A need for a forensic specific policy regarding experiencing sexuality: a study of quality of life in medium security patients

Purpose: In Belgium, mentally ill offenders often spend extended periods in forensic psychiatric hospitals, where restrictive living conditions can affect their quality of life (QoL). QoL is a key factor in these settings, influencing both short- and long-term recidivism risks. Despite its significance, research on QoL in Belgian forensic psychiatry is scarce. Internationally, studies highlight that the sexuality domain tends to score lower than other QoL areas. This study aims to explore QoL in forensic psychiatry with a particular focus on the sexuality domain.Design/methodology/approach: This cross-sectional, observational study involved 275 male forensic psychiatric patients, all found not guilty by reason of insanity and under court-ordered psychiatric treatment. Patients resided in either treatment units or long-term forensic care units. Data were analyzed using R Studio. Findings: Patients in medium-security units in Flanders reported the lowest satisfaction in the sexuality domain compared to other QoL areas. Additionally, overall QoL declined with longer stays in forensic psychiatric care. Practical implications: The study underscores the need for clear policies regarding sexuality in forensic psychiatric settings. Integrating sexuality and sexual health assessments into routine evaluations is recommended. Future research should explore long-term QoL changes while investigating the impact of sexuality policies and considering gender and cultural differences. Collaboration between forensic institutions is key to improving data collection, while staff training on addressing sexuality is essential. Including patients in policy development and promoting their sexual health rights will help create a more inclusive environment. Originality/value: To the best of the authors' knowledge, this is the first study to pool data from three forensic medium-security units in Flanders, providing new insights into QoL in Belgian forensic psychiatry.