Purpose Self-injury is common in forensic psychiatric settings. Recent research offers some insights into the functions and management of self-injurious behaviour but generally focusses on either the experiences of staff or patients. This study aims to explore the experiences of both staff and patients with non-suicidal self-injury in a Dutch forensic psychiatric hospital. Design/methodology/approach In total, 6 patients and 11 staff members were interviewed about the functions they ascribe to self-injurious behaviour, the emotional experience provoked by this behaviour and the management of self-injurious behaviour. The interviews were transcribed and analysed using a thematic analysis. Findings Four main themes resulted from the analysis: functions; emotional distancing; patient needs; and management. Overall, findings illustrate that staff reports limited knowledge of the different functions of self-injury. To circumvent potential automatic stereotypical judgement, staff should proactively engage in conversation about this topic with their patients. In managing self-injurious behaviour, clarity and uniformity among staff members should be promoted, and collaboration between the staff and patients is desirable. Staff recognised the potential benefit of a management guideline. Staff may find detached coping strategies to be effective but should be vigilant to not let this evolve into excessive detachment. Practical implications Increased knowledge and awareness of self-injury functions among staff can allow for better understanding and evaluation of self-injury incidents. Circumvention of automatic, stereotypical judgement of self-injurious behaviour is warranted, and more accessible explanations of the variety of functions of self-injury should be used. More proactive engagement in conversations about functions of self-injury by staff, can facilitate this. Detached coping can help staff to remain resilient in their job, but requires vigilance to prevent this from turning into excessive detachment. Clarity and uniformity among staff when managing self-injury incidents is considered beneficial by both patients and staff. A guideline may facilitate this. When imposing restrictions on patients, staff should strive to establish collaboration with the patient in determining the course of action and ensure the restriction is temporary. Originality/value The impact of self-injurious behaviour on all those involved can be enormous. More research is needed into experiences of both patients and staff members regarding the impact, motivations, precipitants and functions of self-injurious behaviour, and effective treatment of it.
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The specific risks and mental health needs of women in forensic services and the relevance of gender-responsive treatment include gender differences in criminological and psychiatric characteristics; gender-sensitive risk assessment; and gender-sensitive management. Some recommendations are provided for practitioners working with women in forensic services.
Research shows that victimization rates in forensic mental health care are high for both female and male patients. However, gender differences have been found in types and patterns of victimization (more sexual abuse and more complex trauma for women), cognitive appraisal, and response to traumatic events. Gender-responsive treatments focusing on trauma have been designed to adhere to these gender differences; however, despite promising research results, these interventions are yet to be introduced in many settings. This study examined how trauma is addressed in current clinical practice in Dutch forensic mental health care, whether professionals are knowledgeable of gender differences in trauma, and how gender-responsive factors such as self-esteem, self-efficacy, social relations, and coping skills are considered in treatment for female patients. We used a mixed-method design consisting of an online survey and 33 semi-structured interviews with professionals and patients. The results suggested that Dutch forensic mental health care could address trauma more structurally, and professionals could be more aware of gender differences and gender-responsive factors. Early start of trauma treatment was deemed important but was not current practice according to patients. Based on this study, guidelines were developed for gender-responsive, trauma-informed work in forensic mental health care.
In het forensisch werkveld staan drie vragen centraal. Het gaat dan om “wie is het”, “wat is er gebeurd” en “wanneer is het gebeurd”. Alle informatie die bijdraagt aan het beantwoorden van deze vragen is waardevol in zaakonderzoeken. Vaak wordt er wel een biologisch spoor gevonden, maar is er geen “match” met de databank. In dit geval kan profileringsinformatie helpen bij het zoeken naar de juiste persoon. Met profilering wordt hier bedoeld een serie stoffen, ook markers genoemd, die informatie geven over de levensstijl van mensen. De levensstijl kan bestaan uit kenmerken, voeding, gewoonten en activiteiten. Een recent voorbeeld van een profileringsmethode is het analyseren van de buitenzijde van mobiele telefoons. Door het hanteren van de telefoon laten mensen zweet en stoffen achter die gekarakteriseerd kunnen worden. Het profiel van deze stoffen geeft een beschrijving van de levensstijl van de eigenaar. In veel zaken zijn er echter geen mobiele telefoon aanwezig, maar wel andere sporen zoals haar. Daarom is er behoefte aan een methode om haar te gebruiken voor profilering. Bovendien geeft haar een indicatie van tijd en gebeurtenissen uit het verleden omdat het langzaam groeit. In principe kan er dan informatie over de drie vragen (wie, wat, wanneer) verzameld worden. Haren worden op dit moment vooral gebruikt voor het meten van drugs, alcohol gebruik, cortisol en nicotine. Er is echter behoefte aan een breder palet van stoffen dat in één keer in haar kan worden gemeten. Het doel van dit onderzoek is daarom het ontwikkelen van een methode waarmee in één analysegang een profiel van circa 15 uiteenlopende markers kan worden gemeten.
