Patient profiles in high-security forensic psychiatry in Flanders

Abstract

Recent research emphasizes the importance of personalized treatment in forensic psychiatry. However, the heterogeneity of forensic patients regarding psychopathology, offenses and risk and protective factors makes it difficult to provide personalized treatment. To facilitate the treatment indication process, previous research has developed patient profiles with corresponding treatment trajectories to compare individual patients with more homogeneous groups. The current study applied latent class analysis in 399 high-security patients in the two Forensic Psychiatric Centres in Flanders, based on their psychopathology, criminal history and risk and protective factors (Historical Clinical Future - Revised; HKT-R). Five patient profiles were found: the antisocial patient, the psychotic patient with diverse criminal behaviour, the patient with a personality disorder and multiple problems, the psychotic patient with physical violent crimes and the patient with a paraphilic disorder and sexual crimes. Similarities and differences from previous research and the importance to clinical practice and research are discussed.

Key words:

• criminal history
• forensic psychiatry
• latent class analysis
• patient profiles
• protective factors
• psychopathology
• risk factors

Ethical standards

Declaration of conflicts of interest

Sophie Verschueren has declared no conflicts of interest

 Inge Jeandarme has declared no conflicts of interest

 Ruben van den Ameele has declared no conflicts of interest

 Bert Buysschaert has declared no conflicts of interest

 Stefan Bogaerts has declared no conflicts of interest

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. The research was limited to use of the descriptive database of inpatient characteristics compiled by employees of the forensic psychiatric centres involved in the study. Full ethical approval was granted by the Commission Scientific Research and the local Ethical Committee of the FPC NV.

Notes

1 An HKT–R >assessment was not performed if the patient had been hospitalized only for a short time (n = 10), if the patient was only recently admitted and a HKT–R assessment was planned but not yet performed (n = 18), if the patient only committed a non-violent stalking crime (n = 6), or if the patient only committed a non-violent sexual crime or a sexual crime against a minor (n = 68). For the last patient group, the Sexual Violence Risk − 20 (SVR–20; Hildebrand et al., 2001) or Static–99R (van den Berg et al., 2017) and Stable–2007 (Smid et al., 2017) were used to assess the risk of recidivism, because these tools are substantially validated to predict the risk of sexual and violent crimes for sex offenders. Moreover, the HKT–R is not validated as a risk assessment tool for offenders who only committed sexual crimes against minors. For patients who were only convicted for a non-violent stalking crime, the Stalking Risk Profile (MacKenzie et al., 2009) was used to assess the risk of stalking. Certain groups of patients could thus not be included in the study due to the nature of their crimes. However, these groups are rather small (11.7%).