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