Forensic Psychiatry and Psychology in Europe

346 Pages·2018·3.871 MB·English

by  Kris Goethals

Forensic Psychiatry and
Psychology in Europe
A Cross-Border Study Guide
Kris Goethals
Editor
123
Forensic Psychiatry and Psychology
in Europe
Kris Goethals
Editor
Forensic Psychiatry and
Psychology in Europe
A Cross-Border Study Guide
Editor
Kris Goethals
Antwerp University Hospital,
University Forensic Centre (UFC) &
University of Antwerp, Faculty of Medicine
and Health Sciences
Collaborative Antwerp Psychiatric Research
Institute (CAPRI)
Edegem/Wilrijk
Belgium
ISBN 978-3-319-74662-3 ISBN 978-3-319-74664-7 (eBook)
https://doi.org/10.1007/978-3-319-74664-7
Library of Congress Control Number: 2018943755
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Why I See the Necessity for Such
a Study Guide
It is a pleasure for me to see the publication of the new book Forensic Psychiatry
and Psychology in Europe: A Cross-Border Study Guide, which has been edited by
Prof. Kris Goethals from the University of Antwerp. In this book, the editor brings
together authors from different countries and also from different disciplines that
discuss important issues affecting the sphere of forensic psychiatry regarding their
importance for the field and their consecutive relevance for the education and train-
ing of forensic psychiatrists. As the field of forensic psychiatry is characterized by
a blend of different professions that are involved in and cooperate during the legal
procedures, the treatment, and the rehabilitation of the patients, it is important that
young psychiatrists and psychologists in training are aware of the importance of this
interprofessional interactions and their presence in different countries. Furthermore,
it is dependent on the legislative and judiciary culture of a country in which way it
deals with psychiatrically ill offenders. The interaction of different agencies
involved in the process of dealing with psychiatrically ill offenders (multiagency
working) differs considerably between the European countries. To describe these
different cultures and their manifestations in the systems of forensic psychiatry in
different European countries provides an important basement for the discussion of
advantages and disadvantages of different approaches.
The concept of the book subdivides the contributions into five main categories or
areas that are legal frameworks, forensic services, mandatory skills, education, and
diverse issues.
The legal frameworks relevant to forensic psychiatry are discussed with respect
to the importance that the knowledge of different legal aspects has in the training of
forensic psychiatrists and psychologists in order to be able to exert their profession
in the field of forensic psychiatry. Here, the international aspect gains an ever
increasing importance as, specifically in Europe, legal institutions tend to converge.
Judgements from local courts in exempli gratia the countries of the European Union
(EU) are subject to evaluation by the European superior courts (European Court of
Human Rights). Furthermore, placement/hospitalization and treatment in psychiat-
ric hospitals and prisons are subject to review by the Committee for the Prevention
of Torture (CPT), which is an institution of the Council of Europe that is dedicated
to the surveillance of the regulations that have been fixed in the European Convention
for the Prevention of Torture. Furthermore, the study guide outlines the provision of
forensic services in different countries. From the differences and commonalities of
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vi Why I See the Necessity for Such a Study Guide
these implementations and their differential effects on criminological outcomes
interesting conclusions can be drawn that are very illustrative for trainees in forensic
psychiatry. Also important is the reflection of skills that are crucial for the work as
forensic psychiatrists. Here, not only language skills are necessary but also a deep
understanding of transcultural problems in psychiatry as well as in transcultural dif-
ferences in moral norms. These latter transcultural aspects gain an increasing impor-
tance not only due to the challenge of the European societies by migration from
poorer countries but also because of the increasing professional migration of physi-
cians that also affects forensic psychiatrists. Aside from such specific questions, it
has also to be discussed what professional requirements are present in different
countries for professionals working in forensic psychiatry.
Training in a medical specialty such as forensic psychiatry on the one hand relies
on theoretical knowledge, which can be obtained from the study of literature and
books such as this study guide. On the other hand medical training also requires
real-life interaction and discussion of the contents that have been theoretically stud-
ied. Naturally, the discussion of these aspects of different systems of forensic psy-
chiatry in different countries cannot succeed sufficiently when discussants from
only one country are present. Rather, such a discussion requires the participation of
discussants from these different cultural backgrounds and forensic psychiatric sys-
tems. In order to provide a training opportunity for young psychiatrists from differ-
ent European countries, the Ghent group has established an international European
summer school for forensic psychiatry. This summer school brings together senior
experts and junior professionals as well as trainees in forensic psychiatry from a
range of European countries. Therefore it is a perfect real-life counterpart of the
present study guide in order to further explore and differentiate the concepts of
forensic psychiatry and the approaches taken in different European countries.
This study guide is a very important contribution to the education of young psy-
chiatrists interested in forensic psychiatry. It provides a collection of important
insights and descriptions of how forensic psychiatry is carried out in several differ-
ent European societies. Moreover, it compares different aspects and allows for a
consideration and evaluation of the effects of the different approaches. This may in
the future contribute to a possible European convergence of systems while fostering
beneficial elements and attenuating more problematic elements.
Kolja Schiltz
Recommendations to the Practice of Teaching,
Training, and Research in Italy
The reform in Italy of treatment for mentally ill offenders led to the closure of
Forensic Hospitals, mainly hospital prisons, at the end of 2016: new facilities, resi-
dences for security measures (REMS), run totally by Mental Health Services, have
since been built. Furthermore, community services are currently taking charge of
the less dangerous patients not guilty by reason of insanity.
Psychiatrists, psychologists, nurses, and rehabilitation workers need to increase
their knowledge of juridical and forensic issues and should receive better training
due to the fact that therapeutic plans for forensic patients are currently very com-
mon in the network of Community Mental Health Services.
At the same time, health workers in prison have the responsibility of identifying
detainees suffering from mental illness as quickly as possible and must not only take
care of them but also involve the community services in their future treatment.
This complex change in Italy will transform the organization of the mental health
network without changing the “non-institutional” principle that led to the closure of
the psychiatric hospitals in 1978 (Law 180/78).
The personnel working in mental health, and in the juridical system, including
forensic psychiatrists and psychologists, judges, and any other parties who are
involved in the pathways of treatment and security needs, will be trained therefore
to have an active participation in the reform.
An initial training of health workers is currently underway, but it must be rein-
forced and become permanent. The main items to stress with the aim of improving
or introducing skills regarding treatment and assessment are, in my opinion:
knowledge of the legal framework
knowledge of the mental health network of facilities
a common language between juridical and medical systems for defining the
actions to be carried out
to introduce the methodology of risk assessment of violence
rehabilitation and recovery interventions inside REMS and in community
facilities
therapeutic techniques for patients with violent behaviour
It is necessary to develop a systematic and national work of research that would
be able to follow the changes inside the system.
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viii Recommendations to the Practice of Teaching, Training, and Research in Italy
REMS and the network of the mental health services currently look very differ-
ent and this can radically change the care pathways of the people who are sentenced
to security measures. The judges can adopt different decisions according to the level
of security that the REMS, or the community facilities, can guarantee.
University faculties, the National Health System, and the judicial system should
therefore promote a common plan of research that includes monitoring of the num-
ber of patients on security measures, their relapse or recidivism, the quality of the
treatment they receive, and any other item involved in this field.
The book by Goethals, and the co-authors, is a helpful instrument that describes
methodology and the entire process aimed at carrying out a survey of the system and
the implementation of a teaching and training programme. In the book there is a
contribution of an Italian colleague, who is working in a REMS of the Veneto
Region, and who shared with me his experience in the COST (Cooperation in
Science and Technology) Action IS1302 “Towards an European research frame-
work on forensic psychiatric care”. The Italian Reform is undoubtedly a courageous
experience that can demonstrate that it is possible to create a care pathway for men-
tally ill offenders within the network of a community health system.
I sincerely recommend reading it and paying attention to the suggestions in the
book and the network of European experts.
Franco Scarpa
Mental Health Services USL Toscana Centro
Pistoia, Italy
Contents
Part I L egal Frameworks
1 Adversarial Versus Inquisitorial Systems of Trial and 
Investigation in Criminal Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
John Gunn and Paul Mevis
2 National Laws and Their History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Vicenç Tort-Herrando, Nicoleta Tataru, and
Fernando-Luis Barrios-Flores
3 Legal Approaches to Criminal Responsibility of Mentally
Disordered Offenders in Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Michiel van der Wolf and Hjalmar van Marle
4 New Developments in Legal Systems and Their Impact
on Forensic Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Hans-Jörg Albrecht
5 The European Impact on National Forensic Psychiatry . . . . . . . . . . . 71
Anton van Kalmthout and Paul Mevis
Part II S ervice Provision and Frameworks
6 Mapping Offender-Patient Pathways . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Bradley Hillier, Christopher Lambourne, and Pamela Taylor
7 Organization and Funding of Forensic Psychiatric Facilities
Across Europe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Ellen van Lier and Vicenç Tort-Herrando
Part III Specific Skills
8 Challenging Language Barriers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Esperanza Gómez-Durán and Roland Jones
9 Multi-agency Working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Lindsay Thomson, Kris Goethals, Joachim Nitschke, and
Norbert Nedopil
ix
x Contents
10 The Roles of Forensic Psychiatrists and Psychologists:
Professional Experts, Service Providers, Therapists, or
All Things for All People? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Thierry Pham and Pamela Taylor
11 Forensic Psychotherapy in Forensic Mental Health . . . . . . . . . . . . . . 165
Frans Koenraadt, Gill McGauley✠, and Jochem Willemsen
Part IV Teaching and Training
12 Teaching Forensic Psychiatry and Psychology in Europe . . . . . . . . . . 183
Sheila Howitt and Lindsay Thomson
13 Specialist Training in Forensic Psychiatry in Europe . . . . . . . . . . . . . 199
Norbert Nedopil and Pamela Taylor
14 Impact of Service Organisation on Teaching and Training . . . . . . . . 211
Harry Kennedy, Luca Castelletti, and Owen O’Sullivan
15 Evidence-Based Treatment in Forensic Settings . . . . . . . . . . . . . . . . . 239
Norbert Schalast, Conni Lebbing, and Birgit Völlm
16 A European Perspective on Risk Assessment Tools . . . . . . . . . . . . . . . 249
Michiel de Vries Robbé and Vivienne de Vogel
17 Prioritizing Research in Forensic Psychiatry:
A European Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Florence Thibaut and Thierry Pham
Part V C apita Selecta
18 A (Possible) Role for International Associations in the Development
of Forensic Psychiatry Education and Training . . . . . . . . . . . . . . . . . . 279
Marc Hermans and Florence Thibaut
19 Deinstitutionalization Versus Transinstitutionalization . . . . . . . . . . . 293
Thomas Marquant and Francisco Torres-Gonzalez
20 Ethical Issues in Forensic Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Paul Cosyns
21 Pathways to Radicalisation and Violent Extremism . . . . . . . . . . . . . . 315
Thomas Marquant and Norbert Nedopil
22 Recommendations to the Practice of National Teaching,
Training and Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
Kris Goethals
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343