After several serious incidents with patients with a criminal justice order of enforced care
by the state (TBS1) during unsupervised leave, the Lower House decided in 2006 to start a
parliamentary inquiry into the functioning of the TBS system (the Visser commission). The
commission reached the conclusion that the TBS system in general meets the tasks set to it,
yet that it is necessary to adapt its execution to modern standards. One of the commission’s
recommendations was to carry out more scientific research on the effectiveness of
treatment in forensic psychiatry. To this end, the Scientific Research and Documentation
Centre (WODC) drew up a TBS research programme, in cooperation with the TBS field
and relevant actors. For the purpose of this TBS research programme a study was needed
that would take stock of and describe the current execution of the TBS sentence.
This report is the reflection of this stock-taking and descriptive study and of a
quantitative analysis of a representative sample of prisoners sentenced to TBS. The study
consists of two parts. The first part presented a description of the characteristics of the
research population, the execution of the TBS sentence, the design of this execution, the
formal legal framework, the bottlenecks and the question in which ways the execution –
and more specifically the treatment - is in keeping with the scientific research. In the
second part, the profiles of the group of studied prisoners sentenced to TBS were drawn
up.
In this study, we have used four research methods to answer the research questions: a
synthesis of the literature, file research, interviews and focus groups. The aim of the
literature synthesis was to answer the research questions from a theoretical point of view
and to provide insight into the evidence-based treatment methods within the forensic
domain. The objective of the file research was, among other things, to gain an
understanding of different aspects regarding patients and their treatment. The semistructured
interviews were conducted to gain insight into the execution of the TBS
sentence and in questions that could not be answered by means of the file research. Finally,
we established three focus groups to provide an opportunity to key figures (treatment
directors, therapists and researchers) to reflect on the most important research results. The
focus groups also gave input regarding aspects of the research that were insufficiently
illuminated by means of the file research.
The sample size of the file research had been fixed by the WODC at 180 cases. In
the thirteen Forensic Psychiatric Centres (FPCs), the cases were randomly sampled from
the population present at the hospital at that moment. The number of selected cases for
each hospital was determined with a weighting factor. Included in the sample were patients
who had entered the hospitals after 1 February 2000. Excluded from the sample were
detainees sentenced to TBS who were indicated for long-stay forensic care and detainees
sentenced to TBS who were living in the Netherlands illegally. We checked the
representativeness for six characteristics: sex, age, offence category, primary disorder,
1 In Dutch: ‘terbeschikkingstelling’, abbreviated from here on to ‘TBS’; we will use the untranslated term because of the
uniqueness of the Dutch TBS-system) nationality and IQ. Data regarding five of the six characteristics could be provided by the
FPCs, except for those regarding IQ; for this reason, the representativeness of the IQ was
checked on the basis of the scored file data.