Dutch TBS forensic services: a personal view.

Introduction The Dutch TBS system is sometimes given as a model to improve British forensic psychiatry services. This paper is based on first-hand experience of an attachment to a TBS clinic. Dutch law and the TBS system Under the 1986 TBS Act a judge may order a serious offender deemed to have 'defective development' or a 'psychological disturbance of his mental faculties' to TBS. A prison sentence may also be imposed as well as the TBS order. The Pieter Baans Centre in Utrecht assesses all potential TBS patients over a seven-week period. If an order is imposed, the patient is transferred to the Dr F.S. Meijers unit, also in Utrecht, for a further six-week assessment. The patient is from there directed to one of the seven TBS units in different parts of the country, each ostensibly serving a different function. There are about 800 such TBS beds. TBS orders are now mainly imposed for violent offences (91% of the total); 27% of the patients have psychosis, and over 50% are deemed to have a personality disorder. The average TBS patient stays 50 months in a TBS unit, and 69 months in custody altogether. TBS Treatment and effectiveness In the Pompekliniek observed, the main treatment is a therapeutic community with good occupational facilities. Discharge is supervised by the probation service. A total of 42% of patients reoffended during the TBS order. Post-order recidivism was 52%. Observations The TBs service is overloaded. Many patients have to wait in a queue for their place. Staff have few psychiatric and medical skills. There is a shortage of psychologists. In the Pompekliniek there was excessive use of seclusion. Forensic psychiatry has, on the whole, a sympathetic press. t and treatment. The Dutch system would gain from specialist forensic psychiatry training schemes, as in Britain. [ABSTRACT FROM AUTHOR]