Are Mentally Disordered Offenders Admitted to Appropriate Secure Settings according to Security Needs? A Cross Sectional Study in Belgium

Abstract

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.

Keywords:

• Mentally disordered offenders
• mental health services
• security
• forensic psychiatry
• HoNOS-secure

Acknowledgement

This study was part of the interuniversity research project: “For-Care, a realist evaluation of the Belgian policy reform program for mentally-ill offenders”. The study was funded by a grant from the Belgian Federal Public Service on Health, Food Chain Safety, and Environment (2016-2019), Grant No. [PSY/VL/03/2016/256117]. This study was carried out by the Vrije Universiteit Brussel (Pr. Mark Leys), the Institute of Health and Society (IRSS) of the Université catholique de Louvain (Pr. Vincent Lorant, Dr. Pablo Nicaise, Delphine Bourmorck), the Institute for International Research on Criminal Policy (IRCP) of the Universiteit Gent (Pr. Freya Vander Laenen, Pr. Wouter Vanderplaaschen, Marjolein De Pau, Sara Rowaert, Anouk Mertens), and the Université de Liège (Pr. Frédéric Schoenaers, Coralie Darcis, Sophie Thunus). We are grateful to the members of the Strategic Committee on Internment and Interment Center, who collaborated and supported the study and designed the experimental routine registration system. Data were provided by professionals across all the services. Their contribution was greatly appreciated.

Data availability statement

The dataset used for this study is property of the Strategic Committee on Internment and Interment Center, Belgian Federal Public Service on Health, Food Chain Safety, and Environment. Requests to access the datasets should be directed to Vincent Lefebvre ([email protected]).

Declaration of interest

The authors report no conflict of interest.