Community Forensic Mental Health Services Relapse Prevention Report

This report focuses on the Community Forensic Mental Health Service (CFMHS) and its role in preventing relapse among patients in Qatar. It addresses the high risk of re-offending and multiple readmissions associated with forensic mental health patients, who often exhibit non-compliance with medi...Read More

Community Forensic Mental Health Services
Role in effective Relapse prevention
Introduction
The overriding philosophy of this service will be a balance between on-going patient needs and ensuring
public safety, and this will be achieved through risk assessment, management, and treatment.
Community forensic mental health service (CFMHS) is a new service within the widening range of
specialized community mental health services in Qatar Under HMC/MHS
CFMHS are found in various locations as shown in figure 1
The Community Forensic Mental Health Service (CFMHS) is the service delivery arm of the outpatient
clinic and community-based programs.
The programs provided by the CFMHS are primarily for people who have a severe mental illness and
have been offenders or are at high risk of re-offending. Specialist assessment and treatment are also
provided for people who present with a range of severe problem behaviors.
The community forensic mental health team plays a vital role in surveillance, with a proactive response if
circumstances change to increase risk.
Figure 1 below shows some of the police posts in Qatar where there is CFMHS

Figure 1. Some of the police post in Qatar where there is CFMHS
Summary statement
This research is designed to address the relapse rate in forensic mental health patients.
Background

Forensic mental health patient was having a high risk of re-offending and involvement in the criminal
justice system, and multiple readmission rate to in-patient unit with high offending behaviors against the
community, family, as well as against themselves.
They were mostly noncompliance with oral and injection medication, with threatening behavior toward
general community mental health service staff, which lead to high and recurrent relapse phases, thus
affect patients, family, and the community. and high re-involvement in the criminal justice system
Aim
To decrease the relapse rate for forensic mental health patients by 50% within 6 months.
Objectives
- To Increase patient /family awareness about mental health medication
- Monitor patient long-acting injection
- To increase the number of visits depending on the risk assessment conducted on the patient
- To involve community police and other healthcare disciplines in patient care
- To building a therapeutic relationship between the nurses and the patients
Methods
The methodology that will be used will include:
- Conducting interviews
- Conducting Surveys
- Listening to patient stories
- Holding site visits
- Literature review
- Listening to patient experiences
- Using the HCR20 Risk Assessment Tool (Figure 2)

Figure 2. The HCR20 Risk Assessment Tool
Intervention
- Increase patient /family awareness about the diagnosis, treatment plan, and Relapse signature
- Monitor patient long-acting injection within 6 months
- Increase number of visits depends on Risk assessment from 1 to 4 visit each month within 6
months
- Involve community police and other healthcare disciplines with the patient care within the first 3
months of treatment
- Building a therapeutic relationship with patients and their families within the 1st month.
- Early detection of relapse symptoms by visiting the patient from 1 to 4 times each month depends
on patient risk assessment. The HCR20 Risk Assessment Tool will be used. (Figure 2)
- Comprehensive referral screening, evaluation, and pathway.
referral pathway reduces the waiting time and therefore to provide the care on time (Figure 3)

Figure 3. Risk assessment pathway used for relapse readmission
Results
Implementation of the interventions above as resulted in a decrease in the rate of relapse. an example is
shown in Figure 4; through effective patient/family education, it was possible to reduce the relapse rate
Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Effective Patient-Family Education
Diagnosis Relapse Signture Treatment Plan Patient Numbers
Figure 4. A graph showing the impact of effective patient/family education.

Outcomes
According to Figure 5, there was a high relapse rate in January. Towards the end of the year 2019, there
was a significant decrease in the relapse rate
Jan-19 Feb-19Mar-19 Apr-19May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19
0
1
2
3
4
5
6
7
6
3
4 4
3
2
1 1 1 1
2 2
Readmission due Relapse
Patients Number
Figure 5. the relapse rates in the year 2019
There was also a decrease in the harms incident as shown in figure 6

JAN-MAY 2019 JUN-DEC 2019
0
2
4
6
8
10
12
14
16
18
20
18
3
Harm Incident
Harm Incident
Figure 6. A graph showing the harms incident
Conclusion
In conclusion, the relapse rate in forensic mental health is a significant concern in Qatar. However,
through effective interventions such as patient/ family education, building therapeutic patient-nurse
relationships, early detection, active monitoring, among other interventions, it is possible to reduce the
relapse rate. The Community Forensic Mental Health Service plays a significant role in the control and
management of the relapse rate.