Aging TBS Patients: A Growing Crisis in Dutch Forensic Care

The number of individuals over 65 undergoing Teringsbeschikking met Voorwaarden (TBS) – a Dutch measure involving conditional commitment for individuals deemed a danger to society – has more than doubled in the past decade, exceeding one hundred patients. This surge is straining TBS clinics, which are increasingly faced with patients experiencing age-related cognitive decline, such as dementia. Treatment effectiveness diminishes as patients age, yet options for alternative care are limited, with nursing homes often reluctant to accept individuals with a history of serious offenses and ongoing TBS orders.

The Cycle of Extended TBS

Judges are increasingly imposing TBS, even after lengthy prison sentences, and have the authority to extend TBS orders indefinitely. This practice, coupled with the aging population within TBS clinics, creates a complex situation. The lengthy TBS orders, combined with the lack of suitable alternative placements, result in patients remaining in TBS clinics for extended periods, even after their initial sentence has been served. Currently, 270 individuals are awaiting placement in a TBS clinic even as remaining incarcerated, despite having completed their prison terms.

Challenges of Treating Dementia Within TBS

Clinicians are encountering significant challenges in providing effective TBS treatment to patients with dementia. Suzanne van Vugt, a mental health psychologist at the Pompe Clinic in Nijmegen, notes that the core principles of TBS – learning new skills, establishing boundaries, and taking responsibility for behavior – are difficult, if not impossible, to apply to individuals with significant memory impairments. “A TBS treatment department is very much focused on learning new skills… But we can’t actually teach anyone new anything new to someone who has such significant memory problems,” she explains.

TBS Netherlands, the organization representing eleven TBS clinics, acknowledges the increasing number of patients with dementia and the difficulties this presents. Betty Brouns, chairman of TBS Netherlands, highlights that dementia can exacerbate existing personality traits and impair emotional regulation, potentially increasing the risk of dangerous behavior. “In people with dementia you often see a sharpening of a character trait. And that the regulation of emotions becomes worse, people receive angry more quickly. If that happens to a TBS patient, someone can be even more dangerous.”

Strain on Staff and Resources

The growing number of older, and often frail, TBS patients is placing a significant burden on clinic staff. Clinics are facing patients requiring assistance with basic daily living activities, such as washing, dressing, and eating. Tijn Schellekens, head of patient care at the Van der Hoeven clinic in Utrecht, points out that regular TBS staff are trained in psychiatry, not geriatric care. Finding qualified nurses or home health aides willing to work with TBS patients is also challenging due to safety concerns and the need for specialized training.

The Need for Forensic Nursing Homes

TBS Netherlands advocates for the development of specialized “forensic nursing homes” to provide appropriate care for TBS patients with dementia. These facilities would require staff trained in both forensic mental health and geriatric care. Such facilities would free up beds in TBS clinics for patients who can still benefit from treatment and alleviate the pressure on the system. The Ministry of Justice and Security recognizes the urgency of the situation and has announced plans to create fifty new places, including those for older TBS patients, though the timeline for implementation remains unclear.