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Mentally Ill Offenders in Prison: The Belgian Case

by Stijn Vandevelde, Veerle Soyez, Tom Vander Beken, Stefaan De Smet, Anka Boers, and Eric Broekaert (2011). "Mentally Ill Offenders in Prison: The Belgian Case." International Journal of Law and Psychiatry, 34(1): 71-78.

A 2007 Europe-wide study on mental health disorders in European prisons found that accurate data is difficult to find. In this article, Ghent University researchers summarize available Belgian information, with particular focus on offender screening and assessment, psychiatric expertise, and the availability of forensic psychiatric treatment and care.  Vandevelde et al. consider mentally ill offenders as those "who should normally be treated in general or forensic psychiatric settings, including private psychiatric hospitals, psychiatric nursing homes, sheltered living projects, psychiatric wards of correctional facilities, and departments of social defense."  Excluded from this group are mentally ill prisoners considered responsible for their offenses.

Belgian treatment of mentally ill offenders should be considered under the following context: "Under the Belgian law," the authors note, "mentally ill offenders can be interned. This can be considered as a safety measure with regard to protecting the society. From the offender's point of view, treatment and care should be provided. The law, however, which foresees providing treatment and care for severely mentally ill offenders, is not always applied properly, This leads to incarceration of a substantial number of mentally ill offenders in prison instead of providing treatment for them (e.g., in specialized psychiatric facilities). As a result, Belgium is currently facing a number of challenges in dealing with this large population of (interned) mentally ill offenders residing in the already overcrowded correctional establishments. These difficulties are mostly related to the absence of (evidence-based) treatment protocols and initiatives in correctional establishments where many mentally ill offenders involuntarily end up."

As of mid-2008, approximately 1,000 mentally ill offenders are interned in Belgian prisons. Seventy-five percent of these offenders have dual- or multi-diagnoses, including substance disorders, psychotic disorders, personality disorders, impulse control disorders, and other severe mental disorders. Intellectual disabilities are the most common form of co-morbidity among dual-diagnosed Belgian prisoners.

Vandevelde et al. report a high number of prevalence studies, wherein mentally ill offender population figures can range from 7% to 91%, but they find "no internationally standardized assessment procedure." Accordingly, it is difficult to "correctly interpret and compare statistics with regard to the prevalence of mental disorders in prison settings." In particular, "non-standardized screening procedures in prison settings may lead to distorted prevalence ratings," which in turns contributes to underestimated counts, wrongful clinical diagnoses, and inadequate treatment and care. Belgium currently does not use standardized screening and assessment instruments in its prisons.

In 2012, legislation, originally passed in 2007, will take effect that will move jurisdiction for the interning of mentally ill offenders to a multi-disciplinary court. Belgian officials have been particularly slow in drafting criteria for psychiatric expertise, a matter which varies across Europe. In any case, the availability of psychiatric services, in Belgium as well as in Europe, is alarmingly low. Various problems exist with the adequate provision of forensic psychiatric care, including no systematic collection of data, high levels of co-morbidity, lack of residential and non-residential treatment options, overcrowding in prison-based psychiatric wards, heterogeneity among mental mentally ill offenders, conflicts between treatment and control orientations, On Belgium, recent emphasis has focused on developing a continuum of psychiatric care, which has lead to the construction of two psychiatric treatment centers, with specific units that would cover persons suffering from psychotic disorders, personality disorders, intellectual disabilities, substance abuse, and other common psychiatric disorders.

Belgium faces a major problem in that many mentally ill offenders are incarcerated without appropriate treatment and care, raising not only structural issues, but also ethical issues. Vandevelde et al. argue for standardized assessment procedures that would more accurately identify the prevalence of mentally ill offenders and serve "as a starting point for treatment." The high qualitative standards required for such assessments, however, are not necessarily evident ion correctional settings. Difficulties include getting accurate diagnoses of mental health problems at the start of a person's incarceration,  Prisons are not ideal in terms of accurately observing prisoners' behavior. In addition, the authors note that "correctional clients may try to deceive their evaluator as they feel that an honest evaluation will not help them especially during the psychiatric expertise procedure."  Significiantly, Belgium lacks treatment possibilities for its mentally ill prisoners. In 1998, Belgium was given judicial notice of the legal inappropriateness of interning mentally ill offenders without sufficient and timely treatment.

Vandevelde et al argue that simple standardized forms are not effective or useful. Moreover, they raise concerns not only about the inadequacy of standards for expert psychiatrists, but also about the education and training of day-to-day practitioners. "Given the seriousness and complexity of the problems mentally ill offenders present," they conclude, "training is absolutely necessary on how to deal with this population in daily practice. Such training at least includes giving insight in a number of common psychiatric disorders in order to be able to recognize mental illnesses, how to handle violence, etc. But also other people involved with mentally ill offenders - like police officers or correctional officers - need at least some basic training on dealing with this population."

For further information contact Stign Vandevelde at (e-mail) Stijn.Vandevelde@hogent.be.




Posted Fri, Aug 26 2011 2:23 PM by Tracey Vessels
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