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Tijdschrift voor Psychiatrie 57 (2015) 5, 314 - 322

New research

Clinical decision making with regard to the granting of escorted leave for forensic patients detained by court order in a Dutch psychiatric clinic. Role of gender, disorder and the type of offence in the procedure

P. Ter Horst, A. Jessen, S. Bogaerts, M. Spreen

background An increase in the length of time until the first escorted leave is granted to a patient detained by court order (tbs) results in a longer period of treatment. Physicians involved in the treatment and clinic managers are striving to reduce, in a responsible manner, the length of the period of treatment preceding the patient’s first escorted leave.
aim Forensic Psychiatric Clinic (fpk) ‘De Woenselse Poort’ aims to find out to what extent gender, pathology and the type of offence committed by the detainee influence the length of time that elapses before the patient’s first leave is granted.
method We conducted a retrospective study based on patients’ records.
results Although men use physical aggression more often than women, we found that gender, pathology and the type of offence had no influence on the length of the treatment period that preceded the granting of the patient’s first escorted leave.
conclusion Partly on the basis of risk management scales, clinicians judge whether the patient has adopted a more positive or a more negative attitude to risk factors relating to his or her offence. If the risk factors have become more positive, one would expect the application for leave to be made earlier. Surprisingly, this was not the case. In order to speed up the decision-making process regarding the application for leave, a clinical method for evaluating risk related treatment needs to be developed in which offence related risk factors are identified and the patient’s positive or negative attitude to these risks are measured and monitored. At each treatment evaluation practitioners should be required to produce arguments that determine whether or not the patient is to be granted permission to go on leave at a particular moment.

keywords clinical decision making, detention by court-order (tbs), forensic