Bottlenecks in the Belgian forensic care system: A qualitative study on residual patients

This study aimed to explore the difficulties encountered in admitting Not Guilty by Reason of Insanity (NGRI) patients in Belgium, as well as identifying bottlenecks and potential improvements within the Belgian forensic care trajectory. Expert insights were gathered through focus groups involving professionals from both the Justice and Mental Health Care sectors. A total of 87 participants engaged in 14 focus groups, 43 from Flanders and 44 from Wallonia, representing diverse professions and facilities associated with NGRI care. The focus group data were analysed using inductive thematic analysis to identify recurring themes. Participants emphasized that admissions are particularly challenging for patients presenting with a high risk of violence, substance abuse issues, sex offenders and people with dual diagnosis. Participants also underscored systemic issues, including the imperative for standardisation in the conceptualization of forensic psychiatric care, the necessity for a common language, and the urgency to streamline the forensic care system. Additionally, the sharing of forensic knowledge and expertise was proposed as a solution to mitigate stigma and foster collaboration between forensic institutions but also between forensic and general psychiatry. This study sheds light on crucial aspects of NGRI patient care and underscores the urgency of systemic improvements to ensure better outcomes for all stakeholders involved.