Self-perceived views on offender rehabilitation in detained adolescent boys: a qualitative analysis in the context of the good lives model.

Introduction: An upcoming offender rehabilitation model, the Good Lives Model (GLM), proposes that effective offender rehabilitation should adopt a dual focus: reducing recidivism risk as well as enhancing the offender's well-being. To achieve this, the GLM suggests rehabilitation should include the prosocial fulfilment of a universal set of human needs termed "primary goods." A focus on primary goods attainment and well-being is hypothesized to improve treatment motivation and achieve more sustainable desistance from future offending. Although this model sounds promising, empirical evidence for these assumptions is limited, especially among youth. Methods: Twenty Flemish and Dutch detained adolescent boys (14 to 17 years old at the time of their arrest) were interviewed during their detention using a semi-structured interview. They were asked about their well-being, needs and goals during rehabilitation, their treatment motivation, and their views on recidivism and rehabilitation. Results: The results show that a match between the boys' well-being needs, and the treatment goals set in collaboration with the institution could improve treatment motivation and rehabilitation efforts. The boys also mentioned other factors with a positive impact on their treatment motivation: increased levels of freedom and autonomy; having a future (prosocial) perspective; investing in a therapeutic alliance; and, working on individual factors (i.e., improving coping skills, school or work skills, and relationships with prosocial friends and family). Discussion: These factors closely align with working on the GLM primary goods of "excellence in work and play," "excellence in agency," and "relatedness," which can be helpful in enhancing well-being and treatment motivation in offender rehabilitation.

Best practice recommendations on the application of seclusion and restraint in mental health services: An evidence, human rights and consensus-based approach.

WHAT IS KNOWN ON THE SUBJECT?: Seclusion and restraint still regularly occur within inpatient mental health services. The Council of Europe requires the development of a policy on for instance age limits, techniques and time limits. However, they only define the outer limits of such a policy by indicating when rights are violated. Within these limits, many choices remain open. Staff and service managers lack clarity on safe and humane procedures. Research literature provides limited and contradictory insights on these matters. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The study resulted in 77 best practice recommendations on the practical application of restraint and seclusion as last resort intervention in inpatient youth and adult mental health services, including forensic facilities. To our knowledge, this is the first study in which the development of recommendations on this topic is not only based on scientific evidence, but also on an analysis of European human rights standards and consensus within and between expert-professionals and experts-by-experience. This approach allowed to develop for the first time recommendations on time limits, asking for second opinion, and registration of seclusion and restraint. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The 77 recommendations encourage staff to focus on teamwork, safety measures, humane treatment, age and time limits, asking for second opinion, observation, evaluation and registration when applying seclusion and restraint as last resort intervention. The implementation of the best practice recommendations is feasible provided that they are combined with a broad preventive approach and with collaboration between service managers, staff (educators) and experts-by-experience. Under these conditions, the recommendations will improve safety and humane treatment, and reduce harm to both service users and staff. ABSTRACT: INTRODUCTION: Seclusion and restraint still regularly occur within inpatient mental health services. Professionals lack clarity on safe and humane procedures. Nevertheless, a detailed policy on for instance age limits, techniques and time limits is required. AIM: We developed recommendations on the humane and safe application of seclusion, physical intervention and mechanical restraint in inpatient youth and adult mental health services, including forensic facilities. METHOD: After developing a questionnaire based on a rapid scientific literature review and an analysis of human rights sources stemming from the Council of Europe, 60 expert-professionals and 18 experts-by-experience were consulted in Flanders (Belgium) through a Delphi-study. RESULTS: After two rounds, all but one statement reached the consensus-level of 65% in both panels. The study resulted in 77 recommendations on teamwork, communication, materials and techniques, maximum duration, observation, evaluation, registration, second opinion and age limits. DISCUSSION: Combining an evidence, human rights and consensus-based approach allowed for the first time to develop recommendations on time limits, asking for second opinion and registration. IMPLICATIONS FOR PRACTICE: When combined with a preventive approach and collaboration between service managers, staff (educators) and experts-by-experience, the recommendations will improve safety and humane treatment, and reduce harm to service users and staff.

Means of restraint in residential care when there is no acute danger. Time for the European committee on the prevention of torture to set the standard.

This contribution analyses the approach of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) to means of restraint in residential psychiatric and disability care. Generally, the CPT states that means of restraint can only be applied in cases of acute danger, and if all alternatives have failed. Detailed and strict conditions apply, including for the duration (usually minutes rather than hours). However, an analysis of the CPT's country reports shows that sometimes longer-term use is implicitly accepted, first to preventively maintain order and safety in a care facility and second, to protectively safeguard the interests of the patient. Based on country reports and general human rights principles, this contribution tries to provide the clearest possible picture of the conditions for applying means of restraint and the required legal guarantees in these cases. Nevertheless, many loose ends remain. To safeguard the rights of patients, it is desirable that the CPT is more explicit concerning means of restraint when there is no acute danger.