Community Mental Health Journal

, Volume 54, Issue 1, pp 58–65 | Cite as

Forensic Assertive Community Treatment in a Continuum of Care for Male Internees in Belgium: Results After 33 Months

  • Thomas MarquantEmail author
  • Bernard Sabbe
  • Meike Van Nuffel
  • Rudy Verelst
  • Kris Goethals
Original Paper


Non-forensic or regular assertive community treatment (ACT) has positive effects on non-forensic outcomes but has poor effects on forensic outcome measures. In this study, we examined non-forensic and forensic outcome measures of a forensic adaptation of ACT (ForACT) within a continuum of care for internees. Data were collected retrospectively from files of 70 participants in the ForACT group who had been released from a forensic hospital. The control group comprised internees who had left prison and entered community-based care (n = 56). The ForACT group demonstrated significantly better outcomes on forensic measures, such as arrests and incarcerations, and had better community tenure. However, this group showed high hospitalization rates. The findings indicate that this type of community-based care can be beneficial for such internees; however, internees continue to experience difficulties reintegrating into society.


Forensic assertive community treatment Community Internees 



Funding was obtained from the Scientific fund of the Broeders van Liefde.

Compliance with Ethical Standards

Conflict of interest

All authors certify responsibility for this manuscript. There are no conflicts of interest to be reported.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of the University of Antwerp with the number BE300201628708. The study was also done with the written authorisation of the Belgian prison system (EPI).


  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th Edn., text rev.). Washington, DC: American Psychiatric Press.Google Scholar
  2. Andrews, D., & Bonta, J. (2010). The psychology of criminal conduct. New Providence: LexisNexis.Google Scholar
  3. Beach, C., Dykema, L., Appelbaum, P. S., Deng, L., Leckman-Westin, E., Manuel, J. I., et al. (2013). Forensic and nonforensic clients in assertive community treatment: A longitudinal study. Psychiatric Services, 64(5), 437–444.CrossRefPubMedGoogle Scholar
  4. Bond, G., Burns, B. J., & Edgar, E. R. (2001). Moving assertive community treatment into standard practice. Psychiatric Services, 52, 771–779.CrossRefGoogle Scholar
  5. Burns, T., & Firn, M. (Eds.). (2002). Assertive outreach in mental health: A manual for practitioners. Oxford: Oxford University Press.Google Scholar
  6. Burns, X. (2011). In C. Williams, M. Firn, S. Wharne & R. MacPherson (Eds.), Assertive outreach in mental healthcare: Current perspectives. Chichester: Blackwell.Google Scholar
  7. Cimino, T., & Jennings, J. (2002). Arkansas partnership program: An innovative continuum of care program for dually diagnosed forensic patients. Psychiatric Rehabilitation Skills, 6(1), 104–114.CrossRefGoogle Scholar
  8. Coldwell, C. M., & Bender, W. S. (2007). The effectiveness of assertive community treatment for homeless populations with severe mental illness: A meta-analysis. The American Journal of Psychiatry, 164(3), 393–399.CrossRefPubMedGoogle Scholar
  9. Cosyns, P., Koeck, S., & Verellen, R. (2008). De justitiabele met een psychische stoornis in Vlaanderen [English title of article]. Tijdschrift Voor Psychiatrie, 50, 63–68.PubMedGoogle Scholar
  10. Crawford, M. J., de Jonge, E., Freeman, G. K., & Weaver, T. (2004). Providing continuity of care for people with severe mental illness. Social Psychiatry and Psychiatric Epidemiology, 39(4), 265–272.CrossRefPubMedGoogle Scholar
  11. Cusack, K. J., Morrissey, J. P., Cuddeback, G. S., Prins, A., & Williams, D. M. (2010). Criminal justice involvement, behavioral health service use, and costs of forensic assertive community treatment: A randomized trial. Community Mental Health Journal, 46(4), 356–363.CrossRefPubMedPubMedCentralGoogle Scholar
  12. De Witte, N., Crunelle, C., Sabbe, B., Moggi, F., & Dom, G. (2014). Treatment for outpatients with comorbid schizophrenia and substance use disorder: A review. Journal of European Addiction Research, 20, 105–114.CrossRefPubMedGoogle Scholar
  13. Drake, R. E., & Latimer, E. (2012). Lessons learned in developing community mental health care in North America. World Psychiatry, 11, 47–51.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Drake, R. E., Essock, S. M., Shaner, A., Carey, K. B., Minkoff, K., Kola, L., … & Rickards, L. (2001). Implementing dual diagnosis services for clients with severe mental illness. Psychiatric Services, 52(4), 469–476.CrossRefPubMedGoogle Scholar
  15. Field, A. (2013). Discovering statistics using IBM SPSS statistics (4th edn.). London: Sage.Google Scholar
  16. Greenberg, G. (2014). Psychiatric correlates of past incarceration in the national co-morbidity study replication. Criminal Behaviour and Mental Health, 24(1), 18–35.CrossRefPubMedGoogle Scholar
  17. Hayes, A. (2014). A 21-year retrospective outcome study of New South Wales forensic patients granted conditional and unconditional release. The Australian and New Zealand Journal of Psychiatry, 48(3), 259–282.CrossRefGoogle Scholar
  18. Jeandarme, I., Bogaerts, S., Vander Laenen, F., Wittouck, C., Ampe, M., Oei, T. I., et al. (2015). Forensische pilootprojecten ‘medium security’. Herval in delictgedrag na behandeling van geïnterneerden ressorterend onder CBM Gent [English title of article]. Panopticon, 36(3), 227–247.Google Scholar
  19. Lamberti, J. S., Weisman, R., & Faden, D. I. (2004). Forensic assertive community treatment: Preventing incarceration of adults with severe mental illness. Psychiatric Services, 55(11), 1285–1293.CrossRefPubMedGoogle Scholar
  20. Manguno-Mire, G. M., Coffman, K. L., DeLand, S. M., Thompson, J. H., & Myers, L. (2014). What factors are related to success on conditional release/ discharge? Findings from the New Orelans forensic aftercare clinic: 2002–2013. Behavioral Sciences & the Law, 32(5), 641–658.CrossRefGoogle Scholar
  21. Marshall, M., & Lockwood, A. (2011). Assertive community treatment for people with severe mental disorders. Cochrane Database of Systematic Reviews, 4, CD001089.Google Scholar
  22. Parker, G. F. (2004). Outcomes of assertive community treatment in an NGRI conditional release program. Journal of the American Academy of Psychiatry and the Law, 32(3), 291–303.PubMedGoogle Scholar
  23. Robertson, P., Barnao, M., & Ward, T. (2011). Rehabilitation frameworks in forensic mental health. Aggression and Violent Behavior, 16(6), 472–484.CrossRefGoogle Scholar
  24. Simpson, A. I. F., Jones, R. M., Evans, C., & McKenna, B. (2006). Outcome of patients rehabilitated through a New Zealand forensic psychiatry service: A 7.5 year retrospective study. Behavioral Sciences and the Law, 24(6), 833–843.CrossRefPubMedGoogle Scholar
  25. Smith, R. J., Jennings, J. L., & Cimino, A. (2010). Forensic continuum of care with Assertive Community Treatment (ACT) for persons recovering from co-occurring disabilities: Long-term outcomes. Psychiatric Rehabilitation Journal, 33(3), 207–218.CrossRefPubMedGoogle Scholar
  26. Solomon, P., & Draine, J. (1995). Jail recidivism in a forensic case management program. Health and Social Work, 20(3), 167–173.CrossRefPubMedGoogle Scholar
  27. Stein, L. I., & Test, M. A. (1980). Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry, 37(4), 392–397.CrossRefPubMedGoogle Scholar
  28. Ward, T. (2002). The management of risk and the design of good lives. Australian Psychologist, 37, 172–179.CrossRefGoogle Scholar
  29. Webster, C. D., Douglas, K. S., Eaves, D., & Hart, S. D. (1997). HCR-20: Assessing risk for violence, version 2. Burnaby: Mental Health, Law, and PolicyInstitute, Simon Fraser University.Google Scholar
  30. Webster, C. D., Nicholls, T. L., Martin, M. L., Desmarais, S. L., & Brink, J. (2006). Short-term assessment of risk and treatability (START): The case for a new structured professional judgment scheme. Behavioral Sciences and the Law, 24, 747–766.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.University Hospital Antwerp (UZA) Belgium, Collaborative Antwerp Psychiatric Research institute (CAPRI)Antwerp University (UA)AntwerpBelgium
  2. 2.UPC St Camillus BierbeekBierbeekBelgium
  3. 3.Belgian Penitentiary SystemBrusselBelgium
  4. 4.Antwerp University Hospital, Belgium, University Forensic Centre, Collaborative Antwerp Psychiatric Research Institute (CAPRI)University of Antwerp, BelgiumAntwerpBelgium

Personalised recommendations