Tilburg University
Psychiatric Detention and Long-Term Imprisonment as 'Belt-And-Braces' Measure Oei, T.I. Published in: XXXIIIrd International Congress on law and mental health book of abstracts Amsterdam July 14th - 19th, 2013 Document version: Publisher final version (usually the publisher pdf)
Publication date: 2013 Link to publication
Citation for published version (APA): Oei, T. I. (2013). Psychiatric Detention and Long-Term Imprisonment as 'Belt-And-Braces' Measure. In D. N. Weisstub, & H. van Marle (Eds.), XXXIIIrd International Congress on law and mental health book of abstracts Amsterdam July 14th - 19th, 2013. (pp. 335-336). Unknown Publisher.
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Download date: 21. okt. 2015
TBS - Dutch Phenomenon of Psychiatric Detention Some Actual Aspects and Facts Karel Oei Emeritus Professor Tilburg University XXXIIIrd Congress IALMH, Amsterdam, July 14th-19th, 2013
In the Netherlands we often see that in the case of serious crimes, such as rape followed by murder, the judge will impose a sentence combining extended imprisonment with compulsory treatment in a clinic. In addition to imprisonment, a convicted person who at the time of committing a severe crime was suffering a disorder can also be convicted to terbeschikkingstelling or TBS. After serving the prison sentence the convicted person is detained in a TBS-hospital for treatment. The aim of the measure is to guarantee the safety of society against this person both by preventing the person from committing more (new) crimes and at the same time by offering him a treatment. The TBS can be imposed with or without a warrant for secure clinical (intern) treatment. The TBS can be extended if necessary when the risk of recidivism still exists. After serious crimes committed by TBSpatients on leave the general public and also the politicians insisted on more security measures regarding the on leave-procedures of TBS-patients.
Traditionally a step-by-step procedure in allowing patients to re-enter society formed an essential part of the treatment. The Ministry of Justice, responsible for the execution of the TBS-measure, decided to implement a stricter policy in giving permission for leaves of TBS-patients in order to prevent recidivism. Among other factors, this slowing down of the procedure for leave was one of the causes that the intramural treatment duration considerably increased. As a result the already existing capacity problems in the TBS-system have increased, notwithstanding the efforts of the Ministry to extend the capacity by building new clinics and to adapt prison units for the treatment of TBS-patients. (H.J.C. van Marle et al. In: T.I. Oei & M.S. Groenhuijsen, Progression in Forensic Psychiatry: About Boundaries, 2012)
For a long time, the practice was that the compulsory treatment would already start after a third of the prison sentence had been served. This practice has now been discarded. We also see that for many offences the maximum prison terms have been increased. This means that an offender often has to spend many years in prison before any treatment in a clinic can commence. In these cases, the judge uses the compulsory treatment as a ‘belt-and braces’ measure to make doubly sure the offender is not released.
Let’s face now actual rates and facts about TBS in the Netherlands (bron: Ministerie van Veiligheid en Justitie)
Aantal opleggingen tbs (rate of verdicts; 1:6 proportion)met bevel tot verpleging 2008-2012
Aantal opleggingen tbs met bevel tot verpleging 2008-2012, naar differentiatie (types) 2008
2009
2010
2011
2012
tbs met bevel tot verpleging
116
105
90
99
83
gemaximeerd e tbs (4 yrs)
2
4
4
0
8
tbs met voorwaarden omgezet in tbs met verpleging
11
7
8
6
2
totaal
129
116
102
105
93
Geweldscomponent (with violence) bij tbsdelict 2008-2012 (o.b.v. het aantal opleggingen tbs met bevel tot verpleging), in procenten (percentage) 2008
2009
2010
2011
2012
Afwezig (absent)
5%
4%
4%
3%
6%
Aanwezig (present)
95%
96%
96%
97%
94%
totaal
100%
100%
100%
100%
100%
Tabel 2.3 Seksuele component (sexual driven) bij tbs-delict 2008-2012 (o.b.v. het aantal opleggingen tbs met bevel tot verpleging)
2008
2009
2010
2011
2012
afwezig
64%
70%
66%
69%
73%
aanwezig
36%
30%
34%
31%
27%
totaal
100%
100%
100%
100%
100%
Aantal opleggingen tbs met bevel tot verpleging naar IQ (intelligence; 1:3) van de tbs-gestelde 2008-2012 2008
2009
2010
2011
2012
< 80
16%
27%
25%
25%
21%
>= 80
76%
70%
75%
75%
76%
onbekend
8%
3%
0%
0%
3%
100%
100%
100%
100%
100%
totaal
Aantal opleggingen tbs met bevel tot verpleging naar stoornis (with personality or psychiatric disorder 1/3 to 1/2) van de tbs-gestelde 2008-2012 2008
2009
2010
2011
2012
Persoonlijkheids stoornis
71%
61%
65%
65%
53%
psychotisch
29%
37%
34%
35%
44%
onbekend
0%
2%
1%
0%
3%
100%
100%
100%
100%
100%
totaal
Duur van de gevangenisstraf (length of prison verdict in combination with tbs) die in combinatie met tbs met bevel tot verpleging is opgelegd over 2008-2012 2008
2009
2010
2011
2012
ontslag rechtsvervolging
22
19
14
18
16
< 6 mnd
18
28
22
13
16
6 mnd t/m 1 jr
18
19
25
19
19
> 1 jr t/m 2 jr
30
23
11
17
14
> 2 jr t/m 3 jr
14
10
10
10
6
> 3 jr t/m 6 jr
14
8
12
17
11
> 6 jr
13
9
8
11
11
totaal
129
116
102
105
93
Leeftijd (age when tbs is starting) tijdens het onherroepelijk worden van het vonnis tbs met bevel tot verpleging 2008-2012
2008
2009
2010
2011
2012
gemiddeld
35
36
35
36
38
mediaan
33
34
33
35
36
Aantal opleggingen tbs met voorwaarden (under conditions), naar geslacht (sex) 20082012
Aantal opleggingen tbs met voorwaarden 20082012, naar differentiatie (types)
2008
2009
2010
2011
2012
tbs met voorwaarden
42
46
29
44
62
tbs met voorwaarden omgezet in tbs met verpleging
11
7
8
6
2
totaal
53
53
37
50
64
Duur van de gevangenisstraf (length) die in combinatie met tbs met voorwaarden is opgelegd over 2008-2012
2008
2009
2010
2011
2012
ontslag rechtsvervolging
3
5
1
1
4
< 6 mnd
11
6
5
7
7
6 mnd t/m 1 jr
15
18
17
16
14
> 1 jr t/m 2 jr
15
18
8
18
23
> 2 jr t/m 3 jr
9
6
5
8
11
> 3 jr t/m 5 jr
0
0
1
0
5
totaal
53
53
37
50
64
Duur van de gevangenisstraf (length) die in combinatie met tbs met voorwaarden (under conditions) is opgelegd over 2008-2012 28
29
21
211
212
ontslag rechtsvervolging (discharge)
6%
10%
3%
2%
6%
< 6 mnd
21%
11%
14%
14%
11%
6 mnd t/m 1 jr
28%
34%
45%
32%
22%
> 1 jr t/m 2 jr
28%
34%
45%
32%
22%
> 2 jr t/m 3 jr
17%
11%
14%
16%
17%
> 3 jr t/m 5 jr
0%
0%
3%
0%
8%
100%
100%
100%
100%
100%
totaal
Leeftijd (age convict) veroordeelde tijdens het onherroepelijk worden van het vonnis tbs met voorwaarden 2008-2012
2008
2009
2010
2011
2012
gemiddeld
36
37
36
34
36
mediaan
33
36
33
32
36
Bezetting longstay per geslacht (sex), 20082012, ultimo september
Percentage tbs-gestelden (tbs convicts) dat binnen twee jaar na opname in een FPC met begeleid verlof (on accompanied leave) gaat, per jaar van opname 2000-2010
“Routekaart Tbs” Vonnis Rapportage
Gevangeniswezen
+ TBS met voorwaarden + TBS
HVB Forensisch Psychiatrische Instellingen TBS
Longstay (rijks-TBS, part.TBS, FPK, hoeve Boschoord
TBS met voorwaarden
Overige instellingen voor behandeling of verblijf. APZ, verslavingskliniek,,FPA, poliklinieken, VG-instelling, RIBW, maatschappelijke opvang
Plaatsing in een psych. Ziekenhuis
21
27 november 2009, Van Vliet
Samenleving Master SW
TBS GGZ
Forensische psychiatrie
Gevangeniswezen
22
27 november 2009, Van Vliet
Master SW
30% vóór TBS geen hulpverleningservaring 40% vóór TBS voor 18e jaar tehuiservaring
20% vóór TBS ambulante hulpverleningscontacten 20% vóór TBS civielrechtelijke opnames (Van Emmerik& Brouwers, De terbeschikkingstelling in maat en getal, 2001)
Psychotici in
30%
TBS
3% 1978
23
2 november 2006, Van Vliet
2000 OGGZ
For details on the original Good Lives Model, see e.g. Ward, 2002; Ward & Brown, 2004.
Good Lives Model
Risk & promotive factors Reoffending
Quality of life
Transitions in life
Life course
Psychiatric relapse
The individual patient The ward The hospital: wards and teams
Figure 1: An ecological model of a secure hospital: made up
of concentric groups of people carrying out different tasks for the group in the centre who are the group of patients. Mirror Mirror: parallel processes in forensic institutions* Gwen Adshead, in: T.I. Oei & M.S. Groenhuijsen, Progression in Forensic Psychiatry 2012
In secure settings, a range of parallel psychological processes are
operating out of consciousness, which affect the completion of the primary task of secure organizations; namely to care for and contain the wish to hurt others. Dr. Adshead suggest that it is possible to think
of toxic family group dynamics being re-enacted when insecure attachment mental organizations are activated; and these dynamics are then reflected in a process of malignant mirroring across the different
layers of the organisation. Awareness of these multiple reflections across the different spaces in forensic secure services may help institutions to hold themselves together when anxious and maintain
integrity of therapeutic purpose.
When the attachment system is stimulated (ie when the individual is in need, pain or danger), it produces neural signals that in turn stimulate physiological effects that influence thought and feeling in the neo-cortex. In a feedback loop, these thoughts and feelings produce more physiological manifestations of anxiety and arousal, which agitate the attachment system further. A ‘secure’
system makes it possible to process anxiety and arousal effectively, which includes being able to reach out to carers and be comfortable with vulnerability. An ‘insecure’ system can neither process anxiety or arousal well enough at times of distress; and those with insecure attachment representations will struggle to form useful relationships with care providers (Henderson S. Care
eliciting behaviour in man. Journal of nervous and Mental Disease, (1974) 159: 172-181.)
Attachment Attachment representations of forensic, clinical en normal populations & child killers (A.J. Verheugt, 2007) 60
forensic population
percentage %
50
clinical population
40
normal population of mothers normal population of fathers child killers
30
20 10 0
Attachment representation
Conclusions
a.We often see this combination (of a long prison sentence followed by compulsory treatment of 10 years now) especially in those cases where the experts fear that the offender in question is only marginally susceptible to treatment (Robert M. case, pedosexual, multiple child rape). b.The possibility of a perpetrator ever returning to society – after all one of the aims of compulsory treatment – in this kind of cases is small, which shows that the current system no longer operates as it should.
