How family members of mentally ill offenders experience the internment measure and (forensic) psychiatric treatment in Belgium: A qualitative study

Abstract

Mentally ill offenders in Belgium can be subjected to mandated care under an "internment measure" if they are viewed as a danger to society. This study investigated how family members of mentally ill offenders experience this internment measure and view the (forensic) psychiatric treatment of their relative. Semi-structured interviews were conducted with 24 relatives and analysed using Nvivo 11. Six different themes emerged: (1) the criminal offence and the internment measure as an additional stigma, (2) ambivalent feelings towards the judicial system, (3) prison is not the right place to be, (4) mental health support as an answer to problems, (5) fight a losing battle, and (6) while there is life there is hope. The experiences of family members indicate the need for improved treatment guidelines that allow earlier compulsory interventions to prevent crime and preferential admission to (forensic) psychiatric facilities rather than prisons. In addition, family members expressed the need for better communication from mental health professionals and the judicial system during the process and greater availability of peer support.

Family Support Groups for Family Members of Mentally Ill Offenders: Therapeutic Factors

“…This may partly reflect the needs of the participating population of family members in our study. Indeed, family members of mentally ill offenders often feel strongly isolated, chronically burdened, and stigmatised by the mental illness and criminal offence, and that they lacked professional and social support both in our groups as well as in international research studies (Nordström et al., ; Rowaert, Vandevelde, Lemmens, & Audenaert, ; Tsang et al., ). Yet, other therapeutic factors – such as ‘interactional confirmation,’ ‘expressing mutual positive feelings,’ ‘experiencing positive feelings,’ ‘forgetting own problems through helping others,’ ‘hope from seeing progress in others,’ ‘guidance from therapists,’ and ‘getting interpersonal feedback’ – gradually become more frequently reported over the course of the intervention.…”

Family Support Groups for family members of mentally ill offenders: a pilot study

“…in terms of its format and content) which was designed to foster a context that enabled family members to disclose their emotions. This feature is important as many family members of PMIO are confronted with a diverse range of emotions, a double stigma, and poorer well-being, which warrants particular attention during treatment (Moses, 2010;Ridley et al, 2014;Rowaert et al, 2017;Tsang et al, 2002). Moreover, many participants were listened to by others (i.e., therapists and family members) for the first time, which may also have positively influenced their emotional well-being.…”

“…Research has shown that family members struggle with feelings of anxiety, powerlessness, and grief (Nordström, , Kullgren, & Dahlgren, 2006;Rowaert et al, 2016). As society tends to doubly stigmatise PMIO through the application of constructs including that of 'psychiatric patient' and 'criminal', they frequently experience guilt and shame, and feel socially isolated (Absalom-Hornby, Gooding, & Tarrier, 2011;Pearson & Tsang, 2004;Rowaert et al, 2016;Rowaert, Vandevelde, Lemmens, & Audenaert, 2017;Tsang et al, 2002). Family members reportedly struggle with feelings of (self-)blame which often exacerbates their perceived burdens and diminishes their sense of hopefulness (Moses, 2010).…”

A Family Support Group for Family Members of Offenders with a Mental Illness – Part 2: Treatment Protocol

“…This further increases their levels of stress (Rowaert et al., ). Despite these burdens, and the lack of support from family, friends, and professionals, many family members continue to support their relative, which only increases their needs (Loukissa, ; Marsh & Johnson, ; Rowaert, Vandevelde, Lemmens, & Audenaert, ; Wynaden, ).…”

“…Until now, few interventions have been developed to support family members of OMIs (Absalom, McGovern, Gooding, & Tarrier, ; Absalom‐Hornby, Gooding, & Tarrier, ; Geelan & Nickford, ). This might be due to the fact that family interventions in forensic settings may face particular challenges, including: the separate living arrangements of the OMI and their relatives; the distances between forensic services and the family members’ residence; the traumas family members experience (e.g., violence within the family, court proceedings, visits to prison) that are linked to the criminal activities and the relative's mental health problems (Fadden, ; Rowaert et al., , ). Forensic professionals often lack training in family‐based support, and appropriate facilities and/or time are often not available (Fadden, ).…”