Select Committee on Home Affairs First Report


26. Other countries have arrangements for continued detention of those perceived to be dangerous on completion of their sentence. "This is an international problem. Different countries deal with it in different ways in public policy terms but, in scientific terms, it is an international problem ...".[29] We are not aware of any country which detains people who have not committed an offence but are regarded as dangerous and are untreatable. We have looked at how these issues are dealt with in the Netherlands. There a procedure has been in place since the 1920s for handling people with personality disorders who commit crimes. The legal system is different from that in the United Kingdom—the procedure dates back to the provisions of the Napoleonic Code. Nonetheless the principal elements of the TBS[30] can be compared with the various provisions in the UK:

  • medical assessment process
  • court order
  • detention in hospital for treatment
  • release into community at discretion.

27. The TBS order can be made by a court as an alternative to either long-term imprisonment or confinement in a psychiatric hospital. The aim is to strike a balance between security, treatment and protection. When someone is charged with a serious criminal offence and there are grounds for believing there is a connection between the offence and mental disorder, the court can order them to be detained for assessment. The results of that assessment are made available to the court at the trial. If the person is convicted of the offence, the court can make a TBS order. After serving a period in prison, the individual then goes to a special hospital where he or she receives treatment. This treatment includes opportunities for education, workplace training, financial management and social skills—all of which are designed to help the patient live successfully on release. If progress is made in reducing the risk of the patient to others, the court may permit release.


28. The medical assessment process is applied to those charged with serious criminal offences in the period before trial. It involves a seven week programme in a secure clinic. The assessment is carried out by a team including a psychiatrist, a psychologist, a social worker and a lawyer. The ratio of staff to patients is high, with each expert having a maximum caseload of four patients at any one time. The focus is on the connection between the offence and the state of mind of the individual. This leads to advice to the court on the degree of accountability. The process is not concerned with establishing guilt—though in most cases it appears that the defence case is not that someone else committed the offence. In about 50% of cases, the assessment concludes that there was some degree of diminished responsibility and there is a high risk of future dangerousness. If the person is then convicted, the court can order detention under the TBS special hospital order. There are a small number of cases when the person is nonetheless acquitted. They then walk free, irrespective of the outcome of the assessment.


29. The court can order a period of imprisonment plus the TBS special hospital order. A normal prison sentence or committal to a mental hospital are alternatives. For TBS to be available, there must have been a conviction for a serious offence carrying a minimum penalty of at least four years' imprisonment and a recommendation from the assessment clinic for TBS. Although the period of TBS is now up to four years, it can be extended in cases of violent crime involving other people and if an extension is necessary for reasons of public safety. Extension of the TBS is decided by the court and is subject to appeal. In most but not all cases the court follows the recommendation of the TBS hospital involved. An extension taking the TBS order over six years requires an opinion from independent experts. TBS orders can be for out-patient as well as in-patient treatment. A variation on the TBS order can include setting conditions on an individual's behaviour while they are living in the community.


30. Following the period in prison laid down by the court, a person subject to a TBS order is moved to one of the six main TBS hospitals. The programme there is based on community living and a structured programme of work within a secure premises. For each patient a step by step approach is adopted towards eventual release into the community. That is the incentive which encourages compliance with the regime of the hospitals. That process may move a patient from full-time residence in the hospital to occasional outside visits, then outside work, and later living in the community while remaining an out-patient at the hospital. The emphasis is on rehabilitation and the staff encourage the patients to make the progress they need in order to qualify for release. After an average of about six years from sentence, most patients are fully released. The decision to release or to continue detention is made by the court. About 10% of TBS patients are considered too dangerous ever to be released. Of those released from the hospital we visited, the number who re-offend in a similar way to the original offence is about 10%.

31. The clinic we visited in Utrecht is very much part of its local community. Its swimming pool and gym are used by people living nearby. The extensive workshops for patients supply local businesses. Patients who start to work outside the clinic do so in cooperation with local organisations. The same applies to patients who move to live in houses run by the clinic elsewhere in the city. Within the clinic, patients live in groups of up to ten, with their own rooms and communal living and cooking arrangements. Great emphasis is placed on maintaining close contacts with families and visits by spouses and partners are a normal part of the regime. The only obvious limitation on patients' freedom within the clinic is a restriction on access to the Internet. The workshops provide both purposeful activity and the opportunity to acquire skills and external qualifications. All these factors ensure a positive incentive to comply with the programme.


32. Both the nature of the court order and the dedicated treatment facilities for TBS in the Netherlands are completely different from the legal and resource arrangement in the UK. Nonetheless the assessment process and the treatment methods are not unique. There are frequent international exchanges between the medical experts in this very specialised area. The TBS system bears a strong resemblance to the proposals set out in option B in the Government's consultation paper. There are obvious attractions in a court order following conviction which sends the offender first to prison for a number of years and then for treatment in a secure clinical facility.

33. A move to a TBS-type system in the UK would not, however, produce an immediate solution to managing dangerous people with a severe personality disorder. The system in the Netherlands has been operating for more than 70 years; the benefits of doing something similar in the UK would probably not be apparent until a decade after the legislation had been passed and the resources made available. If a TBS law was enacted in the next year or so, it would not apply to people in prison now and serving determinate sentences—it would not apply retrospectively and they will be released in the normal course of events. There would also be an interval before the law came into effect when it would not apply to people in psychiatric hospitals now but deemed untreatable and likely to be released. Similarly, for those currently in the community who have not committed a serious offence, there would be a time lag before the assessment process was put into effect and the facilities were made available. On the other hand, such a change could be applied to people coming newly before the courts as soon as the legislation was passed.

29  Q194 (Dr Eastman). Back
30  Terbeschikkingstelling-known as a special hospital order within the criminal code. Back

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries

© Parliamentary copyright 2000
Prepared 14 March 2000