The Treatment Perspectives of Mentally Ill Offenders in Medium- and High-Secure Forensic Settings in Flanders

• Author: Stijn Vanheule,Wing Ting To,Stijn Vandevelde,Stefaan De Smet
• Published date: 01 December 2015
• Date: 01 December 2015
• DOI: 10.1177/0306624X14566355
• Subject Matter: Articles

International Journal of

Offender Therapy and

Comparative Criminology

2015, Vol. 59(14) 1605 –1622

© The Author(s) 2015

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DOI: 10.1177/0306624X14566355

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Article

The Treatment Perspectives

of Mentally Ill Offenders in

Medium- and High-Secure

Forensic Settings in Flanders

Wing Ting To1, Stijn Vanheule2, Stefaan De Smet1,

and Stijn Vandevelde2

Abstract

There is an increasing interest in mentally ill offenders’ (MIOs) treatment experiences in

forensic settings. This study focuses on the treatment perspectives of MIOs in treatment

as well as in prison settings in Flanders. Seventeen MIOs were interviewed about the

treatment they received. Data were analyzed using thematic analysis to derive key

themes while acknowledging the individuality of the participants’ experiences. Treatment

perspectives of MIOs in both settings revolved around similar themes, including “good”

staff and privacy. However, their views differed on two themes: MIOs in treatment

settings reported on feelings of lacking control and experiencing too much pressure,

whereas MIOs in prison settings reported the opposite. The positive experiences in

prison settings may complicate the transition from prison to a forensic treatment setting.

The study further underscores the major challenge to create more opportunities for

MIOs to meet their needs of self-determination in secure forensic treatment settings.

Keywords

mentally ill offenders, treatment, service user perceptions, forensic mental health

Introduction

There is an increasing interest in gaining clients’ personal perspectives on care in

forensic mental health services (Coffey, 2006; Faulkner & Morris, 2003; Morrison,

Burnard, & Philips, 1996; Ryan et al., 2002; Sainsbury, Krishnan, & Evans, 2004;

1University College Ghent, Belgium

2Ghent University, Belgium

Corresponding Author:

Wing Ting To, Faculty of Education, Health and Social Work, University College Ghent, Voskenslaan

362, BE-9000 Ghent, Belgium.

Email: wingting.to@hogent.be

566355IJOXXX10.1177/0306624X14566355International Journal of Offender Therapy and Comparative CriminologyTo et al.

research-article2015

1606 International Journal of Offender Therapy and Comparative Criminology 59(14)

Wood, Thorpe, Read, Eastwood, & Lindley, 2008), contrary to the past, when little

attention was paid to psychiatric service users’ own views on their treatment (Rogers,

Pilgrim, & Lacey, 1993). Persons with mental health problems were seen to lack the

objectivity in determining the appropriateness and quality of treatment they received

(Lebow, 1982) and were deemed unable to give valid opinions (Weinstein, 1979).

However, mental illness does not preclude people from offering clear, valid, and

objective perspectives in the services they receive (Hoge et al., 1998; Lidz et al.,

1995). Service users’ views can inform professional responses to their complex needs

(Coffey, 2006) and may help to determine health needs, which could lead to improve-

ments in quality of life and increased satisfaction with services (Sullivan, 2003).

Mentally ill offenders (MIOs) residing in forensic institutions often have complex

support needs and multiple problems to address in treatment. A Belgian study showed

that approximately 75% of the imprisoned MIOs had a double or triple psychiatric

diagnosis (Cosyns, D’Hondt, Janssen, Maes, & Verellen, 2007). Another study found

that 45% of imprisoned MIOs showed co-morbidity of a major mental illness and a

substance abuse disorder (Young, 2003). The treatment of MIOs in forensic settings is

further challenging due to the dual objective of protecting society on one hand, while

treating the MIOs on the other hand. Recent publications on the rehabilitation of MIOs

emphasized the importance of pursuing treatment, rather than only concentrating on

risk reduction (Andrews & Bonta, 2010; Barnao, Robertson, & Ward, 2010; Robertson,

Barnao, & Ward, 2011; Ward & Brown, 2004; Ward, Yates, & Willis, 2012). In this

respect, the Good Lives Model of Offender Rehabilitation (Ward & Brown, 2004;

Ward et al., 2012) is a promising strength-based approach because of its focus on the

offender’s personal hopes, quality of life, and well-being, while addressing the offend-

er’s criminogenic needs (Ward et al., 2012). From this standpoint, efforts to disclose

how MIOs perceive treatment may be regarded as paramount in responding to the

MIOs’ complex support needs.

Previous international research on the service users’ perspectives in forensic mental

health services mostly focused on specific subgroups of MIOs such as older MIOs (De

Smet et al., 2014; Schroeder, 2013), forensic patients with personality disorders (Ryan

et al., 2002; Sainsbury et al., 2004), or MIOs with an intellectual disability (Wood

et al., 2008), as forensic mental health users are not homogeneous group. A review

study of Coffey (2006) pointed out that service users in forensic mental health valued

the therapeutic relationship and that providing supportive yet challenging therapeutic

assistance was helpful. Furthermore, institutional controls were seen as punitive and

negative experiences of professional responses were reported in relation to self-harm-

ing behavior, control and restraining procedures, and failing to establish clear thera-

peutic boundaries. Moreover, restrictions on liberty were a concern, and, finally,

communication of information needed to be improved.

To gain insight into the factors that might facilitate or hinder treatment of MIOs, the

current study aims to assess the perspectives of medium- and high-risk MIOs on their

treatment (admission, treatment, and discharge process) in forensic institutions in

Flanders, the northern part of Belgium. This is an interesting case, as the development

of forensic psychiatric treatment services, housing high- and medium-risk MIOs, is