Minister Dekker: further improvement of TBS system is possible

The TBS system will be further improved by enhancing the capacity and quality of forensic care, through better management of TBS treatments and by tightening the procedure by which leave is granted. This was the substance of a letter submitted to the House of Representatives by Minister for Legal Protection Sander Dekker in connection with two reports from the Inspectorate of Justice and Security.

Minister Dekker:

‘It is good that the Inspection helps keep us alert. While we've taken several steps in the right direction, we're not home and dry yet. There is no way to guarantee with absolute certainty that no incidents will ever occur. Yet – with a number of additional measures – I believe it is possible for us to further improve the TBS system. I also feel that it is important for us to learn from anything that might go wrong, both now and in the future. TBS is (and will remain) a human undertaking and requires our continual attention.’

Increasing capacity

At the end of their TBS treatment, forensic patients are transferred to an institution with a lower security level or, for example, sheltered accommodation. The Inspectorate has observed an obstacle with regard to the quantity and quality of such placement spots for forensic patients once their treatment has ended. The TBS centres are becoming quite crowded as a result of this bottleneck in the transition and release process. Due to the evident nature of this problem, action is currently being taken. More placement spots in forensic care will be created in the short term, with the primary focus being those spots that are necessary to allow patients to transition out of TBS detention. In addition, greater emphasis will be placed on the quality of care, including with regard to the Custodial Institutions Agency's decisions on purchasing care. To that end, the Agency will establish more specific agreements with the TBS clinics and other forensic care institutions.

Improving management

In order to improve the management of TBS treatments, a number of measures will be implemented. Firstly, the Inspectorate has observed that, in some instances, generic measures are an impediment to providing a necessary personalised approach to forensic care, serving to further increase pressure on the TBS clinics. An example of this is the automatic suspension of leave privileges for the duration of one year when a forensic patient violates the rules, for instance by failing to return from leave. In some cases, this general rule placed a disproportionate degree of pressure on an individual's treatment. This rule is therefore being abolished – which, in turn, expands the potential for personalised measures. Previous missteps will naturally be taken into consideration by every new leave application. If leave is not considered safe, it will not be granted. Secondly, all efforts to improve staffing in TBS clinics will be maintained. The Inspectorate notes that, among other problems facing TBS clinics, these clinics are dealing with a shortage of permanent staff, resulting in a heavy workload for their employees. Last August, the Task Force on Safety and Quality in Forensic Care launched a job-market campaign called “Working in Forensic Care”. The website, various radio commercials and a magazine about working in forensic care have been created to draw attention to the work being done in this vital sector.

Tightening of leave procedure

The Inspectorate notes that care is being exercised in the procedure for granting leave. That being said, there is potential for improving the evaluation that serves as the basis for granting such permission. The reports reveal a need to further tighten the agreements in connection with the provision of information for the purpose of reviewing leave applications, such as in the event that a patient is transferred to an external facility. The external evaluation of leave applications by the Advisory Board on Review of Leave from Detention under a Hospital Order (AVT) is among the key priorities of the TBS system. If it is to properly carry out its vital task, the AVT must have access to all relevant information. The AVT intends to organise a conference with the clinics soon, aimed at finding ways to improve the existing processes and procedures. In addition, when incidents do occur, doctor-patient confidentiality sometimes makes it impossible to share the full details of what has been learned from reviews with the Inspectorate. We intend to remedy this by means of an amendment act, which has now been presented to the Council of State for advice.