Mandatory treatment of forensic psychiatric patients in the Netherlands: costs and benefits in perspective

• Published in: Tijdschrift voor psychiatrie Vol. 58; no. 10; p. 739
• Main Authors: Nagtegaal, M H, Goethals, K, Meynen, G
• Format: Journal Article
• Language: Dutch
• Published: Netherlands 2016
• Subjects: Commitment of Mentally Ill - economics; Commitment of Mentally Ill - legislation & jurisprudence; Cost-Benefit Analysis; Crime - psychology; Forensic Psychiatry; Health Care Costs; Humans; Mental Disorders - therapy; Netherlands; Recurrence; Treatment Outcome
• ISSN: 0303-7339

So far, it is not known what costs and benefits are connected with the tbs-measure, a measure that involves a mandatory treatment programme for forensic psychiatric patients. AIM: To explore the costs and benefits that the tbs-measure has on society, on other important stakeholders such as victims and/or next-of-kin and the forensic psychiatric patients themselves. METHOD: We studied the relevant literature. RESULTS: The average costs of the tbs-treatment programme are 1.5 million euros. Additional costs result from recidivism among patients after tbs-treatment. Of these, 21.2% commit another serious offence after 9 years; this recidivism rate is much lower than rates for former offenders who have not received tbs-treatment (63.8%). Other costs arise through the impact that crimes have on stake-holders. Among the benefits of the tbs-programme are a reduction in psychopathological symptoms and in risk factors and lower recommitment rates (including judicial, non-judicial, voluntary and mandatory recommitment rates). Yet another benefit is the resultant increase of protective factors. CONCLUSION: Forensic psychiatric patients form a unique group within the mental health system in the Netherlands; these patients have multiple complex psychiatric problems and display serious criminal behavior. This group cannot easily be treated elsewhere in the existing judicial or mental health care system because these systems differ in (judicial) frameworks and have different treatment goals, and the forensic psychiatric patients have different psychiatric disorders and display more serious criminal behaviour than patients in the alternative systems. The daily costs of treatment in the tbs-system are higher that in other systems - but they are not exorbitant, given the complexity of the group. The tbs-measure therefore contributes to the safety of society.