12 Chapter 1 Forensic psychiatric care People who commit crimes and have experiences of victimization, psychiatric, or socioeconomic problems related to their risk of criminal behavior – forensic psychiatric patients – make up a large portion of the prison population (Dirkzwager et al., 2021; Fazel et al., 2016). A recent study found that 30% to 56% of the youth in prisons in the Netherlands reported emotional or physical neglect and 10% to 26% have experienced physical abuse in the past, which is substantially higher (38%) among youth in juvenile correctional institutions (Appelman et al., 2021). As for adult prisoners, most research on victimization has been conducted in females, showing that 30% of the females experienced physical abuse in childhood and 25% experienced sexual abuse. Furthermore, previous research demonstrated that a large part of the prisoners in the Netherlands were likely to have experienced socioeconomic and (mental) health disadvantages prior to imprisonment (Dirkzwager et al., 2021). For example, compared to a control group, prisoners were found to be twice as likely to have social problems (i.e., migration background, low income, no paid job, and no romantic relationship) and were 3.5 times as likely to suffer from psychological problems. In the Netherlands, about 60% of the prisoners are diagnosed with a psychiatric disorder (Dienst Justitiële Inrichtingen, 2022b). The mental health problems are also complex, as almost 60% is diagnosed with one or more comorbid psychiatric disorder (van Buitenen et al., 2020). Moreover, extensive research showed that prisoners worldwide are more likely to suffer from mental health problems (Fazel et al., 2016). Depending on the severity of the risk of recidivism and the complexity of mental healthcare needs, forensic psychiatric patients can be referred to either inpatient or outpatient forensic mental healthcare services. In the Netherlands, most referrals of offenders to forensic psychiatric treatment are imposed by judges, for example, as a part of their sentence or as a measure. Additionally, although less often, patients are being referred by general practitioners. In 2021, about 2500 individuals in the Netherlands received forensic inpatient care and 12.078 people received outpatient care (Dienst Justitiële Inrichtingen, 2022a). The overarching goal of forensic psychiatric treatment is twofold: (1) reducing the risk of criminal recidivism and (2) enhancing mental health and wellbeing of an individual. Forensic treatment is therefore personalized and multimodal, aimed at addressing both complex criminogenic and mental health needs of patients (Nicholls et al., 2022; Völlm et al., 2018). There are two dominant treatment models used to frame forensic mental healthcare. The risk need responsivity (RNR) model, applied since 1990, is the most widely
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