Long term effects of longstay treatment of the criminal minds

good evening

what is your first thought when you hear

that there is a person who receives a

mandatory forensic psychiatric treatment

because he killed or raped a few persons

you probably think that person is very

dangerous

and you might even think that you can

see it

that this person is dangerous well

first let me tell you a few things so

you understand what i’m going to talk

about

in the netherlands the most serious

mandatory forensic psychiatric treatment

is called tbs and that means

treatment on behalf of the state

the goal of the tbs is to secure the

society

by giving people providing people a

psychiatric treatment

so the risk of recidivism is reduced the

reoffending is reduced

somebody can be sentenced by a penal

court

for having committed a serious crime

the serious crime has to be

combined with a mental disturbance of

very serious nature the person is

influenced

in his behavior by the by the

disturbance

and has not all the responsibility that

he normally

would have so that means that he

first goes to the prison and after that

he goes to one of the seven

forensic psychiatric hospitals in the

netherlands which are called

tbs clinics everybody in the netherlands

with a mental disturbance

who commits a very dangerous crime

towards somebody’s personal integrity

can be sentenced to this tbs

this very intensive forensic treatment

takes a very long time the mean is

at the moment eight and a half years

that means that you go to a very high

secure

clinic for about six years

and after that you go to society

where you can be under supervision for

about two and a half years

the results of this treatment are very

good

when you look at the big picture most of

the patients

who have tbs treatment do not

recidivate in a serious crime but

sometimes it happens

and when that happens everybody

is looking in the papers and seeing that

the press

makes it a very big thing which is a big

thing

of course but it happens about

once in two years

so when you look at for instance traffic

incidents

that is a much larger number that’s

about 680

traffic death per year in the

netherlands

so the relative understanding

of how many tbs patients kill

people for instance that’s not normal

in the sense that people think that

every day

tbs patients kill people which is not

the case

many years ago a tbs patient of mine

went on a supervised leave with the

supervisor and went to the shop

in the village he did that every week

and he did that for some years so he had

about 250

leaves supervised leaves until then

suddenly and totally unexpectedly before

the supervisor could react

he grabbed a knife from a wreck

and heard a person next to him

everybody was shocked and

the victim went to the physician the

stabbing was not very serious so after

some time they could resume their daily

activities and the patient was

of course went to the present

the same weekend in the same region of

the netherlands so

it was in brahman which is in the south

which is not very populated in the same

region

two young young boys were

killed by stabbing in the night life

two boys one weekend i know the

difference

what happened was that the incident with

the tbs patient

was on all first pages of all papers

was in the news and there were questions

asked in

the government and there was questions

asked in parliament

and was a big uproar for weeks and weeks

the two boys who were stabbed to death

got five lines in the local press

so there is a kind of a stigma on the

tbs patients

whenever they do anything it’s real big

in the press

but what happens if somebody is has had

this very intensive

forensic psychiatric treatment but

doesn’t progress

in his behavior and cannot go out

into society if somebody with a tbs

has a very long history of being in

treatment

with no progression and no prognosis of

bettering he can get a tbs

with long-term forensic psychiatric care

which was

called before long stay and then he

comes to the clinic

where my team and i uh work

and he comes it’s the only clinic in the

netherlands with these

patients and he will be there for

some time sure

our clinic is in zealand it’s in brahman

near ude

and it’s we have about 99 patients

and we started in 2006.

now you have to know my father was an

officer

in the dutch army during second world

war and he was

detained for many years in a prison of

war camp in

eastern germany he came back fortunately

obviously otherwise i wouldn’t have been

here

but he learned me a few things never

give up

think out of the box and think for

yourself

there i was in 2006 sitting in my car

waiting for my application because i

applied

for a job to go and develop a long stay

clinic and then i got the call

i was accepted i was cheering in my in

my car

and some people some colleagues

that said that’s crazy you went to

college

you had 13 years of training as a

psychologist and a psychotherapist

what they are going to do with these tbs

patients who will not react to whatever

you do

so that’s wasted time we started

in new zealand with first 30 a light

later 99 patient

and we developed a special method for

these patients

and why we argued these patients have

had

the best treatment you can get in the

netherlands with the best specialists

it didn’t work so why would we do the

same as they did

we are we must change something

so we stopped treating them for the

resistance

recidivism risk for the re-offending

risk

because it didn’t help what we did is

continuing the psychiatric treatment

and he specialized in treating

the quality of life in getting the

quality of life as high as possible

and concentrating on safety that they

feel safe and that they are

safe because when you are in the clinic

i don’t know if you realize that

when you are in a clinic your neighbor

can be very mad and can be very

dangerous

as they consider you are to be very

dangerous and very mad

and the neighbor next to that also

so you are 99 people who are very afraid

of each other

can you imagine that these patients are

considered

by society they will never get out

they will not be able to change

so they will stay there and probably

die there well

i’ve known some patients my current

patients

a few of them i know since i was 24

and in my first job

i saw people getting worse and worse

with lots of declining functions

a few of my patients died in the

meantime

and that’s very hard when you know a

patient that long and he dies

it sticks to you but i have also seen

people recover

i have seen patients who got better and

better

one of them is even a colleague of mine

now

because he is giving lectures on

a college another one is giving lectures

for schools

this summer research has been published

in which was established that 50 percent

of

all the lfpc patients all of the

long-stay patients

which have been in our clinic left

the lfbc system and went back

in the direction of society they are not

all in society yet

but there are a few in society already

now you can wonder how is it possible

because

society thought they are hopeless

these cases will not come back again

ever but still

they changed their behavior and it

changed their behavior in such a way

that we as the tree treating staff

but also the in

independent assessors saw changes in

their behavior

and the changes of their behavior was in

such a way

that they could meet the criteria to

leave the system again

the system that gave up on them but they

asked

back again so 50

50 we thought that cannot be a

coincidence

50 is too much and we knew the figures

of course

because we know what people go and what

people come

but we didn’t have the facts and we had

didn’t have the scientific evidence that

this was 50

but now we had it and we thought

how come then we also saw

that from the patients who left the lfpc

system

there was nobody who had a serious

recidivism

so no serious offenses after they left

our system how is that possible

because they had sometimes even 15 years

of treatment

then they come to us and then he went

back

so what do we do well the main

thought we have is that we treat people

we contact people on a normal high level

contact way

when you have normal eye level contact

with somebody you can

get high level normal behavior back

and what we also see is that in the

environment

of the inhabitants and the atmosphere in

the

premises in the facility is one of

acceptance

and humanity so no repression

and no disrespect and that’s

quite the opposite from the prisoner of

war

camp my father told us about we do not

judge

the patients we call inhabitants

because they live with us for a very

long time so we they are not patients

anymore they are persons

we are called they have a room they

don’t have a cell

they can make their own meals in the

evening if they want and they can they

can

order groceries if they if they want

and they can they grow their own

vegetables if they want and they can

and in this way they can show

more that they what they can instead of

what they can’t

so we don’t judge them as a as a

perpetrator

but we see them as human people like me

i’m i’m more than a psychologist and

psychotherapist i’m a father i’m a

husband i’m a mediocre tennis player i’m

a bad cook

and subsequently also our patients

have more uh more to it than

being a perpetrator they are also a

brother or a sister they are also a

friend

they also have contacts and they

learn in this way what they are good at

we look mostly at safety and the

security

and quality of life and when you see

that when you do this long enough

you see emerging from this very

very concrete personal growth

you can see that people learn to

react in a different way to frustrations

and to setbacks instead of aggression

they learn how to present themselves in

another way

and when we started this we didn’t have

a well-defined plan

we just went along with what worked we

only knew we had to do something

differently

in the first years we were the only

clinic

in the in the whole of europe which

worked in this way

now there are more clients which are

working like this

and we in fact we were blessed with the

situation that nobody expected progress

everybody thought lost cases never

talking about

anymore but whatever we did

and was progress it was fine nobody

expected it

failure society expected failure

ministry of justice expected failure

nobody expected success so

that was very helpful for us because we

got a lot of space

to develop our ideas and to think

out of the box now

last year we started the pilot research

where we looked at patients who left the

clinic

and are living in society who have been

with us for some years

went back to tbs went out and

are living now in society and a few

patients who are

on the edge of going from treatment to

living on society

and we are asking how did you manage to

get out

what helped you what didn’t help you and

there are two words

very important in this matter that is

trust

and commitment trust in the people

around them

staff but also trust in themselves that

they could do it

and commitment commitment

to the to stick to their own plan to

stick to their own perspective

but also commitment of staff

one of the patients said

about his therapist

they believed in me they

believed that i could before i myself

believed i could

i have been doing this work for 42 years

now

of which 14 years

with the long-stay patients we focus on

quality of life

because that’s very important for the

patients but what also is very important

for us

as staff is that we have a lot of

support at home

in our own personal habitat because you

have to

draw the straight line and stay healthy

yourself

so it helps very much when people at

home are very normal

and acting very normal expecting from

you that you are very normal

and then well-being

people feeling well get well

so we have to respect the patients

in a way that we would like our own

loved ones to be respected

when they are in treatment that’s a very

difficult one

and most important is that you

should think for yourself think

independently

think out of the box and especially

never give up thank you