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Tijdschrift voor Psychiatrie 61 (2019) 8, 536 - 543


Reflecting on intramural incidents: how do judges think about intramural crimes in mental health care?

A.J.E. Visscher, E. Tonkens, A.W. Braam

background Various measures aim to stimulate prosecution of violence and aggression against mental-health workers. Considering a possible increase of inpatient incidents through article 2.3 of the Bill Forensic Care, this is a desirable development. Mental health care and the judiciary seem to have opposing opinions whether the emphasis should lie on care or punishment in handling intramural offense.
aim To investigate which arguments judges apply in their trial of intramural incidents, to gain insight into the obstacles which impede awarding punishment during treatment, and to give recommendations for balancing the need for care and the need for punishment.
method A qualitatively thematic analysis based on semi-structured interviews with eight judges. Themes were based on relevant literature and case reports.
results The majority of the judges considered judging intramural incidents complicated because of: 1. insufficient information on possible exclusion of guilt, 2. the fear that punishment will lead to recidivism, and 3. ambiguity on the impact of the crime on the victim. They emphasized that they needed more up-to-date information from the institution. Judges wanted to avert punishment as this may lead to discontinuity of care or worsening of the mental health of the suspect.
conclusion A verdict can also support a (clinical) mental health treatment. With the arrival of the ‘bopz-brigades’ (Law bopz: Law on Compulsory Admission to Psychiatric Hospitals) at the Public Prosecution Service, all relevant information from mental health care, police and Public Prosecution can be combined into a claim, leading to a verdict in which care and punishment serve each other optimally.

keywords acute psychiatry, intramural incidents, reporting crime, suspect