The Prevalence of Personality Disorders in Outpatient Forensic Mental Health in the Netherlands

Mentally disturbed people who commit or are at high risk of committing a crime, are treated in forensic psychiatry in the Netherlands. Treatment aims at preventing recidivism or lowering the risk of committing a crime by treating the psychiatric or psychological problems. Some people are committed in a hospital to receive this forensic psychiatric treatment, but a large group is treated in an outpatient forensic health (OFMH) facility.

All diagnoses and additional offences are treated in forensic psychiatry. Diagnoses are usually established through the DSM-5 and include, for example, psychotic disorders, substance-related disorder or sexual dysfunction. The offences are for instance, aggressive behavior, sexual violence, acquisition crimes or behavior problems like stalking.

In the Netherlands the Risk Need Responsivity (RNR) model is used in all kinds of forensic treatment and also in OFMH. Besides working on the most common risk factors like substance abuse or problematic circumstances at school or work, recognizing psychiatric diagnoses is important because this can be a risk factor in itself. Mental health problems can be seen both as a criminogenic need or as a responsivity factor.

Personality disorder (PD) is one of the diagnoses that is important to recognize. PDs are associated with increased risk of violent and antisocial behavior, and with recidivism risk. PD's also require a specific treatment approach; therefore, there are programs that focus on this group. Knowledge about prevalence is important for several reasons. Prevalence studies show the disease burden of certain conditions and promote both the recognition of these and the formulation of policy in healthcare. Knowledge of prevalence rates can also help therapists to be more attentive to certain problems or diagnoses, such as PDs. Consequently, this knowledge can facilitate the identification of PDs, which also ensures that treatment approaches are better tailored to PDs. A systematic review of studies on detainees found that 46% of the men and 21 % of the women were diagnose with antisocial PD and 65% of the men and 42% of the women exhibited a PD, including antisocial PD. In forensic inpatients almost 78%* of the population had a PD with 28% a cluster B PD and 42% a PD not otherwise specified. So, prevalence figures in forensic populations are quite high. The question however arises whether PDs are also common among forensic outpatients in the Netherlands? Figures on prevalence of PDs in OFMH are however scarce. Therefore, this research aims at identifying the prevalence of PDs in OFMH in the Netherlands.

research question: What DSM-5 classifications have been made (primary and secondary)? How can the group with a PS be described with respect to gender, age, education, nationality, legal title, nature of offense and care received.