The introduction of virtual reality in forensic mental healthcare - an interview study on the first impressions of patients and healthcare providers regarding VR in treatment.

Background: Recognizing the potential of Virtual Reality (VR) as a powerful technology to support behavior change, the careful introduction of this technology into treatment settings is essential. This is especially important in vulnerable populations like forensic psychiatric patients. This study aims to gain insight from the impressions of both patients and healthcare providers concerning the integration of VR in practice. The study aims to contribute valuable information that guides the introduction of VR technology, ensuring its optimal use in the complex context of forensic mental healthcare. Methods: Semi-structured interviews were conducted with healthcare providers (n = 10) working at forensic outpatient clinics and forensic psychiatric patients (n = 8). All participants experienced VR before the interview. Inductive thematic analysis was employed for analyzing the interview data. Results: Patients valued the unique opportunity to simulate personal experiences in VR scenarios and reflect on them with healthcare providers. In addition to positive first impressions, areas for improvement were identified, including the wish for enhanced realism and reduced physical discomfort while immersed in VR. Finally, important factors contributing to the successful introduction of VR were identified. For example, taking into account psychological distress experienced by patients or supporting healthcare providers with implementation resources. Conclusion: The integration of VR into forensic mental healthcare holds great potential for behavior change. However, its immersive characteristics also increase the chance of amplifying psychological distress. This emphasizes the need for caution when using VR- especially when a vulnerable patient group is subjected to triggering scenarios. This study advocates for a gradual introduction of the technology and provides valuable insights into essential elements for this introduction in clinical practice. It highlights that even the initial step of integrating VR into practice - the introduction phase - demands careful planning and a personalized approach. This underscores the need for ongoing refinement and a systematic approach to the overall implementation of VR. These efforts are crucial to fully realize its potential in clinical practice.

[Intoxicated women: A study into gender differences in substance abuse in forensic psychiatric patients]. / Vrouwen onder invloed: een studie naar genderverschillen in middelengebruik bij forensisch psychiatrische patiënten.

BACKGROUND: Substance abuse is an important risk factor for (violent) offending, but is mostly studied in male populations. More knowledge about women is needed.
AIM: To gain insight into possible gender differences in substance abuse and offending in forensic psychiatric patients.
METHOD: Files were analysed of 275 women and 275 men who have been admitted between 1984 and 2014 to one of four Dutch forensic psychiatric facilities and related to incidents of violence during treatment or recidivism after discharge (for 78 women).
RESULTS: Although substance abuse was common in women (57%), it was significantly more prevalent in men (68%). Men were more often diagnosed with substance dependency and more often committed the index-offense whilst intoxicated. Predictive accuracy for violent incidents during treatment was better for men. Both women and men with substance abuse had significantly more historical risk factors compared to those without substance abuse. A history of substance abuse was not a significant predictor for recidivism after discharge in women.
CONCLUSION: There are gender differences in substance abuse and the relationship with offending was stronger for men. These differences may have implications for substance use treatment in forensic mental health services.

Development of the forensic inpatient quality of life questionnaire: short version (FQL-SV).

PURPOSE: Aim of this study was to develop a brief version of the Forensic inpatient Quality of Life questionnaire (FQL). METHODS: Data from a longitudinal study of quality of life (QoL) among long-term forensic psychiatric care (LFPC) patients (N = 130) were used. Per domain, the FQL item that correlated most highly with the mean domain score and Overall QoL was selected. Internal consistency was investigated by calculating Cronbach's alpha. Construct validity was examined by investigating the relationship with the WHOQOL-Bref and EssenCES. RESULTS: The original division into 15 QoL domains was retained, while the number of items per domain was reduced to one or two. The amount of subjective items was shortened from 114 items to 19 items. Reliability analysis demonstrated good internal consistency (Cronbach's α = .79). Content validity was assured because the FQL-SV is based on the items of the original FQL that was derived from LFPC patient's and staff's opinions. Construct validity was demonstrated. CONCLUSIONS: This study has shown that the FQL-SV is a psychometrically valid abbreviation of the FQL and can therefore be used to monitor or assess QoL in forensic psychiatric care. However, when certain domains should be targeted in treatment, the FQL (full version) can assist both the patient and the clinician to get a more complete view of the individualized targets they should be aiming at in order to improve QoL.

[The quality of life of patients in long-term forensic psychiatric care]. / Kwaliteit van leven van patiënten in de langdurige forensische psychiatrie.

BACKGROUND: Quality of life (QoL) is an important issue in long term forensic psychiatric care (LFPC).
AIM: To provide an overview of the knowledge that has been obtained over the last few years about patients' QoL in LFPC.
METHOD: The quality of life in LFPC has been researched every year since 2007. The research has involved the use of the Forensic Inpatient Quality of Life Questionnaire (FQL) which was developed specifically for patients in LFPC. During the longitudinal research project several studies were conducted in order to identify some of the factors that possibly define patients' QoL.
RESULTS: The QoL of patients in LFPC seems to depend less on patient characteristics and more on the environmental circumstances and on the degree to which the patients have accepted these circumstances. Research has also shown that professional carers do not seem to be sufficiently aware of the QoL of their patients.
CONCLUSION: The fact that it is mainly environmental circumstances that are being associated with QoL offers a positive perspective on improving/optimizing QoL of patients in LFPC. Professional carers could, for instance, be trained to discuss QoL with their patients in a structured manner. This would enable carers to identify potential aspects that require further improvement and to optimise these aspects in discussion with their patients.

[Violent women: a multicentre study of the characteristics of female forensic psychiatric patients]. / Gewelddadige vrouwen: een multi-centeronderzoek naar kenmerken van vrouwelijke forensisch psychiatrische patiënten.

BACKGROUND: Violence perpetrated by women has attracted more and more attention in the past few years. However, there is lack of background information about women admitted to forensic psychiatric hospitals and about risk factors for recidivism. AIM: To conduct a multicenter study which will give more insight into female psychiatric patients and which will probably have implications for psychodiagnostics, risk assessment and treatment in (forensic) psychiatric settings. METHOD: We coded the files of 297 women who, between 1984 and 2013, had been admitted to one of four Dutch forensic psychiatric facilities by reason of violent delinquent behaviour. We used an extensive coding list and several risk assessment tools including the recently developed Female Additional Manual (fam) for women. RESULTS: The general picture that emerged was one of severely traumatised women with complex pathology and a high level of comorbidity. Many of the women had experienced previous treatment failures and had caused many incidents during treatment. CONCLUSION: Female forensic psychiatric patients are a complex group that deserves more specific attention. Attention for traumas from the past, intensive supervision in relationships and training for staff in dealing with, for instance, manipulative behaviour are the most important implications from this study.