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Tijdschrift voor Psychiatrie 59 (2017) 1, 9 - 19

New research

(Too) long in tbs? A study on patients receiving forensic psychiatric tbs-treatment for 15 years or longer

H. Nijman, S. Lammers, M. Vrinten, E. Bulten

background In 2013 in the Netherlands about 100 forensic psychiatric patients were treated in tbs-hospitals for 15 years or more.
aim To investigate the variables that characterise patients who have been receiving forensic psychiatric treatment (tbs) for 15 years or more, and to obtain insight in which actions might be helpful to facilitate discharge or transfer of such patients to other (mental health care) facilities, according to their caregivers and experts.
method The group of long-term tbs-patients (n = 97) was compared with regard to diagnostic characteristics, ‘basic historical risks’ (as assessed by risk assessment instruments), and behaviour  to three other groups of forensic patients: a. a group who had received treatment for 5 to 10 years, b. a group of patients who had been recently discharged, and c. a group of long-stay tbs-patients.
results Long-term tbs-patients relatively often had been sex offenders (50% compared to about 20% of recently discharged tbs-patients), and had been admitted in a tbs-hospital at a relatively young age (on average they had been five years younger on admission). The professional clinicians of the long-term tbs-patients considered that the psychopathology of the long term tbs-patients was more severe than the psychopathology of the average tbs-patient. The clinicians also indicated that the long-term tbs-patients all need long-term supervision; however, they considered that only a minority of these patients (17%) required a maximum level of security and very restricted possibilities for temporary leave.
conclusion Patient related factors and organisational factors within the tbs-hospital and the general mental health care system seem to play a role in the lengthy period of tbs-treatment of the long-term tbs-patients. According to tbs-clinicians, these patients require prolonged and intensive supervision which the general mental health care system is often not equipped to deliver.

keywords forensic psychiatry, long-stay, treatment duration