When the security measure meets bordered penality: Release procedures for persons who are not criminally responsible without residence rights in Belgium.

Offenders considered to be persons not criminally responsible (hereafter Persons NCR) in Belgium, are subjected to a security measure. This is executed by means of a forensic care trajectory, often beginning in high-security prison units or forensic psychiatric facilities, and moving through medium and lower security psychiatric facilities, with the intention to ultimately integrate them back into society. Within this group there are 145 persons without residence rights. This article is attentive to how the forensic care trajectories for people without residence rights are currently navigated. Six qualitative interviews were conducted with key decision-makers in the forensic care trajectories of Persons NCR. Moreover, we analyse the legislative framework regarding the security measure and illustrate how features of 'bordered penality' are clearly present. Our results indicate that when working towards a return to the country of origin fails, Persons NCR without residence rights become neglected, either in high-security prison units or forensic facilities. We explore avenues to improve this precarious situation, and consider possibilities to guarantee mental healthcare according to a persons' security needs rather than their residence rights.

Voices to be heard: Understanding family perspectives in forensic care trajectories.

Introduction: De-institutionalization of psychiatric care has greatly increased the role of family members in the recovery pathways of Persons labeled as Not Criminally Responsible (PNCR). However, the role of family members in supporting PNCR in forensic psychiatric care remains understudied. Scarce evidence indicates that PNCR have to deal with stigma and endure specific burdens (i.e., symptom-specific, financial, social, and emotional). Recovery-focused research showed that recovery in both persons with a severe mental illness and family members develop in parallel with each other and are characterized by similar helpful principles (e.g., hope and coping skills). As such, the recovery pathways of PNCR often goes hand in hand with the recovery pathway of their family members. During the family recovery process, family members often experience not being listened to or being empowered by professionals or not being involved in the decision-making process in the care trajectory of their relative. Therefore, the aim of this study is to capture how family members experience the care trajectories of their relatives, more specifically by looking at family recovery aspects and personal advocacy of family members. Methods: Semi-structured interviews were conducted with 21 family members of PNCR from 14 families. A thematic analysis confirms that family members suffer from stigma and worry significantly about the future of their relative. Results: Regarding the care trajectory of PNCR, family members experienced barriers in multiple domains while trying to support their relative: involvement in care and information sharing, visiting procedures, transitions between wards, and the psychiatric and judicial reporting by professionals. In addition, family members emphasized the importance of (social) support for themselves during the forensic psychiatric care trajectories and of a shared partnership. Discussion: These findings tie in with procedural justice theory as a precondition for family support and family recovery within forensic psychiatric care.

Crushed by the Belgian system: Lived experiences of forensic care trajectories by persons labelled as not criminally responsible.

BACKGROUND: Care trajectories of Persons labelled Not Criminally Responsible (PNCR) are often characterized by multiple transitions from one (forensic) mental health service to another and by long periods of admission. So far, little research has been conducted on forensic care trajectories, in particular on how PNCR perceive the trajectories they are subjected to. METHOD: Data were obtained via semi-structured interviews (N = 23) with PNCR in various (forensic) mental health services in Belgium. A maximum variation sampling strategy was applied to recruit a heterogeneous group of PNCR and inductive thematic analysis adopted to analyse the data. RESULTS: PNCR's experiences about care trajectories in Belgium are marked by an absent voice and passive position in the decision-making process in addition to a lack of support during transitions. Barriers for admission in (forensic) mental health services and the indeterminate duration of care trajectories contribute to overall negative lived experiences. CONCLUSION: Although some findings are interchangeable with general mental health care, PNCR's care trajectories differ by their undetermined nature, barriers for accessing care and power dynamics in compulsory forensic care. As concepts from prison sociology, such as tightness, power holders and pain of indeterminacy, seem to be equally relevant for the situation of PNCR, the balance between a criminal justice and mental health approach in forensic mental health care is questioned.