. Relational security as a discriminative factor is debated and an extension of this institution-oriented model to the policy-and service users' level is recommended. Finally, we propose to disentangle the concepts of therapeutic security, risk and care in forensic mental health.

Mentally Disordered Offenders (MDOs) who have been declared not criminally responsible for their offense due to their mental condition should be admitted to settings with lowest possible level of security to support their social reintegration. In the context of the reorganization of care for MDOs in Belgium, we assessed the predictors and retrospective appropriateness of 3529 MDO admissions in 2017 according to security needs. Although there was a positive association between the security needs of MDOs and the level of security of the settings to which they were admitted, there was a gap between high and lower security levels. Medium-security settings made up 46% of all admissions, covering a variety of security need profiles. Half the sample of MDOs with high security needs was found in low-and medium-security settings, while a significant proportion of MDOs with low security needs was found in medium-security settings. Clinical characteristics predicted admissions more strongly than custodial characteristics. Decision-makers should refine criteria and procedures for MDOs' care access. Indeed, the mixed results in relation to admission appropriateness in medium-security services may result from the lack of formal guidelines.

IntroductionDe-institutionalization of psychiatric care has greatly increased the role of family members in the recovery pathways of Persons labeled as Not Criminally Responsible (PNCR). However, the role of family members in supporting PNCR in forensic psychiatric care remains understudied. Scarce evidence indicates that PNCR have to deal with stigma and endure specific burdens (i.e., symptom-specific, financial, social, and emotional). Recovery-focused research showed that recovery in both persons with a severe mental illness and family members develop in parallel with each other and are characterized by similar helpful principles (e.g., hope and coping skills). As such, the recovery pathways of PNCR often goes hand in hand with the recovery pathway of their family members. During the family recovery process, family members often experience not being listened to or being empowered by professionals or not being involved in the decision-making process in the care trajectory of their relative. Therefore, the aim of this study is to capture how family members experience the care trajectories of their relatives, more specifically by looking at family recovery aspects and personal advocacy of family members.MethodsSemi-structured interviews were conducted with 21 family members of PNCR from 14 families. A thematic analysis confirms that family members suffer from stigma and worry significantly about the future of their relative.ResultsRegarding the care trajectory of PNCR, family members experienced barriers in multiple domains while trying to support their relative: involvement in care and information sharing, visiting procedures, transitions between wards, and the psychiatric and judicial reporting by professionals. In addition, family members emphasized the importance of (social) support for themselves during the forensic psychiatric care trajectories and of a shared partnership.DiscussionThese findings tie in with procedural justice theory as a precondition for family support and family recovery within forensic psychiatric care.

Racialized people who are labeled Not Criminally Responsible (NCR) are relatively overrepresented in forensic mental healthcare. In this respect, it is essential to provide culturally sensitive treatment in forensic mental healthcare in an attempt to reduce ethnic disparities. Both general mental healthcare and prison settings are actively exploring and producing empirical knowledge on culturally sensitive treatment, but it remains unclear what evidence is available for forensic mental healthcare delivery. To answer this question, a scoping review is conducted. Three databases (i.e. Medline, Web of Science and APA PsycArticles) were systematically searched for any qualitative, quantitative or theoretical paper about practices or treatment focused on racialized people labeled as NCR in forensic mental healthcare. In total, 551 articles were retrieved. After a detailed selection procedure by two independent researchers, only a small number of eligible articles (<10) were retained. Research on cultural practices in forensic mental healthcare seems to be predominantly based in Western countries and conducted in the last decade. Thematically, the research efforts are targeted toward culturally sensitive assessment tools, therapeutic interventions and programs, and forensic care organization. This study demonstrates how this research field is still in its early stages. There is an undeniable lack of evidence considering culturally sensitive therapeutic frameworks or approaches in forensic mental healthcare. In conclusion, it is imperative that this topic firmly emerges on the research agenda.