PubMed · 16185051
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Simon Lawton-Smith. 2005. Increasing returns.. https://pubmed.ncbi.nlm.nih.gov/16185051/
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Protecting the public from dangerous mentally ill offenders is an important issue in may countries. The UK, Scotland and Germany for example are looking for new ways to deal with this issue and some have looked at the Dutch system of first sending the offender to prison for a number of years and then for treatment to a secure clinical facility. Dutch law uses the term TBS: detention at the government's pleasure. Legal rights of the patient under the TBS-order are protected by regular evaluations to help the court determine if the patient still poses a danger to society. These evaluations take place every two years, at the end of each extension period. Every six years an extra assessment by independent experts is obligatory. In this same period other types of assessment occur too, such as for transferral to a long-stay unit. A complicated succession of experts may visit the patient, asking the same questions and using the same files, distracting his or her attention and motivation from the treatment process. This system is threatened by the qualitative and quantitative scarcity of properly qualified experts. Measures have been taken to counteract these difficulties, but will they suffice?
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OBJECTIVE: To determine whether the observed accelerated increase in the number of involuntary admissions in The Netherlands coincides with the implementation of the Dutch Act on Compulsory Admission to Psychiatric Hospitals (BOPZ) in 1994. DESIGN: Retrospective. METHOD: The extent to which the number of involuntary admissions changed after implementation of the BOPZ was examined by means of Poisson regression on the basis of national data from the Patient Registration of Intramural Mental Healthcare for the period 1979-1995 and data from the Healthcare Inspectorate for the period 1992-2004. For this purpose, the curve prior to implementation of the BOPZ was compared with that following its implementation. RESULTS: The number of involuntary admissions of psychiatric patients had more than doubled in 25 years, from 3101 in 1979 to 7450 in 2004. The increase in annual numbers accelerated significantly after implementation of the BOPZ in 1994. CONCLUSION: There was an accelerated increase in the number of involuntary admissions after the implementation of the BOPZ. Other possible contributing factors include an increased number of admissions, shorter hospital stays, and changes in social concepts.