July 5 juillet 10:15 – 12:15
Room CPCL-101
Chair: Eric Blaauw , Free University of Amsterdam
Discussant:
Gian Carlo Nivoli
, Italian Forensic Society, Sassari, Italy
The Dutch government is reevaluating the current method of
managing mentally disordered offenders. In order to design sound policy, the
Ministry of Justice commissioned the Department of Clinical Psychology of the
Vrije Universiteit Amsterdam to study the management of mentally disordered
offenders in several countries. The main objective of the research project was
to compare the foreign systems with the Dutch so-called TBS system. The
countries involved were Canada (British Columbia), the UK, Sweden, Germany (Hessen),
Belgium, France
and The Netherlands. Information was gathered about legislation regarding the
assessment, placement, furlough, release and after care of inmates that are
found to have a mental disorder during the committing of a crime. In addition,
data about how these countries handle inmates in practice (e.g. procedures, type
of institution) were studied. The interesting results from the study are
discussed.
In this case presentation, the treatment of a high risk child sex offender will be discussed. The patient has been in the clinic for the past two years. His offences and diagnosis (accountability) will be outlined. Moreover, the treatment program, obstacles encountered during his treatment, and the long run prognosis of this young male will be disscussed.
The Dutch entrustment Act, the Terbeschikkingstelling (TBS), has existed since 1925 because the penal courts sought different laws to apply to personality disordered offenders (PDO’s) and the mentally disabled. Though the TBS is still appreciated, offering full possibilities for treatment, disadvantages have been noticed with regard to the connections between general psychiatry and the financing of the provisions. This is not startling because since its inception, the TBS was a measure of the security of society, providing intensive care for the PDO’s and the possibility for treatment. The facilities’ quality and low recidivism rate made it popular with the courts. Thus, in the 1990’s, a waiting list arose without the ability to control the system’s efficacy. Since then, changes in the penal law have lead to many conditional variations of the TBS: TBS with conditions and the conditional release from TBS. The routing of the patients within the system has been differentiated: long stay provisions have been erected so an undetermined treatment is no longer granted. Also, rehabilitation (‘transmuralisation’) was integrated at an earlier stage of treatment, but with intense supervision and surveillance. These changes made the next problem visible: how can the most dangerous disordered offenders be differentiated from the less dangerous within these different treatment modalities? The proposed Dutch solutions to these forensic psychiatric problems will be discussed with regard to existing law, ethics and state of the art psychiatry.
In this presentation, the treatment, diagnostic procedures
and research in “de Kijvelanden”–a forensic psychiatric hospital in the
Netherlands–will be discussed. First of all, an outline is given of the number
of patients and their psychopathology (axis I, axis II and co-morbidity).
Moreover, the various disciplines working in the hospital and the different kind
of units will be discussed. Finally, the five ‘special care programs (SCP)’
for specific groups of disorders and/or psychiatric problems will be presented, i.e. the SCP for
psychotic patients, SCP for mentally retarded patients, SCP for patients with
substance-related disorders, SCP patients from different cultures, and SCP for
patients convicted of sexual offences.
Most prison systems hardly pay attention to the needs and
capabilities of remand prisoners. Usually, prisons for sentenced prisoners have
drug treatment programs, programs for successful reintegration into society,
special care programs for mentally disordered prisoners, maximum security
programs for prisoners with a high risk of violence, and several other programs.
Assessment for the placement of prisoners in such programs usually takes place
once a prisoner has been sentenced. A study in The Netherlands investigated
whether it is also possible to decide about future placements in special
programs while prisoners are still in their pre-trial phase. For the study 160
adult prisoners, 80 young adult prisoners (18 to 24 years of age) and 20
juveniles were interviewed (at different points in time) about many aspects that
could be important for the placement of prisoners in special regimes in prisons.
The study showed that it is possible to identify the most suitable programs for
prisoners at a very early stage. The study also showed that the programs
required by some less mature18 to 24 year olds differ from other 18 to 24 year
olds. The presentation will address many findings of
the study.
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