TRANSFORENSIC
PSYCHIATRY
,PRESENTATION
- Iedereen moet praten
- 10 minuten
- Powerpoint
WEEK 1: MENTAL HEALTH CARE WITHIN THE
CRIMINAL JUSTICE FRAMEWORK
INTRODUCTION
- Forensic psychiatry concerns the assessment and treatment of individuals with psychiatric disorders
who have committed, or are suspected of having committed, criminal offences.
o In these cases, mental health problems and criminal behaviour intersect, raising complex
questions about responsibility, risk, treatment and public safety.
o Forensic psychiatric care therefore operates at the interface between the mental health care
system and the criminal justice system.
- In the Netherlands, forensic psychiatric treatment is typically imposed or facilitated within a criminal
justice framework.
o Courts may require individuals to undergo treatment as part of a criminal sanction or measure,
such as probation conditions, treatment orders, or the TBS measure.
- Unlike regular psychiatric care, where treatment is primarily focused on promoting the mental health
and well-being of the patient, forensic psychiatric care also has an explicit societal dimension.
- In addition to improving the mental health of the individual, treatment aims to reduce the risk of
reoffending and to protect public safety.
- As a result, forensic psychiatry involves balancing several objectives that may at times be in tension:
therapeutic care, risk management, legal accountability and the protection of society.
o This requires close interaction between different actors within the criminal justice system,
including courts, probation services, forensic mental health institutions and policymakers.
This week’s theme introduces the main legal frameworks governing forensic psychiatric care in the
Netherlands, with particular attention to the different phases of the criminal process and the role of
treatment within criminal sanctions. It also examines the organisation of forensic psychiatric services and
the policy developments that shape the current system.
LECTURE: BRIDGING THE GAP BETWEEN LAW AND CARE
- Two types of mental treatment:
o Forensic psychiatry: reducing forensic risk
o Regular psychiatry: focus on symptoms, so people feel better
- Transforensic psychiatry creates a bridge between forensic and regular psychiatry.
▪ If there are people who don’t have the access to forensic treatment, they fall through the
cracks. Transforensic psychiatry creates a place for them. Treat them and diminish risks
MENTAL HEALTH CARE WITHIN THE CRIMINAL JUSTICE FRAMEWORK
FORENSIC MENTAL HEALTHCARE
What determines the types of care?
- Expert opinion: treatment recommendation
- Mental disorder: risk assessment and the extent to which it influenced the office
- Care needs during the enforcement of sanctions: the court or the minister of justice and security
1
,Who makes the decisions then?
Prosecution Court (trial) Minister of justice and
security (execution of
sentences)
- Emergencies - Determines need for - Implementation
treatment - Placement (prison vs.
- Sets the legal framework forensic clinic
- Based on expert advice - Transfers and progression
- Level of security and care
- Since 2008: integration of:
o Mental healthcare (GGZ)
o Addiction care (forensic addiction services)
o Services for individuals with intellectual disabilities (ID services)
- Aim: balance between (AANVULLEN)
FORENSIC CARE ACT (WFZ- WET FORENSISCHE ZORG, 2019)
- Organisation of Forensic Mental Healthcare
o Forensic Mental healthcare is private, it has nothing to do with the criminal justice system
- Ensuring that individuals requiring forensic care are placed in the appropriate setting
- Facilitating transitions between the justice system and (forensic) mental healthcare
- Guiding patients towards an optimal balance between care and security
HISTORICAL CONTEXT
- Punishment vs. measure
o Punishment (sentence)
▪ Based on culpability (guilt)
▪ Retrospective in nature
o Measure (forensic/therapeutic measure)
▪ Aimed at a prospective goal
▪ Focus on treatment and public protection
- When there is a lack of criminal responsibility:
o No punishment possible (no criminal liability)
o Which measures are possible?
Two types of approaches
Classical approach Modern approach
- Free will is central - Behaviour is determined (biological,
- Individual is responsible for their actions psychological, social factors)
- Aim: protect the (vulnerable) citizen from - Focus on underlying causes of behaviour
excessive state power - Aim: protect society from reoffending
- Focus on guilt and culpability - Focus on risk and dangerousness
- Punishment based on guilt, seriousness of - Measures based on risk and need for
offence, personality intervention
Increasing integration of punishment and measure:
Punishment (sentence) Measure
- Infliction of suffering - Focus on the offender
- Focus on the act - Central role for the expert (psychiatrist/
- Judge as primary decision maker psychologist
- Aimed at treatment
2
, - How is a measure such as TBS experienced?
o Uncertainty about duration
o Intrusive and inclusive treatment
o Potentially long-term deprivation of liberty
- Limiting principle:
o Duration may be restricted based on proportionality (capped TBS – gemaximiseerde TBS) → foe
offences that are not aggressive in nature
CRIMINAL LAW FRAMEWORKS APPLICABLE FOR FORENSIC PATIENTS
The suspect with mental health needs:
- Vulnerability plays a key role throughout the criminal justice process (aanvullen)
o Care needs (
o Fitness to stand trial
o Behavioural expert assessment to support fair adjudication/ trail
- 28 forensic care titles (criminal law frameworks within which care is funded by the ministry of justice and
security)
o 4 frameworks related prosecution
o 6 frameworks-imposed adjudication
o 8 frameworks during the execution of sanctions
Legal frameworks related prosecution
- 1) Conditions dismissal of prosecution (sepot)
- 2) Suspension of prosecutions due to unfitness to stand trial
o Very rarely applied
o The defendant is no longer able to understand the nature and purpose of the proceedings
- 3) Suspension of pre-trial detention under conditions (schorsing)
o Bargaining tool?
o Outpatient treatment
o Admission to a forensic psychiatric unit
o Alcohol and drug prohibition
o Internet restriction
- 4) Prosecutorial penalty order with behavioural conditions (= strafbeschikking met
gedragsaanwijzingen)
o This may also include care/treatment for the duration of a specified probation period
▪ Example: 4MMC → treatment
Legal frameworks imposed at sentencing:
- 1) Partially suspended custodial sentence (frequently used)
o Subject to specific behavioural conditions (treatments requirements)
o No mandatory forensic (expert) assessment, although often applied in forensic contexts
o Most common legal frameworks in forensic psychiatric practice
o Breach of conditions may result in activation of the suspended sentence
o Generally, not used for the most serious offences
▪ Fully suspended: typically, short sentences > 2 years
▪ Partially suspended: longer sentences (approx. 2-4 years)
- 2) Care authorisation within criminal proceedings (art. 2.3. Wfz)
o Art. 2.3. Forensic Act
▪ Fits the profile of the transforensic patient
▪ Facilitates transition from criminal law to civil mental health law
3
PSYCHIATRY
,PRESENTATION
- Iedereen moet praten
- 10 minuten
- Powerpoint
WEEK 1: MENTAL HEALTH CARE WITHIN THE
CRIMINAL JUSTICE FRAMEWORK
INTRODUCTION
- Forensic psychiatry concerns the assessment and treatment of individuals with psychiatric disorders
who have committed, or are suspected of having committed, criminal offences.
o In these cases, mental health problems and criminal behaviour intersect, raising complex
questions about responsibility, risk, treatment and public safety.
o Forensic psychiatric care therefore operates at the interface between the mental health care
system and the criminal justice system.
- In the Netherlands, forensic psychiatric treatment is typically imposed or facilitated within a criminal
justice framework.
o Courts may require individuals to undergo treatment as part of a criminal sanction or measure,
such as probation conditions, treatment orders, or the TBS measure.
- Unlike regular psychiatric care, where treatment is primarily focused on promoting the mental health
and well-being of the patient, forensic psychiatric care also has an explicit societal dimension.
- In addition to improving the mental health of the individual, treatment aims to reduce the risk of
reoffending and to protect public safety.
- As a result, forensic psychiatry involves balancing several objectives that may at times be in tension:
therapeutic care, risk management, legal accountability and the protection of society.
o This requires close interaction between different actors within the criminal justice system,
including courts, probation services, forensic mental health institutions and policymakers.
This week’s theme introduces the main legal frameworks governing forensic psychiatric care in the
Netherlands, with particular attention to the different phases of the criminal process and the role of
treatment within criminal sanctions. It also examines the organisation of forensic psychiatric services and
the policy developments that shape the current system.
LECTURE: BRIDGING THE GAP BETWEEN LAW AND CARE
- Two types of mental treatment:
o Forensic psychiatry: reducing forensic risk
o Regular psychiatry: focus on symptoms, so people feel better
- Transforensic psychiatry creates a bridge between forensic and regular psychiatry.
▪ If there are people who don’t have the access to forensic treatment, they fall through the
cracks. Transforensic psychiatry creates a place for them. Treat them and diminish risks
MENTAL HEALTH CARE WITHIN THE CRIMINAL JUSTICE FRAMEWORK
FORENSIC MENTAL HEALTHCARE
What determines the types of care?
- Expert opinion: treatment recommendation
- Mental disorder: risk assessment and the extent to which it influenced the office
- Care needs during the enforcement of sanctions: the court or the minister of justice and security
1
,Who makes the decisions then?
Prosecution Court (trial) Minister of justice and
security (execution of
sentences)
- Emergencies - Determines need for - Implementation
treatment - Placement (prison vs.
- Sets the legal framework forensic clinic
- Based on expert advice - Transfers and progression
- Level of security and care
- Since 2008: integration of:
o Mental healthcare (GGZ)
o Addiction care (forensic addiction services)
o Services for individuals with intellectual disabilities (ID services)
- Aim: balance between (AANVULLEN)
FORENSIC CARE ACT (WFZ- WET FORENSISCHE ZORG, 2019)
- Organisation of Forensic Mental Healthcare
o Forensic Mental healthcare is private, it has nothing to do with the criminal justice system
- Ensuring that individuals requiring forensic care are placed in the appropriate setting
- Facilitating transitions between the justice system and (forensic) mental healthcare
- Guiding patients towards an optimal balance between care and security
HISTORICAL CONTEXT
- Punishment vs. measure
o Punishment (sentence)
▪ Based on culpability (guilt)
▪ Retrospective in nature
o Measure (forensic/therapeutic measure)
▪ Aimed at a prospective goal
▪ Focus on treatment and public protection
- When there is a lack of criminal responsibility:
o No punishment possible (no criminal liability)
o Which measures are possible?
Two types of approaches
Classical approach Modern approach
- Free will is central - Behaviour is determined (biological,
- Individual is responsible for their actions psychological, social factors)
- Aim: protect the (vulnerable) citizen from - Focus on underlying causes of behaviour
excessive state power - Aim: protect society from reoffending
- Focus on guilt and culpability - Focus on risk and dangerousness
- Punishment based on guilt, seriousness of - Measures based on risk and need for
offence, personality intervention
Increasing integration of punishment and measure:
Punishment (sentence) Measure
- Infliction of suffering - Focus on the offender
- Focus on the act - Central role for the expert (psychiatrist/
- Judge as primary decision maker psychologist
- Aimed at treatment
2
, - How is a measure such as TBS experienced?
o Uncertainty about duration
o Intrusive and inclusive treatment
o Potentially long-term deprivation of liberty
- Limiting principle:
o Duration may be restricted based on proportionality (capped TBS – gemaximiseerde TBS) → foe
offences that are not aggressive in nature
CRIMINAL LAW FRAMEWORKS APPLICABLE FOR FORENSIC PATIENTS
The suspect with mental health needs:
- Vulnerability plays a key role throughout the criminal justice process (aanvullen)
o Care needs (
o Fitness to stand trial
o Behavioural expert assessment to support fair adjudication/ trail
- 28 forensic care titles (criminal law frameworks within which care is funded by the ministry of justice and
security)
o 4 frameworks related prosecution
o 6 frameworks-imposed adjudication
o 8 frameworks during the execution of sanctions
Legal frameworks related prosecution
- 1) Conditions dismissal of prosecution (sepot)
- 2) Suspension of prosecutions due to unfitness to stand trial
o Very rarely applied
o The defendant is no longer able to understand the nature and purpose of the proceedings
- 3) Suspension of pre-trial detention under conditions (schorsing)
o Bargaining tool?
o Outpatient treatment
o Admission to a forensic psychiatric unit
o Alcohol and drug prohibition
o Internet restriction
- 4) Prosecutorial penalty order with behavioural conditions (= strafbeschikking met
gedragsaanwijzingen)
o This may also include care/treatment for the duration of a specified probation period
▪ Example: 4MMC → treatment
Legal frameworks imposed at sentencing:
- 1) Partially suspended custodial sentence (frequently used)
o Subject to specific behavioural conditions (treatments requirements)
o No mandatory forensic (expert) assessment, although often applied in forensic contexts
o Most common legal frameworks in forensic psychiatric practice
o Breach of conditions may result in activation of the suspended sentence
o Generally, not used for the most serious offences
▪ Fully suspended: typically, short sentences > 2 years
▪ Partially suspended: longer sentences (approx. 2-4 years)
- 2) Care authorisation within criminal proceedings (art. 2.3. Wfz)
o Art. 2.3. Forensic Act
▪ Fits the profile of the transforensic patient
▪ Facilitates transition from criminal law to civil mental health law
3
